04060068 (2) 1
CITY OF CUPERTINO
BUILDING DIVISION PF-RMICOM CRAC.TOR INFORMAT �.
sten.''
BUILDING ADDRESS: CHEN' S CONSTRUCTION CO PERMIT NG04060068
7548 B
PERMR LSLJE DATE
NER'S NAME:
PATRIC YAM 1271 WASHIN 4
NE: SANITARY NO. CONTROL NO.
(510) 639-0853
BUILDING PERMIT INFO
ARCHITECi'ENGINEER:
BLDG ELECT PLUMB MFAH
0 I�
mou O p LICENSED CONTRACTOR'S DECLARATION Q nnYs n
a F I hereby affirm that 1 am Iicensc0 under previsions of Chapter i(commencing
zu,, with Sccti n7 )af Division Soflhc Businea eo�Rmfcssiuna Code.end myliccnm is �
n`o`w in full m ad r«t. - /�—t ry.1 R INTERIOR REM®D1 BATRRMS/WINDOW/
j✓�? License L Lic.N
nFp pace Cuntmctor t CIRCUITS)
ARCHITECTS OEC ON DEC /)4 e1001•
z-s ^I undem an y plans shall W used as public records CC OJ 7— L vI
J,U
a.F Licensed Professional
'� OWNER-BUILDER DECLARATION q®) re��,k��tf�/�
'aS I hereby.(Seco then I am exempt from the Contractor's License Low for the �I L®I� V RT
0 which
q.i...Permit
71W.5.Business and Professions Coale:Any city orcounty IRMy� ��88 RR
;C
--K which rtyuirns a permit m cnnsweL alma imprnvc,dcmulkiM1,m mpvr any stoemm
P-'^ ptionn its issuance,also mquims the applicant forsuch Permit o Tile a signed Statement
-�a that he is licensed pursuant m the pmvisions of the Contractor's License Law(Charter 9 Sq.F[. Floor Area Valil l'Qo 000
XFQ (commencing with Section 7")of Division 3 of NC Business and Profnssions Code)or .
'd than he is exempt thcnefmm and the basis for the alleged caampfiort.Any violation of
Section?031.5 by any applicant for a permit subjects the applicant to a Civil penalty of APN Number Occupancy Type
.at mom than Eva hundred dollars($M. 35924003 . 0 0
Cin 1,as owner of the property,or my employees with wages in their mlc compensation,
will do the work.and Ne sacwrt is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Cade:The Commumm s Licence law docs cot apply to an owner of q P
mainly who buildsor improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered forsale.If.
1•awevcm the building at improvement is sold within one yar of ComPlcdan.to owner-
builder will have the burden of moving that he did not Wild or improve for puryou of
sale I
h as owner of the property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li-
<cnu law does not apply to in owner of property who builds or improves themon,and
who contracts for such pmjeets with acommctor(s)licensed pursuant in the Contractor's
Lt...Law.
El I am exempt under See. B h P C for this reason
w r
Data
WORKER'S COMPENSATION DECLARATION
I Mreby aRtm under penalty of perjury uan of the fallowing declarations:
Ihave and will mainuinaCcnihcaw of Conummulf-insurtforWorketsCompcn-
sation,as provided for by Section 37M of the Labor Code.for the performance of the
work for which this permit is issued.
❑1 have and will maintain Workcfs Compensation Insurance,as required by Section
3700 of the Labor Code.for he performance of the work for which this permit is issued. '
M.Workefi Co pe-auonl arta asriv and Paltry number are: q�
ampr. Poli,No.: �V l
�CA OFEXEMPnONFR�0hhffW� RKERS'
COMPENSATION INSURAt 1
(This section need not W completed if the permit Is for one Worked dollars IS 100)
or pus.)
1 certify that in the performance of the work for which this permit u issued,1 shall not
employ any person in my manner m as to become subject o the Workers Compensation
laws of Caliromis.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Code,you muse
.Jfzs foMwith comply with such pmvisions or this permit shall be deemed revoked.
Z ~1 CONSTRUCTION LENDING AGENCY
[x+14 l horeby affirm that then is a coosuuctinn lending agency for the Performance of
G' 7 the work fur which this permit is issued(See.309'1,Civ.C.)
