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05060184 CITY OF CUPERTINO w %A VW 7,� 'f'�, 7%6Wir,kRd%,6RjN WOUT1 ON-,A� BUILDING DIVISION PERMIT BUILDING ADDRESS: SUM' S CONSTRUCTION PUMITNO05060184 1526 POPPY WY OWNER'S NAME: PERMIT ISSUE DATE ldhi YANN-MING WAY 347 ESTHER AVE 06/28/2005 4 ONE: SANITARY NO. CONTROL NO. (408) 202-6501 ARCH117ECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MOECH a 8 6 LICENSED CONTRACTOR'S DECLARATION rd I hereby affirm that I Son assumed under provide.of Clospour 9 femormatch,ji, Job Description with section 70(k),dDivniian 3.FdW Businessland Professions Code,and my licensee an 10 r itromma d IT UPGRADE ELECT. (200AMP) /WATER HEATER Em- ==21m C Lic. e3z Can an« FURNACE & A/C UNIT 11CLA1 IN I understood my plans Shall W used as public accords jo Licensed Praftem...I OWNER-BUILDER DECLARATION I hereby affirre that I zon exempt from the Conuscion's License Low for the ti following mason.(Section 7031.5.Business no Pretensions Code:Any city or county which mq.l=a permit to caramel,aftea.Improve.demolish,at icatir any smucture prior to its Issuance,also inquires the applicant rot such permit in rile assigned statement that he is licensed pursuant to the panvisions of the Comaustar's Licsome Law(Chapter 9 Sq.Ft.Floor Area Valuat$)A2 0 0 (commencing with Section 7000)of Division 3 of the Business and Prorestions Code)at that he is exempt therefrom and the basis for the.11.3cal exemption.My'i.atfor,of Section 7031.5 by MY Applicant for.permit Subjects the applimool to a civil penalty of APN Number Occupancy 1', oat am that five Waited claim($500). _e ❑I.as owner of the property,ca my employees with wages as their Sale compensation. 36610112 . 00 U� will do the work.and the net..snot intended or offered rot age(Sec.704S.Business Requir9d N's'lectioniL L9 LLJ and Proposed..Cede:The Cmsnxcum�License Law does an,apply to an owner of propeny who Infliclacrimparams thastuartand whodoessuch work himsefforthmulh his oweremployces,provided thatexchimprovernmistranot imended arofferedfortale.It, however,the Wildlagorimparowevern,fissold within One yearrofcompiction.the Owner. Still 2005 builder will have the burden of proving the hat did not Wor build Improve far purpose of ass.). C]1.as Owner of the property,am exclusively contracting with licensed commeturs ut construct Nees (Sec.70 .Business and Praftassions Code:)The Contracter's Li. BUY Nft�:� ere Law does not apply 0 an matter of property who Wild,or improves theream.and who contracts far such project,with A conuactor(s)licensed purousm to the Contractor's License LAW. []I....P1 wader Sm &P C for his..a Owner Data WORKER'S COMPENSATION DECLARATION j I barely sill, M,am under penalty of perjury coveofflue following I haw And will asst. reandittiC, sation,as Providd for by Section 3700 of the labor Code,for the performance of the work for which this permit is isswet. 0 1 have and ME maintain Worker's Compensation Insurance,as mquimd by Section 37110 of the Labor Code,for the performance of the work for which this permit is issued My workers CTImmmort himming:coria er and policy number am; Center. b .1 1 Po — 10licy No.: e tR71F TE OF&EMPTION FROM WORKERS' COMPENSATION INSURANCE MIS section need not Wcomplcmd if Ce purmil Is forcre hundred&Jim($100) or Iasa) I certify that In to Performance of the work for which this permit Is Issued,I Shall not employ anylicaumn in any answer So as in became subject to the Worked Compensation LA.ofCalifimei..Dan, Applicant NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you Should baccom Subject to the Worker's compaeonflon Provisions of the Labor Coft you a= Z forthwith comply with Such provisions or this Permit shall be domedmvokad. z 0 CONSTRUCTION LENDING AGENCY I boreby.fnan,that ther,Is 4 construction lending agency for use p aforanual of CYi> the work for which this permit It jamed(Ser.3M.Civ.C.) Landcfs Name z Leader's Add. D U 0 1 unify that I haw tend this application and Sam that the above information is U. correct.I Alimse to empty with all city ad county ordinsuncei,and saw is"passing to OSU^ Wilding construction.and hemby authorins mprosemstives of this city to enter upon the LU show-mentioned property for Impaction purposes (We)somia to Saw,indemnify and keep harmless the City of Cupertino apost En liabilities.judgments,costs and expenses which may in my way accrue agairs,Wit City in consequence of the grarefing of this rmit. APPLICANT UNDERSTANDS ANDpeWILL COMPLY WITH ALL NON-POINT Issued by: Date SOUXkRECULATIONS ' 41-- iC2 �- Re-roofs Signature of Applic"Commictor Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or rutum,Wilding occupant alone ish-mlk h-_abousmaunial as claimed by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety Ode.Sudan 25532(,)' - 0y. /dN. All roofs shall be inspected prior to any roofing material being installed. Will the applicant or rulume Wilding Occupant um equillftnalL Or devices which If a roof is installed without first obtaining an inspection,I agree to remove It membas air commori is duallned by live Bay Area Air Quality Management all new materials for inspection. 0 Yes RZ1. District? I howmad the hatardmamaterialtaxmarrams under Chaptuali.95ordiecajifor. ni.Health&Safety Cade,Sections 25505,25533 and 25534.1 taxicamand Lhatifth,Wilding does act normally have x unamt,thin it is my rememsbelity,to badly the occupant of ft mqui mam :Zmelp met$Ccruncw a iy. Signature of Applicant Date' ISS V I All roof coverings to be Class"B"or better 10vant,"thmixed1goK Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 � &C Fax(408)777-3333 UPEkTINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE #C 2- GENERAL GENERAL CONTRA OR: *1 // FAX # I am not using any subcontractors: 2q � ' lam— 6 L 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 5- OwWcont;(act6 Signature Dat CITY OF CUPERTINO CUPERTINO PERMIT APPLICATION FORM APN# Date: 2& a S ' � o I I 2-- Building Address: Mailing Address (if dif ereht fforn building address): IS-2- ,6 0 Owner's Name: �] Phone#: b�� �'�' — 7 6 2-8 ROK Contractor: License#: p Q 3 3 14 M S Gu h s' P _LCtlL 0 Contact: Phon,�4o0) Cupertino Business License#: Scf rl Fax: 2-1 2- Krd Building Permit Info: UpIuvftR et r: par i ; Y%-e— a Cµrp,nccs A r(, LA Bldg. ElC Elect Plumb Mech Job Description• Urjrufe 2 vo A k o� pan= , Ips rtw w4-tem hzvhv, *kr"7 Residential _ ,,: Commercial ❑ Sq.Ft. Floor Area: /000 $/Sq.Ft.: D Cost of Project: Zp'U Occupancy Group: � Type of Construction: I Please check this box if the project is a (OA.Q r'n P, �tin�; o�s second-story addition: ❑ . 10 J Project Size: Standard Large ❑ Major ❑ 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 be BUILDING 30 � 3� 1 of3 CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM QuantityFee 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/Backfio 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 Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfln MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL 1 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 CITY OF CUPERTINO CUPER,TINO 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 BRENIVENSYS 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 Chane BUILDING 3 of 3