03110034 (2) CITYOF,CUPERTINO
BUILDING DIVISION PER ",1®RM P .ON:
BUILDING ADDRESS: NEIL CHANG PERMIT N003 110 034
OWNER'S NAME: PERMIT LS UE DATE
NEIL CHANG11/07/2003
HONE:
SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
3020 LICENSED CONTRACTOR'S DECLARATION
Z C 1 hemby affirm Wal 1 son liaud m
cMcr pmovwfta or ChOpow 9(ammmcncing lob Description
<t> wild Seetch700).f DiAsimt Sof WC Bus.W Rofeu4ma Cndc.end my rc..is
-_n% infull(ma° ft.ff REVISION--IN HOUSE USE ONLY
y:l? Dante Chiu IX.e
Da. "''SDE. NO NEW PERMIT/ORIG. #03110034
A,shall ECI-S DECIIJ ATION
..&
f 1 undcrvanJ my plans shall W vctl u Puldic marJx
C u Licensed Professional
�0 OWNER BUILDER DECLARATION
y 1 hereby alllrm Wu 1 em,,,,crept room de Cuou-tors License I�w far the
00 following reason.(S uon 71016.Bminess W PmfCWnv Cale:My Coy or county
5$� which rcquhu a Permit to rnwrvc.Aller,improve,demoliN,or repair any atmcmm
ZT priCl bila lasuanCe.Also requires We applicaN for such Permit to file A algocd Klement
x< Watl<u liansal Pursuant In the pmvisiuv of ted Caat.ora L ee.LAW(CTyncr 9 Sq. Ft.Floor Area < � Valuation 0
(aanmencing with Section 7000)of Division 3 a the B usinus and Nofcaiov C<vb)or
5 Wu W V cusnPt d¢mf c m And lie lrosis for de alleged.,...Any violation or
Si..70316 by Any."NeAnl for•anmil subjuts the applicant to A civil pcnahy of 3@,RiNMJ)Ber00Occupancy TYPe
ore mac than Bvc hundred dollars u!iOOL C`
0 1,u owner of We property,or my rseploycec with wages As WCW sole compensation,
Will do the,work and theswctum is not inmmled a offered for sola see.7O .Basi. Required Inspections
and Professions Coca:The Cortractml L)taue Law does s napply b An amu of q
prolctY"ho Wilda a imfaores IAeraan,and wbodoessuW work himself orthrough bas
own cmployaes,pro,fdad than such impro.ements arc not inerd,,d rcaRcred far ale It.
bowevcr,JU Wilding or lmpm.em.t is sold within one)ear or compkion.the aaar- "
builder will han IW burden of proving that W did rot bol Id a impmte fm purpoce of
ala).
❑ 1,u owns of the pr I,Am udusiv,,ly c..Ling with licuud contractus to
C.U.the Poject(Sec.70aC,Bosinus aW Pmruslov Cod,,:)The ConvanwS U-
.lawdoeriaApply'.an.sonoa .,cot,wbo Wildsm,ireWfte there.,and,
who contacts fa.ud projects with a contactor(s)licensed pt.uant to the Contractors
Lice.LAW
❑lam ase no uSee B k P C for this reason
Dale t l 07 p
47 WORKER'S COMPIE ISATt DEC
I hereby aeirm unhr penally Of p,,0ury ore of Je rclbwing declanliov:
1 M1s.e arch will main W n•GCmfielc of Cantu m calf-insure for WarkcrY Comlen-
Aron.As provided for by SaCdon 37110 of Je labor Codi for the No..of We .
work four which hist pemir Is issued.
❑1 bare and will cram aln Wurlter.Coon,mati.Inau.,As rtyuirtL by Section,
3700 of ted La Wr Code.for ted percameta or t e wort for which this permit Ire hued.
My Worker's ComPeasatioa Inswarvz carrier am Polity number are:
C.I. Policy N.,
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
This section reed nothe coropleed if t e Permit is for ore hundred drum($]W)
Or lesa)
1 ccJfy Net In the pvfamana of the wok fa which this permit is isned.I sAaB.t
employ any pmmn in any...'aft as b become wbj'cI bO rte Worters'Canpnmdoo
I-Aws of CdlrOMIL Da¢
Applicant
NOTICE TO APPLICANT:If,after roWn,OU Certificate a Eaempti.,you should
baomc.ubjet m ftWorlelu
.Compcatim pmvlsions M be LaWr CN you mtul
Z forthwith comply with such Envisions Or this Permit shall be deemed mrnkca
Z.O CONSTRUCTION LENDING AGENCY
I bandy".that Jere b•Cass 1ian tabling agency,1'a the pofnrm.of
0'7 the WO&fa which this Permit is issued(Sec.3(19.1,CW.C.)
