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03020021 (2) W CITY OF CUPERTINO � � BUILDING DIVISION PERMI `'CONTRACTOR INFWI ORM BUILDING ADDRESS: PERMITNO. 20286 PINNTAGE PY 03020021 OWNER'S NAME: APPLICATION SUB DATE STEVEN CHAN 02/06/2003 HONE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT' PLUMB MECH �Oo LICENSED CONTRACTOR'S DECLARATION O O O O < P I hereby alTirm that 1 am licensed under provisions of Chapter 9(commencing Job Description �zj3 with Struma]000)of Division 3 of the Business and Professions Code,and my license is za Ll mfull Dome Classandeffed. X 7,�NO7� KITCHEN REMODEL z Licenseclmx Li n CONTRACT ort=c Dam T'S Donor (gyp ///��iii��•��'��++ �+ (�/�p�� 4uQ,� ARCHITECTS DECLARATION 256+�s`W`L'NING SCD 26 Q 1 understand my plans shall M used az public records F ■�rE//Z']'�, LL o Licensed Professional MAR 2Z 2003 OWNER-BUILDER DECLARATION af. I hereby affirm that 1 1. exempt from Ne Codons Co License Law for the followax: whichingrcasoa Permit rten toOunsruci,a5. nesx and Professions Code Any city OrCounty WX which mquisune,also re cnnsWLLalNc,improve,aeermitt or repair any structure — rte its issuance,alsore requires;the applicant lir such gra z� prim q ppi Permit upChapoent ME son MENLO^ Valuation �"Q that he islicenwit pSectio 7 the of Division 3 NC Cunbwessand erase Law(Chodmr9 Sq.Ft. zF (commenciternalhomfon]0nd)ofDivisionr aftheeged exe and Professions Crede)or thin io is exempt therefrom and dm beers for be alleged exemption.Any violation of $1500 Section ]bete by any applicant fora permit subjects the apPlicwt m a civil penally of APN Number not marc thw EK hundred dollars($soB). Occupancy Type ❑I,eaownerofthepmpeny,ormyemPloyeeswithwagesmfte wlecompenmtion, 36947024 . 00 will do the work,and the soucom is not intended aroffered forsale(Sec.7q44,Business and Professions Code:The Conlrsou ri License Law does not apply On an owner of 101 — I''OUNDA 1rEd IDSpeCIIODS progenyre who buildsor improves thereon,and who doeswch work himselfor through his LV own employees,provided that such improvements arc not intended or offered for mlc.it. 102 — PIERS however,Ne building or improvement is sold within one year of completion.the owner. builder will have the burden of proving that he did not build or improve for purpose of 103 - UFER NI"' - 104 - REBAR ❑I,as uctOwner mfthe Princely(Sec.70U, Buram da and contraProfessions Codeth:)Theedconmwtore to 10 -55 — ANCHOR BOLTS construct the project(Sec.]044,Business and Prolemions Code:)The Consorters Li- cemefawdoesnotapplymanownero(property who Wilds or improves thereon,and 106 - SEWER & WATER who contracts for such pmjects with a conmamor(s)licensed pursuant to the Contnnore' 'ZO2 — UNDERFLOOR PLUMBING License Law. ❑I sin exempt under Sea B k P C for this reason 203 - UNDERFLOOR MECHANICAL Owner Dam 204 - UNDERFLOOR FRAME WORKER'S COMPENSATION DECLARATION I hereby efiren under penalty,of perjury one or the following declarations: 205 — UNDERFLOOR INSULATION I have and will maintain a Certificate of Consent in a elf-inwre farworker'a Compete 301 — ROUGH PLUMBING nation,as provided for by Section 37M of the Labor Code,for the performance of the 302 - TUB & OR SHOWER work for which this permit is issued. 303 - ROUGH MECHANICAL ❑I have and will maintain Workers Compensation Insurance,h his Perm by Section 3 04 - ROUGH ELECTRICAL 3]00 of the labor Code,for the Performance of the wed for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number art: 305 — FRAME Carrier: Policy 306 - HOLDOWNS CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 307 - INSULATION (Otis section need not be completed if the Permit is formic hundred dollars(1100) 308 - SHEETROCK I certify 309 - EXTERIOR LATH employ ecnify Nat er the Performance of the wed for which Nis permit is issued,I shall nest Lawsoanyperson in any manncrso into become subject to the Workcri Compensation 310 - INTERIOR LATH Laws of California.Date 311 - SCRATCH COAT Applicant NOTICE TO APPLICANT:IL after making this Certificate of Escmption,you should 313 - ROOF NAIL become subject to the Worker's Compensation provisions of the labor Code,you most 0 ,`G-forthwith comply with such provisions or permit shall he deemed revoked. 501 — FINAL ELECTRICAL ENERGY zO 'CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY F� I hereby afforn that them is a construction lending agency for the Performance of 503 - FINAL MECHANICAL ENERGY R work thefor which this penilisimucd(Scc.309l,Civ.CJ rk Name 504 - FINAL BUILDING ENERGY W G. the w 7 Lender's Address 505 - FINAL ELECTRICAL U o I certify that I have read this application and stem Net the above information is 5 0 6 - GAS TEST W f~- correct.1 agree to comply with all city and county ordinances and state laws relating to U buildingconswaion,andherebyauthorizerepresentativesofthiscitymenteruponthe FINAL PLUMBING W shave-meminnctl property for inspection purposes. 