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09010132 CITY OF CUPERTINO �� 7 7��I��Yw';. BUILDING DIVISION PERMIT PERMIT NO. POWNER'S ADDRESS: ngni n1 '12 1 BA T TH B plfftMTfISSUE°ATE NAME: ow Be 9 A CONTROL NO. 7 408) 370-3 5 3 5 BUILDING PERMIT INFO ARCHI7ECT/ENGINEER: BLDG ELECT PLUMB MECH 0 ad C LICENSED CONTRACTOR'S DECLARATION Job Description UI hereby affirm that I am licensed under provisions of Chapter 9(commencing z with Section 70(10)of Division 3 of the Business and Professions Code,and my license is RP LC WATER HEATER, 1ST F LR n'O a-in full force and effect. Lic 8 'a? License Class Date Contractor ARCHTCECTS DECLARATION -� l understand my plans shall be used as public records gyri O rn Licensed professional OWNER-BUILDER DECLARATION 'r from the Contractor's License Law for the 1 hereby affirm that I am exempt p O following reason.(Section 703 1.5,Business and Professions Code:Any city or county 9 which requires a permit to construct.alter,improve,demolish,or repair any structure $ Ft.Floor Area Valuation y"w prior to its issuance,also requires the applicant for such permit to file a signed statement –^< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $975 YF=-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type Section 70315 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($50o). 32611092 . 0 0 0 1,as owner of the property,of my employees with wages as their sole compensation, Required Inspections will do the work and the structure is not intended or offered for sale(Sec.7044,Business and professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,Provided that such improvements are not intended or offered for sale.If. however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ;X L as owner of the property,am exclusively contracting with licerhsed contractors to Eonstmct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and, who contracts for such projects with a contractor($)licensed pursuant to the Contractor's License Law. B&P C for this reason 0 I am exempt u er Se Owner '>� Date WO CER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code.for the performance of the work for which this permit is issued. My Worker's Compensation insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (chis section need not bo completed if the permit is for one hundred dollars($100) or less) I certify that in the performance of the work for which this permit is issued,)shall not employ any person in any manner so as be come a ct to the workers'Compensation Laws of California ant r/ ois a Data Applic NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ',Z forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY E-r�.,,•, I hereby affirm that there is a construction lending agency for the performance of (:i> the work for which this permit is issued(Sec.3097,Civ.C.) W QL.endees Name a. Lendees Address I certify that 1 have ad this application and state that the above information is LUL� re cored 1 agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes a (We)agree to save,indemnify and keep harmless the City of Cupertino against hFo liabilities,judgments,costs and expenses which may in any way accrue against said City Date �s— U Z in consequence of the granting of this permit ►� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: sovR uLATiN}�s, i .�"/0 Re-roofs Signature ofAppli t/Contractor Dare T of Roof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Cade,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. 0Yes JXNo 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 all new materials for inspection. .it hazardous air contaminants as defined by the Bay Area Air Quality Management ..Zrict? Yes �No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if to building docs not currently have a tenant drat it is my responsibility to notify the occupant of the Signature of Applicant Date requiremc which t be met prior to issuance of a Ccrificatc of occupancy.J d- �` All roof coverings to be Class'R'or better Owner or autha .ed agent Date CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: Patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 32611092 . 00 DATE ISSUED. . . . . . . : 01/30/2009 RECEIPT #. . . . . . . . . BS000007078 REFERENCE ID # 09010132 SITE ADDRESS 10701 BAXTER AVE SUBDIVISION . . . . . . . CITY LA IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : LYNN TANG & KAINING WANG ADDRESS : 10701 BAXTER AVE CITY/STATE/ZIP . . . : LOS ALTOS CA, 94024-7410 RECEIVED FROM • ' : RICKING PERKINS LIC # 22605 CONTRACTOR . . . . . . COMPANY SOUTH BAY PLUMBING ADDRESS 441 N CENTRAL AVE STE 3A CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE (408) 370-3535 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC- --NEW-BAL- _ ---- ---------- 1BCBSC VALUATION 975 .00 1 . 00 0 .00 1 . 00 0 .00 1BSEISMICR VALUATION 975 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1PPERMITFE FLAT RATE 1 . 00 40 .79 0 . 00 40 .79 0 .00 1PRWHEATR UNITS 1 . 00 24 .48 0 . 00 24 .48 0 . 00 00 1TRAVDOC FLAT RATE 1 .00 40 .79 0 . 00 -----40_79 -- ----0_ TOTAL PERMIT 107 . 56 0 . 00 107 . 56 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ------------ --------------- -- CREDIT CARD 107 . 56 MC --------------- TOTAL RECEIPT 107 .56 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- -------------------- -------- ---------------- -- 518 WATER HEATER 0o oI3,� CITY OF CUPERTINO .: WATER HEATER Of CUPEIiTINO PERMIT APPLICATION FORM APN # Date: Building Address: /070 / qllo24' Owner's Name: Phone #: _ �t717 "d �i�7 �V teve - 73ZY T,(�J 9 �� Contractor: Phone #: 11oe3 70_ 35-35 S-cai-h A P��/�9 Fax #: o a - Cupertino Busi ess License #: Contractor State License #: Contact: Phone #: t 5-0 G� .�e Fax #: Building Permit In Bld ❑ ElecMech Residential E3/,- Commercial ❑ Job Description: Strapped tj On Platform Bonded New Location ❑ Replacement Valuation (cost of project): Project Size: Express � Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Green Building Points achieved: Revised 01/07/09 CITY OF CUPERTINO -: WATER HEATER VRCUPEfCITY�TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Permit Type Group 1 PCWHEATR Commercial Water B PCWHEATR HeaterNent 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICOM Seismic Commercial B 1PRWHEATR Residential Water B PRWHEATR HeaterNent 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1 PPERMITFEE Plumbing Permit P 1TRAVDOC Travel & B Documentation 1 BUSLIC Business License B -ResDurres Energy 'P M.indoor Air Quality and Finishes 1.Use Low/No-VOC Paint 1 IAQ/Health pts y--yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y--yes 0 3.Use Low/No VOC Adhesives 3 IAQ/Health pts y--yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts yryes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 6IAQ/Health pts y--yes 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y--yes 0 7.Seal all Exposed Particleboard or MDF 4 IAQ/Health pts y---yes 0 B.Use FSC Certified Materials for Interior Finish 4 Resource pts y--yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y--yes 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y--yes 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts yeses 0 2.Use Rapidly Renewable:Flooring Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y--yes 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 i 1 1 Total Points Available: 1401 130 57 Total Points Project Received: -0 01 0 G:daWProg i�res sl nbuilcgngguidefinestr amodelerslgreenpointsfinal2.1204protectedxls Community Development :... 10300 Tone Avenue ,{ Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ';UPEkTINO Buildin De artment JOB ADD 11 /'0 7`, a.X PERMIT 0 d Z'0_5tis C 9 OWNER'S NAME: w Tan `1? PHONE # Dom" GENERAL CONTRA TOR: FAX # C�rrtr ct t^phartP- ; 40 0-3"?^° I am not using any subcontractors: Signature Date Please check a licable subcontractors and complete the follow in 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 36) deo r/ on actor Signature Date