04110009 'CITY OF CUPERTINO w e n '+`"-y"."n A'�� i''urN
BUILDING DIVISION PF. 1�F�,d
PERMIT NO.
aulLDwc ADDRESS: 04110009
PERMIT ISSUE DATE
S NAME:
SANITARY �tkOL NO.
PHONE:
BUILDING PERMITINFO
ARCHrrECT/ENGINEER: BLDG ELECT PLUMB MECH
0 0 0 0
�Z
LICENSED CONTRACTOR'S DECLARATION Job Description
s 1 FacbY affirm mat 1 am IicensM uMcr pmvidoas of pupur 9(commcming
with Swdp�n�7ayf)of Di Sof du Busnesa Profrssions Code.ab myliccn¢o
@d in fonrw iFd ffea n KITCHEN & BATHRM REMODEL
A i Licence CIL£
_i Z Dau Afo _ CONTRACTOR: HITECH CONSTRUCTION
CnLD TION
11undersandroyplanashW
used as records
yU
Licensed Pmfesstoml
n 5 OWNER-BUILDER DECLARATION
I hereby
so efncm that 1son.Bumps from tW Coniators License law for the
p o which. reason.(Section 701.5.caddoj Business and Ne,de ons Code:Any tm On county
$(v which requires a permit m conunw,a@q WPmse.dcmoliah,or repair any swnum
Prier to its issuance.also mquima me applies,for such permit to file a signed statement SFtFloor ea Valn [gyp
this rte is licensed P.M to AMpmvismas of the Contractor.License Law(Chapter9 q. . Ar1.7n000
$ (commencing with Section 7000)of Division 3 ofthe Bminessand Pmfessinns Code)or
that he is uempt fluent m and the,basis far she alleged csempdon.Any violation of
Section 7031.5 by any applicant far•Parmil subjcss Ne appfiam to a civil penalty Of APN Number Occupancy Type
.or more Nan rive hundred&INN,ISSD3).'
❑1.as Owner of the prupony,w my employees with wages as duly sole compensation. 37513007 . 00
will do thewon Cod Ne umuun000ts License
Low ml does out
apSec.1 Dare Business Of Required Ins 'Cu_ 'o9s
tad Profadark COdc: co Contractor's Lion¢Law does not apply man Busin ss q P ctio''1
property who buildsorimprovvs thereon,and who dousuch work himaelfwduough his X
own emplOyeas.provided mar ash improsrsrunu tie not in¢MrL wo0ered fwaWe B.
however,Ne /
Wilding w vnPmsament is cold within arc Xv Of comPledon,the owrcr-d e.s
Wilder will have me burtico of pound,Net he did no,Wild or improve for poryou of {�J✓?//O
sateyy`-jlJ/
1.as owner or the propenY•am eaeludvey connotes,with licensed sarmeanars m
construct Ne project(Soc.7044,Business sad Porle o oas Code:)The Contractors Li-
cense Taw does not apply to an Ownu of pmpenY who Wilds or improves thereon,and,
who comment for awh pmjMm withacom unsAa)licensed personas W the Convectors
f,ittnse Law.
lamesempsusukr Sec .B&PCfor Nismsson
Dau
WORKER'S COMPENSATION DECLARATION
I hereby strum under pensllY of Pony,arc of me following declaration.
IheveandwillmainuinaCertificamofConsenuoeelFinsurtfwWorkeM1Compen-
suion,as pmvided for by Session 37M of doe Labor Code,far the Penfwmance Of me
were for which or.Permit is Issued.
1 have and will maintain Workers Compensation Insunnm.as.quimd by Seedo t
37000f she UINt Codefor the pMWmuuc of the wart for which this pentr t is issued.
My Warkera Compensation Insunsce carrier and Polity number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This rection need not becompleted ifdrc permit is forme hundred dollars(SIM)
W Isss) - -
i candy Not in she performance of the wore for which this permit is issued,I shall not
employ any Pe�o9+n any mentor so as to boomLlmbjees to the Workers'Comlcnandon
taws of Wifdm(a.Dace
Ap i t 0., t_ _ C
N TO APPLICANT:.IL after making Nb Cenifiau of Exemption.you sbouW
Iubjwt a the Works)Compcnuden Provisions a mo tabes Code-you mute
D O forthwith comply with such provisions w No Permit And W deunod revoked.
