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020200756 / I - aN CITY OF tCIUPEkTINO PIA • CITY OF CUPERT • CO r T � �� PERMIT APPLICATION FORM APN # • � � .® Date: / Building Ad ess: S �1 `i' Av&-, cgnertjJb, cry SUr Owner's'Name: � (� Phone #: ��' Contractor: BCONSTAX License #: Contact: Phone #: Applicant/Contractor: BUILDING Fax #: wild g Permit Info: Bldg Elect Plumb Mech Residential: Hotel and Motel Sq.Ft. Floor Area: It $ /Sq.Ft.: Architect/Engineer: BUILDING Valuation: Type of Construction: Elec 600V <= 1000A Occupancy G up: �f Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC 1001 Elec 600V > l OOOA ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BNEWMULTI New Multi-family Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING # I Y93 p 1 of 3 u0CFF of U fZ^ y¢� Zit h f a O'c 3�t ce Xrf HZ� z F_' i a3- �! k F i 0( E -i c CIT OF Y u G DMSION EE I CONTRA CTOR ® TL* BUILDING ADDRESS: 10810 S BLANEY AV JAMES LI'S _ PERMIT NO. 02020075 OWNER'S NAME: APPLICATION S B DATE 0221 2002 JAMES LI'S PHONE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH II L -1 C. u LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing ADD 598 S Q F T with Section 7000) of Division 3 of the Business and Professions Code, and my license . . is in full force and effect. License Class Lic. R Date Contractor ARCHITECT'S DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER - BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's license law for the following reason. (Section 7031.5. Business and Professions Code: Any city or county $60000 i which requires a pemsit to construct, alter, improve. demolish, or repair any structure prior to its issuance, also requires the applicant for such permit tofile a signed statement - - --• • - °- °— - • -- - .. 3 �r.,qg� Valuation Nai he isi ornsed ppisuam tq tht: provisions of the Contmcror's License Law (Chapter 9 (commencing with Sccrion 74100) of Division 3 of the Business and Professions Code) or that a is exempt therefrom and the basis for the allei6ftiemdti6n. Any violation 9 9 of Section 7031-5 by any applicant for a permit subjects theapplicam to it civil-penalty of not more than five hundred dollars (s500). 10 I&N PfV0*1'DAT I ON :' Occupancy Type o I, as owner of the property, or my employees with wages as their sole compensation, 102 — PIERS will do the work. and the structure 'is not intended or offered foe sale (Sed: -7044, Business and Professions Code: The Contractor's Licence Law does not apply to an 1 0 3 — U) -",ER - Required Inspections owner of property Who builds or improves thereon, and who does such work himself 104 — REBAR or through his own employees.provided . that such improvements,are nokintcnded or offued for sa1e. It, however, the btulding of improvement is sold within one ar ye of 105 — ANCHOR ' BOLTS` completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). 106 — SEWER & WATER tl "L as owmer.af the property, am ezcmewely contmding "wed licensed �antraerora m 2 02 - -UNDERFLOOR "PLUMBING-- construct the project (Sec. 7044, Business and Professions Code:) The Contractors 203 — UNDERFLOOR MECHANICAL-- License Law does not apply to an owner of property who builds or improves thereon, and-who contmcis.for such projects with a contraaor(s) licensed pursuant to tae- - - -... 