LLL QISMcrs Nuns
D. Lenders Address `
V Q 1 cer'by that 111.c mad thin application and sae that the aWve infamati.is
w Collet`I Agree to Comply With All City And county ONlnareCa NJ sate laws Milling to
building convnaction.and hereby amhonx mprueanlims of bis city to enter upon the
Ill .Wtc-menfi.d pro,eny fur lvpccuort lv,p.
(We)agree to save,Indemnify afd seep humku the City of Cupcni..,ain't
N Ilabililla,judgments,costs and caper.ae which may In An,Way amue gaim said City
U Z In cmtseci.of Ne Basing of We Pcrmlk
^' APPLICANT UND RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOURCE ULA ONS. jl/c7
1 Z ^T Re-roofs
$ftaa.re fAplSi.nuCcft Data
HAZARDOUS MATERIALS DIS LOSURE Type of Roof
Will the applkan or future building acupant store m handle hvaNuos material
a cafrcd by IW Cupenl.Muniopal Code,Cvplcr 9.11,and We HnIW And Safely
CW,,.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes u
Will IW.'111011 er comm Wilding m eft use wthpment arde.i.<.which If a roof is installed without firs[obtaining an inspection,I agree to remove
emit hvsrMre air cenmminanu as caGmd by the Bay Area Air Quality Management all new materials for inspection.
Dlstrkt)
t]Yu XNu
1 hAve read the hva ftrr mamrlals myulremenuunderClupterG95ofWeCAiror-
rUHcalW k Sa cty Coca,Sabru 25505,25533 And U534.I undcaund Wet if b.brain;
does hot. .I,h..cae.an.that it is my reftontiMlny to notify the tof Je
rc,u ts .h uRbcmetpiprwlssvareco(,Cmirc.mo�°y`�o°�,``� Signature of Applicant Dale
All roof coverings to be Class "B"or better
er car auWoria.J.gem � D.rc
CITY OF CUPERTINO
!em 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp : Rng : Sub: Blk: Lot :
APN . . . . . . . . . 36616037 . 00
DATE ISSUED. . . . . . . : 11/07/2003
RECEIPT # . . . . . . . . . 23725
REFERENCE ID # . . . : 03110034
SITE ADDRESS . . . . . : 1630 ASTER LN
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : NEIL CHANG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5207
RECEIVED FROM . . . . : NEIL CHANG
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : NEIL CHANG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5207
TELEPHONE . . . . . . . . :
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FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL
------ - - - - - - -------- - -- - --- ------ - ----- - ---- -- ----- --- - ---- --- --
BPLANCKREP HOURS 2 . 00 111 . 00 0 . 00 111 . 00 0 . 00
--- - ------ ------ - - -- -- - - --- - -- - --
TOTAL PERMIT 111 . 00 0 . 00 111 . 00 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- - - - - - -------- - -- --- - - - - - ---- ---
OTHER 111 . 00 DISCOVER
TOTAL RECEIPT 111 . 00
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r may. # 6J
4TY0
MCITY OF CUPERTINACU ERNO PER APPLICATION FORM 6 .3
Ah
APN # i Date: /
Building Addrea.
Owner's Nam Phone #:
Contractor: Iv License #:
Contact: n � I L— Cupertino Business License#:
j� CK
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Descriptioj�:
Residential m (57 Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: O _ Occupancy Group: --77
i
Type of Construction:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> l OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> IM to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu 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 <= IOOOA ELECTRICAL
BELEC1001 Elec 600V > I 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
Z3 � Z
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WITY OF CUPERTINO*
CITY
OF� PERMIT APPLICATION FORM
CU RT N•
Quantity Fee ID Fee Description Fee Group
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI Multifamily Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res PLUMBING
BNUSFD New Single Family Res BUILDING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINI'ERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain & Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER WaterHeater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 c8n MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace > l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
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, &ITY OF CUPERTINO
CUPEf�TINO PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanical s. . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
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