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CITY OF CUPERTINO
BUILDING DIVISION ]�][t� ]['Ili
BUILDING ADDRESS:
HUI ZHANG,
XINYANG QIAN
PERMIT NO.
20643 GREENLEAF DR
OWNER'S NAME:
APPLICATION SUB DATE
HUI ZHANG, XINYANG QIAN
12/12/2002
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT' INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby 1 licensed Chapter 9
Job Description
affirm that am under provisions of (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and effect.
KITCHEN REMODEL
License Class Lic. tl
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 703 1.5, Business and Professions Code: Any city or county
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 file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License law (Chapter 9
Sq. Ft. Floor Area
$ 2 5'UQOtion
(commencing with Section 7000) of Division 3 of the Businessland Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (5500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation.
—
equlred Inspections
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
Professions Code: The Contractor's License Taw does to
and not apply an owner of
102
- PIERS
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
103
— OFER
however, the building or improvement is sold within one year of completion, the owner-
104
— REBAR
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
105
— ANCHOR BOLTS
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
106
— SEWER & WATER
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li-
cense I.— does net apply to an owner of property who wilds or improve$ thereon, and.
202
— UNDERFLOOR PLUMBING
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
203
— UNDERFLOOR MECHANICAL
License law.
I am exempt under Sec. Sec. , B & P C for this reason
204
— UNDERFLOOR FRAME
/'j�•A`
°w r
205
3 01
— UNDERFLOOR INSULATION
— ROUGH PLUMBING
WORIER'SCOM�PENSTIONDECLA n
I hereby affirm under penalty of perjury one - the fo ing declarations:
302
— TUB & OR SHOWER
❑ I have and will maintain a Certificate of Consent to self -insure for Workers Compen-
sation, as provided for by Section 3700 of the Tabor Code. for the performance of the
303
— ROUGH MECHANICAL
work for which this permit is issued.
304
— ROUGH ELECTRICAL
❑ I have and will maintain Workers Compensation Insurance, as required by Section
305
— FRAME
3700 of the Tabor Code, for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
306
— HOLDOWNS
Carrier. Policy No.:
307
— INSULATION
CERTIFICATE COMPENSATION INSURANCE ORKERS'
308
— SHEETROCK
(Thissection need notbecompleied ifthe permit is foronc hundred dollars ($100)
309
— EXTERIOR LATH
or less.)
310
— INTERIOR LATH
1 certify that in the performance of the work for which this permit is issued, I shall not
311
— SCRATCH COAT
employ any person any manner so as 4 bee a sub'ect io the Workers' Compensation
IawsofC t ate
313
— ROOF NAIL
Applicant
501
— FINAL ELECTRICAL ENERGY
NOT APPLI 'T.Al' fl making this "ifi a fExcmption,y should
beco bject to the Worker's ompensation provisions of the Tabor C ywo mug
502
— FINAL PLUMBING ENERGY
' forthwith comply with such provisions or this permit shall be deemed revoked.
503
— FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
504
— FINAL BUILDING ENERGY
' the work for which this permit is issued (Sec. 3097, eiv. e.)
505
— FINAL ELECTRICAL
4 Lenders Name
Lenders Address
506
507
— GAS TEST
— FINAL PLUMBING
1 certify that 1 have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state taws relating to
building construction, and hereby authorize representatives of this city to enter upon the
5
FINAL MECHAN I CAL
above - mentioned property for inspection purposes.
0 9
F I N
(We) agree to save, indemnify and keep harmless the City of Cupertino against
F) liabilities, judgments, costs and expenses which may in any way accrue against said City
5
T
F N G
in consequence of the granting of this permit. -
APPLICANT UNDERSTANDS AND WILL PLY WITH ALL NON -POINT
Issued by51
— WORKS Date
S RCEREGULATIONS.
12
Re -roofs
Type of Roof
Signature of Applitant/ContracW Dale
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
kkkppp YesNo
All roofs shall be inspected prior to any roofing material being installed.
❑
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes o
I have read the hazardo wrials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 505, 25533 and 25534.1 understand that if the building
does not currently have a tenant, that it is my responsibility to notify the occupant of the
remems which mttst be met or to issuance of a Certificate of Occupancy.
Signature Of Applicant Date
2 h
JlOwnworaut.horize
All roof coverings to be Class " B" or better
agent Date
CITY OF CUPER'I'[NO
BUILDING DIVISION PERMIT
'f'W"'o
,C0NTRACT0RiINF0RMATI0N
BUILDING ADDRESS:
HUI ZHANG,
XINYANG QIAN
PERMITNO.
