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05070019 • CITY OF CUPERTINO BUILDING DIVISION PERMIT �*CONTRACTOR INF.ORMATIOr _ 4Y''d�"r#.'D�„__ w*. .�5, vi%wG"$kk�:3»-•il. BUILD]NO ADDRESS: PERMIT NO. 05070019 W NER'S NAME: PERMIT ISSUE DATE KEVIN YEN NE: SANITARY N6. tcOC`N­0. ARCHffECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 1100 LICENSED COMRACI'OR'S DECLARATION Ib Description Z C I hereby affirm Nvi at 1 Am licensed undo,prosions of Chapter 9(eoOOSCrip raomming <U wRh Sccrie ]dcffo DivixionJof lAC Business and Prufcssiam Codc.anJ mylicenu is in License anaen« NEW FURNACE IN ATTIC/EXTEND GAS LINE �z Licenu Clue Com n=, Dau - T'S DEC, ARCHITECTS DECLARATION 1�< I understand my plate ahA]I he used As public ueorN ' oats o l Licensed Pmfusional gryh ��® .� 3 OWNERBUILDER DECLARATION Yp`,l�L" tli{9��Np'- <y 1 hereby.(firm that I Am exempt form UC Comncmra License Lew(or the O O following reason.(S.etian 93 1.5,Business and Professions Cade:Any city ar county 5: which roquiree A permit us ennawa,shut,improve,demolish,or repair any structure - _i� prior to its Issuance.Alan requires the applicant for such permit o file a signed statement < that he is licensed pursuant othe provisions ofdo,Contractor'aLitton=Law(Chapur9 Sq.Ft. Floor Area 19 Valuation Ai -m (commnuing with Section 7")of Division 3 of the Business and Professions Code)to y 3— that he is exempt therefrom and the basis for the alleged exemption.Any violation of section 7031.5 by any applimnr for a permit subjccu Ne applicant to a civil penalty of 3 MN2-baliberp p BU1I 1MMf���111 anC T e not more Nan five hundred doll..n500). lhj y yp ❑1,u owner of the property,or my employees with wages As their WIC compensation. will do the work,and the swemre is not intended or offered for sale(Sec.]044,Business and Professors Code:The con]momrs License law doe,not apply In an owner of Required Inspections property who builds orimpowes thereon,and who doessuch work himself or through his own cmploycu,provided that such improvements arc not intended or offered for sale.IL however,the Wilding or improvement is mid within ore year of completion,the owncr- Wilder will ban the burden of proving tion he did trot build or improv for purpose of sale. 1.As owner of the property,am exclusively contracting with licensed cenuacwrs to construct the project(Sec.7044,Business and Professions Cadt:)The Chairman's Li cense law dos not apply to an manor of property who Wilds or improves thereon,and who contacts for such projects with a Bonar mor(s)liccnmd pursuant to the Contractara License Law. I Am exempt under Soc. .B h P C for this Mason Ownct Dauv1� WORKER'S CDWF SATION DECLARATION WSJ- I hereby affirm under penalty of perjury aro of the following dalandorac I ban and will maintain a Certificate of Consent o se]r-asum fe,Workers Compcm 7371W ion,ns provided far by Section 3]00 of the TAW,Code.far the performance of the rk for which Nis Permit is issued. I have and will maintain Worker's Compensation Insurance,u required by Section of the Labor Code,for the performance of the work for which this Permit is issued. Workers Cantramation Insurance carrier and Policy number ore: rrier. Policy No.: -CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section need Out W completed if the permit is foram:hundred dollars($IM) or I.ss.) ]certify thm in the performance of the work far which this permn is issued.I shall nut employ any perm.in any manner sn u mdaeome suj�t lathe Workers'Compensation Laws of Califomis Da (—rC f•1 Applicant . NOTICE TO APPLICANT:I( making this CcniEcate of Exemption,you should became subject in the Worker's Compensation provisions of the Labor Cade you must .,z forthwith comply with such provisions or this pammil shall he doomed invoked. z CONSfRUCION LENDING AGENCY 'e+� I hereby affirm that there is a construction lending agency for the Performance of !Yi the work for which this permit Is issued(Scc.3(97.Civ.C.) W�Q lender's Nam. z Lender's Address V O 1 cenify that I have read this application and suite than the above information is D.FCorrect.1 agree m comply with all city and county ordinamas and sou laws relating to C)V building construction,and hereby maborim repre-unutiva of this city an Cour upon the �[fl ahovc-mentioned property for inspocdon purposes. (We)ague to use,indemnify And kap bound ss IW City of Cupomr.against F'y liabilities,judgments,Costa And a.,.which may in Any way...against said City U z in consequence of the granting of this Permit. ^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGU Signaure of ApplianVCan ter ate— future MATERIALS DISCLOSURE Type of Roof Will the applicant or(Muni building acupapt race orhandleHealth ndSafrmaterial As Ocfin.d mi 25 Cupertino Municipal Code.Chapter 9.13,and the Herth and Safety ode, Summit 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Ycs Cllr Will the applicant or futurebuilding ocupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove It hazardous air contaminants As defined by the Bay Area Air Quality Management all new materials for inspection. Dlxvict] ❑Ycs I have rad the haarsims maurud s roquiromcno under Chapter(i of the Califor- asHealth A,Safety Code.Sections 255(15.25533 And 25534.I undersand thr if the Wilding docs not currently hart a tenant.that it u my reapmu mbay to notify Out axupant or the requimments which m'pacumissaanno.f.comficataofoavp rye Signature of Applicant Date owndmr.ptWrircda q7 te—/fes All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue i It Cupertino CA 95014 Telephone(408) 777-3228 CITY 0, Fax(408)777-3333 UPERTINO Building Department JOB ADDPERMIT # ZlRS L — oS0-700/ OWNER'S NAME: �OJAJY&Aj PHONE # 6 4 yaq-473^I 7vU GENERAL CONTRACTOR: (J✓A Kd CH ley o /b o4 .,(-z FAX # I am not using any subcontractors: Signature Date 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 Tile Owner/Co a for Signature 'Date (a CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO APN# ` Date: ! � /O S^ Building Address: Mailing Address (if different from building address): 2/661 LINby LANA, (u nfhwu 93Vy Owner's Name: Phone #: rCV(A/ YC-A/ (? y08- 173`t ?oo Contractor: �� ./I License #: 610 v a-V'A4e✓I C✓ n A,,(T Contact: Phone: 81U$-2S-5--Yo8 Cupertino Business License#: CRFax: Building Permit Info: &,.t ps l,be 104�eef tN-t pfb j' 4WOOc M Ir fkz— Bldg ❑ Elect ❑ Plumb ❑ Mech ❑ Job Description: 9�z B,r� (vk�f INtn a(hz; iti5}A(1ArnAC 'MA 'C- Residential C' Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ Project Size: Standard E— Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILERS 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 <= 1O00A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD I Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1of3 �- CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMhlE New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTMIE Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg 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 .S'tonn/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 BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfin MECHANICAL BREMAIRHAN A/C Units<= 10,000 cf n 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 BRENC RAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMACWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO CITY OF PERMIT APPLICATION..FORM CUPE TINO Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Sips, 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 Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3of3