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OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
INNWECITY
UILDWO ADDRESS:
PERMIT NO.
19028 STEVENS CREEK BLVD.
TDN QUALITY CONSTRUCTION
02040016
R'sNAME:
IDR. SHANE HUANG (#A & B)
2114 SENTER ROAD
APPLIC TION S B 13
04,02%262
r PHONE:
(408)998-0980
SANITARY NO. CONTROL NO.
ARCHITECDENGINEER:
BUILDW O PERMIT NFO
BLDG ELECT PLUMB MECH
U
LICENSED CONTRACTOR'S DECLARATION
1 hereby affimrtha I atm licrnsed under provisions of Chapter 9 commencing
Job Description
TENANT IMPROVEMENT.
wish San..7")of Division 3 oflh, Businessatnd Processions Code. and my license
"11 in ten rase and IT t.
c.
LianxCas� LiDECLAR �
Date Comon,...�99-2L�•�r``__"__�L✓✓
CHITECTS Do,bli, a
I undersand my plans shall be used as public retards
w�pa,
G® ®�
`a \�
Licensed Professional
DECLARATION
Oat
1 hereby (Rrm thio 1 I am eu the Contmcio Law for the
�1 T
mason. 1. sin s an o e: Any c
Business and Curie: Any city or county
whawing re,st(Semon construct. improve demolish
which rcgoircs or repair any tenure
permit re comrrvm, Im,applicant
n
i,Sy :0 0.0-0
u-
n Permit t
-Drio tens issuance, also requires applicam for,uchperminofile asigned smmmcm
r' t,"� ,G '�,< y.�,r A.. ;--.,;;
l f 3 1"��'Y 1 �`YY lY l �' •• 1
, Valuation
error be'ii lieeosee Puixuonnd,hFitrbvislous of the Contmaor's License Law (Chapter 9
(commencing,, Section n or the Business Professions Code)
orchatawith
he bass he 1fi
orchatis 31.5b ianyabni'anJ the basisforubject
deicant t, Anyil
:,•
- -'
Pennon
1-offsection 9011.5 by any applicant for a permit subject the applicant m v civil Penalty
the
:of.. more door Five hundred do1lan 55001.
101APN liftMO ADATI ON
F A'::T X0 Occupancy Type
O1, as owner ofthe property. or my employees with wages anheir sole mmpensmion,
102 - PIERS
will do the dark. and the strvctue s not intended oroffered for sale (Se: ]a4.'
,will
and Professions Code The Commcmr's License Law does not apply to an
10 3 - UFER Required Inspections''",
owner o
r f prolixity Who builds or improves thereon. and %to does such work himself
104 - REBAR
or Nnvigh his own employees: provided that such improsamems are not intended or
orr,ad fo, i If, hew m building po mem i, le item one of
--_-_ -.- _ __
-- 10.5 =
-7-ANCHOR-'BOLTS
year
complained. the owo".di Id ill basaltic harden f P ming that he did na build or
ANCHOR BOLTS -' "
mprovefnrpapoxorsale.).
106 - SEWER & WATER
_
s ce of the am ucluamsla c uxhng with I c c normo s m
_. _
- ... .,I !
con (Sec.7 :) n
License! me project tea ]Burt Business a Profess ons Cnde) The Contractor's
Litems Law tots apply a ow'n,r Property who Wilds or improves memos,
2 03 - UNDERFLOOR MECHANICALi. a l t r
.f is sh i).
gojttu.mm.a connacra(,).iicensm.parsuanr.ro me.
.mW .ho esLicmd rLdw.
---204---- UNDERFLOOR--FRAME=---._—..- -..-. _.__._.. _.. _...__..._.__. .
ComracmrsLicenuLaw. ..,
,
❑lamcaamprunder5ec.' '' ''' "'13d'PCfurthinrcsson
205 - UNDERFLOOR, INSULATION
ownq?1v' '''" `''"gate '--' "'''`
301 - ROUGH PLUMBING
COMPENSATIONDECLARATION
/..,cl
302 - TUB & OR SHOWER
hereby affirm ane�rPan mtyorperja:yop� nrthe following a«lamrons:-
303 - ROUGH MECHANICAL
❑ 1 has.- add »rel maintain .'Cirtmcme of Convert to sav-insarc fee Worker,
304 - ROUGH ELECTRICAL
Compcmation, as Provided for by Section 3]00 -or the Labor Code, ror she
305 FRAME
perfonreree of the work for which this perm! i, issued.
