02090065-FPCUPEkTINO
10 1
irIVIL's wTo 01010 i Id
APN it
Date:
Date:
Building Add ss: /,2 jj
9,5_
Owner's Name:/,,
Phone 0 g'9? je c
Contractor: (2 w lvER
License
Contact:
Phone #: 49 497 2 c9 j2 6
Applicant/Contra tor:
Fax
f/Buildihg P it Info: —(M
k Bldg :�n Elect (Plumbech
�Cription*
Residential: — Co rcial:
Sq.Ft. Floor Area:
3
$IS Xt.: 80
Architect/Engineer:
Valuation:
$40
Type of Construction:
Occupancy ra
I
Fee Descript,,
5 im 0 a rel I I Cal
Other liances
FEWER
Construction Tax
ImpjImm
I WT
Ind/Off/Conuri/Quasi
Us
Con. Tax for BQ Zone
Hotel and Motel
-----------
A
a',
Constax –Resi/Mobile
m-3:14:141mg
00
Elec 600V > 1000A
ELECTRICAL
Elec Svcs 600V <= 200A
�--EERTRICAL
Ally ` lm
a
MWI—*
BUILDING
Enq_gy Add Multi
I
all
Investigation fee
IN
Housing Mit. Fee
]Q
Res. Housipg it Fee
New Multi-F��RyRes___
WWI 0 1
New Multi -family Res
IMBRIUM
gimoj
'l New Comm Electric
ELECTRICAL
New Comm Mechanical
M
1W11WM&WA* I d1$
IA• •P1
SW LVIO)MIfEr
I
C1
I a Do Nd I v W-11 a a
Cos.
124
3 of 3
Fee Descrip
Alon
Fee Gro U
003 H: 3 a VA a C "M
'Vent Fan Shigle Duct
NO
Ventilation Systems
Scb Specific Plan
BSEISMICOM
Seismic Commercial
03 1
Fee Res
WINE
1
amily New Add
—09 1 1
Inspection
Ternpo+g Power
ELECTRICAL
"WOUVIOUN
-bTbA—PI SvCS
Ternp Dist Svcs
ELECTRICAL
II II .; 1.�'
Business License
Electrical
NJ
53-um"'.1311 31
Elec Permit Issuance
Mechanical sq. foot
$I* Irma
MITI Rol _qfi,*,MIvj -V VA -39
Mech Permit Issuance
14W-11
ID)
Plumbina Permit Issue
M'Plumbing Fee sq foot
1 1.3 1 Nk
M., MOTOR■Address
Change
I
��oiler <= 100,000 Btu
L
-.3 406111 a
Boiler> 1 OOK to 500K Btu
0-101
Boiler> OOK to 1 M Btu
ONE
-5
Boiler> 1 M to 1.75 M Btu
Boiler> 1.75 M Btu
Cos.
124
3 of 3
rM
I
PERTINO
BUILDING DIVISION
PERMI'
BUILDING ADDRESS:
PERMIT NO.
812 MILLER AV
LU DONG HUI
02090065
QZUR B
'rNb HUI
APPLICAMON SUB DATE
09/10/2002
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
L_J L.LJ
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby mu'" lZn licensed under provisions of Chapter 9 (commencing
on affirm
vu_
with Section M)iitl), J 3 of the Business and Professions Code, and my license
ADD
53 SQ.FT./REMODEL
is in full force and effect.
License Class Lic. #
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 70315. Business and Professions Code: Any city or county
$40000
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to rile a signed statement
Valuation
that'he is licensed pursdommthe prqxisions of the Contractor License Law (Chapter 9
(commencing with Section7*) of Division 3 of the Business and Professions Code)
or that he is-exempi diemfimrriaqd the basis for the aflcgeriexcmption�. Any violation
of Section 7031.5 -by any applicar kItforn Permit subjects the applicant to a civil penalty
of not more than five hundred dollars ($500).
10 1AP-N Vet�MAT I ON
Occupancy Type
0 1, as owner of the property, or my employees with wages as their sole compensation,
102
— PIERS
will do the work"ami-the structure is not intended or offered for sale (Sec. 7044,
Business'arid Professions Code: The Contractor's License Law does not apply to an
- -
103
— UFER Required InspeiftioJis
owner of property Who builds or improves thereon, and who does such work himself104
— REBAR
or through his own employees. provided that such improvements are not intended or
-
offered for sale. IT boweiii, die building or improventerin is iold within one year 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
0 1, as owner of thaproperty, am exclusively contracting with licensed contractors to
202--
UNDERFLOOR PLUMBING
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's
License Law does not apply to an owner of property who builds or improves thereon,
203
UNDERFLOOR MECHANICAL`�
and who contracts for, such, projects. with. a contractor(s)- licensed pursuant to the
204
-UMERFLOOR FRAME --
Contractor's License Law.