20643 GREENLEAF DR
:9 NAME:
APPLICATION SUB DATE
HR
UI ZHANG, XINYANG QIAN
12/12/2002
PHONE:
SANITARY NO CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under Of Chapter 9 (commencing
Job Description
std Profess
with Section 7(00) nfpivisinn 3 of the Ousincss enJ Professions Coda, anJ my license is
fault
in mB tumaatideffea.
KITCHEN REMODEL �INALaED
License Clasx Lic.x
Dale Cont raelnr
ARCHITECTS DECLARATION
I understand my plans shallM used as public records
MAR 1 8 2003
'
Licensed Professional
OWNER - BUILDER DECLARATION
I herchy affirm that 1 am exempt from the Convector's License Law for the
Billowing reason. (SCCtom 7831.5, Business and Professions Code: Any City,), county
BUILDING
which requires a permit to construct, alter, improve, demolish, nr repair any structure
prior to its issuance, duo requires the applicant tin such peemiuo file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
Sq. Ft.
Floor Area
$25Vi0l
(commencing with Section 7100) of Division 3 of the Business and Professions Code) nr
that he is exempt thertfrom and the basis for due alleged exemption. Any violation of
Section 7 031.5 by any applicant for a perm it subjects the applicant to a civil penalty of
OCCD Occupancy
P Y
Out more than five hundred dollars (5508).
❑ 1, a owner of the properly, or my employees with ..Sea as their sole mmbimaddim.
will du the work, and the awcmm is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor. Lt... Law does not apply in an owner of
102
- PIERS equlred Inspections
pispcn , y who builds or improves dome and who dues such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
103
— UFER
however. the building or improvement is sold within one year of completion, the owner-
104
REBAR
builder will ban the burden of proving that he did not build or improve for purpose of
-
ia10')'
105
- ANCHOR BOLTS
❑ I, asswnerofthepmperq& amexclusivelycontractingwithlicensedcontractorsto
106
- SEWER & WATER
construct the project (Sec. 7014, Business and Professions Code:) The Co dmicmrS Li.
cense law Oxes not apply to an owner of property who Wilds or improves damon. and
202
- UNDERFLOOR PLUMBING
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
License Law.
203
- UNDERFLOOR MECHANICAL
I am exempt under See. , B A, P C for Nis reason
�tAltcl
204
- UNDERFLOOR FRAME
yr— AA Dare 2
205
- UNDERFLOOR INSULATION
WORKER'SCOMPENS TIONDECLA TI
\ Iherebyafftrmunderpenaltyofperjury oneofthefo indcdclartoo
301
- ROUGH PLUMBING
m:
302
— TUB & OR SHOWER
❑ I have and will maintain a Cenificafe of Consent to ar)(4msure for Workers Compem
smioq as provided for by Section 3700 of the Laird Codc, for the performance of the
3 03
- ROUGH MECHANICAL
work for which this pc,mu is issued.
304
- ROUGH ELECTRICAL
I have and will maintain Worker's Compensation Insurance, as required by Section
3 0 5
- FRAME
", of Bid Labor Code, for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number are:
306
— HOLDOWNS
Carrier: Policy No.:
307
- INSULATION
CE RTIFICATE OF EXEMPTION FROM WORKERS'
COM PENSATION INSURANCE
308
— SHEETROCK
(This section need not M compIcmd it permit is for tine hundred dollars (S lfg)
309
— EXTERIOR LATH
irlcss')
310
- INTERIOR LATH
1 cenify that in the performance of the work for which this permit is issued. I shall not
empinyany run' any mannerist asl Men csuKecun lbe Wnrkers'Compenaation
311
- SCRATCH COAT
Laws of Calf oats
Appl'canl '
313
501
- ROOF NAIL
- FINAL ELECTRICAL ENERGY
Yry
NOf E onpru :Ir mm�sJCsmiace i�fineiFaM.rcodtrnohmuxd
bccnm omplywMwn,hp provehtn .
forthwith comply with such provisions nr this permit shall M deemed revoked.
502
- FINAL PLUMBING ENERGY
503
— FINAL MECHANICAL ENERGY
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
504
- FINAL BUILDING ENERGY
the work l iv which this permit is issued (Sec. 30iD. Co, C.)
Lender's Name
505
506
- FINAL ELECTRICAL
- GAS TEST
lender's Address
1 cenify that I pave and state tht
I hay this application and seem this the shove information is
5 0 7
- FINAL PLUMB ING
Cnrrecl.larif (Oat
with athi ityandcion
with ordinances
and stunt lawsrelating to building construction, and hereby a ulhofm represcaudinsof this city to enter upon the
5?&X
FINAL MECHANICAL
aMrvcmentioned property for inspection purposes.