-�'0 CONSTRUCTION LENDING AGENCY
I Wreby of ton that frt oto comm�ncrine lending agency rue me penfomunm of
Y> Nc work fm which Nis permit is issued(Sec.3097.Civ.C.)
TJ Q Lenders Name `� ,��••
L Lender's Address
0 I ccNfy Nn I have mad Nis application am suis that me aWm infomntion is
Z(••' cortex I agree to comply with all city and county ordinances and suis owe relating to v
D V Wilding construction,aM thereby authorire monjundsom of this city....ion the
„w above-mentioned proPcnY for impeedon PwpOW L
(Wu)agree to ave.indcmnifY and keep harmlasf the City of Cupertino against
y IiaMlidu,judgmenu,ewu and espouses which may fouty way amwagainss cold City
j z in eomequence of Nc Granting of Ads permit
�•' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURIREGULATIONS.
ti Re-roofs
SlLnnurt of
HAZARDOUS
Applicaactor te
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
by
t e Cupertino suni Municipal
C le.Chaptsort .hando h' umaurid
fined by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
.Section 25531(.)? All roofs shall be inspected prior to any roofing material being installed.1P No
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
emir lWeammus air conuminatu as defined by dte Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes 14 Na
I hers mad dm huandmu maurialsrtquirtmenu underCWpur695 of Ne Califor-
niaHealth&Safety Code,Settions 25505,35533 and 15534.1 unMrsund muifine Wilding
does not currently have a censor Nu its my responsibility to notify do Occupant of der
te menuwhich..INmetpriortoissuanceoraCertifcateofOecupancy' Signature of Applicant Date
OwAll Date All roof coverings to be Class"B"or better
• CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp : Rng : Sub: Blk: Lot :
APN . . . . . . . . : 37513007 . 00
DATE ISSUED. . . . . . . : 11/02/2004
RECEIPT # . . . . . . . . . : 27623
REFERENCE ID # . . . : 04110009
SITE ADDRESS . . . . . : 18856 ARATA WAY
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . :
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : KIMOON KIM
ADDRESS 18856 ARATA WAY
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : KIMOON KIM
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
• CITY/STATE/ZIP . . . ,
TELEPHONE .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------ - -- - ------------ - - - -------- ----- - ---- ---------- ---------- -- ------- -
BENERGY PERMIT FEE 223 . 56 107 . 31 0 . 00 107 . 31 0 . 00
BPERMFEE VALUATION 15 , 000 . 00 223 . 56 0 . 00 223 . 56 0 . 00
BPFIXTURE UNITS 9 . 00 81 . 00 0 . 00 81 . 00 0 . 00
BPGAS OULETS 1 . 00 5 . 40 0 . 00 5 . 40 0 . 00
BPLANCHK PERMIT FEE 223 . 56 298 . 34 0 . 00 298 . 34 0 . 00
BPREPIPE NO OF FIXTURE 9 . 00 81 . 00 0 . 00 81 . 00 0 . 00
BPSEWAGE UNITS 1 . 00 67 . 14 0 . 00 67 . 14 0 . 00
BPSEWER SEWER SYSTEM 1 . 00 21 . 58 0 . 00 21 . 58 0 . 00
BPSPRINK NO OF SPRINKL 1 . 00 13 . 19 0 . 00 13 . 19 0 . 00
BPSTORM PER DRAIN 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00
BPTRAP NO OF TRAPS 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00
BELEC200 METERS 1 . 00 29 . 43 0 . 00 29 . 43 0 . 00
BPVENT UNITS 1 . 00 10 . 79 0 . 00 10 . 79 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BPWATER UNIT 1 . 00 9 . 00 0 . 00 9 . 00 0 . 00.
BREMAPPLI NO OFAPPLIANC 3 . 00 21 . 06 0 . 00 21 . 06 0 . 00
BREMFIXT NO. FIXTURES 20 . 00 24 . 00 0 . 00 24 . 00 0 . 00
BREMINHOOD NO UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00
BREMPOWER POWER UNITS 4 . 00 101 . 93 0 . 00 101 . 93 0 . 00
BREMRECEPT NO. OUTLETS 20 . 00 24 . 00 0 . 00 24 . 00 0 . 00
BREMVENFAN NO UNITS 1 . 00 45 . 39 0 . 00 45 . 39 0 . 00
BREMVENSYS NO UNITS 1 . 00 10 . 26 0 . 00 10 . 26 0 . 00
B ISMICRE VALUATION 15, 000 . 00 1 . 50 0 . 00 1 . 50 0 . 00
E MITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
M MITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
- --------- - ------ --- --------- - --- - --- ---
TOTAL PERMIT 1319 . 25 0 . 00 1319 . 25 0 . 00
• CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 37513007 . 00
DATE ISSUED. . . . . . . : 11/02/2004
RECEIPT # . . . . . . . . . : 27623
REFERENCE ID # . . . : 04110009
SITE ADDRESS . . . . . : 18856 ARATA WAY
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . :
IMPACT AREA . . . . . .