2 -04 — UNDERFLOOR FRAME Contractors License Law. 0 am exempt-uniler See, s PC for drsritesoa � z ' nat� 5L O 205 — 301 - UNDERFLOOR INSULATION ROUGH PLUMBING —WORKER'S COMPENSATION DEC ON 302 — TUB & OR SHOWER I hereby affirm under penalty of perjury one of the following declarations: 303 — ROUGH MECHANICAL s ❑ 1 have and will maintain a Certificate of Consent to self -insure for Workers 304 — ROUGH ELECTRICAL Compensation, as provided for by Section 3700 of the Labor Code, for the 305 — FRAME performance of the work for which this permit is issued. ❑ 1 have and will mainisin,Worker's Compensation lnsurance, as required by, Section 306 — HOLDOWNS 3700 of the Labor Code, for the perfinrmance of the wrork for which this permit is 307 — INSULATION ' issued. My Worker's Compensation Insurance carrier'arid Polity number ere: - -308 = SHEETROCK CERTiP7CATI0NOFEXEMPnbNFROMWAR74FiR5' 309 — $XTEitIOR LATH cOMPizlsnnON]rrsURnNCE -310- — -INT-ERIOR- - LATH. _... ., .. . _ _..... ___ (This section need not be completed if the permit is for one hundred dollars 311 SCRATCH COAT ($100) or less•) 313 ..---ROOF, - NAIL..._. _......_._..._ ..... I certify that in the performance of the work fo'r which this permit is issued, 1 shall not employ any person'in any am f =o aab °bf,o thew°fkers 'a. U 501 — , FINAL ELECTRICAL' ENERGY Compen,�aoogpLaws of a Applicant$ _ i'- ..- 502.. - 503 — FINAL PLUMBING.. ENERGY......._, FINAL MECHANICAL ENERGY NOTICE YO APPL C!>�_Nf1f, aflfr making this Certificate of Exemption, you should become subject todw*brker's Compehsation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 504 - _ FINAL BUILDING ENERG i CONSTRUCTION LENDING AGENCY S 0 5 - FINAL ELECTRICAL ' I hereby affirm that the.re'is'a constiuetion lending agency for the performance ' 5 0 6 — GAS TEST of the work for which this pernMls issued (Sea 3097, Civ, C.) 3 Lenders'Name• , ...' — ... .. -. ,... .. ,_ — ._.. , .: 507 — FINAL PLUMBING _..... _ _...- Lenders-Address 508 — FINAL MECHANICAL I certify that 1 have read this application and state that the above information is i comet. I agree to comply with. all city and county ordinances and state laws relating 509 — FINAL GRADE _ to building construcliom and hereby duthorize representatives of this city to enter upon the above - mentioned . property for inspection purposes. 510 — FINAL PLANNING i (We) agree to save, indemnify and keep harmless the City of Cupertino against 514 - FINAL PUB I C WORKS liabilities, judgments, costs and expenses which may in any way accrue against said City in donseuence of III e granting of this permit. APPLICKN'tUNDERSTA\DS .ND A,-ML COMPLY NNTM ALL NON -P O CE 1.aTt Issued by: Date - ign ;' pp icatn/Cohtia'ctnr .' Da Re-roofs Re -roofs HAZARDOUS MATERIALS DISCL Will the applicant or furore building aeupantsore or handle hazardous material T�rpe of Roof as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety ... Code. Sccitoo 23532.01? .. - by. N° ' All roofs.shall be inspected prior to.any.roofing material being installed, 'Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection J agree to remove emit hazardous air contaminants its defined by the Bay Area Air Quality Management Di4ti ct ?' yrr¢q/(� - all new materials for inspection. Applicant understands and will c_ omply_ with °Ya \ No ,, , , all non -point source regulations:.. , '1 have read the hazardous materials rigairements under Chapter 6.95 of the California Health & Safety Code, Sections 25505.25533 and 75534. 1 understand that if the�'b,u,�ilding does ua cureatly have atenagc that it is my responsibility to notify the I Opfi of the'requiremems which must be met priaj to issuance, of a Certificate of P� Signature of Applicant... Date _ . All roof coverings to be Class `B" or better a o' agent Dare .. OFFICE OWZ �OO 'tub in < a t—=)z OZM— C aN�r�i F6 0 x3�t- r�a"QQ N fA .J a%�� Les A t—za CFO a 0 Z as Qa a� Z UO_ V. 0U U U eb CITY OF CU P1ERTIN® BUILDING DIVISION ]�][i' y/��t �T.