0 9
FIN DR
(WC) agree to save, indemnify and keep harmless the City of Cupertino against
liohilitics, judgments, costs and expenses which may in any way accmc against said City
CUNDERSTANDSIAND
5
N G r
APPLICANT WIL O3MPI.Y WITH ALL NON -POINT
Issued by 51
WORKS Date
S 7 RCEREGULATIONS.
t2�/410
Re-roofs
Type of Roof
Signatureof Appll antuConnac Dmc
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hara,dous material
deB tied by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
de. 0YCa 25532(a)+ ,{Vs(
All roofs shall be
inspected prior to any roofing material being installed.
\No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant m fuwrc buildingsccupvm um cyvipmem or devices which
emit momodous air Commotion B u defined by the Bay Area Air Quality Management
all new materials
for inspection.
District]
❑ Yes
havumadtheMmnlou. mrlals requirements under Chapter 695 of the Califor-
_
nix l lcuh Sr Safety Code, SCCtions 5115,25533 and 25534.1 uad:mtand that if the holding
does not currently have a (Count. that it is my,esrymsibility m and I the eccupanl ol'tht
rcquiremcnuwhiehmaslMme I rim to issuance of a Cenifieateof Occupancy.
Signature of Applicant
Date
All roof coverings to be Class °B° Or hC[lCf
Owner. authorim agent t Datc
WWNER- BUILD 'ER VEEURC 1®1\,J
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
� is
If B or C is checked, complete 2-or
2. A state licensed contractor will be hired to do:
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. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that Inlay be an employer (see reverse sidle). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office..
Person/]Firm
Address /City I Phone Number I 'Type of work to be
...................................................................................................................................................... ...............................
I declare under penalty of perjury that the above is true and correct. II have read and understand the
Owner-Builder Information (reverse side),
Property Owner's Signa Dat Y ry 1(L (2- �.
Job AddrgsV PrroQIA S in%/' Permi #
Anv chances to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
City of Cupertino Building Department
CITY OF 10300 Torre Avenue
C �� ]NO Phone: (408) 777 -3228
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
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 Blame.
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 government 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 compensa tion
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 �md the Division of hidustrial
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 an 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 tha t
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department,
City of Cupertino
Printed on Recycled Paper
s . CETY (OF CUPERTEN®
CITY ��1J��YOF��� 1C E1i�llV'1LE AFF L ECATJ1O FORM
o2,Z 'Vp
APN 9' � Z � � � � � �
Date:
Building Address: 0 6(+ 3 emenkak DY . CL&PtyVo, CA, Q V 14
Owner's Name:
8ui -.kaK )(«yAK Q,�km,
Phone #:
2 2 82-
!
.0
Contractor:
License #:
-W 6 WS 119- bLjrf(Cg_
Construction Tax
Contact: ktt( a �9
Phone #:
Applicant/Contractor:
Fax #:
uiVin Permit Info:
Bld Elec Plumb Mech
'2
,; Description: yep (a Li rx i4?_
Residential: merc 1:
Sq.Ft. Floor Area:
Architect/Engineer:
Valuatio
Type of Construction:
Occupancy Gro
BCONSTAXR
Constax — Resi/Mobile
Quuantn
Fee ID
]Fee Descn-n moon
lFee Grou
BAPPLOTHER
Other A liances
MECHANICAL
BCONSTAX
Construction Tax
BUILDING
BCONSTAX
Ind/Off/Comm/Quasi
BUILDING
BCONSTAXBQ
Con. Tax for B Zone
BUILDING
BCONSTAXH
Hotel and Motel
BUILDING
BCONSTAXR
Constax — Resi/Mobile
BUILDING
BELEC1000
Elec 600V <= 1000A
ELECTRICAL
BELEC 1001
Elec 600V > 1000A
ELECTRICAL
BELEC200
Elec Svcs 600V <= 200A
ELECTRICAL
B ENER GY
]Enen
]BUIILDING
BENERGYADD
Energ Add Multi
BUILDING
BINVESTIGA
Investigation fee
BUILDING
BMITIGATC
Comm. Housing Mit. Fee
BUILDING
`
BMITIGATR
Res. Housin Mit Fee
BUILDING
BMNEWMULTI
New Multi -Famil Res
MECHANICAL
BNEWMULTI
New Multi -famil Res
ELECTRICAL,
BNUCOMME
New Comm Electric
ELECTRICAL
BNUCOMMM „
New Comm Mechanical
MECHANICAL
BNUCOMMP
New Comm Plumb
PLUMBING
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SIGNATURE
704
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634
1I
All dimensions & size designations
given are subject to verification on
job site and adjustment to fit job
conditions.
THE
���®
This Is an original design and must
not be released or copied unless
applicable tee has been paid or job
order placed.
3341
Scale : 318 ° = 1'
Design: 07/15/02
Date : 12/03/02
Designer
GLENN FORMAN
17
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w
FD
C42-
724
w
1I
All dimensions & size designations
given are subject to verification on
job site and adjustment to fit job
conditions.
