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04060189 _awjw CITY OF CUPGRTINO 1�"�� + i^ ' ' `"" �" "'°' BUILDING DIVISION P).ERNO ��l�I,T12ACTQR ZNFORM BU I LONG ADDRESS: m PERMIT NO. IXZIBIT 04060189 % 0 'R-12 OWN RAM PERMIT ISSUE DATE tk PHONE: a SANITARY OL NO. BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH too LICENSEDCONmtACTOR'SDECLARATION Job Descri tion y F 1 hereby affirm Thai 1 am licensed under,provisions of Chapter J(comencing p <2 to n wort Section] put DivisionJof the Business andP O s Code.and my lmicenm;s in full To a deflect, f�f L; nse ue.g_ / �� ADD 345 SQ. FT . FOR BEDROOM Z—w Da¢ Contractor— ARCHITECTS ontractor f Y ) t 121 T Ya— AR HITECPS DELLA O--�Nr—a,—w—�-r—� Y3i crsmmd my plans shall fire used as puldaq r �aU 3 G G Licensed Professional g OWNER-BUILDER DECLARATION 1 hereby affirm Nm 1 am exempt from the COntrrcmYs License Law far the 0O followingmason.(Section]!131.5,Business and Profasiom Code:Any city or county K w which requires a permit to consumer,alter.improve,demel;xh,or mpab any structure ' 2 prior m its issuance,also requircs The applicant forsuch permit,file axigned statement csja that he is licensed pursuant To the provisions Of The Contracmrs License Law(Chapter 9 Sq. Ft. Floor Area Valuation �FG (commencing with Section]WD)of Division J of(be Business and Profnssims CMG)of to that he is exempt decipher and Ne baso for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit wbiees me applicant n a civil penalty of APN Number Occupancy Type not mos Than five hundred dollars($500). I,as owner of the pmperzy,or my employees with wages as Meir aide compensation. will do the work and The somehow is not intended or offered for sale(Sec.]oaa,Bnximxa 35912025 . 00 and Pmfcuians Code:The Conmcmts License dos not apply m an owner sir Required Inspections property who builds or improves theuoq and who doessuch not m work or offered own a however. the that r suchent is cold wit arc net intended m paved foe alft.own r- builder.me M1uil The or improvement is old,;min one yea or completion,the purpose of builder will haw me burden of proving That he did not mild or improve for purpmc Of tile.). ❑I as owner or me property,am exclusively confessions with licensedsummationm / comma the es not (Sec.]Baa,Business and Professions ds or The Contractor's rad C c Taw dors not apply IO et owner of proper(who builds or improves thereon,end whonse"contents for such projccs wireaconmanor(s)liccnutl pursuant To Thc Contracmr's Liccnu Law. I am exempt antler Sec.' .Bk PCfor this..on Owner Date TIO WORKER'S COMPENSATION DECLARATION 1 hereby afnon under penalty of perjury orc of The following declarations: C1 Than and will forbyneCerir3ate7M of me Laboent tor self for The Wmkefance Of e urian,az provided for by Section Poe of The Tabor Cotler far Tho peAonmamw of Nr. work for which this permit is issued. I have and will maintain Worker!Compensation Insurance,az required by Section 3?BD of he labor Code,for The performance of The work for which This remit is issued. My Worker's Compensation InsuraCiAiNdnce earner and Policy number are: Cay Po gy lgcer& E TI ATEO In E%EMIOR KW COMPENSATION INSURANCE (This unite seed not tecomplemd if ftr permit is fon One hundred dollars($100) or it.) 1 cert fy that in the performance of the work for which This Permit is issued,I shall net employ any Personany manner ser az to hccomc subject To The Workers'Compensation Laws Of Californiate Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the"hot Code,you mum ,J O forthwith comply with such provisions m this petmh shall be deemed revoked. Z" CONSTRUCTION