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05070179CITY OF CUPERTINO �a 'y° *'' ��CONTRATTOR�INFORMATx BUILDINQ DIVISION PERMIT C'"✓ ION <; FELECTRIC BUILDING ADDRESS: AAA INC PERMIT NO, 05070179 04 6 PRCTNF TRFF TA R'S NAME: PERMIT ISSUE DATE LIU ALEXANDER C AND DOROTHC 3245 STEVENS CREEK RLT Fno; E: SANITARY NO. NO. (408)557-8899 ARCHITEC (ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Descri A �� 1 hereby affirm that l am licensedCONTRACTOR'S under Previsions of Chapter 9 (commencing p with Section 7M)of Division 3 of the Business and P.fcuiansCode. and my license is ' V d off '"In"on—(O REPLACE MAIN PANEL 200 AM Lic.g Data Contractor ARCHmE SDECLARATION /,, C -g 2 UU untie I undersand my plans a l e recmds / 000 L JJ Licensed Pmfcssmnal - RATIO OWNER -BUILDER ❑ CLARATION 1 krchy affirm Nal I am exempt from Ne tors License Law for the �''I�®I�� V following mason. (Section 7031.1, Business and Professco Professions Code: Any city or unty which requires a Permit te construct. alcor, improve, demolish, or .,air any swear. prior m its issuance. sins acquires the applicant for such Permit o file a signed statement Met In, is licensed pursuant to the pmvisionsof the Convector's Licenu UA,(Chaps, 9 Sq. Ft. Floor Area Valuation (commencing with Section 9UD0) of Division 3 of Me Busincu and Profwions Code) or Nal M is esempl therefrom and de, basis for the Weged exemption. Any violation of .3 A1514 g Occupancy Yp Occas Type Section 7031.5 by airy applicant for a Permit subjects Ne applicant M a civil penalty ofanC not more Nan five hundred dollar ($500). 1,uownaofdupmpeny,mmyemplo wiNwagmsslheirmleeompcnuuon, willdothcwork,end Ne swmumisnotimmndedaroffe Aforsaic(Sec.73,a,Business Required Inspections and Prefessinns Code: Thc Conoumr's Licenst taw does tot apply As an owner of property who buildsorimprom thereon, and whodoessuch amkhimself or through his own employees, Provided that such improvements Am not intended oroRcred for sale. If. however. the building or improvement is old within am year of camplcuon. Ne saner builds( will Aare Ne burden of p.ving Out he did nos Wild or improve far purpose of sato.). ❑ 1, as owner of Ne property, am exclusively contracting with li..d me Mae. as coret.ct Ne project (Sec. 70x4, Business and Professions Code:) The Conuacwts Li. came taw does not apply m an owner of property who builds or improves thereon, and who Contracts for such pmjecu wish a conuacter(s) licensed pursuant to Use Conlractoe3 License law. 1 am exempt under Sec. , B At P C for this mason r Date WORKERS COMPENSATION DECLARATION 1 hereby affirm under penally of perjury ore of Me fulloaina declaration: ❑Ihaveand will meinuinaCenifinu of Consent no self-insumfor Workefs Cornier - ma. As as pravld, for by SCNon 3703 of the tabor CedC, fm that pefar111a11CC of the work for which this permit u issue+ ❑ I have and will maintain Wurkeri Compensation Insurance, u.quired by Section 3700 of the labor Code. for Ne performance or the work for which this Permit is issued. My War camps�iso nmranm carie and Policy number art: Cartier:' ms's- l `- ^'✓ Polity No.: > -03 - CERTIFICATE OFEXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thusection need not kcomplemd if the permit is taron hundred dollars ($101) or loses) I terrify Out in the performance of Ne work for which shin Permit is issued. I shall not employ any penin in any meaner u u te become ubiml a. the Workers' Compensadon Laws of Califsmia. Dau Applicant NOTICE TO APPLICANT. IL after making this Cenificau of Exemption, you should bo ane subject m Ne Worker's Compensation previsions of the lobar Code, you mus forthwith comply with such provisions or this Permit&halt k deemed tooted. CONSTRUCTION LENDING AGENCY I hereby wDrso Net Ne. I,. emssl.ctinn ending agency In, Me performance u( Ne work (ver which this Permit is issued (Sm. 3(X7, Civ, C.) LcndcYs Name Lender's Address I certify that 1 have read this application and sou Nat IAC eW vc infamade. is . mato I agree to Comply with all city and county ordinances and state laws totaling to Wilding construction, ant hereby authorim representatives of this city se enter upon the , Wvc-menusned properly for inspection purposes (We) ague to save, indemnify and keep harmless the City of Cupertino against and cspeues wilco may in My way+scree agalnatsaid City 1. caiva.judgmcnu,,cosu o(Nis permit. n conuqBE= APPLICDS AND WILL COMPLY WITH A L NO POINT Issued by: Date J— f SOURC Re -roofs SignatlioMCmuracmr aw HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Nc applimm