05060023 CITY OF CUPERTINO '"'k rx*.ia k. c "•'
BUILDINGDfv,Ion PERM* CONTRACTOR�INFO$M t Nu
w
BUILDING ADDRESS: NEIL CHANG PERMTTN005060023
OWNERS NAME: PERMITISSUIROATE
ONE: SANITARY 0. CONTROL NO.
ARCHr1ECl/ENGINEER: BUILDING PPRMMINFO
BLDG ELECT PLUMB MECH
LOp LICENSED CONIRACITYR'S DECLARATION O O
I hcmby affbm toat I am licensed under movisions of Chapmr 9(commenting Job Description
i wlthpcctim 70fA))af DNWon 3mlhe Bumd.and Hufcsslons Code.aM my liamcb
in full fora and effect.
gpi IJentaelaa Li.1 REACTI .ORIG. #03040106
D1C Con.r ARCHITECTS ECL.DECILA0.AT10N 1/2 PERMIT FEES PAID ON THIS PERMIT
oU IUodA.dmyphoa"IWus,da'bircc«d, REOPEN THE ORIG. #03040106
3$In Litxnwd Prvfcaiaml
j_:, OWNE0.-BUILDER DECLARATION
I Winhy Afrnm that I am uunpt fmm de Conumtars IJamc W for Int
00 (olb sur,m,Asan.(S«tlm 703 LS,Bu,in a sod Praraulom Code:Any city or county
$ whicM1 mqulma a permit On con i.alta.Improlc,dcmWi,h.IX mp,ir my imcuac
prior n iu u,uaree,Alto n,mr z tit applimt fo,mh pamlt to Bit a Ali uvcmcm
!'I< uutdebliamodpumianttoftpmvivnotaftCmumwriU..La.(Ch,plm9 Sq. Ft. Floor Area Valuation
Iso (eonmoncingwith SCNmi 7000)a Division J arthe B.m..W Pmfralmu Code)«
3 thus k b mcmpl thaeftoa and ftbub fa ft alitpcd eampdm My vlolatim of
S«dm ML5 by ad,appllam for apt,rmh sti Ne,ppBant to A civil pculty a APN Number Occupancy Type
not mom than 11,e buMred donna(M).
I,u awmcr of the pmpeny,IX my empbleu Mbh..ga a de'v sole mmpemW m,
Mill da the VOrk,M dm iQllClaR 61KKNIeMIed IXOlread(«LAIC(Sa.7DM.BIOIm3,
and Pmfessioru Cade:The Conmaa s Liame LAM ae oar Apply Apply W An awns m Required Inspections
Iuapany who buildas orimpmeb ftmoo,arta Mbn daeas c wort himself Cir through hu
awn employoq'm lbat,aeh Impmveacnu as not ImeMedCir offered rIX ale IL
b..the building«Impm,mment a sold wl W n.year of mmploim,the.,
built 1 ba,e the W dco a mmin that M did not W id IX den mm,c for purpas of
Oak.).
1,u owror of Int pi And uchwvrly,.Aram'wish licensed.=uArn m _
Oom amct tM nojca(Sec.70at,Business and Pmfmdom Cade:)The Coomaub V
time Law Eau not apply to an oMm of pmi v W build,or Iso mm drrton.and,
.ho conumu for each po*m with a..-LIX(,)n dpmaant to thus Comr ,V.
Cicero.law.
❑lam uemq under See .Bk PC fm Nbromn
rox NEt C �D.d Nbo o
WORKERSC � NRATIOS
1 hereby Arm under pemlry of perjry not,of dm following derLnllorte
IrumudwplmalnuinaCe fla of Camaswulf-iniumfa Wa is Compos.
uuan,u prnviM.d f«by Section 3700 of the Labor Cock.for ft pOrfmmma of the
Mak for whdb this pump h imed.
1 basso ud rill m,inuin W«lxY,Co mpemadon Inmruwe.As rtyuimd by Semon
3700 aT lhn Labor Code.for the Nr(ormaocc aft work fIX wtith this pnmil is issued.
My Warke .Compensation I...attiu"Policy numb«art:
Cartier: Polity bre,
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(nnis i.naN rot Wemipkned Ytine prnnb b faane lbM doll.(s)(0)
or rat)
I certify dui in dm pnfm,nuec of lir work fIX which Nu Pertnh b Inucd,I,hall vas
employ Any perm.in soy.An. ay/p bjrcl to de woksri CwnpemWm
�ofApF1kLbL 4Ddc
NOTICE TO APPPPL1r IL dw matin{Ilds Cori of Exemption,you should
b«ome,ubjw to the Warkc'a ComPerdiatim pmvwon,of the Labor Code,you mon
.J0M
fowith mmply with such proiwi «dperm
ais itshall W ed
dominvoked. .,
'Z "" CONSTRUCTION LENDING AGENCY
[--„�-, IWmby,fnrm UAA dem 1,a conuuairm luming.aoey Or the Pc tame a
C> the wok I.
which Nis permit is mond(Sec.3097,Civ.C.)
QI es Name -
z lander,Adonis
U O I certify that 1 has suss thus applianm and sunt that the abow Infmmatim b .
E a«re«1 cepa b comply W111 all City ansm
And owxe
ny atdla,nd sue law,mlating to
0M building cmnmNon.Arid bereby,ulholrz MPruamad,en of thin city u mux upnn lh
Cit. aho.e-memi«ind prole"for inspeaim purp=L .
