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06090232OC Z C D] � LL C U ,2 VC U. OF I•" V U2 CITY GF CUPERTINOcep^ Z7�7.. INFORM�TI N BUILDING DIVISION PERMIT CUNTRACTUR IT5•', z. fi. BUILDINGADDRESS: G CONSTRUCTION P 'HTNo06090232 1197 CANDLELIGHT WY OWNER'S NAME: PERMIT ISSUE DATE ft RATHNA QIRI 1060 LYNN WAY 09/25/2006 NE: SANITARY NO. CONTROL NO. (408)396-8184 ARCHITECT/ENGINEER: BUILDING PERMIT INFO PLUMB l� O l� l� LICENSED CONTRACTOR'S DECLARATION lob Description p I Iereby affirm Nat I am licensed under Term u m s of Chopmr 9 (cemmmmir with Section 7000) ofDvision S of the Bual,w and Profemi"na Code, end my Iiaase is REMODEL MASTER BATHROOM NON STRUCTURAL, REMODEL larallrmMandefrect u°—�=Z=cle" $ IXTURE & SHOWER STALL ONLY. COPPER REPIPE Dam Dam= - GSy__CSDECr ARcxrrEGrs DEcuannoN �sqy� ce�iITIRE HOUSE. 1 undcmm�J y plans,hal bFud as u m rtards Limmed Pm 'ane OWNER -BUILDER DECLARATION I lemby am. mat I.. exempt from the Conuactrs Llano Law far sho fallowing mason. (Section 703 1.5, Business and Procidum Code: Any city Of county which requires • permit to consume, shot. relent demolish, Or repair any structure prior Of its issuance, alae enquirer Thu applicant mrsuch permit to file A signed sW(mcH me Contractor', Name Law (Chapter 9 Sq. Ft. Floor Area Valuation that he is licensed innocent to tieprovisions of Sectio" 70D0) of Division 3 of me Busi"etsand Professions Cade) or $7000 (commencing with mat he is exempt therefrom and the basis for the alleged exemption. Any vioudon of APN Number Occupancy Type Secdon 7071.5 by any applicant for a permit subjects the applicant to A civil pemlty of not mom man Ew hundred dollars ($500). 0 1, As owmr of die property, or my employees wish wages As timu sole compensation, D n�D will erthe walk. And did stmclumuOut intended and Professions Code The Conussam's Liame LAW data not apply m an owner of imselredmenu his wiidoesrtdforaale kitime.70at,Bulhhis property who buiWaa improwsth and who ' Ns tiedoroffer-Plemed for le If. AM Muhammad own employe,, provided m imp( sen Muhammad ens ove is To within year own builder mmimprovement4mudwithinoro)earofsumPhtifrtheowrcr- bdlder will haw the buNce of proving mat ba did m, Wild or supreme for purpose of will ole.,. am siness 1. as Owner of the Sec. s Code) TM CContruAMA licensed �rossU ccoonstruct me pmjee, ( 70044. BuAad Professionlusively conte law does rot apply to an owner or progeny whe Wilds or improwa tMauron, and whomnacu for such projects with aconvacmr(U llicenspursuantedpursuanttodue Contractor's m Law. em exempt under See ilio PCfoe Nu mean 0 1BUILDING G Owns, Dam WORKER'S COMPENSATION DECLARATION 1 hereby of an under penalty of perjury om of me following declarations: I have aha will mal Made a Civil fears of Consent in self -imam far Workers Compen- Aadon, as provided for by Section 3700 of the labor Code, fm me performers, Of me work for which this permit is issued. 