*,'aexcmPt-uderSe�.',� ,"B i P C for this reason
205
UNDERFLOOR,'INSULATION
301
ROUGH PLUMBING
"WORKER' ON DECLARATION
302
TUB & OR SHOWER
I hereby affirm under ptualty of perjuey one of the following declarations -
303
ROUGH MECHANICAL
0 1 have and will maintain a Certificate of Consent to self -insure for Worker's
304
ROUGH ELECTRICAL
Compensation, as provided- for by Section 3700 of the Labor Code, for the
performance of the work foNwhich this permit is issued.
305
FRAME
01 hav6'arril will inihanin Wirker's Compen6tion Insurance, as required by Section
306
HOLDOWNS
*3709 of the Labor'Code, for the performance of die work for which this •permit is
307
INSULATION
issued. My Worker's Compensation Insurance carrier and Policy number are:
308
:7
PoRcyNor "
�.CERTIFICATIOWOF EXEMPTION FROM WORKERS'
3 ol 5
+SHEETROCK
C0MPFNSAT1oN.INSU.R1CNqE1,
3-10
INTERIOR--- -LATH
(Thi �sectiun need not be completed if the permit is for one hundred dollars
311
SCRATCH COAT
($,100) or les;s.),
raume of the work for which this pe
not employ nner to bocoina subject to the Workers'
3,13-
501
-ROOF NAI ' L
FINAL ELECTkICA't 'ENERGY
{shall any person to so
502
503
FINAL PLUMBING ENERGY.-
FINAL MECHANICAL ENERGY ,
e me subject to e Worker's Co pen3atioa provisions of the Laboe Code, you must
forthwith comply with such provisions or this permit shat{ be deemed revoked.
504
FINAL BUILDINGENERGY
CONSTRUCTION LENDING AGE14CY
505
FINAL ELECTRICAL
I hereby affirm that there is aconstruction lending `agency for the perforrance
a
506
GAS TEST
the work for which this permit is issued (Sec. 3b97, Civ. C—)
Len`L&n61rsA4dre�si;,,r'.
507
FINAL PLUMB-ING
I
50�--,
FINAL MECHANICAL
I certify that I have mad this application and s tate that the above information is
correct. I aggrectocoiriply, withnil city.And county ordinances and state laws relating
5
NAL G E
:o building constriction; and authorize representatives of this city to enter upon
he for inspection
510
— 111INAL NG
above-mentioned property purposes.. ,
'(We)'agme io save, indemnify and keep harmless the City of Cupertino against
'liabilities,
51
— INAL RKS
tte
judgments. costs and expenses which may in any way accrue against said
5
City in consequence of granting of this permit.
APPLICA1,17 UND8RSTARE)8 A.N WILL COMPLY WITH ALL NON-POlINT
SOU%E I_1.,A
Issued by:t
D
AG TIONS A
f
SigniitumOlAppficaht/Contrarml , L Date
Re -roofs
MATERIALS DISC LO SU
Win the.'appiicant or ,ixildiog' occupant store or handle hazardous material
Type of Roof
,as defined by the tuperfing Municipal Code,,Chapter 9.12, and the Health and Safety
Code, Section 2.5532(a)?
'KNo
All roofs. shall be, inspected. prior. to any. roofing material_ being installed.
Will the applicanr'or future building occupant use equipment or devices which
If a roof is installed without first obtainin an inspection, I agree to remove
9
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
-
all new materials for inspection. Applicant understands and will comply with
0 yes XNo
all non -point
source regulations.
I have read the hazardousmaterials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533 and 25534, 1 understand that
if the building does-not,cuorently have a tenant. that it is my responsibility to notify the
occupant of the mi6rements which must be met prior to issuance of a Certificate of
Occupancy,
- �s
��g`uature�fApplicant
. 11.11,
1 Date
All roof cLngs to be Class "B" or better
_4
& 110
Owner thoriz#diigent Date
OFFiCE
Dear Property Owner:
City of Cupertino Building Department
10300 Torre Avenue
Plione: (408) 777-3228
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.t.
For your protection you should be aware that as owner -builder you are the'responsible party of record
on such a permit. Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself, you
may protect yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you
should be aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work
(including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
if you are an employer, you must register with the state and federal govermnent as an employer and
you are subject to several obligations including state and federal income tax withholding, federal social
security taxes, workers' compensation insurance, disability insurance costs, and unemployment compensation
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers' compensation insurance.
For more specific information about your obligations under federal law, contact the Internal Revenue
Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your
obligations under state law, contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees, without a licensed contractor or
subcontractor, only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure in owner -builder
building permit, erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License,
Board in your community or at 1020 N Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
City of Cupertino
Printed on Recycled Paper
RM1010
1. (Check one) I or my immediate family (parent, spouse or child) will perform:
A. All the work authorized by this permit
B. A portion of the work
C. None of the work
I If B or C is checked, complete 2 or 3 below. 1
A. All of the work
B. A portion of the work (complete section below)
Contractor
Address/City Phone # State License # Type of work to
be performed
3. 1 will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
PersorVFirm.