LENDING AGENCY I hwrehy affirm That There i...prowction lending agency for NC performance of C The work fur which this pvmit is issued(See.309],Co.C.) W Leader's Namc 7 z Lmaier's Address U p 1 certify That 1 haw read This application and gate mat the.bow information is U,E circa l agree to comply with all city and county ordinances and sum laws aiming TO 1 �C) building conxuuction.and hereby aumodae representativts or This city To cmer upon the W about-mentioned property for inspection purposes. (We)spec To saw,indemnify and keep harmlcas in.city of Cupenino againa I,T liabilities.iudgmcnu,COSTS and expenses which may in any way accrue against said City C.)z APPLICgANT UNDERSTANDS ANDrWILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. -' ' '-rj - Re-roofs ler.Of Applican✓Cunotob r Date / HAZARDOUS MATERIALS DISCLOSURE Type of Roof /,d Will The applicant or future building Occupant store or handle hara sous material defined by The Npenom MunJ third Code.Chapter 9.13,and me Healthand Safetyde.SeNon25532(a)? Y, All roofs shall be inspected prior to any roofing material being inst ❑Yes 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 emit h.aardnus air contaminants is defined by tic Bay Area Air Quality Management all new materials for inspection. District?mi? ❑Yes t'INu I haveendCa err usmaterials5533=dcnsunder Chapter thatirtimthe building n;a Health er Saftly haw.tecdmshat it i my r and255ba.1 un corny t c Occupant building da.not curcntly naw a tenant that it is my esponzibiliTY m noufY�aeupann of The require cowhmch ys)» met normisseameofaCcolmnrarxmz e Signature of Applicant Date ownmorauthori.mapem Date All roof coverings to be Class "B"or better AUG-04-2004 14:00 MARK THOMAS CUP 4082535173 P.01i02 DRQ~`gyp SANtTgq�.lox DISTRICT MANAGER-ENGINEER > S BOARD OF DIRECTORS MARKTHOMAS&COMPANY,INC. WILLIAM A.BOSWORTH DAVID E.ROSS DR.JOSEPH F.BROWN % JOHN M.GATTO DISTRICTCOUNSEL elf, (tSNEp �p`a CURTIS B.HARRISON ATKINSON•FARASYN,LLP HAROLD S.TOPPEL 20839 STEVENS CREEK BOULEVARD,SUITE 104 WENDELL H.KERB,JR, CUPERTINO,CALIFORNIA 950142154 (408)2537071 PHONE 0 (408)2535173 FAX August 4, 2004 File: CSA—MOP Building Dept. —Cupertino Community Development Department—Building City of Cupertino 10300 Torre Ave. Cupertino, CA 95014-3202 REVISED 8/4/2004 Subject: Residential Addition-Approved (Submittal No. 2) �q Name: Chung Residence A(� r®�� Address: 10152 Barbara Lane ( or Issuing APN: 359-12-025ulldjn Control/Plan Ck No. 13321 Permit No. 04060189 g Plumbing Permits The Cupertino Sanitary District has reviewed the plans for the subject project: AN Sanitary sewer is available and the existing building is connected to sanitary sewer, see conditions/requirements listed below. The following Conditions/Requirements are made: • Videotape Inspection of the existing/new Cleanout, Point of Connection and Street Lateral is required prior to passing The City of Cupertino Final Inspection. Owner to call District 48 hours prior to video inspection to schedule a District Inspector. • An approved Backflow device is required, Storm water from surface or roof drains, other general surface runoff water or condensate from any residential HVAC equipment shall not be discharged to the sanitary sewer. SUPPLYING SANRRIY SEWERAGE SERYIcES FDR: CITY OF CUPERTINO, PORTIONS OF THE(ITHS Of SARATOGA, SUNNYNLLE, LOS AITOS AND SURROUNDING UNINCORPORATED ARRAS WWW.cup elfin DSGn 11GYydltill c1.cam AUG-04-2004 14:01 MARK THOMAS CUP 4082535173 P.02i02 Subject: Residential Addition Approved(Submittal No. 2) Page 2 Name: Chung Residence Address: 10152 Barbara bane APN: 359-12-025 