05050067 CITY OF CUPERTINO r �rTirkgt� -' �y�1:a'?r»Te'��irrEE1Eya�'':
BUILDING DIVISION PELT Y � Yl IUCTQO�Tl�'c®gam C`
BUILDING ADDRESS: PERMIT NO.
TUNG KET GHAI 05050067
'TIN137JEAR AV
R1 AM : PERMIT15511EDATE
PHONE: SANITARY ROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BIRO ELEC' PLUMB MECH
000 LICENSED CONTRACTOR'S DECLARATION Job Description
1 Inrebffi
y arm Nat 1 am licensed under provisions of Chapter 9(commencing P
with Section 7")o(Division 3 of Ne Bas.and Profession Code,and my license is
<< in full farce and effect
g'>g:
License Class Lm.x KITCHEN REMODEL
i p Dam Conmma1
4 ARCHITECTS DECLARATION
2 1 understand my plans shall he used as public rmudds
D U
30� Licensed Proposal onel
r.m OWNER-BUILDER DECLARATION
qy 1 hereby off.Nal I am exempt from the Contest's U'mense Law for 0m
i C following mason.(Section 703 1.5,Business and Pmfesuam Cade:Any city tar county
which mqulrca a permit In annarmlm
l,er.improv,,demOl4h,or rtPat,any I.M.
�a prior to its issuance.also requires Ne applicator for such permit to file a signed statement
< that he is licensed pursuant the provision of the Connector's License Law(Chapter 9 Sy.Ft.Floor ACCs Valuation
� $ (commencing with Section 700()of Division 3 of the Business and Profusion,Code)or
3 Nm he is exempt therefrom and Ne basis for Me alleged exemption.Any violation of
Section 7031.5 by any applicant for a want[subjects the applicant to a civil penalty of APN Number Occupancy Type
.or mom Nan five hundred dollars($300).
❑I,as owner of the property,or my employes with wage as Neo sale mmpemtion,
will do dm work.end the structure 4 nut intended or offered for late(Set.7W,Business 32603021 . 00 Required Inspections
and property
who u Cade:The vesu acmn,License Law don not apply lf an ower of 9 P
me era whced,provided
impmvuthcrm r and who me ssuchwmk Mmsel(or Nrouthmic his
own er,Me iprovided proveh Improvementsamne year fe oro@rW foo own It.
however,Ne building or improvement Is mid within rete year of mprow(n,Ne awncP
builder will hese dm burden of proving Ned he did not build or improve(m purpose of ,{/
❑1,as owner of Ne propcory.See.704 am exclusively ad contusions Cid licensedThe
Ccanwmon N Q w
construct the prokm(Sec.toad,Business and Professions Code:)The Concrete and,
/
cense law dots not apply m is owner of property who builds or improver thereon,and,
who contracts for such projects with a conwnor(s)licensed pursuant w the Conuxmr's �a�
License Law. J`
MT
B&PCP Nis n
FF Data
r'1 9 .
cr ORKER'SCOM ENSATIONDECLARATION
I hereby affirm under penally of perjury am:of Ne following declmters:
❑Thaveandwillm inminaCcAiflmwof Conscnitoulf-InumforWorkeesCompcn-
sm en,as provided for by Section 3700 of the Labor Code,for the performance of to
work for which Nia permit Is Issued.
❑1 have and will maintain Workers Compereadon Insurance,as acquired by Section
3700 of the Labor code.for the performume or the work for which Nis permit is Issued.
My Workers Camperdadon Insurance nniar and Policy number art:
Carrier: Polity No.:
CER 1FICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need mtbccampicmd If the Permit Is(mom hundred dollars(5100)
or lana)
I certify that In Ne performance of the work for which this permit Is issued.)shall not
employ any person In any�mm�ne u�gbecome subjectto the Warkere Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cari ficare of Exemption.you sh odd -
become subject m Ne Worker's Compensation provisions of Ne Ichor Cade,you am
.J Q forthwith comply with such provision or Nm
is Permit shall be do ed mvokcd.
rIn CONSTRUCTION LENDING AGENCY
[.w I hereby after.that Nem its construction lending agemy far the Performance of
a rte
the work for which this permit is Issued(See.3097,Civ.C.)