�� s�(( �Tq� CON R&CTOR NI � BUIL1?I8(&J*ES.S BLANEY AV JAMES L I I S PERMIT NT 2 10 0 0 4 0 OWqAMEG L I IS APPLICATIt11UIj0( 191 2 0 0 2 �� `"' PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I am licensed under provisions of chapter 9 (commencing REVISION--IN IB�- 1�Scr� ONLY with Section 700X) of Division 3 of the Business and Professions Code, and my license is in full force and effect. ORIG. #020200075, NO NEW PERMIT ISSUED. License Class Lic. 4 Dale Contractor ARCHITECTS DECLARATION 1 understand my plans shall he used as public records Licensed Professional OWNER - BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Secuon 7031.5. Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure $60000 prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of pivision 3 of the Business and Professions Code) or 369230S1.00 that he is exempt therefrom and the,basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type p y YP net more than five hundred dollars ($NO). 101 - FOUNDATION ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended oroffered for sale (Sec. 7044, Business Professions Code: The Contractor's License Law does not apply to an 102 — PIERS Required Inspections and owner of 103 — UF•ER property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, 104 — REBAR however, the building or improvement is sold within one year of completion, the owner- 105 — ANCHOR BOLTS builder will have the burden of proving that he did not build or improve for purpose of sale.). 106 - SEWER & WATER ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to 202 — UNDERFLOOR PLUMBING construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon, and . 203 — UNDERFLOOR MECHANICAL who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. 204 — UNDERFLOOR FRAME ❑ I am exempt under Sec. B & P C for this reason 205 - UNDERFLOOR INSULATION Owner Date 301 - 302 — ROUGH PLUMBING TUB & OR SHOWER WORKER'S COMPENSATION DECLARATION I hereby affirm under penally of perjury one of the following declarations: 303 — ROUGH MECHANICAL ❑ I have and will maintain a Certificate of consent to self -insure for Workers Compen- sation, as provided for by Section 3700 of the labor Code, for the performance of the work for which this permit is issued. 305 - FRAME ❑ 1 have and will maintain Workers Compensation Insurance, as required by Section 306 — HOEDOWNS 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: 307 — INSULATION Carrier: Policy No,: 308 — SHEETROCK CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 309 - EXTERIOR LATH (This section need not becompleted lithe permit isforonc hundred dollars(S100) 310 - INTERIOR LATH or less.) 311 — SCRATCH COAT I certify that in the performance of the work for which this permit is issued, 1 shall not 313 — ROOF NAIL employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Dale Applicant 501 - 502 — FINAL ELECTRICAL ENERGY FINAL PLUMBING ENERGY NOTICE TO APPLICANT: If, after making this Cenificatc of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must 503 — FINAL MECHANICAL ENERGY forthwith comply with such provisions or this permit shall be deemed revoked. 504 — FINAL BUILDING ENERGY CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of 505 — FINAL ELECTRICAL the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Namc 5 0 6 - 507 — GAS TEST FINAL PLUMBING Lender's Address I certify that I have read this application and state that the above information is 508 — FINAL MECHANICAL correct- I agree to comply with all city and county ordinances and stale laws relating to building construction, and hereby authorize representatives of this city to enter upon the 5 FINAL GRADE above - mentioned property for inspection purposes. 