W� A Lender's Namc
=z lender's Addrss
O Q I certify that 1 have read this application and sow that the about information is
F' Correct.I agree w comply with all city and county eminences and sow laws relating to
O V building Construction.and hereby authorise mproentiives ofthis city to enter upon the
W about-hon ioncd promeny for inspection purposes, s
F (We)agree to save,indemnify and keep harmless the City of Cupenino against
fd'A liabiliticajudgmemceosts and expenses which may in any way accrue against said City
V z in
Cnce of bad NT UNDERSTANDS ranting of this
ND WILL COMPLY WITH ALL NON-POINT Issued by: Date-v I
SOURCER ULATIONS. 1
Re-roofs
Si atureo(AppContruar at
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hayon! us material
ei defined by the Cupenino Municipal Code.Chapter 9.12,and the Health and Safety
Code.Section 25532(-)? All roofs shall be inspected prior to any roofing material being installed.
[I Ye No
Will the applicant or Team building occupant see equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hayardaus air Contaminants as defined by We Bay Area Air Quality Management all new materials for inspection.
Disvic"
❑Yes k'No
1 have read the hoaNnus materials mquimmcn¢under Chmmr 6.95 of the Califm
raiz Hulth gr etyCedc,Scedmtx 25505,25533 and 25534,1 understmd thin ifthc building Z 4�i' `•���� /./"p ,s -7
dots wt cutrtnth ha.c a meant dot it is my responsibility w notify 1M occupant of dm
C'(
reyuitcmcmes which must Wmd onto issuawcaI. Ccmr, le of ctaymer. Signatur6of Applicant / g Date
/o7 �"0
Ow�r au{ riyedp cat ( baro All r�ioaf coverings to be Class "B" or better
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fkTY OF CUPERTINO
�
CITY OF PERMIT APPLICATION FORM
CUPETINO
APN #
Building Address: l Mailing Address 6f differ nt from building address):
AV CA
Owner's Name: Phone #:
a G —
Contractor: 13—censel:
o .
Contact: Phone: Cupertino Business License#:
Wm Fax•
Building-Permit Info: tfemv ClcZ[0 Qy ,Z _ czl ,f 611e 56W 6ef,
I1D�+rre YCl��e/cr (2v^Dry t� �/� €fPl /<id
Me
e�cChElect Plumb C
'Bldg v ll H
Site
Job Description: �, _
Residential fi��Y�-- 7" ��— rc a
Sq.Ft. Floor Area:
Cost of Project: I a Occup y Group:
Type of Construction: Pleaseeek this 6oi if t roject is a
second-sto
Project Size: Standard ❑ _Large ❑ Ma or ❑
Quantity—
uanti Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 1 OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M 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 <= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
\ BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA investigation fee BUILDING
1of3 ( (
P"0n CITY OF CUPERTIN#
CITYOF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee 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 PbIg 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 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 Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREMSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm 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
BREMPOWER Power Device/Apparatus ELECTRICAL
C� BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT I Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
2of3
'(d- fkTY OF CUPERTINO
CUP TYOF O PERMIT APPLICATION FORM
uanti 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 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 sq. foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
e
3 of 3
Community Development \
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
OJPERTINO
Building Department
JOB AD ESS: PERMIT #
I co 4 O 04,2
OWNER'S N PJONE #
GENERAL CO CTO _FAXX# ( _0c ^ 3
I am not using any subcontractoosy i1 " �C/� ` (� 00 �--
/Signature/ D e
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
i • Tile �
ontractor Si ature to
CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACT®RzINFORMA'IIIQN
BUILDING ADDRESS: CHENTS CONSTRUCTION CO PERMIT"°04060068
7548 BOLLINGER ED
OWNER'S NAME: PERMIT MUE DATE
PATRIC YAM 1271 WASHINGIQN AVE, 06/07/2004
E: SANITARY NO. CONTROL NO.
