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050700420 CITY OF CUPERTINO CONTRACTORIN10RM BUILDING DIVISION PER BUILDING ADDRESS: 21661 LINDY TA PERMIT NO0 5 0 7 0 0 4 2 OWNER'S NAME: PERMIT ISSUE DATE KEVIN YEN 7'12 INFNE: SANITARY NO. CONTROL NO. ARCHITEC tENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description P I hemby affirm Nat I am licensed under provisions of Cloquet 9 (commencing with Sauna 7000) of Division 3 of Ne Business and Profession Code. and my license is in full form and effect. KITCHEN REMODEL License Class Lic.as Dam Convector ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER-BUILDER DECLARATION I mh by affirm Nat I am exempt from the Con"Clor's License Law for the following reason. (Section 7031.5, Business and Froressimu COde: My city Of county which requires a Permit to Chr mmct, alter, improve, demolish, or repair any structure prior in its issuance. also requires the applicant for such Permit to file a signed vummctn Contractor's License Law (chapter 9 Sq. Ft. Floor Area Valuation thin he is licensed pursuant to the provision of the (commencing win Section 7000) of Division 3 of the Business and Profession. Code) or that he is exempt IMrefrom and Be basis far the alleged exemption. Any violation of 3 5>dyb2CIb*er0 0 Occupancy Type Section 7031.5 by arty applicant for a permit subjects the applicant In a civil penalty of not more Nan Rm hundred dollars (5500). C L as owner of the property. or my employees with wages as their sole Compensation, Required Inspections will do Be work and the swarm Is nos intended or offered for sale (Sec. 7014. Business and Professions Code: The Conuacmh License Law dos not apply to an owner of property who builds or improves Hereon, and who docs sucb work himself or through his own employees, provided Het such improvements are not intended or offered for ¢ale. If, bowevar, the building or improvement is sold within one year of completion. He owner- n builder will have the human of proving Hat he did not build or improve for purpose of sale.). S ❑ 1. as Owner of the property. am exclusively contracting with licensed crntmmors to e convect the pmject (Sac. 70,14, Business and Professions Cade:) The Contractors Li- •cense law don not apply to an owner or prop my.who Wilds or improves thereon, and the Oon,rsemrs who contracts for such projects with a contractor(x) licensed pursuant toan License law. C l am exempt under Sea .Bk PCf Nis > nee !�J Dam _ WORKER'S CQM- SATION DECLARATION WOR I hereby affirm under penal,, of perjury one of the following declaration: ❑ I ham and will maintain a Cenlfmam of Consent to self-insure for Worker's Compen- author, w provided for by Section 37W of the labor Code, for He performance of the work for which this permit is issued. p 1 have and will maintain Worker's Compensation Insunmm, n required by Section 37W of Ne labor Code, for the performance of the amok fir which this permit is issued. My Worker's Compensation Insurance cartim and Policy number tie: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need art becompmmd tribe permit isfar ome hundred dollars ($100) or less.) 1 choir, Hm in the perfomunce of the work for which this permit is issued. I shall nm employ any person in any mannerso � Fe subject m the Workeri Compensation Laws of California. Dow , Applicant NOTICE TO APPLICANT If. after making this Ccam of Exemption, you should pv rens or He labor Code, you mum become subject m He Worker's Compensationro forthwith comply with such provision or His permit shalt W deemed mvnked. CONSTRUCTION LENDING AGENCY 1 herby affirm that there is eunn lending agency for the perfurmanc Of the work for which His permit is issued (See 3097, Civ. CJ ' Lemdcri Name Lcnder'¢Address j 1 cCmf, Hat I have rood this application and ¢um the, the above imfmmauun is ' correct 1 agree m comply with all city and county ordinances and sixth laws relating to building construction. and hereby authorize nepmumatims or this city to en cr upon use .hove-motion til Property for inpectimn Purposes (We) agree to save, indemnify and keep harmless He City of Cupertino against j liabilities judgments, Costs and ..pectus which may in any way acme again, said City in consequence of the gunfing of this permit ' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:: Date SOURCE REGULATIONS Re-roofs *)/7/e)' Signature of Applinnucanuactor a HAZARD ATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant stem or handle hvardous material n defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety We. Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed. CY 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 coli, hacamon air conmminama as defined by the Bay Area Air Quality Management all new materials for inspection. Disuict7 ❑Yes [XNu 1 have read the harammms materialsoequimmenb under Chap Cr6.95 of the Califon nix Health & Safny Cock, Scemn 25505.25533 xnd25534.1 uh&r,.d Hmif thc building docs not currently hale a mnanl that it is in, re¢pmrsituh, it nnufy the ¢Cu,.t Of He requirements which must lat o, tu'.iiara or acerdre.m oraap'y�r. Signature of Applicant Date " 7/?S All roof coverings to be Class "B" or better m Owner autho,iaed open, D �mZ �o CoC 0 nF m ;yU a0� �pC YFC y�Su 0 2 Z C P>_ a� UC UC � F Q LLL a U2 CITY OF CUPERTINO �`'*� •� %'x°�^'�" BUILDING DIVISION PERMITCONTRACTOR INFORMAT-19 `� .,...Mix., _ BUILDING ADDRESS: 21 661 T.TNT)Y T.A PERMIT "b 5 0 7 0 0 4 2 n NEWS NAME: PERMIT ISSUE DATE KEVIN YEN 07/ 7Z200F� 'AMNE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 LICENSED CONTRACTOR'S DECLARATION {{���j rrKKkk pp JOlgj ' [Q11 �a t{ 9(com 1 hereby affirm that I am licensed under provisions of 9 (commencing herebafofm that pr r� on3ofthcednder Pmfcssiof chapterand my Cenci is With SCI Code. — ��WWptYlploit`�9TEpTm1tY1��III mmBfrom ad affect. I[YB�r KITCHEN REMODEL License Class Lk.N Doo: contractor ARCHITECTS DECLARATION 1 understand my shall W used o aeards a(� /`O 2905 plans public t� J Licensed Professional OWNER -BUILDER DECLARATION 1 Wrchy affirm that 1 am exempt from dm Contnctafs Liccnx Law for IM �® BUILDING, following motion. (Section 7031.5, Business and Professions Codd: My city or county Y which mquires a pmmit to construct. altar, improve, demolish, or ¢pair any structure prior to its issuanre. also rcyvires the applicant for such permit m file a signed stammcm that he is licensed pursuant o the provision of lW Contractor's Liccnx Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7") of Division 3 of the Business and Professinm Cade) or that he is exmpt Nmafmm and the buss for the alleged exmption. Any violation of 3 5+&XZ0l 2ABet0 0 Occupancy Type Section 7031.5 by any ap,li., for a permit subjects the applimnno a civil penalty of not more Nan five hundred dollars I, as; owner of Ne property, or my employees with wages as their auto eampcnadon, Required Inspections will do Newark and Ne ssmcmm u not inwnded oroffemd ror vk (Sec. )014. Business and Prefcuiom Code: The Canvacxh Limma law does out apply in an owner of property who Wilds or improves themon. and who doessuch work himxlror through his , own employees, pmvided Nat such improvements are not intended or offered for We. If, however, the building or improvement is sold within one year of completion. the owner. builder will haw the burden of proving Nn M did not Wild or improv for purpr x of nk.). Q I. as worm of thee pmpcny am exclusively contracting with licensed convectors m cmmmct the project (Sec. 7055, Business and Protestant. Cade:) The Cmisxmr's Li came law does not apply m an owner of property who Wilds or impmvas diemon. and who comment for such pmjeeu with a contrai licensed pursuant to use Contractor's Liccnx law. ❑ 1 am exempt under Sec. . B k P C fo Nis /' ,mer Da w WORKER'SC SATION DECLARATIOIF N 1 hereby affum under nmty of perjury e m of the following dacluatiou: ❑ I haveand will maintain a CeniGeam of Consent to self-insum for Worker's Compere cation, as provided for by Section 37M of the IaWr Code, for the performmxx of the work for which this permit is issued. ❑ 1 have and will maintain Wmkcr's Compensation Insurance.. requimd by section 37M of No labor Code, for dm performance of the work for which this permit is issued My Worker's Compensation Insurance carrier and Policy number am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (TIs In. need timbeeomplemd if the permit is for.. hundred dollars (SIM) at Ices.) I mrdfv Nat in the performance of Wa walk for which this peman is issued, l shall an, employ any' parson in any maon�n Jk�ar¢subject to the Wmicrs'Comlareaun Laws of California. Data II Applicant NOTICE TO APPLICANT: If. arm, making this C t scam of Emurpniun, you should became subject m One Worker'sCompensation provons of Ne V Wr code, you muse forthwith comply with such provisions or this fermitshall be deemed rooked. CONSTRUCTION LENDING AGENCY I Wmby affirm that them is a eomtruction lending age¢ for the performansx of One wart for which this permit is bound (Sec. 3047. Civ, C.) Leadcr's Namc L ander'a Address I certify Nat 1 have read this application and $um Nat the aW ve Oform.Imn u comma 1 agree to comply with all city and county omimmums and some laws miming to building contraction, and hcmby authonne mpxcenutices of this city in enter upon the , arrive mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expcmcs which may in any way accord against said City in come'limea of Ne granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS Re -roofs Signature of ApplicanuComme., a HAZARD MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding occupant mom or bandit Initiations materia . defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safely rmk, Sermon 25532(a)7 All roofs shall be inspected to any roofing material being installed. 0Ycs [+f�'o prior If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future Wilding occupant use equipment or devices which emit haiardous air conuminanu m dcrincd by thus Bay Ama Ail Quality Management all new materials for inspection. Dishim7 ❑Yes 2flu% 1 have mad the Wrardous materials requirements under Chapter 6.95 of the Cabral Iia Hul"Safety Code, Sections 25505.25533 mu125531. 1 undersand Nat if the Wilding does Inst euncraly haw a woes. Nat it is my responsibility to notify the occupant of the mquimmcnts which most tae t or to isauaaccofaccn;neamofacap y. Signature of Applicant Date -747/3 All roof coverings to be Class "B" or better Owner ar authorised agent Dim C • • • &EIRL CITY OF CUPERTINO • Assessor's Parcel Number: I Name of owner. Kc= V/ N YCnI Project address. Z (, G ( Z -//V 0 Y LfINC Contact person. )CGV/ N / E/\j Phone. &S cl 4 _o77 3 -1 i o j Fax. S`U9'�ss -8962 Net square footage of lot. Existing Proposed Square footage: First floor: S&I^c Second floor: sU Garage: S TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? 1 N Is privacy protection planting required for the project? Y On what floor(s) is work being done? O Brief description of work. tci�(,L Code editions: 2001 CBC (Y - N)2001 CFC (Y - N)2001 CMC (Y- N) 2001 CPC (Y - N)2001 NEC (Y - N) Effective 11/1/02 Plan Review Process Work Book Page -8-Revised 4/28/04 CITY Or CUPERTINO *CITY OF CUPERTIN# PERMIT APPLICATION FORM APN # Date: Building Address: Mailing Address (if different from building address): ZI b6 I WAIbY LANE Owner's Name:0-/N Y Phone #: Contractor: 'License #: Contact: Ph e: 408-255-'-Yo8$ Cupertino Business License#: Cir f (v ✓ iK Li'K Fax: Building Permit Info: f�G P14.1li4 Bldg ❑/ Elect P— Plumb'— Mech ©-' Job Description:/ 14117.l,,,, Residential LAY Commercial ❑ Sq.Ft. Floor Area: 16kR , 1 z 4 $/Sq.Ft.: Cost of Project: Occupancy Group: Type of Construction: Please check this box if the project is a v second -story addition: ❑ / BCONSTAX Project Size: Standard C Large ElMa or L1 BUILDING Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL 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 1 of 3 it I D as, CITY OF CUPEkTINO *CITY OF CUPERTIN(O PERMIT APPLICATION FORM Quantity 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 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 rinkler/Backflo PLUMBING BPSTORM Storm/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 Reins ection Fee BUILDING 13REMACOVER 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 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 13REMR-ESAPP Remodel Res App liance ELECTRICAL 2of3 Cm of CUPERTINO OITY OF CUPERTINO 0 PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs 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 1919- 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 is 3 of 3