W Q Lender's Name
z Leaders Address
U Q I certify that I have read this application and sure that Ne above infnrmaliun Is
W F coned.I agree to comply with all city and county ordinances and sum laws reading to
Q U building construction,and hereby numodm repmeenlativer of this city to enter upon Ne
W shove-mmuoned property for inspection purpasea
(We)agree to an=.indemnify and keep harmless the City of Cupenino against
i—t faA liabilities.judgments,costs and expenses which may In any way see=against mid City
U 7 in consequence of the gadding of this permit.
�7 APPLICANT UNDERSTANDS AND WILL OMPLY WITH AL NO POINT Issued by: Date
SOURCE REOULATIOT
7rrY I ss Re-roofs
Signature of Aerlicant/Cam,mor 7 Dam
HAZA fJOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant at future building occupant store or handle hnrardous material
as dented by the Cupertino Municipal Code,Chapter 9.12,and the HesIN and Safety
otic,Section 255320)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu
Will the applicant or future building occupant tax equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
curt hazardoas air contaminants u defined by the Bay Area Air Quality Management - all new materials for Inspection.
Disuia7
0Y0
I have mad the hmardou materials raquimmcnu under Chapter 6.95 of Ne Califon.
die Health&Safety Code,Sections 25115,25533 and 25534.1 undersand Nm dust building
does nor currently ham a moan.that It is my rcsmmoihility do until'y the to ant Of Ne
requimmcmt whit uud mel prior to issuance Cenificamatfoc IF y Signature of Applicant Date
uS All roof coverings to be Class"B"or better
Owner or authortxd aF nd Dam
• CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32603021 . 00
DATE ISSUED. . . . . . . : 05/12/2005
RECEIPT #. . . . . . . . . : 29655
REFERENCE ID # . . . : 05050067
SITE ADDRESS . . . . . : 10735 PENINSULAR AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : ' TUNG KET GHAI
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0121
RECEIVED FROM . . . . : TUNG KET GHAI
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : TUNG KET GHAI
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0121
• TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 3 , 000 . 00 83 . 16 0 . 00 83 . 16 0 . 00
BPLANCHK PERMIT FEE 83 . 16 110 . 98 0 . 00 110 . 98 0 . 00
BSEISMICRE VALUATION 3 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
BENERGY PERMIT FEE 83 . 16 39 . 92 0 . 00 39 . 92 0 . 00
ELECTRIC SQUARE FEET 200 . 00 16 . 00 0 . 00 16 . 00 0 . 00
PPLBG SQUARE FEET 200 . 00 16 . 00 0 . 00 16 . 00 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
MPERMFEE SQUARE FEET 200 . 00 16 . 00 0 . 00 16 . 00 0 . 00
MPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
PP2RMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 397 . 67 0 . 00 397 . 67 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 397 . 67 1262
TOTAL RECEIPT 397 . 67
•
EW
P OMEG.- ce,-0.
ONC
?V E, ^I�rSH ESTI .
CUPEkTINO
Assessor's Parcel Number:
Name of owner.
Project address. I tj
-�tVq
Contact person. Phone. 4q-5- 2-5 8
Fax. L5 ?;?,C — 557
Net square footage of lot.
Exis in Proposed
Square footage: First floor: 111050
Second floor: I
Garage: zf�z--<D
TOTAL: 9—ea• cy
Are there at least two 10 foot by 20 foot clear spaces inside the garage? N
Is privacy protection planting required for the project? Y
On what floor(s) is work being done?
Brief dese ofwork.