-
01 have rod will ionotain' WAi,_. Comp matmn inscous".'a; rayLired by Section
306 - HOLDOWNS
3]00 of the labor Code for NI perfotm mor"me work for nom pe is
307 - INSULATION
issued yWorkefs Compe uonln",mncec&mi dPlicy ba'I.:
S
--
308 SHEETROCK-"'
Cun<r Y g Iicy N s U _Il (
�.
i TIFlCATION OFFJ�EMPTION FROM WOR IiRS I -
) - y.-, -
3 b:§ v � t EXTEKI OR LATH! /
I COMPENSAIION wsuRAycE_
310 - INTERIOR--- LATH'----
,'., (Th s u<t n need the p ed if the pcnmt s for hundred dollars
-a:: ,-ln,I rc:•::rm fetor: I nl
311 SCRATCH COAT '
(5100) less)
------------_.3-13----•ROOF ... NAI L_...._
cttopermit since, l
g': 1 tartily Na in in on n cc of the work for once subhisject
shall 'net employ sossio become rub3ttt io the Workers
- ..
501 FINAL ELECTR'I CP:L`''ENBRGY'
Cio arr.nymanncr
Comps t Ise, of Cal fon Dam "' --'
Laws
-APPI,.nt __:. _.:.., .:_. _ _ .. _
. _..... _. -.5,02._ ...FINAL ...PLUMBING .ENERGY.
NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you, should
503 - FINAL MECHANICAL'`ENERGY'"-
become subject to the Worker's Compensation piibnsll the lamer Code; you must
forth th comply Teti such Provisions or this pearmt hall be deemed revoked.
5 0 4 - FINAL BUILDING ENERGYI
\i'7 s CONSTRUCTION LENDING AGENCY
505 - FINAL ELECTRICAL "'" ''`•
-' ) hertby athrin that Nert Is'e consuu<t on lending atgency fa Me performance_
of Ne okfor M1ich th permt raided jSc 309] Cm. C.)-
- GAS TEST ..I:.` '
-506
5 0 7�' '- -FINAL- �' PLUMBING �
Lender a Address • ., .
.
508 FINAL MECHANICAL
i<en fy th tlh nth svpplicm dtxthouheaboe !o .,,on is
conttr 1 ag t comply to 11 c �Y end counry Nr nets nd st t s rclanng
509 - FINAL GRADE
mbu ld gm t'cdon rte hertby aumonze Pres mat'uof rids nym erupon
the abo e t d pr perry f spenion purpa
510 - FINAL PLANNING"ga
INe)aprte to save. indonnily atnd keep harmless rhe Cir"y of Cupertino.nsr
514 - FINAL PUB IC WORKS `
liabilities, judgments, toad etd gpense, worm may in any way eccrve a{ot'saiaid
u nst
City m co req ncc of the gmnung of this pemnu
ER$T AND HILL CO\/PLY'W'�}{I ALL\p\P0M17"
AOURCE Y`
^ ` '
! Oat
Issued by: Date
S.\DS
SOURCE REGI A s
REO
`l b✓ 1
Si{namu'ot Ap tantKbmnno ':' +� -Dat
Re -roofs
HAZARDOUS MATERIALS Di$CLOSURE s -
'•"d I Wd1 the a treat or I art dldm aced t sore ar handle
-M
Type. of Roof - -- "
i Health an Safety
ane the Health ands.
Cod.' dby th 53pert pil Cod, Ch pt 11
code Im 2 >;11
•a. Ito ,• _ -
sin n7' u.
oY, fd� rIrw s +3. Y,` ^ k
All -roofs.shall be inspected,prior-to.any.roofing material.being.installed -
Wlithe applicant or future buileiioccup t use equipment rdevices which
_-____-. ,-_
If a roof is installed without first obtaining an inspectioh?Fagiee-.toliAinove
t hazardo s aircomamhimil ai dc0 b5 the Bay Arta A r Quality M,ngemcm
Di,m<t
all for inspection, understands and will comply With
0 4I @Ro
_new -materials _Applicant _ -
all -non -point source regulanons: �. .
l
;' 1; h e revd'ihe hax Nous maeri.Q rcqu reme is under Chapter 6.95of the
� ;, •
CSlifomia a.] at Codc. secrlons 25505: 25533 and 8534:1 understand that
if iIdina., rrtn Y ate a tun r that r s my re 11y m nai(y the
b6' f the qui,cma. x1t cA lnusi be m t p a or isformse Cecil a e of
-,
` p'Q O
Signature of Applicant Date
.
