08100071 CITY OF CUPERTINO
BULDING DPVISION PERMIT
`:"a�ONTRACTOR INFORMAT®IO:, N,
BUILDING ADDRESS: PERMIT No.
7568 BOLLINGER RD DALCON, INC. 08100071 .
OWNER'S NAME: PERMIT ISSUE DATE
JOHN CHANG 757B CHESTNUT ST. 10/14/2008
WE. - SANITARY NO. CONTROL NO.
(408) 298-1690
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
'
BLDG ELECT PLUMB MECH '
u o o LICENSED CONTRACTOR'S DECLARATION
imF 1 hereby affirm Thar I am licensed uakr provision of Chapter 9(commoncing Job Description
irk winS"don7M).fDlvislon3.fN Budrcaaditfedo and/mylicwnia INSTL 2 RUNS 3/4" EMT FM ATIC TO INVRTER(GARAGE)
in full fora and c y S� lACJ
> License I `.`c.Y &
ARCHITEcrs DDECLAMMON f i INSTL DISC SWTCH TO MN SVC PANL& INTRCNCT INVRTR
its IundmanJ my plw shallWused uWhile tanto TO PG&E SOLAR DISC SWTCH RATE CIRCT 240V 30AMP
g C t; Licensed Professional
xy3OWNER-BUILDER DECLARATION
E I
.by
al0m
that 1 am pempl from the Conkactols License Law for the
p o following reason.(Section 7031.5.Business and Profession Code:Any city or county
res
which requia permit to convrucr,Jar,improve,demmtah,or repair any sbumurc
LZ priorm its issuanec.alsu mquires Nc applicant forsuch permit to rile a signed statement
Na ha is licensed pursuant to me MvWom of the Contractor's Lice=Law(Chap=9 Sq.Ft.Floor Area Valuation
X (commencing with Section 70110)of Division 3 of the Business and Professions Code)or $2000
$
at he k comp,thereftorn and the basis for the a11cgW exemption.Any vioiuiore of
Sectim 7031.5 by u0 applicant for a permit subjects the applicant W.civil penalty or 681Number - Occupancy Type
not more then fnw hundred dollars(M). 3 5 9 2 2 0 6 8 A
L a ovaner of de property,or is wploycp with ages as Mev sok mmpeas amen
win Pe Ntood..andC.&Tin,Co menc s I Meds,Law do fs WE apply W ren B or
and my wh Int cm°mpp Commences era License law aces ml apply if rt owner or Required Inspections
Own Employees,
buildsmimprowschimp and who sue not
h:...-Oorthrough his
own employers.providd that such imPsosemw t tie net can fe oro0esvm forsale B.
builder.the Wilding u improvpnuu u held within arc year orI m ro oro.Nn mvner-
bd..). will love dm burden of proving that K did Out bold or improve for purpose of
ak.).
E:]1,a owner of the property,am exclusively courec,ing with licensed convenors N
construct the project(Sec.7004.Business and Professions Code:)The Cortmoades Li-
cc=Law does not apply b an owner of property who Wilds or improves Merton,and.
who contracts for such projects with ammacmr(s)licensed Wramnl a the,Gnuaclm's
Lkeae Law.
❑I am aacmpt under See .B k P C for this reason
owner Dena
WORKERS COMPENSATION DECLARATION
1 hereby aRim under petWty of perjury ore of Nfollowing
e dedsommor
I hawandw lmaintaina Ce fi=mofG=ntmself-insumfar Work sCompm-
sadm,as poviMd for by Section 3700 of da labor Code.for da p ofomarce of Ne
wak for which this permit is isseed.
❑1 haw am will maintain Workers Compensation Insurance,as required by Second
3700 of Ne labor Cad,for the performance of the work for which this pemil is Issued.
My Wdrkefh Compensation Ltyytame. r dPoli numberam:
Grtkr. F S Ilq No..r �
CERTIFlC O OF EXT Pf1I NFROM WORKERS'
COMPENSATION INSURANCE
(nets socdm need rot On comploed Hoe permit Is(acne hundred dollars($100)
or kis)
1 certify Nat in Ne perfomaace of the work for which this Permit is second,I"I rot
employ any person in any mmrerso as he become subject in Ne WMrkerf Comp ss atim
I.of California.Dae
AMU.,
NOTICE TO APPLICANT':If,after making this Ccrofrpa of Eacmption.yen should
become subject en the Workefs CompMeatim provisions of 1M Lahor Code,you most
.J O forthwith comply with such peovisioa or Nu permit soul be docrrcd new u d.
Z"' CONMUC ION LENDING AGENCY
[--� rN+ Ihereby affirm then,dart ua construction lending a,ney for the perfomance of
Ota. Ne work for which this permit is issued(Sec.3097.Civ.C.)