Code editions: 2001 CBC (Y -N)2001 CFC (Y- N)2001 CMC (Y-N)
2001 CPC (Y -N)2001 NEC (Y - N)
Effective 11/1/02 rr
•
Plan Review Process Work Book Page-8-Revised 4/28/04
U
� z
{
CITY OF CUPERTINO �p �-�+•. wp1e �♦,'
BUILDING DIVISION PERMIT l3iCONTRACTORTINFORMATION �-
mm'9th
BUILDING ADDRESS: PERMIT NO.
TUNG KET GHAI 05050067
R AM AV PERMIT MUM DATE
E: SANITARY OL NO.
ARCHITECTi'ENGINEER: BUILDING PERMIT INFO
BLDG O Ply MECH
O
y0ij LICENSEDgotIAmONIadCTOWS underpDEConsorCON Job ���®
1 7 affirm that 1 am of the
Bu under and
Imam of Chapter 9(commencing
withSmile.for And
Affect.
7 ofthe Bounces and PmfeWone Code,old my license B
is full fares anti ercmL
Gas Class Mor KITCHEN REMODEL ��_
C
ARClmEC`S DECLARATION 1OU
�i 1 understand my plans Nall he used as public records � J
7yc777
;0
Licensed Pmfcssian.l BUILDING
UIL ®IB G
OWNER-BUILDER DECLARATION L N
D>' 1 Mmhy.(Sect on I nm exempt from the Communes Co Littman C Law for the
which re moron.(Section 70131.5,Business and Profession,Code:Any city at county
$ which myulma a permit re cnr s,the alar,impmw,demolish.t,nr a pair any ed tateraurt
poor biuissuance.
sedreatanttoso restharini. o for suehpennitmee Law(Chapter
K�sx< that mmurn nicevied Sm,ion? the)aDv anfnfdContractor'sBudce r=i Cbapter9 Sq. Ft. Floor Area Valuation
(eammendnj pt Scction70ndus basis n3O(theeged amennuon.Ar,ali Codd tar
�.. dot he'in taempt tMaefrom and use tau fa the allegro eaempam.AaY viWatlon Of
Semon 7031.5 by airy applicant for.permit subjects the applicant to a Wil penalty of APN Number Occu ane
not more Nan B.huMrtd dallaa(M). - P Y Il'Pe
❑L,as,owner of tie Property,army employees with wages a their sale compensation,
willdothew66.end the aweture isnat intendedor offered ims.le(Sec.7044,Business 3260302100 Required Inspections
And ProfcW..s Code:The Contractor's Lice .
License Law docs not apply he an owner or q P
property who buildsor i mprowa a minor,and who doessuch work himself or Uuough his
own employees.provided that such improwmenu are not intended orartered formic.If,
however,the building or improwment is said within oro year of completion.the owner•
builder will haw the burden of proving that he did not build or improv for purpose of
ale.).
❑1,u Owner of the property,am exclusively contracting with licerue i momma ton to
construct the project(Sec.7044,Business and Professions Code:)The Contractors U.
cense Taw does not apply to an owner of property who hoods or improwa Merton,and,
who contracts for such pmjcco with a contractor(s)licensed pursuant to the Contractor's
License Law.
�r^ B&PCT this uon
Owner IkA1WCOMPENSATION
ET DIO `a f2 _
ORKERS COM SATION DECLARATION
1 hembY anon under penalty of perjury am of tie following declarationer
❑1 row cosi will maintain•Certificate of Conserv m self-imurt for Workers Compen•
ation,u pmvided for by Section 3700 of the labor Code,for the penfonnance of the
work for which this permit is issued.
Q 1 haw and will maintain Workers Compensation Insurance.As required by Schon
37W of the Labor Code.for the performance of de work for which this permit is Wand. '
My Workers Compensadan insurance carrier and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' '
COMPENSATION INSURANCE
(This mcaon recd not becomple t d if the permit Is(oronenundrro dollar($low)
or leu.)