(Wer)agree on ase.iudantvfy And teey hadmd a the City W Cvlrniro.palm!
F' ti liatilidmjudgtronu,cmu and cxpemm w may in any May acrnc against aid City .
f, in con¢gaiue of idem gaming of this p il.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALJ.NON-POINT Issued by: Date
SOURC4EGU T10N . 6 03 OS
\ f Re-roofs
Sigmuurt mf G Due
HAZARDOUSrputumMATERIALS DISCLOSURE Type of Roof
WillyftCXntIX(otuebullmnpaamp,mtu«cor l bhvallound Stial
AA dented by�Copeniro Municipal Cade.Chapmr 9.13.and the Health anal Salny
Cade' pro 153334)' �( All roofs shall be inspected prior to any roofing material being installed.
41 Will IW applkmt or fuwrt building acvpam Out cyuipmmt or device,which If a roof is installed without first obtaining an inspection,I agree to remove
omit hvatdous air cons minants u dc0rod by the Bay Arta Alt Quality Mwpcmcu all new materials for inspection.
DIALM7 y,yu
❑m �L
I bow mad Ne hvathv,mnaialzrcW innrcnu uedorCh,pv 693 d&Calif.-
ma HealLi Safay Cade,S-tio a 25345.25333 ed 2553x.1 mderwnd thus if the Wt inp
doo rotcumNl me•rnuu that It u my rO,m biity n coury de oauPont nr de
mgr w hmonbcmnpdarmiatmnaa ,cnrnePr O Signature of Applicant Date
oM ned.ad. ent z 31o5 All roof coverings to be Class "B" or better
I
CITY OF CUPERTINO
Oem 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng : Sub: Blk: Lot :
APN . . . . . . . . . 36616037 . 00
DATE ISSUED. . . .' . . . : 06/03/2005
RECEIPT # • • • • • • . . . : 29849
REFERENCE ID # . . . : 05060023
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*
j COMPANY NEIL CHANG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5207
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------ --------- --- ------- ---------- --- ----- -- ------ ----
BPERMFEE----- VALUATION--- - --- -48 , 000 . 00 261 . 36 0 . 00 261 . 36 0 . 00
!BPLANCHK PERMIT FEE 522 . 72 348 . 78 0 . 00 348 . 78 0 . 00
IBSEISMICRE VALUATION 48 , 000 . 00 2 . 40 0 . 00 2 .40 0 . 00
BENERGY PERMIT FEE 522 . 72 125 . 45 0 . 00 125 .45 0 . 00
, ELECTRIC SQUARE FEET 413 . 00 16 . 52 0 . 00 16 . 52 0 . 00
; PPLBG SQUARE FEET 413 . 00 16 . 52 0 . 00 16 . 52 0 . 00
' EPERMITFEE FLAT RATE 1 . 00 19 . 68 0 . 00 19 . 68 0 . 00
IMPERMFEE SQUARE FEET 413 . 00 16 . 52 0 . 00 16 . 52 0 . 00
MPERMITFEE FLAT RATE 1 . 00 19 . 68 0 . 00 19 . 68 0 . 00
� PPERMITFEE FLAT RATE 1 . 00 16 . 52 0 . 00 16 . 52 0 . 00
---------- --------- - ---- ------ -- ----- ---
TOTAL PERMIT 843 . 43 0 . 00 843 .43 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- -- - - -----=-- ---------------- --
OTHER 843 .43 NOVUS
TOTAL RECEIPT 843 . 43
II
I
- q
am,&,
�C "�SCITY OF CUPERTINO
y
CITY PERMIT APPLICATION FORM 0-S—O �� Z
CUPERTINO
APN # 3�6 ` —03 Date: jai/b S�
Building Address: 1,630 LfaN�
t' Mailing Address (if different from building address):
AST�IZ
Owner's Name: e IL C- -{AAC;:r Phone#4oa —_ -7 -13-
Z.SZ 2
Contractor: dvJ�c� QUIL�E(Z License 9:
Contact: Phone: Cupertino Business License#:
Fax:
Building Permit Info:
Bldg Ef Elect Plumb ❑ Mech ❑ \
Job Description:
ResidentialL� ommerc:a
Sq.Ft. Floor Area: 4C1 $/Sq.Ft.:
i3
Cost of Project: Occupancy Group:
Type of Construction: ��� 1 T 0 Please check this box if the project is a
11 second-storyaddition: ❑
Project Size: Standard NJ Large ❑ Major ❑
i
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL
j BBOILER3 Boiler> 500K to IM Btu MECHANICAL
BBOILER4 Boiler> 1M 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 <= 1O00A ELECTRICAL
BELEC1001 Elec 600V > IOOOA ELECTRICAL
BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
I of 3 -p—
1
tWWITY OF CUPERTIN01*
CUP TYOF O PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
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
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Rei a 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 Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
BREMAMHAN 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 Rein Non-Res Appliance ELECTRICAL
j BREMPOLE Pole/Platform Fixture ELECTRICAL
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
2 of 3
�GC.. •CITY OF CUPERTIN69
CUPERTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
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 Swinuning Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Tenip Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
Y( ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
/ MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/ Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Chane BUILDING
•
3of3