0 1 haw and will maintain Warkers Comperesdon Insurance, as required by Section 7700 of the Labor Code, for the performance ATOM work for which mi° permit is Wokc. ' My Warhoes Compensation ust. artier and Policy number art: Carrier. . Polley No.: CE FICA OP EKEMPrION FROM WORKERS' ' COMPENSATION INSURANCE (Thu mesion aced rat be completed if the permit is foram b ummeldollm (SIM) or less.) I certify Tho, in the performance of the work for which This permit is Issued, I shall not , employany person in anymanrcraa mhccpmc Pectin mompsmsation Laws ofCaliforni'4WRam�— Applicant NOTICE TO 1PPLICANT&X2ahcr making this CcnlBuam of Exemption, you should become subject to the Workers Compmsadon provisions of the Labor Code, you am forthwith comply with such provisions or this permit °MTI ba decreed ravelled. CONS ON LENDING AGENCY m is a construction lending agency forme performance of I Thereby thi this dem is a e0mwc. Tho work for which @u perms u issued (Sec. 7097, Civ. C.) which 3 Lenders Name IanmrS Add. j I certify that I have mad This application, AM sum that de above infomadun Is ' core". I agree 10 comply with all city and county ordinances and sum laws relating to building construction, and hereby autharim muesenmiva of aha city to enter upno the 1 altove-mentioned properly for inspection purposes. (We) agree la saw. indemnify and kap battles, she City of Cupertino against j liabilida,jadgmenm, costs and expcma which may in my way accrue Against mid City in consequence of the {ranting of this Perms, ' APPLICANT UNDERSTANDS AND WILL COMP Y WITH ALL NON -POINT Issued by: Date NS.� SOU/RCE REGULAMO,il °ZI . Re -roofs '—" Type of Roof off ,°% Signature am HAZARDOUS MATERIALS DISCLOSURE Will the applicant m forum Wilding mcupantamre or handle hazardous material As deOmd by the Cupertino Municipal Code. Chapter 9,11. and the Health and Safety Cam. sedan 25532(a)7 ❑Ya VN. All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building accupam use equipment or device, which emit hazamam air cumeminans As defined by me Bay Arta Air Quality Managcmcnt all new materials for inspection. Dia nct7 ❑Yes No I have mad de hazardous materials requirements under Chapter 6.95 of the Califor. nia Halm @ SAfelyCem, Sectors 25505,15533 um 25534.1 understand Nat ifde building docs nal currently hew A moan, dna, it u my responsibility TO notify de occupant of me requirements which mus, be met ortoisstmmc carf�cmrm of occupancy. �"" Signature of Applicant Date "'��" ` All roof coverings to be Class "B" or better Owner '.ed or ash agent Dam' • • L 130Aroo m Co 4ore>-�: 9�s.5"� 3o• -O ISL oa N cew�a c4q�,- G �r�sf�// 51 a w�- w� // c X:/e) ASSESSOR Copy /J s%iolr�er aa,se X33. X 3 2 -� Xa MYC74 l 5ij o w per-) fiahs9rvii e �iocu er- �a�v�/ .Z �er�a •Q�f/ante s� �er,�o,.ss�;c �— CAcPu•c6ar y� s/i ower c�e or h an s 9roi% .�/l o wer �polNlJi� JL O oe-F%► r o o m PL a N Cor�pe�-f;.vo CA ys�i5� �ti�cj Sa�1 :sem � SEP 26I d.t 2006 • &t u 0 101 �>,t� '/vy�� ✓n�G�m�vt m qd��( �' c 3�� &-V EU l / O n ACCOR AD NCE WITH THE CITY Of SAS a CUPERTINO CODES AND ORDINANCES }� 171514u/I 5//0We)- -1A1,1Ce7 )ATE 4-21=o L 3) !77�S7Ldi�/ cs/! d yUGJ- &41� iIGNED/l.---- l chis set of plans and specifications MUS. j IS741 11 1517 O We - a o" oe kept on the job at all times and it is un 9 lawful to make any changes or alteration, oS�IoGtJe� pet�E �1 X 3 tin same without written permission fron. .he building Dept., City of Cupertino. �au0ef <v�pwpy� rhe stamping of this plan and speaticationc S i�AL of be held to permit ation of y provision, be ar S/]rl^�� s yrol� e OGc� gY �aN�,ff any City Ordm nthe ice or) to taw. ° �( AI IL BQ/an e s7� err�o s is s1� ow a-- X007- . v�ifc,- a roam cnAtl7xe -,-!e ce,71� �i -Kn s f,&-0 -;!