Address/City Phone Number Type of work to be
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner -Builder Information (reverse side).
Property Owner's Signature:
Date: 2
Job Address: 14v; Permit # 40 6 0
An changes to the information provided on this form shall be submitted to the Ci !y of CLipertino Build
Department.
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CONTRACTOR INFORMATION:
BUILDING tPERMIT
BUILDING ADDRESS:
PERMIT NO,
812 MILLER AV
LU DONG HUI
02090065
OWN R' AME:
O �ONG HUI
APPLICATION SUB DATE
09/10/2002
HONE:
SANITARY NO. CONTROL NO.
Z ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I_J LJ
LICENSED CONTRACTOR'$ DECLARATION
Job Description
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
w
ADD 5 3 S Q. FT. /REMOD '�+
with Section 0000) of Division 3 of he Business and PmfCssions Code. and my license
in ren force aad erfem
17e�e ,y�
If— u �Tp{ A Q.^
6 Licenu Class Lic.a
"
entimeter
Dae Centimeter—
-
ARCHITECT'S
shall be used m public records
S I understand my plan, shall
OCT 2 4 2002
Licensed Prnfesiewl
OWNER -BUILDER DECLARATION
®e ,�t 8�
oi I hereby affirm that I am exempt from the Contractor's License Law for the
p�
B I 7 � p y rz
�
a following reason. (Section 7031.5. Business and Professions Code: Any city or county
4000'0
O which mi a permit m construct. alter, improve, demolish, or repair any swemm
$ prix t t issuance, do, req' the pPbmm far such permumfleasgned
e ti ns of the Commnors Lcenu law (Chapin 9
- that he sle hsddpa'. name has
,�,, �a��,rm Valuation
(common g rat Sets,]Ig1Q1 b[ Divsn tJof the Buuncu vnd Profvu'onsC dc).
i..is.i.,tkL3,/`�!�'tl1Yf Y-�(�l�AL�:�lit,?ls1',
or Ihai he is eicmvt tlierefmm and the basis for the alleged exempttun. AnY violation
- of Section JOJ LS by any applicant for a permitsubjtt'u the applicant m e civil pemlry-
Crown auft. five hundred dollars (5500).
101A�Yefl1MATION
.'I"''•` Occupancy Type
01, as ownerofthe property, or my employees with wages as their sole compensation.
-
1 02 PIERS
103 - UFER Required Ins ectioilsi<' st = T) I
q p
wlll do the work;'and'the'structure 'is not intended or ofered for sale (see: tau.
Busine'ss did Professions Crile: The Contractor's License Law does not apply to an
ewner of pmpen, Who wilds or improves thereon. a ad who does such work himself
104 - REBAR
or through his
-, urterP 'f r sale. If, howe'vacme Wmlden that himprovements...us s.1arc not intended P
g P ent:s rola wnnr not of.
_ -., - ._. _.._ _. .. .... - -- ._--,.
105 - ANCHOR BOLTS .., o+ : I .
Wild
`rem lve far theewner-builder will have she burden of that he did not Wild or
prove nn pagmee orsme.).
106 - SEWER & WATER
---- -...— --- ...._._ _ .._.. - -
�0 hazownerofahavmpenY. amatlusivcly eomrmunB with licensed romrutonm
--..
202 - UNDERFLOOR -PLUMBING Pl•iu tit, `. '.it, ill"
construct the project (Sec. 71),1,1, Business and Professions Cade:) The contractors2
0 3 - UNDERFLOOR MECHANICAL ' " T 'o 1:1 1,
License Law does not apply to an owner of property who hudds or improves mercer,
and -who contracts far. such. prupects-with. a. conumearms). ficenscal mutationmthe '
_--_...----2'04"--'UNDERFLOOR FRAME--.._.--------- -------__.----.--__--
".9 Contractors License law.., ,..
g�d pt d,s �' ',`-''":B&.Pcrr,mis reason
205 - UNDERFLOOR-INSU'LATION
ow r' z o p�,-/e
301 - ROUGH PLUMBING
WORKIR OMV ION DECLARATION
',- _
302 - TUB & OR SHOWER
I herebyalr.under,pnwpyofNijury,oMormefollowingdeclarations:303
- ROUGH MECHANICAL
,0 1 hn.e'.ad will raainnuie'ncenifina, of consent to self -in sure far Workers
304 - ROUGH ELECTRICAL
Compensation, as provided- far -by -Section 3700 -of the labor Cade. far the
305 - FRAME
performance or the work for which this permit is sued.