Control/Plan Ck No. 13321 Permit No. 04060189 Yours very truly, MARK THOMAS & COMPANY, INC. District Manager-Engineer C44k�� By David E. Ross a CHB: HJP If you have any questions or need additional information, please call Hayde Pacheco or Carl H.Beckham at 408-253-7071. cc: Jeff Ingram, Engineer TOTAL P.02 NOV-17-2004 15:53 MARK THOMAS CUP 4082535173 P.01i01 S1LNIT4ippo'�� DISTRICT MANAGER ENGINEER BOARDOF DIRECTORS MARKTHOMAS&COMPANY,INC. WILLIAM A.BOSWORTH DAVID E.ROSS DR.JOSEPH F.BROWN DISTRICT COUNSELF,r JOHN M.GATTO ATKINSON FARASYN,LLP >4 ISNEO tip' CURTIS B.HARRISON HAROLD S.TOFFEE 20933 STEVENS CREEK BOULEVARD,SUITE 104 WENDELL H!KERR,JR. CUPERTINO,CALIFORNIA 95014-2154 (408)2537071 PHONE 6 (408)2535173 FAX File: CuSD-MOP Building Dept. -Cupertino Community Development Department-Building City of Cupertino 10300 Torre Ave. Cupertino, CA 95014-3202 Subject: Residential Addition/Remodel Name: Chung Address: 10152 Barbara Lane APN: 359-12-025 Permit No. 04060189 ■ Irdeotape and Property Lane Cleanout inspected No additional conditions/requirements by the 0 Inspector: .........George Santos................................ ... Date: ,C�,1 ...11/ 17/04..........:!:x,1.... Sanitary Sewer location: cc: Homeowner SU/PLYING SANITARY SEWERAGE SERVICES FOR: CITY OH CUFERTINO, PORTIONS Of THE (]TIES Of SARATOGA, SUNNYVALE, LOS ALTOS An SURROUNDING 11NINcomntEO AREAS www.C voe rrinos o nira rydis Eric I.RDm TOTAL P.01 City of Cupertino ' (Q Plan Check Transmittal Permit# 04060189 Control# 13321 Project BEDROOM ADDITION Plancheck# 1 Address 10152 BARBARA LANE FileDate 6/22/04 Owner CHUNG Description Plan Check Status (attach comments and return to Building with pian set) Plan Dept check# Date Due Date Staff Comment Date App-jLaval7 BERRYMAN 1 6/22/04 7/6/04 BERRYMAN Planning 1 6/22/04 7/6/04 c 2 Fire 1 6/22/04 7/6/04 Sanitary 1 6/22/04 7/6/04 ❑ Assessor 1 6/22/04 7/6/04 ❑ Additional Plan Check Fee ❑ Hours Planning Fees Housing Mitigation Fee Amount Heart of the City Specific Plan Fee Amount City of Cupertino «l Plan Check Transmittal Permit# 04060189 Control# 13321 Project BEDROOM ADDITION Plancheck# 1 Address 10152 BARBARA LANE FileDate 6/22/04 Owner CHUNG Description Plan Check Status (attach comments and return to Building with pian set) Plan Dept check# Date Due Date Staff Comment Date Approval? BERRYMAN 1 6/22/04 7/6/04 BERRYMAN ❑ Planning 1 6/22/04 7/6/04 D Fire li 6/22/04 7/6/04 Sanitary 1 6/22/04 7/6/04 ❑ Assessor 1 6/22/04 7/6/04 ❑ I Additional Plan Check Fee ❑ Hours Planning Fees Housing Mitigation Fee Amount r Heart of the City Specific Plan Fee Amount 51(lam CITY OF CUPERTINO CUCITY TYOF O PERMIT APPLICATION FORM " APN# ; — 025 O2S Date: 0 (o 122- 10Y BuildGing A dr s Mailing Address (if different from building address): I Owner's Name: Phone #: r . Chufn J -e -3b -3 CS Contractor: License#: la 2?,ee ontact: Phone: b$• bl-095C Cupertino Business License#: kAULY= L e Fax: p 7-gq`llIA-Z-1 BI T Building Permit Info: I�60m N On — 'rOO YY) Bldg Ele Plumb ZG � Mecir_� Job Description: Residential F1, Commercial ❑ Sq.Ft. Floor Area: f \ F L $/Sq.Ft.: li'I OO/Sci • F T• Cost of Project: S 000 1 Occupancy Group: 7roj oConstruction: Please check this box if the project is a1 �10 second-stor addition: ED ect Size: Standard Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1 M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILERS 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 <= IOOOA ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 ofIf � , / 04060189 10152 BARBARA LN � RESIDENTIAL ADDITION (345 SQ.FT.) (plans missing) FINALED 11/22/04