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07050116- PUB LL- Z5 E E a) a) s a ar ) a) E m U IL w v_ 9 s o. CL v 0 a`) p m �ILU ti Vii, �j� �I p 2 U U O Cn Q . � ^i� ::r '�115h {J •1 i:' F,s+'� `a� SIS y�a�# �fii �� a � O a A aJ pq p CD "' v U-) d U w w QLO d CT) HE- 0 F U 0 d W 0 p W o m C3 w b h L] 07 C- �D H J d V Ui p l J F- C U7 U W II II N .--I xiV p `D '-1 C7 O NN O �W LO z CD MW v} `D O U)O a CO CD - z v w N � w x x w r` r o ZD a W C] 4N 'r a l v w r- H T p ILCSD = u = U :5w 14N v '-I W n U m IL _ OL %a) ^aI x� - D Q1 �U � ' a) v' �0 v LO c O m cn _0 Z v -o U QCD I�I LL- U-) 15 o s16 p � -0 U xo O -� {t I— p (D u Z a`�i a�`� v U �a0 < a ,_a a) O 0 0 J c 0o m _is'I ~ a N ,S Idl U t W O LD J L O J CL CD OCD p p 2 0 9 � CO p � CTI Q � i W W O C CQ ' O p p 9 in w L _ LO •� •� O LOLL. J m Q7 O L LO ZZ o o N Z m p 'n 47 Lo CC) co O o O O Cl •�_ x . '^ x ip �a7 a} -0CLp _n xrr 1- a La, p a w o xa o o w v ~ x� a ami v a) ' Li > w p O ^ n < - C C 1P y 05 aJ ID p a) _ Q LY L L p 2 O r0 fo y U U C .0— Q E Q- {n CL Q IL U U U 7 d,1 O C lL �:- W CITY OF CUPERTIN0 BUILDING DIVISION PERI BUILDING DDRESS: PERMIT NO. 1352AS STELLING RD TBD — TO BE DETERMINED 07050116 OWNER'S NAME: PERMIT ISSUE DATE HUANG, REX PHONE: SAM ARY N . CONTROL NO. ARCHITF_C(ENGINEER: BUILDING PERMIT WO BLDG ELECT PLUMB MECH Z LICENSED CONTRACTOR'S DECLARATION ° Job Description F- I hereby affirm that I am licensed under provisions of Chapter 9(commencing p with Section 70(HI)of Division 3 of the Business and Professions Code,and my license is S FDWL/REBUILD HOUSE FROM FOUNDATION UP.COVERED y in full force and effect ? License Class Lie.# PORCH & NEW GARAGE. p Date Contractor ARCHITECT'S DECLARATION --� I understand my plans shall he used as public records a F' Licensed Pmfcssianal w � OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the 00 following reason.(Section 7.031.5,Business and Professions Code:Any city or county which requires a permit to construct,aher,improve,demolish,or repair any structure y 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(Chapter9 Sq. Ft.Floor Area Valuation m (commencing with Section 70D0)of Division 3 of the Business and Professions Code)or $566317 that he is exempt'thcrefrom and the basis for the alleged exemption.Any violation of Section 7631.5 by any applicant for a permit subjects the applicant to a civil penalty of qpN Number Occupancy Type not more man Five hundred donors($soo). 36617108: 0 D p y yp D 1,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered forsalc(Sec.7044,Business and Professions.Code:The Contractor's License Law does not apply to an owner of Required Inspections 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.). qel,as owner of the property,am exclusively contracting with licensed contraaam to ohgtmct the project(Sec.7044,Business and Professions Code:)The Contractor's U. . cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for-such projects with a commctor(s)licensed pursuant to the Contractors License Law. D 1 am exempt under Sec B&P C for this rMcason Owner c ---_ Date 'S MPENSATIQN DL RATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑I have anti 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 Sermon 3700 of the Labor Code,for the performance of the work for which ibis permit is issued. ' My Worker's Compensation insurance carrier and Policy number arc Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION 114SURANCE . (ibis section need not he completed if the permit is for one hundred dollars(SI00) or less.) I certify that in the performance of the work for which this permit is Lssued,1 shall not esmploy any person in any manner so as lIcLcofl$eubbjrc}fo�}mn Workers'Compensation Laws of California.Date �O V��, Applicant _ - � -- NOTICE TO APPLICA �i -,a t aking ibis Certificate o emption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must O forthwith comply with such provisions or this permit shall be deemed revoked. 7 t) CONSTRUCTION LENDING AGENCY �^- I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.C.) a Q Lender's Name +Z Lender's Address ' J Q I cenify that 1 have read ibis application and state that the above information is >~ correct.1 agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorise representatives of this city to enter upon the y ahovc-mentioned property for inspection purposes. y fy (We)agree to save,indemnify and keep harmless the City of Cupertino against y Cn liabilitiea,judgments,costs and expenses which may in any way accrue against said City z in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE L TIONS. � �_®-y 11 Re-roofs Sign tree of kant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type Of Roof 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 Code,Section 25532(a)? Fl Yes LM,.../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 emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? DYcsNo I havetcad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.I undersand that if the building docs not currently have a tenant That it u esponsibility to notify the occupant of the rcquircrpm �m t oracenircatcofOcarsy Signature of Applicant Date Date All roof coverings to be Class "B"or better CITY OF CUPERTINO a NEW SINGLE FAMILY DWELLING CUPFi�TINO PERMIT APPLICATION FORM APN# n De: < � Building Ad ress: Mailing Addre (if different fr building address): Owner's Na e: Phone#: LAowe (409)' 649 4 t 1 O Contractor: p License #: Co tact. 1 ` 1` Phone: �40 4-g Cupertino Business License#: fill Fax: W &b Building Permit Info: ��– S � � f �,p �•[puS-e— Single Story Two-Story ❑ J _L Three-Story ❑ Basement ❑ Sq.Ft. Floor Area: Gay = 2$ /Sq.F�� Cost of Project: ' Cad ofe0) KA Type of,Construction: o �6 Project Size: Standard Large ❑ Major ❑ »�e � yc� ( � Quantity Fee ID Fee Description Fee Group BCONSTAXR Constax–Resi/Mobile BUILDING BELEC1000 Elec 600V <= IOOOA ELECTRICAL BELEC1001 Elec 600V > IOOOA ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL d BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATR Res. Housing Mit Fee BUILDING BOVERTINIE 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 I of 3 Community Development 10300 Torre Avenue Cupertino CA 95014 n Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: i Q� - 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 j Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile �- 7- OwnerjContractorSign e Date