—
All roof coverin s to be Class "B" or better. "
mar or au-th
DEO
'OFFICE'
.5A z CITY OF CCI P ER'I HNG n 1" �
ITY OF PERMIT APPL IIl..AT IO ]FORM
APN #
Date:
412r
Bui ding Address:
MECHANICAL
BBLDGFEE
Bldg Permits . foot
BUILDING
BBOILERI
OV rer` s Name:
MECHANICAL
BB0ILER2
C #:
one *.S -D) g$ 8
Contractor: n
(.OYI St 1C �1/l/
BBOILER3
License #:
Contact:
��SoI,-", r,,
BBOILER4
Boiler > 1 M to 1.75 M Btu
Phone M
(d08) 2<4�7 (�
Applicant/Contactor:
Boiler > 1.75M Btu
MECHANICAL
Fax #:
f—t - G
BUILDING
BCONSTAX
C4o� z s 3l
Building Permit Info:
BCONSTAXBQ
Con. Tax for BQ Zone
ld
Elect
Plumb Mech
Jo escription:
BCONSTAXR
Constax — Resi/Mobile
Residential:
BELEC1000
Commercial: P""ta-� 01f 1 tz
Sq.Ft. Floor Area:
BELEC1001
Elec 600V > 1000A
$/Sq.Ft.:
BELEC200
Elec Svcs 600V <= 200A
ELECTRICAL
B EN ERGY
Architect/Engineer:
BUILDING
BENERGYADD
Valuation:
BUILDING
' BINVESTIGA
Investigation fee
�RD"
o struction:
Comm. Housing Mit. Fee
BUILDING
-scup c Group:
:
Quantiq Fee ]IIID
Fee Description
Fee Groan
BAPPLOTHER
Other Appliances
MECHANICAL
BBLDGFEE
Bldg Permits . foot
BUILDING
BBOILERI
Boiler <= 100,000 Btu
MECHANICAL
BB0ILER2
Boiler > 100K to 500K Btu
MECHANICAL
BBOILER3
Boiler > 500K to IM Btu
MECHANICAL
BBOILER4
Boiler > 1 M 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 <=1.000A
ELECTRICAL' .
BELEC1001
Elec 600V > 1000A
ELECTRICAL
BELEC200
Elec Svcs 600V <= 200A
ELECTRICAL
B EN ERGY
Energy
BUILDING
BENERGYADD
Energy Add Multi
BUILDING
' BINVESTIGA
Investigation fee
BUILDING
BMITIGATC
Comm. Housing Mit. Fee
BUILDING
1 of 3
7 � o 2,
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uIZC
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a3-
CITY OF CUP ERTINO
I
BUILDING DMSION PERMITCONTRACTOR�I`I�TI�'OMWATI
I
BUILDING ADDRESS:
PERMIT NO.
19028 STEVENS CREEK BLVD.
TDN QUALITY
CONSTRUCTION
02040016
Ottq.*ER'S NAME:
DR. SHANE HUANG (4A & B)
2114 SENTER ROAD
APPLICTION S BDA
04702y20�2
PHONE:
(408)998-0980
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
U C_) L
LICENSED CONTRACTOR'S DECLARATION
that
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
Business
TENANT
Job Description
IMPROVEMENT.
with Section 7000) of 3 of the and Professions Code, and my license
is in full force and eff t.
License as Lic. L#
Date Contractor -
CHITECT'S DEEARA 0
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 7031-5, Business and Professions Code: Any city or county
$80000
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to
pe iits issuance, also requires she applicant (or such permit to file a signal smmment
Ufa -i s licensed pursuanilq•(he provisions of the Contractor's License Law (Chapter 9
. .... ... .....- ._. _ .. ._ . _ . -_
3 R� T'a ,h'.dw.,,.r.l.�
Y' Y 1 l/ T
Valuation
(commencing -with Section 7040) pf Division 3 of the Business and Professions Code)
or that We is exempt therefrom and the basis for the alleged.eiemptiod. Any violation
of Sectiorri0313'by any applicant for a permit subjects the applicant to a civil penalty
-of notmore than dive hundred dollars (5500).
101APN 4UIDNDAT I ON
Occupancy Type
❑ I, as owner of the property, or my employees with wages as their sole compensation,
102 —
PIERS
' will'dpWe work. and the structure is not intended or offered for sale (Sec. 7044,
Business and Professions Code: The Contractor's License Law does not apply to an
1 O3 -
UFER Required Inspections' '
owner of property Who builds or improves thereon, and who does such work himself
10 4 -
RE BAR
or through his own employees. provided that. such improvements are not intended or
- _
' .-offered for -sale. If, however, the building or improvement is sold within one year of
105 -
ANCHOR_ BOLTS •-
completion, the owner -builder will have the burden of proving that he did not build or
improve for purpose of sale.).