or future building occupant at= or handle hxaardous material defrncd by Uu CupeNtto Munici I Code. Chapter 9. It and the Health and Safety . r 1Ycs Nu ensss3zp>7 All roofs shall be inspected prior to any roofing material being installed, Will she applicant or future Wilding occupant tins equipment or devices which If a roof is installed without first obtaining an inspection, agree to remove iection, I P taut hanrdnus air contaminants u defined by she Bay Area Air Quality Management all new materials for inspection. DISUIc17 ❑Yes Nu I have read the hmardous ,uria]'requircments undcrchapur6.95ofNcCalifor- nuHealth&SafctyC ,seed 155(15.25533 and 25534.1 mdOcrsurd shaziI& Wilding "Z, drcs raft. un , that it is my responsibility to notify th ccupan of the mquirtmenew" s 1priarmissaanceanceni0c ap x Signature of Applicant Date All roof coverings to be Class "B" or better Owne4 taWrioodAgenl I Oau, Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: /0 �t�7rz�X, PERMIT # OWNER'S NAME: (ter y PHONE # �$ GENERAL CONTRACTOR: /Y-� FAX # I am not using any subcontractors: 2� VS Signature Date Please check applicable subcontractors and complete the following information Owner/Contractor Signature Date 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/Contractor Signature Date t CITY OF U, PEkTINO Community Development. 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS - IOWA P tn115T�Z- �N IT PEO U 7 d f 7 W ONER'S NAME:: 2c> F{ LA y PHONE #' � 9) GENERAL CONTRACTOR: ¢�-1�- ;�Cj��(�rtic FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing i Electrical Excavation — Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal tr ' Painting / Wallpaper ,. Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date Item I of 1 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31633119.00 DATE ISSUED.......: 07/27/2005 RECEIPT #.........: 30550 REFERENCE ID # ...: 05070179 SITE ADDRESS .....: 10416 PRUNE TREE LA SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: kiersaw COPY # : 3 OWNER ............: LIU ALEXANDER C AND DOROTHY ADDRESS ..........: CITY/STATE/ZIP ...: LOS ALTOS CA, 94024 RECEIVED FROM ....: AAA ELECTRIC INC CONTRACTOR .......: PHUOC TAT LIC # 22356 COMPANY ..........: AAA ELECTRIC INC ADDRESS ..........: 3245 STEVENS CREEK BLV CITY/STATE/ZIP ...: SANTA CLARA, CA 95117 • TELEPHONE ........: (408)557-8899 FEE ID UNIT QUANTITY --------------------------------- AMOUNT PD -TO -DT THIS REC NEW HAL BENERGY PERMIT FEE 1.00 -------------------- 34.86 0.00 -------------------- 34.86 0.00 BELEC200 METERS 1.00 29.43 0.00 29.43 0.00 BSEISMICRE VALUATION 2,000.00 0.50 0.00 0.50 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 36.37 0.00 BUSLIC FLAT RATE 1.00 102.00 0.00 102.00 0.00 TOTAL PERMIT . -------------------- 205.16 0.00 ---------- ---------- 205.16 0.00 METHOD OF PAYMENT AMOUNT ----------------- NUMBER ------------ CHECK 205.16 ------------------ 1823 TOTAL RECEIPT 205.16 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL • 0%1-001 G - CITY OF CUPERTINO CITYOF PERMIT APPLICATION FORM • CUPERTINO APN # 31 �O - 33- 1 16 Fee Description Fee Group Date: 2� 1 Building Address: E.40t- e -T -Z /' Mailing Address (if different from building address): LV Owner's Name l BBOILER2 Phone :L-� Contractor: License #: % )--( '-?%" Contact: Phone: Fax: BBOILER4 Cupertino Business License#: Building Permit In o. Bldg ❑ Elect 11�Plumb ❑ Mech ❑ Job Description: Residential W--fi /f`� ,,��.,,��,, nn 2�a'O Cbmrliercial ❑ Sq.Ft. Floor Area: BCONSTAX Ind/Off/Comm/Quasi $/Sq.Ft.: Cost of Project: r - Con. Tax for BQ Zone BUILDING Occupancy Group: Type of Construction: BUILDING BCONSTAXR Please check this box if the project is a second -story addition: ❑ Project Size: Standard ❑ Laze ❑ 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> IM 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 - Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 C' "�- CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO Viju—antity 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 Vacuum PLUMBING BPCESSPOOL —Atmospheric 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 rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Tra 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 cfin 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 BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 za'iml CITY of CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity 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 Insection 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 1 J L