03050130 ' CITY OF CUPERTINO ' zn � '-�'"
BUILDING DIVISION PERMIT ? ONT1t GTQR'II,FORMATION 4:
BUILDING ADDRESS: YING TZU JANG PERMITN003 0 5 0 13 0
94"A RnnRTnTTRq All
OWNER'S NAME: / PERMIT Vc
7y7/2003
N V / L
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUIIDINO PERMIT INFO
BLDGELECT PLUMB MECH
0
30p LICENSEDCONTRACnOR'SDECLARATION o I� 0
rd U 1 hereby 0)of deet 1 am if the
under and
Prof ea of Chapnr 9(mmmense is Job Description
with Section]it of ecDivision 3 of the Businwand Profwinm Code,and my license is
•'�, In full foceandeRUL REPLACE 2 WINDOWS/DOOR
( —GABA r
.E
License Liu..
Date Contractor SWITCH PLUGS
ARCHITECTS DECLARATION
�iI urWcuund my phos shall he used as public records
7 AUG 2 6 2003
;a Licensed Pmfculonal
5ce \ OWNER-BUILDER DECLARATION
.� 1 hereby aM m that 1 em exempt from dee Convector,U...Law for dee BUILDING
� ^ p�(�
EC O following malum(Section 7131.5,Businessand Profession,Code:Any city at county ID U'LAJI ItlC
$�i which requires a permit toconstruct,conuct,aline improve,demolish.or reput,any structure
i�A priorm its issuance.alw mquirm the applitanl for wait pennilb filtssigeedsumment
gFF< that W is licensed pormani in ilue provisions of theCommucior's Uccom Law(Chapter 9 Sq.Ft.Floor Area Valuation
SS
(comm ha h eneingwithSmliun7000)afDivision3oftheBusin udProfwiomCade)or $3000
But exempt therefrom and the basis for lase alleged exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occas
trot mom man five hundred dollars($300). Occupancy Type
❑I,as owner of rex property,or my employes wide wage as their Bola compensation. 35910053 . 00
will do dee want and doe awmum h rant intended oroRerod fouate(Sec.]ON,Butlrcss gg�eG
and Professions Code:The Contractors License Law dam not apply an an Owner of 101 — FOUND A'1'1' d Inspections
pmpertywho W ile sur impmvea memon.and whodoes auchworknimulf ordemugh his
awn employees,provided mat such improvements am not intended croRemd forsale.If. 102 — PIERS
however.the building or Improvement is sold within one year of completion,the owner•
Wilder will have the burden of proving that k dM nm Wild car improve ry
far puose,of 103 — UFE R
sid.j' 104 - REBAR
01.as owmr of the property,am eclusively contracting with llcemed mmmemnm 105 - ANCHOR BOLTS
construct the project(Seo.70",Business and limitation Cade)The Commences Li.
cema Law it=not apply to in owner of property who bunds or Improves daemon.and, 106 — SEWER & WATER
who contncu for such projects with atonuumr(s)licensed pursuant m me Comateme.
L'k..m Law. 202 - UNDERFLOOR PLUMBING
QI' IuoexemptunderSec. .BApclOothisceuon 203 - UNDERFLOOR MECHANICAL
w" °P: am 204 - UNDERFLOOR FRAME
ORI QRS COMPEN 10 DELLA ON
I hemby afRm under penalty of perjury ore of the following declendom: 205 — UNDERFLOOR INSULATION
leave and will maintain.CeRcma "fcansent mulMnrvm fnrWmkcracnmmn. 301 — ROUGH PLUMBING
urian,as provided 1m by Section 37M of the labor Code,for the perf...of the 3 02 - TUB & OR SHOWER
work for which this permit is issued. 303 — ROUGH MECHANICAL
❑I have and will maintain Workers Compensation Insurance,as required by Section
3700 ofthc labor Code.for the performance often work for which this permit is laved. 304 — ROUGH ELECTRICAL
My Workers Compenution Insurance cancer and Policy number are: 305 — FRAME
Carrier. Policy No, 30.6 - HOLDOWNS
CERTIFICATE OF EKEMPDON FROM WORKERS'
COMPENSATION INSURANCE 307 — INSULATION
(Thhssetlon..do.,W."mpleud time permit h force.hundred dellars(SIM) 308 - SHEETROCK
.rim.)