1 cenify that in the performance of the work for which this permit is issued,I shall not
employ any Mrson in any maryre��tybec�e subject o Ne Worken'Compemaian
Law.Of Caifomie.Data
4 FSS
Applicant
NOTICE TO APPLICANT:If,aur making this Certificate of Exemption,you should
hmome subject b the Workers Compensation provisions of the Iabor Code.you mea
.,O forthwith comply with such provisions or this Permit shued remixed.
About he dmmoked.
Z'0 CONSTRUCTION LENDING AGENCY
[w sed. I hereby or..that there is a construction leading gency for the Performance of
CG the work for which this permit is Wand(Sec.3097,Civ.C.)
WRQ Lenders Name
a z Lcnaera Add^..
U Q 1 comfy that I hew mad Ni.application and sum Nu use stow Information is
I2. corma I agrm to comply with all city and marry ordinance,and sou Hwa mlating to
Q„ building construction,and hereby mthatio,reprtmmunim of N4 city b enter sono the
W above-MentionW pmpeny for inspection purposes
gy (We)agree he save.indemnify and keep harmuas the City of Cupertino against
N liabilities,Judgments.costs and expenses which may In any way accrue against aid City
V 7 In consequence of the gaoling of this permit
r� APPLICANT UNDERSTANDS AND WILL OMPLY WITH A NO -POINT Issued by:9i4o� Date
SOURCE REGULATIOrys,
7 ¢s Re-roofs
Slgnaurt OfAppJicAaVCOnWg1,
HAZA OUS MATERIALS DISCLOSURE Dae Type of Roof
Will the applicant or future building occupant stom w handle haadou material
An defined by the Cupertino Municipal Code.Chapter 9,12.and the Hwlar and Safety
ime.Sedan 25532()? All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future building occupant use equipment or devises which If a roof is installed without first obtaining an inspection,I agree to remove
It hmardaus air conn al...ta a defined by Ne Bay Arm Air Quality Management all new materials for inspection.
itrict7 /
❑Yu R a
1 haw mad the hamadeas materiabrtquimmew under Chame,6.95of the Califor.
nu Hes W&Safety Code,Soctimu 25505.25533 and 25534.1 uMemmU theifthn building
don
cot currtnay Mw a tenant ave It u my mapoNinility b Testify tie one ant of de
requimmcnuwhic test metpdorbissuamm ecdfkamoroc Signature of Applicant Date
Owner ar.mnatiand s nl o ta All roof coverings to be Class"B"or better
11 �,Ft ,p-t �r 1' ,•+ w'�" L R �.'h S. k2+k
Zv--Aat
�
CUPEfZ,TINO 8 ,..w., .,. _ ? #a' swa fi. 1
, 8�¢¢
aw
Assessor's Parcel Number:
.
Name of owner. o eµN Rk$
13
Project address. G 8 S
Contact person. 5;?14d g� 041- T'hgne. 92 S- r�21r 3'3
Fax. 'ioT-
Net square footage of lot.
Existin ProDosed
Square footage: First floor: 156,SP X7rG.) J4g,wo VIE L
Second floor:
Garage:
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces inside the garage? ( . Y N
• Is privacy protection planting required for the project? Y / N � �`'
On what floor(s) is work being done? ST --'�
Brief description of work. 6-re-r1 End
h0t-)Aa/ e-s A42 FvoTP;C i,4 -T-5
Code editions: 2001 CBC (Y -N)2001 CFC (Y -N)2001 CMC (Y- N)
2001 CPC (Y -N)2001 NEC (Y -N)
Effective 11/1/02
0
� G
Plan Review Process Work Book Page-8-Revised 4/28/04
0
rod, •� p e�
a o
00
I to
3.
b
�-
� I
O
� N
A
rn I � .
J
T /
0
C*
'of
�n
i
'13 69-I i l ' cma .
C
c
N
p�
A p
A