10 FIN I G (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenseswhich may in any wayaccre againstsaid City in consequence of the granting of this permit, 5 N L I WORKS / APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. Re -roofs Type of Roof _ Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safcty 25532(a)? Code, Section ❑ No ❑ Yes All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? )Yes ❑No I have read the hazardous materials requirements underChapter 6.95 of the Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently have a tenant. that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of certificate of Occupancy. Signature of Applicant Date All roof coverings to be Class "B" or better Owner or authorized agent Date Iu o� u t; < 8 c y�Y yCa QQ� C LL$t u� =v tea Zzc 0 W r yc UO F U w L rt A CITY OF CUPERTINO - Blim,WNG DIVISION PERMIT CONTRACTOR INFORMATION:. BUILDING ADDRESS: PERMIT NO. 10810 S BLANEY AV JAMES LI'S 02020075 ,"TIER'S NAME: TAMES LI'S APPLIC71ON S R DA 02/21/2072 110N E: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u C =1 L .I L—] LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 ore licensed under provisions of Chapter 9 (commencing Section 7000) Division 3 Business lob Description ADD 5 9 $ S Q FT ' with or of the and Pmfcsvions Code, and my license is in full Some endeBat. . . Licenx Closs Lim. g R Data Conor nua ARCHITECT'S DECLARATION 1 understand my plum shall he used as public records 1 A 2003 Licensed Profasinnvl OWNER- BUILDER DECLARATION 1 hereby off am that f am exempt from the [onuactor's License law for the IS.i., 7031.5. Professions Code:Anycityac $60000 ILDING whichfollowing tructBusiness mpr ewe6 improve, demolish. ore ony n r applicant a si, - priatmtscensed issuance, requires theupplieant of the forsuch penni, Licem Law ( nhaptert aging eJ mtion7Dhepnbvivisi - — - ------ - C - -,',., Valuation (cmdr n3oft eBusineslaeenxlawonsCor9 or that ncingwiN eetion7Up0)pfhe boainor the Business and Professions Code) of thatio i5 end the bosis for the P zany the ciietdass to Any t, r >•. ; , ,' , (309 S,11 ,'.J'� f,Hk�,, s , 31.5 b ap.m ct& l - of Smion'tt13 fJ by any applicant for o permit theupplicam to a civil penalty natty �.fdoe hole than five hundred dollars (S500). �.,�.1. 101kPN'2`5*1DAT ION Occupancy Type 01,a,ewncr of the pdrrd,ur my employees. ith wages ostheirrole compcnsvtlon. 102 - PIERS "'will do the-work: and the suvdure'is not intended or' offered go, add (Secf'7(144- - Business and Professions Code: The Connector's License Law does nat apply to on 103 - UFER Required Inspections'= owner of property who builds or improves 0nmod, end who does such work himself 10 4 - REBAR do throe h his own employees. provided that such improvements art not intended or _ pmnmentn sole one year of -- 'oftercd or tthe - - .- _ _ 105 - ANOHOR BOLTS—', whoweroe will have 'camp) a n, the owner-Wilder will have the burden of praying that he did not build or edid build �,1' .•1, t,,. improve for purport otxle.). 106 - SEWER & WATER Qlh osowner ofthe propeny,om exclusively contractors - �_-- dProassiOns CoulensW ondae CONWCtthe Prosser' I apply a wancro endmywhom code:) The Contreron, License law does not apply to an owner of pmpeny who builds or improves thereon. 203 - UNDERFLOOR MECHANICAL-.e, "!.L '•':: . and.who conoocu.fa.such.p oidega with a. contractor (3)- kcenscd.put:uant.no,t c- contractor's License Law. -.,.,, ...._. _.___. 2-04 _. UNDERFLOOR.- ; t_...: ; -... -. ❑lameeempt caste, B8� PC for thisrcmnd �v. .