0 l havebndwdl•mart Wmker.Compcsto 1%um;Ceano iced by Section
306 - HOEDOWNS
'3700 of me Labor Cod r to performance„.. f m wiirk r which this remit is
307 - INSULATION
towed MyWkcri Compensation Insurance[airrand Ml Ymiinbe'r
308, ;=' ,SHEETROCK ' - -
`'.•l.J
.IrR6ti - ..
t. .
s - sf.,t ,i,�i es j,..
309 d-".EX�ERI�OR LATH
1 , CERTIFICATION OF EXEMPTION FROM WORKERS',
COMPENSATION INSURANCes
-
Ohs,clfan r8ed lei tic completed'( the permit is for one hundred dollars
311 * - SCRATCH COAT I
ISIOD) O lez.)
313._ - ROOF=NAIL :-
ma. I c rt fy iM1 , n il Pe f e. f thek f which th P m s issued Ir
shall tcreptYSY� hm,so t !me ubleatpmeWok
Ifez.
t (^f •:
501 FINAL ELECTRICAli 'ENERGY -
.Apjlpcnttf ---1b/�O�$/r
..
..., __..502. -..FINAL. PLUMBING.-_ENERGY-----
503 - FINAL MECHANICAL'ENERGY
�^ypTICETOAPPL{AvrH rnakmgmsCertificate ;r Exemption,you should,
Calc
1IkkNM, svb)ct 5FC 3sbk sC dpensa p softh LaW you t
'r:;nh m plywhn: hp ,rat ro t.nauned sere kind.
_ 504-,_.--,FINAL-..BUILDING.._ ENERGY __...
-
n ��' ° '• CONSTRUCTION LENDING "'
505 - FINAL ELECTRICAL
,'
1lsreby'Rimth tth 'm:iswt 1 dg'u11 for the Iwrf4imiince
r•
-_GAS TEST
beth work fo which this Permit. suedlsec3097cvc)
.... ... . .... .
-'Lt d' N e ...., _..moi ._. __s.,_. ..
_ _ _506_
_ _
507 - FINAL PLUM, IMG.„
[moms Address.'
�,, ?'.., r r -"ec•, ,. ti.
50 FINAL MECHANICAli..
_
I certify tha I have read this application and suit that me above information is
F. nincci. I agree a, all pty.and county ordinances and state laws relating
5 9 - INAL GRADE
inply with
Ci Iwbuildingconaiv<tan: and hi•rehyauthorize rcprc.fcntutive�nfthlscitymenterupon
S 0 - INAL N NG
A the W cd Property f inspection Parry .. _
Q. (Wc) 6 to s e ndemmfy and ke p harmle s the C ty f C pen no against
51 - I NAL RKS
In liabilities.1 dgmen¢, t d I pensns which ray anY y gain void
Z Cityy co seq a cc'o(thegaining of thin pc t
/•
.1 LICAN'TUNDERStANDSANDWILLCOMPLYWITHALLNOY.POINT
11.1111' "•
`/
ISSuedb D to
y
_ SOUR EIFGULATIONS. o A. o% a
-IOOf$
SiOnamrc
ATRALS DISCDSUR
'''� WI(the plHcAm2AorRfDuw0Idingoccupanimrt ret menumluum.avral
Type ofR' Dof_ - - --'a�
M p I Cal Chart 9 IS d di M Safety
a. defnd by thepCupcn Municipal
.1 f1.
' �., `f s' 5i:i
CWC Si 25532(u),s.} .: :.
,; re ss l•,5i C:
All roofs shall be inspected prior to any_roofing.ma[enal.tieing ms[alled _ ........
Will he�onplicdg�'•i,hn;e building ocuupau use egitipare��er eeviees Innen•
If aroof is in'stalled' without first obtaining an- inspection, I'agree to'remove
,Broth and air cot t as defined by the Bay Arco A quality management
D trot
` 0v, PpSa '� '
all new materials for inspection. Apphcant,understands and will comply with, -
-a11 non -point soul'ce regulations.. •'
;
` 1 lai,i rim dailhousai materialsq titan under Chapter 695 of the
, 1, :Ate , v ,
'Calf Health & safety Code. Sections 25505 5533 and 25534. I understand that
ifthc buldin,doe,nuc tlY have a tenant. that iti%myoct,saintala, m inufvthc
irctm u hers must be m t Prior to issuance ora em
' p rcgo fico[ of
occv am of me
a p cy
1--.Dategnature
� - ..
Applicant Date,.- _
'
._ .. _ .. ...._ _. .. _ .. .. - ..
All roof c Brings to be Class "B" or better
Ostif
ia, tbart red en
g
I. ..,. _...._ '..
,.' -OFFICE-
.. _ ... _._... ...- ...-......_