106 -
SEWER & WATER
-
❑ 1, as of the property, am exclusively contradicts with licensed contracctors to
2 02 —
UNDERFLOOR -PLUMBING - ,- ": i � , . •� . -
construct the project (See. 7044, Business and Professions Code:) The Contractor's
License Law does not apply to an owner of property who builds or improves thereon,
203 —
UNDERFLOOR MECHANICAL
Ani contracts for such.projects with a.contractor(s) licensed purt;aant to the
2 04 ' —
UNDERFLOOR -FRAME
Contractor's License Law. ,
❑ 1 am exempt under Sec. . B &•P C for this reason
205 -
UNDERFLOOR INSULATION
Owner Date
301 -
ROUGH PLUMBING
• WORKER'S COMPENSATION DECLARATION
302 —
TUB & OR SHOWER
I hereby affirm under penalty of perjury one ofthe following declarations:3
0 3 —
ROUGH MECHANICAL
❑ 1 hart and will maintain a Certificate of Consent to self -insure for Worker's
304 —
ROUGH ELECTRICAL
Compensation. as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
305 -
FRAME
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
•work
3 0 6 —
HOLDOWNS
3700 of the Labor Code, for the performance of the for which this permit is
307 —
INSULATION
issued.' y Workers'Compe ation Insurance carrier Policy number are:
.,, .. , r... , , . . .��_. //ttA,+�?
4
308 -
SHEETROCK .
Carrier. olicy No.: 1
�jO—I--
TIFICATIONOF P710NFROM 'WQRKEIiS';
30'9 ' `
EXT-E`kIOR LATH
• STOK INSURANCE'
310.--- -INTERIOR,- LATH:
'(This section need not be comp ted if the permit is for one hundred dollars
311 —
SCRATCH COAT
($1000i
313• —
ROOF •NAIL._
I'tenpl that in the performance net s work for which this permit a Drikere
shall not employ any, person in any manner so as to become subject to the Workers
501 —
F I NAL ELECTRT CAL''ENERGY'
compensation Laws of California. Date
Applicant- .•.�' .' .._ - :-_.
502 . —
FINAL PLUMBING ENERGY
NOTICE TOPpbCANr: 1(, after making chi's Ceni(icaie'o(ExempGon, you should
503 —
F I NAL ME CHAN I CAL ENERGY
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit sha11 be deemed revoked.
504 —
FINAL. -BUILDING ENERGT,,
CONSTRUCTION LENDING AGENCY
505 -
F I NAL ELECTRICAL
I hereby affirm that there is a conscuct on lending agency for the performance
ofth6 work'Tar it illi this permi6s issped (Sec. 30975 Civ. C.)
506 —
GAS TEST "
.. .. .. ..._. .
. _
507 —
FINAL PLUMBING
Lender's Address
508 —
F I NPaL MECHANICAL
I certify that 1 have read this application and state that the above information is
state law
cored• I agree to comply -with all city and counry.ordinances arid s relating
509 -
F I NAL GRADE
I to building construction, and hereby authorize representatives of this city to enter upon
510 -
FINAL PLANNING
the above-mentioned property for inspection purposes.
. (%`iTigree io sane: inder&ify and keep harmless the City or Cupertino against
514 —
FINAL PUB I C WORKS t
I liabilities, judgtnentt, costs and expenses which may in any way accrue against said
i City in consequence of the granting of this'permit
\[I ' .
APPi U?DERSTA�DS A`ILCO,Y tN -P
ssued by:
Date
SOURCEREd`s.' _
signatuiepfAp cant/fiohlrado �'.. '.'. ..Da „
'
Re -roofs '
• - HAEAR500SM'A`-ERIALsDISCLOSURE' -
' ii'the oplitni'otfttaebtildag octvpam store dr'haadle hazardous material
Type of Roof-
�ass defined by,the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety
'
Codc Section¢5532(a�? ;..,,--
❑'°s' '
All roofs shall be
inspected prior to.any roofing material being installed-
Will the applicant or fume building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
emit jtazardous air contaminants as defined by the Bay Area Air Quality Management
District?
all new materials
for, inspection. Applicant understands and will comply with
oyeS' ire
all non -point source
regulations.
. I -Have read the hazardous materials requirements undei Chapier'6.95 d the
California Health & Safety Code, Sections 25505.25533 and 25534. 1 understand that
if the'ltdilding Apes not. mnily'haye afepattt. that it is my responsibility to notify the
gccuparjt of the regwrefttents %Vch bi'tisr.bt' met prior tb issuance a Curti nate of
b0ceiY_ Q
Signature of Applicant Date
All roof coverings to be Class `B" or better
r or an nonzed agent te.
OFFICE