309 - EXTERIOR LATH
I Certify met in the perR a cc of the work for which this permit is issued.)mall nut
cm310 — INTERIOR LATH
ployanypersonin ym mer be Wt:Uama keuma
Wm 'Compedon '
Laws fCelifomla a' 311 - SCRATCH COAT
App ret
CE TO APPLIC : L aft •king this Cap a t of Exemption,you mould 313 — ROOF NAIL
once.ubjm undee Wo rs C mrmtioo pmvtsluv of the Labor Code,you must
�2 fonbwhbComply With such pinienmar(his penult shOlbcoccurred rarokcd. 501 — FINAL ELECTRICAL ENERGY
Z502 — FINAL PLUMBING ENERGY
[-a y+ Ihereby&film that there Is a construction
LENDING AGENCY ruction lending agency for the performance of 503 - FINAL MECHANICAL ENERGY
Rt> woulfar a
Lenders,Nixon 504 - FINAL BUILDING ENERGY
(s]A
jz
Lenders 505 - FINAL ELECTRICAL
U 0 1 Cenify deal 1 haw read this application and Ntr that the above information Is 506 — GAS TEST
U. comet.I agree to comply with all city and county ordinances and sou laws relating to
0 nuildingcmSOLmhn,and hereby mmmine representatives ofthis city toimenO`nntiR FINAL PLUMBI G
Ii] above-mentioned property for Impecdan purpmea O S F I CAL.
M (We)agree m uve,indemnify and keep humiw the City of Cupertino•gains)
rr cl liabilitiu,judgmcnts,emes and expenses which may In any way smoeagWatssid City
in
C)? APP IL CconseQANTeUNDERSTANDSOf IAtND WILL COMPLY WITH ALL NON INT Issued by:5 NG Date<
OURCE GULATIONS, _
2 �_ Re-roofs
{nature A lac nuIHAZARDOUS MATERI DISCLOSURE lot em Type of Roof
Will the applieam or future building Occupant port or handle haurdous material
as defined by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safety
We. CYon
.15s3z(a)a All roofs shall be inspected prior to any roofing material being installed.
❑Yin A
Will dic applicant or forum building asupant tax ululpmcnt or deviw which If a roof is installed without first obtaining an inspection,I agree to remove
It havardam air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection.
D'tsuicR /
❑Yu Y No
I have mad the huasdo/ups materials requirements under Chapter 6.95 of the Califor.
ni&Health h Safety Code,Sections 25505.25533 and755J4 I n@ remndmvifecbuilding
it.mol mnendy hew•hum m.that it is my respmvibaby tify deo occupant of O c
quirt c w'hmust be met prior toivuance,of$Certificate 0 upoic SignatureofApplicant Date
, ) u
wn.ra al nri,e sent - nate All roof coverings to be Class "B"or better
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent,spouse or child) will perform:
A. KIAll the work authorized by this permit
B. _ A portion of the work
C. _ None of the work
If B or C is checked,complete 2 or 3 below. 0
2. A state licensed contractor will be hired to do: MAY
7 2003
A. _ All of the work
B. _ A portion of the work (complete sectio
Contractor Address/City Phone # Stat icense # Type of work to
Tb erformed
• 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I maybe an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information(reverse side).
Property Owner's Signature:-,;;4 ' 7/0 3
Job Address: .t Permit# l ��
ell %S
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
AT,; CITY OF CUPERTINO
CUPf�TINO PERMIT APPLICATION FORM
N# , Date:
KI
Building Address: C� uC '
Owner's Name: Phone #: '
Contractor: License#:
Contact: ,cam Cupertino Business License#:
Building Permit/Info: (C7 "o
Bldg q,!�7 Elect Plumb ❑ Mech ❑
Job Description:
Residential ❑ C")
Sq.Ft. Floor Area:
Cost of Project: / Occupancy Group:
Type of Construction:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<-- 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K 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
BMITIGATC Comm, Housing Mit. Fee BUILDING
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CITY OF CUPERTINO
CITY PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI Multifamil Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res PLUMBING
BNUSFD New Single Family Res BUILDING
BOVERTIME 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
BPIN'I'ERCEP 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 HeaterNent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT . Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfrn 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
AL BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
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Sul CITY OF CUPERTINO
CITYOF PERMIT APPLICATION FORM
CUPEI,TINO
Quantity Fee ID Fee Description Fee Group
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
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 S ecific Plan BUII.DING
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 Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
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