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05100037 (2) CITY OF CUPEWHNO BUILDING DIVISION PERMIT CONTRAC,TORJNFORMATIO,N BUILDING ADDRESS: DANIEL SHIAO & ISABEL TSE A4RNO'05100037 10095 BRET AVE OWNER'S NAME: PERMIT ISSUE DATE DANIEL IAO & ISABEL TSE G10095 BRET AVE 10/10/2005 NE: SANITARY NO. CONTROL N0, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 5 0 z LICENSED CONTRACTOR'S DECLARATION U C I hemby affirm Our I am licensed under provisions of Chapter 9(commencing Job Description b with Section 7M)).f Divicim 3 of the But..,and Pmfecviane Code.end my lice..isfT ra y infuRfrom and affect. ADD WINDOWS/PATIO DOOR�(tGRANNY UNIT) j ? License Class Lic.x n�,p Data Contractor lye 'J` ARCHITECTS DECLARATION w, 1 undersand my plans shall be used as public mcords .°pr^ Licensed Professional > OWNER-BUILDER DECLARATION nr.� ya• LD1 hereby affirm Nat I am exempt from the Contractor's License Law for she fyy�(Jry4r r ,.r.j' 7 Co following matem.(MScctim 7031.4 Business and Professions Code.Any cit .1 manty � ���t r•Ptd f. 2148 S aro Y. which m utm5 a emit m eOuSuact,niton improve,demdiFh,nr ifair anyStructure yZi p(IarmilS iII4anCe.alsu¢yuires the applicant(arauch peemitta flcalignedaldlemcnt map N I1. < that he is licensed pursuant In the previsions orOcComessi 'sLimnselaw(Chapter 9 Sq. FL Floor Area s' Valuation yI (commencing with Section 7000)of Division 3 of the Business and Professions Cook)or U it Nat he S exempt therefrom and the basis for Ue alleged exemption.Any violatian of Section 7031.5 by srry,applicant for a permit subjects the applicant to a civil penalty of Occupancy Type nos mom than few hundred dollars(1500). ❑has owner of dr pmpvny,or my employm with wages u their mle mmpenmion, will do thework•and the sometime is nos intended oroRered foraale(Sec.7064,Businm and Professions Codi The Contractor's License law does not apply to an owner of Required Inspections property who builds orimprovns thereon,and whodoessuch work himself or through his own employees,provided that such impmmmcnks arc not intended mattered forsele.IL however,the building or improvement is told within one year of completion,the owtmr. builder will have me burden of moving Nat he did Out Wild or impmve for purpose of sale.). ❑1,as owner of She propeny,am exclusively confuting with licensed mnuecors to construct the project.(Sec.7064,Business and Professions Cade:)The Contractor's Li. cents law does not apply o an owner of property who builds or imposts thereon,and who contracts for such projects with a contraam(s)licensed pursuant to the Confacots . License Lew. ❑ Tom nemp(t�Ylnd'er Sec. .B&PCfar Nis roomy Owner ` -a'�_! Date "(W, ai J WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: - J I haw and will maintain a Cenifnrt of Consent.self-imam for Wohers Compere si sion,as poviEad for by Section 3700 of Use labor Code,far the pteff..nm of tbe work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,as mquimd by Section 3700 of the labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance canner and Policy number am: Canoe Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu scNm recd at be emoplemd if tbe permit is fmonc hundred dollars(110() Or less) 1 minify the,in the performance of 00 work for widen this permit is issued,l"I nos employ any Person in any manner.p u toomisubje,t o U¢Workeri Compensation laws of Califomm Dao J Applicant //! f NOTICE TO APit AW:I,a(rer making this CvniOcaM of ExcmPnion,you mould become subject to the Worker's Compensation provisions of me labor CMa,you must ,J O fonlewith comply with such provisions or this Permit shall be deemed revoked. ^ CONSTRUCTION LENDING AGENCY �-.� Ihumbly affirm that them is a consuuNm lending Spec,liar Ue performance of rL 7 the work(or which this Permit u issued(See 3M.CO.C.) W Q lander'.Name =z L<naera Aeert4a O Q 1 certify that 1 have read Nis application and sat.that 00 above informauun is LL E-' correct.I agree Or comply with all city and county ordinedees and state laws misting to O building convection.and hereby amhorim representatives of this city to enter upon me Wvny above-mentioned pmpfor inspection purposes. (We)agree o save,mri m ify and keep harmless the City of Cupertino against Z in consequence of dm granting of this permit. „Fyh Iiabiliies.judgmcnts,casts and expo cnswhich may in any way accrue against mid City O ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOUryCEJUEGULATIONS. _ ��/L4_Z l °%S Re-roofs E4 Sig awrc of ApplicaH user Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant ser future building Occupant stow2.handle Health add az dc0ncd by the Cupertino Mu iciPat Code.Chapmr 9.13,antl fbe Health and Safety ode.SccYes 35532(a)1 All roofs shall be inspected prior to any roofing material being installed. ❑Yes Nu 70wncWill 0.apphcan,or, future Wilding..,of u.equipment or dcAms which If a roof is installed without first obtaining an inspection,I agree to remove r nit Im.n us air contaminants as divined by UM Bay Area Air Qualify Management all new materials for inspection. istrito ❑Yes 1, Nu 1 have read the hanhhers materialsmquimmenm under Chapar 6.95 Oldie Calrar- OHm1m h Safely Code,S ''ions 25X1515533 and 35534.1 undersand Out if the wilding rs not currently haw a Mount Out it is my responsibility to m my the Occupant of the quimmcnss which must ey met art issuanceofa Cerufcaoof Occupancy. r Signature of Applicant Date 111A `� re,k-`e�S' All roof coverings to be Class "B" or better a authorl'rad, I Oaa: Community Development ' ;J- 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEt�TINO Building De artment JOB ADDRESS: ppgs Bret AvL PERMIT # cupey-b,no, Sol q, 6).g-100D 3 7 OWNER'S NAME: I Oom"ef8 15; -( ; o PHONE # qbS 9,73- o4i-3-P GENERAL CONTRACTOR: FAX # X08 773 -oe�43a' I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 60 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 AW Tile Owner/Contractor Signature Date 06i rEb CANOPY lox CAR F>6WT ye12�9 14 "V41( L—T Fill" T T s'l Te Oki PA -L.'j 906 9 -!a 04 Ii EY1-3T1NC=i 1 WIMPOW ... ........ . ...... 45fx 4?i Aja C o5 ----- ------- ..........- it '0 &)aw i9 -D-b ----------- r� ...... ._ J�I ' 1` 1 '� I I I ! f I ! '✓ �' I �! ! 1 I. I I j �' � � ';-F d- , -'� I � I I I I i 1 I ..........- �. � _f L__-t ... ' � .�-_ "j` �_'�f•__-I I r..._ { __ I I ! r LEL P_- tit Tliti ELE-VAT(OU >Aj ---------- -- ...... ...... El- eA-7K.F tr­ T.- J- J_ OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform: ® A. All 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. 2. A state licensed contractor will be hired to do: A. _ All of the work B. A portion of the work (complete section below) Contractor Address/City Phone # State License # Type of work to LSG G11 V13Y3Cv 3. _ 1 will utilize unlicensed person(s) other than my immediate family to perform all or ® portions of the authorized work. I understand that I may be 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: lel/J U Date: (°%°r4sy Job Address: (oo l� f3Yet &e CcAfLey teno C/� 9S��f{ Permit# Any chances to the information provided on this form shall be submitted to the City of Cupertino Build Department. City of Cupertino Building Department CITY OF 10300 Torre AvenueAft C V P E[?T I N O Phone: (408)777-3 Dear Property Owner. An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner-builder you are the responsible party of record on such a permit Buildingpermits are not required to be signed by property owners unless they are personally performing their own work If your work is being performed by someone other than yourself,you may protect yourself from possible liability if that person applies for the proper permit in his or her name. j Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work,with the exception of various trades that you plan to subcontract,you should be aware of the following information for your benefit and protection If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as contractors or subcontractors,then you may be an employer. If you are an employer,you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes,workers' compensation insurance,disability insurance costs, and unemployment compensatiore contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers compensation insurance. For more specific information about your obligations under federal law,contact the Internal Revenue Service (and,if you wish,the US. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale,property owners who are not licensed contractors are allowed to perform their work personally or through their own employees,without a licensed contractor or subcontractor,only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder building permit,erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street,Sacramento,California 95814. Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, City of Cupertino • Printed on Recycled Paper CITY OF CUPERTINO �m 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 5 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 37511023 . 00 DATE ISSUED. . . . . . . : 10/10/2005 RECEIPT # . . . . . . . . . 31536 REFERENCE ID # 05100037 SITE ADDRESS . . . . . : 10095 BRET AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : DANIEL HSIAO & ISABEL TSERNG ADDRESS . . . . . . . . . . : 10095 BRET AVE CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : HUAH-YEU TSERNG CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : DANIEL HSIAO & ISABEL TSERNG ADDRESS . . . . . . . . . . : 10095 BRET AVE CITY/STATE/ZIP . . . . , TELEPHONE . . . . . . . . : 40FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---- ---- - - - - -- ------ --- ---- BENERGY PERMIT FEE 83 . 16 39 . 92 0 . 00 39 . 92 0 . 00 BPERMFEE VALUATION 2 , 148 . 00 83 . 16 0 . 00 83 . 16 0 . 00 BSEISMICRE VALUATION 2 , 148 . 00 0 . 50 0 . 00 0 . 50 0 . 00 TOTAL PERMIT 123 . 58 0 . 00 123 . 58 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER - -- --------- ------------------ . OTHER 123 . 58 M/C TOTAL RECEIPT 123 58 • C CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM n 7CUPE TINO D 6" N # s— Building Address: Mailing Address (if different from building address): 0o 5 Ye' A✓e_ C 1 Owner's Name: / _ Phone #: Q � 6 Yn Contractor: License#: vr/1 eta Contact: Phone: Cupertino Business License#: Fax: Building Permit Info: (� .Bldg Elect ❑ Plumb ❑ Mech ❑ Jobescriptio add 4 W.', dowS 9 1 pc,-C-o dDDY o 9 aannys oouQ✓ e rear Residentialyet ycl- Commercial ❑ Sq.Ft. Floor Area: 5� q.Ft.: Cost of Project: FN Occupancy Group: Type of Construction: Please check this box if the project is a mO�Pt' second-sto addition: ❑ *r: ect Size: Standard 1 Lar e ❑ Ma'or ❑ 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 WF Is- 1 of 3 Y� CITY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEI�TINO -Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING IMF BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum . PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE PbIg 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 StomVRain 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 clm MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfrn MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Fumace> IOK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE PoWPlatform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT R air/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 t CITY OF CUPERTINO CUP TYOF O PERMIT APPLICATION FORM ► Y QuantityFee 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 BREMVENSYS 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 BTENTSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMHITEE 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 Change BUILDING 3of3