0.f (We)agree to save,indemnify and keep baseless the City of Cupertino against 08 FIN L cn liabilities,judgments,costs and expenses which may in any way seem againstsaidCity 5 I A V 7 in consequence of the granting of this Permit. F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 NG Date 50 R REG L TIONS. Re-roofs r nature plitent/Contrwror Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant of future building occupant store or handle haysdous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(.)7 ❑rs ❑No All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit hazardous air contaminants as dcfned by the Bay Area Air Quality Management all new materials for inspection. District? [_1 yea No I have read the hazzmous materials requirements under Chapter 6.95 of the Califmr- maHealth drSafety CWe,Sections 25505.25533 an it 255]4.l understand that if the building does not currently have a tenant.that it is my responsibility m notify the Occupant of the requirements which must he mel prior to issuance of a Cerdficate of Occupancy. Signature Of Applicant Date net orauth iced agent Date All roof coverings to be Class"B" or better IN ACCORDANCE WITI CUPERTINO CODES A. C17Y 06 CRCINANCE9 PATE Z.— SICNEO This set of - pans _nd sPa a cabons oe kept on the 'cb a a;l ttme MUST lavifui to make = y n es es it is un; n ' cha a alterations on same vnih;u ;1�, r l he bu;:d;n t` r Ra'mission from �h amr g DePt.. Crt r pe!tino. eco the sr 9 �f Cu HALL Mr=ng h' pan and specifications be head to pe;mi ` D "10A -?pnOV31 Of fther;olatit or to be an Ion of any provisions FEB b'?�u Citv Oidirance or State Law, 3 — ey Pv SIwK OFFEE � NCi�K A 7 • IRTY OF CUPERTINO • CUPEIOF PERMIT APPLICATION FORM v`3 APN# .-3 C, (, y 7 L t Date: _ G - 63 Building Address: 7 20 ✓nom Owner's Name: Phone#: s 4 Ct- -%E7'1 - i55-q Contractor: License#: �i1 ov �`d OZ Contact: Cupertino Business License#: 2f 1�0 ✓l0 Building Permit Info: Bldg Elect Plumb 0-�' Mech Q__-,,*� Job Descripti�on:� Residential L� �G Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: Cost of Project: 0 Occupancy Group: v 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 IM 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<= 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 laf3 , L _� � 7. r�� CITY OF CUPERTINO PE� 4�. CUTiNG PERMIT APPLICATION FORM • uanti Fee ID BMITIGATR Fee Descri tion Fee Grou BMNEWMULTI Res. Housin Mit Fee BUILDING BA4NEWSF&2F New Multi-,rami! Res MECHANICAL, BNEWMULTI New Sf&2F Res Bld s MECHANICAL, BNUCONMM Multifam.1 Res ELECTRICAL BNUCOMMM New Comm Electric ELECTRICAL, BNUCOMMp New Comm Mechanical MECHANICAL BNUMULTI New omm Plumb PLUMBING BNUSFD New MCulufamil Res PLUMBING BOVERTIME Naw Sin le Famil Res BUILDING BPBACKFLOW Ins ection Overtime BUILDING BPCESSPOOL '`atmos heric Vacuum PLUMBING BPE)tMCess ool FEE PLUMBING BPFIXT Bid Permit Fees BUILDING P BPGAS bl Facture PLUMBING BP ERC Gas Pi in S stem Fee PLUMBING BPLANCgI{ Ind Waste Interc for PLUMBING BPLANCKADL) Plan Check Fee BUILDING BPLANCKREp Plan Check Add Multi BUILDING BPREpIPE Plan Check Re eat Fee BUILDING BPSEWAGE R i e Of Fixtures PLUMBING B 'SEWER Sewage Dis osal PLUMBING BPSPRINK Sewers PLUMBING BPSTORM Lawn S rinkler/Backflo PLUMBING 13PTRA.P Storm/Rain Water PLUMBING BPVENT Kitchen Tra PLUMBING BPWATER Alt of Drain &Vent PLUMBING 13PWHEATER InstalUAlter Water Pipe PLUMBING BPWSVCS Water Heater/vent PLUMBING BREINSPECT Mam Water Service PLUMBING BREMACOVER Reins ection Fee BUILDING ' BRE 1�IACOV N A/C Unit> 10,000 cfm MECHANICAL A/C Units <= 1000 BREMAPPLI , 0 cfm MECHANICAL BREMBUSWAY A liance Install MECHANICAL BREMFIXT Remodel Buswa s ELECTRICAL BRE Li tin Fixtures ELECTRICAL BREM,rURNOV Relocation of Furnace MECHANICAL BREMFIE ST Relo Furnace> I OK btu MECHANICAL 13REMINHOOD Heater Installation MECHANICAL BREMMISC Installation of Hood MECHANICAL BREM?sMgpp Misc Apparatils ELECTRICAL BREMPOLE Rem Non-Res A liance ELECTRICAL Pole/Platform Fixture ELECTRICAL 2 of 3 9 q' CITY OF CUPERTINO (+ CITY OF PERMIT APPLICATION FORM • CUPERTINO 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 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 Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING • 3 of 3