%/I 0 `JeJ— /; lAAle,/ .7L 7�/ei-moo �e✓ati« s/' �e�.,a.r,S'C i� CITY OF �UPEkTINO Buil JOB ADDRESS: //" &vey soup OWNER'S NAME: Community Development 10300 Tome Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Department PERMIT # !C�11'1 p6o,gjf-k33'2-, PHONE # r1 SS - 'i 7 GENERAL CONTRACTOR FAX # I am not using any subcontractors: '�-' Signature Date Please check annlicable subcontractors and comvlete the following information: Owner/Contractor Signature Date 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 Owner/Contractor Signature Date CITY OF CUPERTINO orm 1 of 1 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36224054.00 DATE ISSUED.......: 09/25/2006 RECEIPT #........ 36193 REFERENCE ID # ...: 06090232 SITE ADDRESS ...... SUBDIVISION ....... CITY .............: IMPACT AREA ....... OWNER ............: ADDRESS ..........: CITY/STATE/ZIP .... 1197 CANDLELIGHT WY CUPERTINO RATHNA QIRI OPERATOR: amyw COPY # : 2 RECEIVED FROM ....: EUNG SAM SEOK CONTRACTOR .......: ENNG SAM SEOK LIC # 23680 COMPANY ..........: SAM PLUMBING CONSTRUCTION ADDRESS ..........: 1060 LYNN WAY CITY/STATE/ZIP ...: SUNNYVALE, CA 94087 TELEPHONE ........: (408)396-8184 WE ID UNIT QUANTITY AMOUNT BPERMFEE VALUATION 7,000.00 137.16 BENERGY PERMIT FEE 137.16 65.84 BPFIXTURE UNITS 1.00 9.00 PPERMITFEE FLAT RATE 1.00 38.37 BSEISMICRE VALUATION 7,000.00 0.70 TOTAL PERMIT : 251.07 METHOD OF PAYMENT ----------------- CASH TOTAL RECEIPT : • AMOUNT ------------ 251.07 251.07 PD -TO -DT THIS REC NEW BAL 0.00 137.16 0.00 0.00 65.84 0.00 0.00 9.00 0.00 0.00 38.37 0.00 0.00 0.70 0.00 ---------- ---------- 0.00 ---------- 251.07 0.00 NUMBER ------------------ /J CITY OF CUPERTINO 0M 230 --- PERMIT APPLICATION FORM N# 05* V f Fee Group Date: '� G Building Address: MECHANICAL Mailing Address (if different from building address): / d - d —d Owner's ame: BBOILER3 Phone #: t4l AV Contractor: Gi(Yl l,(I)) Boiler > 1M to 1.75 M Btu License #: 7,5-a6?3 Apr Contact: aL .eSGrn Phone: (410 i 39 upertino Business License#: o1 oDCx�S"v Building -Permit Info: BUILDING / Ind/Off/Comm/Quasi / Bldg ❑ Elect ❑ e1(V, Plumb Y Mech ❑ Job Description: Hotel and Motel BUILDING Residential IC' Constax — Resi/Mobile Commercial ❑ Sq.Ft. Floor Area: Elec 600V <= 1000A ELECTRICAL Sq.Ft.: Cost of Project: ELECTRICAL BELEC200 Occupancy Group: ELECTRICAL = Energy 2_3 Type of Construction: -CzW Energy Add Multi BUILDING Please check this box if the project is a Investigation fee BUILDING ,second -story addition: ❑ Project Size: Standard ❑ Laze ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 Boiler > IOOK 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 Ci I of 3 CUPERTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM 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 Pb1g 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 rinklerBackflo 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 pA Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace 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 Appliance ELECTRICAL 2 of 3 n u CUPEkTINO CITY OF CUPERTINO PERMIT APPLICATION FORM Fee ID I U__ . .. m 101 S1gns Add Brancl node] Signs Marque ieatrical Lighting Fix lnt Fan Single Duct entilation Systems Scb Specific Plan :ismic Commercial Seismic Fee Res Elec Permit Issuana Mechanical sq. foot Mech Permit Issuanc Plumbing Permit Issu Plumbing Fee sq foot Ing LR Comme/ Mull ing Lone Ranee Re.di 3 of 3 BUILDING