OWNER KIMOON KIM
ADDRESS 18856 ARATA WAY
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : KIMOON KIM
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
• CITY/STATE/ZIP . . . ,
TELEPHONE .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---- - - ---- ------------- ------ - - -- ---------- - - - -- - - - - - - - - - - - ---- --- - - -----
METHOD OF PAYMENT AMOUNT NUMBER
- - - -- ------------ -- - - -------- --- -- -------------
OTHER 1319 .25 VISA
TOTAL RECEIPT 1319 . 25
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----------------------------
101 FOUNDATION 102 PIERS
103 UFER 104 REBAR
105 ANCHOR BOLTS 106 SEWER & WATER
202 UNDERFLOOR PLUMBING 203 UNDERFLOOR MECHANICAL
204 UNDERFLOOR FRAME 205 UNDERFLOOR INSULATION
301 ROUGH PLUMBING 302 TUB & OR SHOWER
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
305 FRAME 306 HOLDOWNS
307 INSULATION 308 SHEETROCK
309 EXTERIOR LATH 310 INTERIOR LATH
311 SCRATCH COAT 313 ROOF NAIL
501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY
503 FINAL MECHANICAL ENERGY 504 FINAL BUILDING ENERGY
505 FINAL ELECTRICAL 506 GAS TEST
7 FINAL PLUMBING 508 FINAL MECHANICAL
9 FINAL GRADE 510 FINAL PLANNING
�
14 FINAL PUBLIC WORKS
�ior
OCITY OF CUPERTINOP
PERMIT APPLICATION FORM
•CUPERTINO
APN # Date:
3 1 l )/. 0 z . Z�
Building Address: Mailing Address (if different from building address):
Owner's Name: Phone#:
Kimoon Kivn +Of-. 3` q 16S(69-
Contractor: License #:
�1-;c.v, be-e ( H f-r.C- N coA/9re ,o� t'3 4-Z
Contact: Phone: Cupertino Business License#:
ffJr ck , L-ek- Fax: al- cl1- s
Building qrmit Info:
f
Bldg-6Elect Plumb Mech�
Job Description: 117
Residential ® i. erct ❑
Sq.Ft. Floor Area: j $/Sq.Ft.:
Cost of Project: Occupancy Group:
e of Construction: Please check this bo ' ❑e project is a
second-story addition:
Pro'ect Size: Standar Lar e ❑ 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-ResiNobile BUILDING
BELEC1000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
VV BELEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD --ffn—ergy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
1 of3 Z)/
1 40CITY OF CUPERTINCS
an OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCONOAM 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/Backflo 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 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
�\ BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT _ Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Fumace 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 Ap liance ELECTRICAL
2of3
WITY OF CUPERTINO*
CUP OF TYO 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
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Insection BUILDING
BSV* M 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
1 MPERMFEE Mechanicals . foot MECHANICAL
_ MPERNHTFEE Mech Permit Issuance MECHANICAL
PPERMITF'EE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane _ BUILDING
•
3 of 3
7
SPARK ARRESTER REQUIRED
39'-0" y
7-11' •t' 10'-f0" T_5^ 12'-10" 'lI,
vr.erm rr.rr — —
..r
4
- rn
o m
Tub/Shower
Y CE
6'9 =3 IrdyA¢O�G11t1l0ANC�WITrknTOR At ICES
SD N 00�CtttltJ I' II�6, M
� ' y �,z" SIWv s ecdic� Ir s n
This set of plana nd P as n Is un
ne kept on the job at Oil tim
• w _ O O lawful to make any the g o
b o on same.wdpet wnM i otu Ogino.
ilding
Pt d p,,Aicatons
o the buthis PI
stamping n or, m be Or.
The
' � 3HALL N07 be held to pe
ODProve, of the violation p
�� at anY 0�� 0 2 2004
�e IuCe to Cu 61 vri
N
4C EDI Wobci.
N —
—6'-0• 16'-6"
•
AcW ess 1 eys'b Ara-tc- woL