�/ MPENe� '" RO`�'''yg� "' 205 - UNDERFLOOR-' INSULATION 301 - ROUGH PLUMBING " WORM 'S COMPENSATION DECLARA730N- 302 - TUB & OR SHOWER ' - 16ercby. Rrmawerpamltyoffe rjury one ofthe following deelarodons: - 303 - ROUGH MECHANICAL ° I base' W will moinuin'e Ccnifteeit'of Consent to self -insure for Worker's 304 - ROUGH ELECTRICAL Comperosibm,, as', provided for by Section 3700 of th.- abor Code, for the performance of Ne wank fro wmgh this permit is ix.cd. 3 05 - FRAME ° Ihaveopt will meiniun,WOAeri C.npm,.tiailosurance,a dotuitd by Section 306 - HOLDOWNS 3700 of the Labor Code, for the perfomantt'of -the work for which this permit Ice 307 - INSULATION sued My Worker's Compenxuon Insurance carrier apt Policy number art „ r O .�,. .. "I -308 . .SHEETROCK-.. �),. ,.. •.:)u r.. v XEiry TI ',Z CERTIFICATION OF E%EMPIION FROM.WORI(ERS „ " ' - a tt • -' + 3 0'9 + .- $kT$RIOR , LATH COIN 'COMPENSATION INSURANCE-,', 310- -- r;INTERTOR--"LATH-- "' lT7t I xeuod need not be iompleted if tht pemtn is for... hundred dollars 311'' - SCRATCH COAT (S100) ,less.) Nat in Neperrommntt ofN rk r.' hen tree p<net;t real ...... — _313-- -- ROOR...NAI -L -__ _. __.. -_.__ A.1 neml shall t employ eny;penon In any n so yybaEo It Ne Wofkeri 501 - FINAL ELECTRICAL' "•ENERGY' ` Core sine Ice iof Ie p �- 502_.._. _.FINAL, PLUMBING EN _ ENERGY... 503 FINAL MECHANICAL 'ENERGY iNOT.11 " APPL�Tflimn making thuCenlfiearcofExemption. should y becomes 63ent dtelVakers COmpenuuo provisions of the Labor Code you must forthwith comply with such provisions or this perm t hall be deemed revoke d. _ -- 504 - FINAL BUILDING. EN ERG'S CONSrRUCnON LENDING AGENCY _ 505 - FINAL ELECTRICAL r I hereby eRrm that Nerc is e'cotis I en dm "agency for the pert riven' a of the m1forhmhNa penrml is issue -.•. issued Sec. tv.e) -' 506 - GAS TEST -L-mde ,Name •_ ,._. - ,....: -,e ,rlcomfy Not Ihate reed thua application r - assortendnauthattheaboveeimon iomn 1 agree to comply with eed - 507 - -FINAL PLUMBING 508 - FINAL MECHANICAL''' 509 FINAL GRADE city all city county ordinances and Nty go en eru, relating then ldngcontionednandh frinspehonxc....a.tivm of this mtymemerupo` the abo a nand d property for t s purposes. - 510 - FINAL PLANNING e add ke Iwjagree iostn,udldlx and whiharmless any yof Ceptru oagund liabilities. judgments. eau atN expenua which may m any ay seems egemn said 514 - FINAL PUB IC WORKS City to dANt U na of Ne grtnitng of Nls permit' APPLICANT UNDERSTA�DS MD HILL C01iRLY \ \TTH ALL N'&"' LNT ! Issued by: Date - Date wHA t/CZOA nRuDanOoUr Re-roofs S MATER] future Suam Ppan meventl wbNa Type of R -.. ..... . oof.1; . rid Clurtin MuNNpl Code Ca ¢r9 @and NeHNNand Sef ty Cade! Section 75$72(p)TV, �r ( {� r '- - s • ', ' i 1 t t ❑Ya pyN )r� { Yt F ,{ +, All.roofs_shall.be inspected prior to any.roofing.material.being installed.. t iWill the epplieent r f tare building acupe t w equipment., devices which neudms atr contaminants u defined by the Bay Area Air Quality Mamgemem If a roof is installed without first obtaining an` inspection d agree.to'remove Dlimm ❑Yee '' mN ° ' all new materials for inspection Applicant understands and will comply with non all -point source regulations;,,, ' 1 qe+e rcedhhe haxallom mpudels rtgwrcineme'uhder Chapter 6.95'of the ` SccdOnn t omm ea a ecuons 5333 and 255341uMusundN erstan at 5.25533 d blif Iu esltln don nuarrend t vsbb pe' tp erR tf t e rt uirtmcnu which must be met not m Iasu�ce of Cenill5 hot 9 P _ .. O ant n. Signature of Applicant„ Date- 0 e gem Data . _ -.,.- -_ ' All roof coverings to be Class B or better f:.4 dtF LY •Yt _ OFFICE-