THE
���®
This Is an original design and must
not be released or copied unless
applicable tee has been paid or job
order placed.
. C0309265
XIN -YANG ZHANG
20643 GREENL JULIE LIE DR
CUPERTINO, CA
Scale : 318 ° = 1'
Design: 07/15/02
Date : 12/03/02
Designer
GLENN FORMAN
- —
b�
cuul or _. al'y Or C.I.-M.
I.. sou"C"
,IOM AND
WATERCOURSE Il CIJAMR 9.18
Any P1. who vmlata -1 pimsv,, of iii.
,d an tit tuipta 1.12 of
this writ,
cavil P—sy N, 'itlitti,s'.
Payment arfueUa to acceunr.
Any person who viniatet arty Provivan of ribs
y
_t or any P—e .taro P— it ienoed pursuant to
this I I Id, t IZ :.I
Sect on I-. liesi-
s—ii, C N, et C-
u. ,tl, to impose, ".v.. 'C' i-Cot it nee The _A�, iel . in ie,s.w. m ail other
...i. —it 1e l. .1 Cie, me st- r..v
hw and wul .,di 1�. Wl.. "', ,
gd 1. ciu's tti,�._iel
1.11titi0 ci,. '—s' for illut 11i..'r-
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Mlly Ii,ilik, l. 1. CR, li, . — sit!
oiid Mlel, 1. it, 1.1 eiolm u
.04 i,, _. t.0i _.u. 1. chy may
"i oie lyi,m, c... P'... 1. Ge._
rt�, 161134— . fir's'e" .'so, aM recover _h
The etW penalty provided ,n rhia sec
be to eidie- e,
an other "_i" available to N City Idis� Stist aM
_e z ti,,,, 1.2, nei_ F_ co
N,i _j wt h paid . chy"
St.- . A..
S(Curti, Dirtily,
Pollution Prevention:
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rr
best Ptanagetneut
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Tn tit<$anU Class Ydiey, storm drains Pow direcay to local creeks and sou b San Francixa
sit
rwaYS snd for the 'cook who I ve near podvted streams or bayia,Js. Proper
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Blueprint IfOr a Clean Bay
Best; Management
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Santa clkila Valley
Nollpoint Source
Pollution control
I'llogiam
property nsr ad the -tu.1-t., s s it
Ria.e.lber: We i;ePotsibiiii;
the activities Clut occur el . ...... serooduix site: You nlay be lteH respausible to y: "
ei,.ul,isuCy1 de-,s .d by,.u,s,b...u&aet .1
Earth-MovilIg
Sue— Di'lett
Ac V
heavy
Equipuricill
Operation
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Best Platiaticiricult
Practices for Uic Letirie.
Gen umwaamw
Ux <l dart or 06
salt
A-
I A111
J.. W b.rre 1,161menon
Best Pla—g—ley'L
Practices for Ilit,
16,11, 1111
Landscaphig,
Gardening,
and
1,001 Maintenance
s.t en n
LeedpIsS d Swinuntng
2+ � on rev tool Paelnlenanc<
Best
Practices for the F..,,wi,V p.
Plainlawrue
1W.", 'Ad
General
construction
and
Site Supervisioll D"I'l r'll"tion
17 te: Ctuest-etleut AdNitle. don ah
� V5,-
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Ft.CIIJCes for the, u 1,
ctsust..ticilly laditstu
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Whet cali You D.?
N, i y._
Ptogrn, e. aanm bed
Roadwork Stows Drain ..
m...'—lut".
l..L c.. you D.?
pW
Irons Roadwork
e_
frae,t iy r.qel;ue,ut
Paving
tl . c st i's site
if
t 11, u, do
owlil".ioil.,
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e knew dtncrJ le ------------
"I u
.... ......
Landscaphig,
Gardening,
and
1,001 Maintenance
s.t en n
LeedpIsS d Swinuntng
2+ � on rev tool Paelnlenanc<
Best
Practices for the F..,,wi,V p.
Plainlawrue
1W.", 'Ad
General
construction
and
Site Supervisioll D"I'l r'll"tion
17 te: Ctuest-etleut AdNitle. don ah
� V5,-
_e__.I......-
Ft.CIIJCes for the, u 1,
ctsust..ticilly laditstu
_X—u-
Whet cali You D.?
N, i y._
Ptogrn, e. aanm bed
Roadwork Stows Drain ..
m...'—lut".
and
Irons Roadwork
Paving
"ImIll.". -Zi1xil, I
warn
c".so'si....
as p
What Cats You Do?
tab
_.e
Best Plaratfumelilt
D Iii=oi,,-
1'r-CLices for tic
A.suu.s
..ui, C.eee—
—s.