(510) 639-0853
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
upz LICENSED CONTRACTOR'S DECLARATION
mF 1 hereby affirm that 1 am licenced under provisions of Chapter 9(commencing Job Deseript'
2, who socipn791MI)ofDivision3ofdmBusinwao�rofcssiunaCode.and my WALE
gam-
Limnmre a 1. / �f INTERIOR REMODEL (KITCHEN/ 8/Ri3�u}yW/
< LLL"`m��Illtttmmm U
�p xart TSL DEC CIRCUITS)
ny ARCHITECTS DEC ON
5v a I undeman my plans shall M used as public rerntds DEC r W o
,6U Ykstrs ter` 2oa4
3 a0� Licensed Professional
I OWNER-BUILDER DECLARATION D 11��
.�<I I hereby alum Nm 11. cBusin from IM f Contractors :A License Law for the O ��1/ Try
p0 following..an.(Scctiun 70]15,Business and Profession Code:Any citymcounty ('IS LII,-,J�'
m wM1ich requires a parotin In ennstmct,alter.improve,demolish,m repair any stmetuo
prior to its ismanim.also mquims the applicant(arsUch permit to file a signed statement p
a that he s licensed pursuant to the provisions of the Cantmemr's License Law(Chapter 9 Sq. Ft. Floor Area Va u 2pD 0 0
xt=—$ (commencing with Section 7")of Division 3 of the Business and Professions Code)or
—
that he is exempt thcofmm and de bads 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
not mom Nan five hundred dollars MOD.
01,u owner of the progeny,or my employees with wages as their sole compensation, 35924(]03 . 00
will do the work.and the swnurt is not intended or offered rot We(Scc.704x,Business Required Inspections
and Professions Code:The Contractor's Liaise Law does not apply to an owner of q P
property who builds or improves desmon,and who does such work himself or though his
own employers,pmvidcd that such impmaements ase not intended or offered forsele.If.
however,the building or improvement is anld within one yearof m rpledion,Ne owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed conmnors to
construct the pmjca(Sec.7044,Business and Profession Cade:)The Contractors Li.
cense law docs not apply to in owner of property who builds or Improves Merton,and,
who contracts for such pmjecm with a cantrscou(s)licensed puramm to the Comostors
License Law.
1 am exempt under Sm. B&P C for this mason
Owner Date WORKER S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury ane of the following declarations:
have and will maintain a CeniOeare of Consent to self-insure for Worker's Camper.
cation.as provided rot by Section 3700 of the labor Code.for the pesfarmanee of the
work for which this permit is issued.
1 have and will maintain Wwkcr's Cons,mumcm Insurance,u remained by Schon
3700 of the"her Code,for the performance of Use work for which this permit is issued.
M,W.rkm` o pensatio s I m.canner end Policy numhm mc: ^�
arti r. Paliry No.: �V>
9 CERTIFl A OF EKEMP IONPA W RKERS'
COMPENSATIONI E
(Thisscetion need not becomphocul if she permit Lantana hundred dollars(51(00
or leas.)
I certify Nat in the performance of the work for which this permit is ismed.I shall not
employ any Peron in soy mortician as in become mbjcn to Use Wort Comramandan
Laws of California.Dae
Applicant
NOTICE TO APPLICANT:If,after making this Ccnincae a(Exemption,you should
become subject m the Worker's Compensation previsions of the labor Code,you most
.J O forthwith comply with such provisions or this Permit shall he domed revoked.
Z" CONSTRUCTION LENDING AGENCY
[r tom. I hereby am that then is a construction lending agency lm the Performance of
C � the work far which this permit s issued(Sec.3097.Civ.C.)
G25 Lenders Name
,=Z lenders Address
U Q 1 certify that 1 have read Nis.11H.d.and salt that the above information is
F' correct I agree to comply with all city and county ordinances and state laws relating to
building consolation,and hereby museum representatives of this city to enter upon the
0O
r(Ll show artnned pram y for inspection purposes.
(We)agree to Save,indemnify and keep harmless the City of Cupcnim against /
F f0.j1
Liabilities.judgments.costs and expeims which may in any way accrue against said City
U in ansm,mosee of the granting of this permit.
Fr APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
v//6
ULATIONS.
V4/e7A14 Re-roofs
Si antro or-AppliegAVC.1moicuffVe
I HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building mcupant store orhandlc hatardous material
as defined by the Cupenina Municipal Code.Chapter 9.12,and the Health and Safety
Ad�kowc,S tun 25532(x)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ycs Nu
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
havmdous air contaminants sm defired by Use,Bay Area Air Quality Management all new materials for inspection.
7-1quouncrit.,whichannistleeTt
im7
[]Yes k1Nu
I how read the haruderas answais nequirtmcns under close.,6.95 of the Califor-
Heard,A,Safctycode,Sections 25505,25533 and 25534.1 undersand dna fda.building
not currently hale a tenant that it s my responsibility to no ily to asupol of the
conuissuancc of Crr\dfcatc of cu ancy. SignaturCof 00icant Date
\ 7 !' ,ri.ed enl tae All roof coverings to be Class "B" or better