QLender's Name
.7- z Lender's Address
U Q 1 certify that l haw read this application and sum Nu the aWve information is
ty Pcoocn.I agree m comply with all city and county ordi ureses and fico tan relating to
C) Wilding construction,and hereby athorim representatives or Nu city to emu upon the
Wabove-mentioned proPcrty for iapenion putpaua
(~G
(WE)agree to aro,i ffthis
fy and kerp lea the y f Cuportino against
y liabilida,judgments.chich dylnany y aglactsecid Gry
U z io corucquerce)) a nsiAPPLICANT,U� STL MP IT A NON-POINT Issued by: Date
SOURCE R CC LLLLLLA 1I$S
Re-roofs /
Signa A icon Conuano as �✓
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
II the appllcant err future building Mcupantsmre or handle locution.material
as d d by the Cupcnino Municipal Code,Chapter 9.13,and the Healte and Safety
Cad,Section 05532(a)? All roofs shall be inspected prior to any roofing material being installed.
,]Yes e
IWill 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
t hvalloa tar cdmamiments a der by the Bay Area Air Quality Marugcment all new materials for inspection.
District?
Yp o
Thaw the rials mew under ChaPat G95 Mf Ne Cuilor.
nta HesIN9 ctyC ,25 aha 25534.ImdrstaM Nuiftha handing
thea rot dy aih0ily notify de Mennen,oI
require whk pri c aeM a p my Signature of Applicant Date
p
0w1,sufficin.dengem a All roof coverings to be Class'Ja"or better
CITY OF CUPERTINO
O 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN 35922068 . 00
DATE ISSUED. . . . . . . : 10/14/2008
RECEIPT #. . . . . . . . . : BS000006337
REFERENCE ID # . . . : 08100071
SITE ADDRESS . . . . . : 7568 BOLLINGER RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JOHN CHANG
ADDRESS . . . . . . . . . . : 7568 BOLLINGER RD
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4335
RECEIVED FROM . . . . : DALCON, INC
CONTRACTOR . . . . . . . : DAVID LEE LIC # 24157
COMPANY . . . . . . . . . . : DALCON, INC.
ADDRESS . . . . . . . . . . : 757B CHESTNUT ST.
CITY/STATE/ZIP . . . : SAN JOSE, CA 95110
TELEPHONE . . . . . . . . : (408) 298-1690
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BREMMISC FLAT RATE 1 . 00 122 . 38 0 . 00 122 . 38 0 . 00
1BSEISMICR VALUATION 2, 000 . 00 0. 50 0 . 00 0 . 50 0 . 00
lEPERMITFE FLAT RATE 1 . 00 40 .79 0 . 00 40 . 79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
BUSLIC FLAT RATE 1 . 00 110 . 00 0 . 00 110 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 314 . 46 0 . 00 314 . 46 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 314 .46 #22288
---------------
TOTAL RECEIPT 314 . 46
•
CITY OF CUPERTINO
e OF
CUPEkTiNO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # � 0 Dad
Building Address:
7s�Pg
Mailing Address (if different from building address):
5 Al-Y) C
Owne 's ame: n A tj Phone#: _ Z
Contractor: ��f �('� , Phone: C0 g _ z F _16 9D
Fax: 229 2615
Contractor License#: S-17-91 (0 a C
Cupertino Business License#:
Contact: _p Phone: � G�
\J a h
VX_ 1k6 INl_ Fax: L4 0 0 —Z-9 Z— q 6
• Residential Commercial
i/
Job Description(D
O _ 3/cit ZA4 7 eey�
AT7-1'4 T 1ti V&.*ZTc'!e �Loc�gT6)
A5 6a,V,&e.T 5w 1 To $Aa /�S�tC t/I L 6;7u,w� l
10r612.CONhE-eT 1wV6IETEP— LO CO. f4W6 C-, -4rZ-
)►s t4 - S1 A-C957 eLjjw�'- 0V.- 30
Building Permit Info: _ /
BldgEl Elect LAS Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
I-A, I-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B 0— 3
Valuation• Square Footage:
Project Size: Express R' Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it
to the application or if applicable, include in plan set& the sheet index.
• Points Achieved:
For help, contact Build it Green at www.buildit reen.or
Revised 7/01/08
alFCITY OF CUPERTINO
CUPERTINO GENERAL BUILDING
PERMIT APPLICATION FORM
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1BBOILERI For the installation or relocation of ea M
boiler/compressor to &including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw
1 BBOILER2 Installation/relocation of ea M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
1 BBOILER3 Installation/relocation of ea M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
&incl 1,000,000 Btu/h
1BBOILER4 Installation/relocation of ea M •
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1•,000,000 Btu/h to
& incl 1,750,000 Btu/h
1 BBOILER5 Installation/relocation of ea boiler or M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
1 BAPPLOTH For ea appliance or piece of equip M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
IELECINSP Other Electrical Inspections (per hour) E
1MECHINSP Other Mechanical Inspections (per M
hour)
1PLMBINSP Other Plumbing & Gas Inspections P
(per hour)
1MEETINGIHR Application Meeting B •