05110070 CITY OF CUPERTINO � ,°� "/� `�""
BUILDING DIVISION PERAMUIT C�iry:J,.l[t1C"�VRT��LUYl� °TV M"
lze ytrva�++ tgtr + a`Sti .v`% tsa4t`��i
Bu1LDmDADDRESS: CHAMPION PLUMBING PERm"N0.05110070
6368 CANDLEWOOD CT
OW NER'S NAME: PERMIT ISSUE DATE
YOON RENA LEE 2059 CAMDEN AVE. 9277 11/is/2nnc;
NE: SANITARY NO. CONTROL NO.
(408) 437-1507
ARCHRECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MICH
0 0
304 LICENSED CONTRACTOR'S DECLARATION Job Descrition
1 homey affirm that 1 am licensed under provanime of Chapter 9(mmmmMng P
with Seldom 701kB of DIA.W.Sof de Businum and Profession;Cade.and my lieseec k
a� mmnromehMeBecL._ 6 Lm.k 74 '11 y� REPIPE REPLACE WATER HEATER
lj? Lleense Cla Cm.
As mail
ARCHITECT'SDECLARATIONmortis
I 1 understand my plana shall be used u public mmrds I ��
y
ati6 Licensed Professional ��
y OWNER-BUILDER DECLARATION
4 1 hereby a(Eect that 1 1. exemptfroms an the Cssions oLicense: C law for the
DO followinguiresa emits 7117IG. t,Alma and improve.
um Code:Any City or county
$
which requires a permit m construct,atW.hnpmse,memoNo,m mpalr ed Hurn m 1 $4000
�S^ prlor b its wuantt,else segkw de applicant for tach permit to 0kasegmd wkmem
€< thuMlalicemedPuwantmthePoveatouoflMContrxlor'sLicenselaw(Chapm9 Sq.Ft. Floor Area U 1005 Valuation
8 (eommencinawi&Sttdon7ODD)or Dlvtsim5ofthe Businmmd Pmfesslom Code)or n
.. dal he ismaterial themfmm and the basis for the alleged aomptim.Any violation of
Section 7051.5 by any appikam for a permit aublow w m1 lkam m a civil Immunity W r mum
. O Cy Type
mm mom Nn Ow
Nan hundred dollen(3500).
❑I,uowrcroftMpmpenymmyoaployemwim"taudtebnkeompetuadw,
ProTh. Re aired Ins ections
per arty who bas ld,w TM Canlranala LlRttb Law dam Ml apply lf rt awRr of l P
property who Mllw vi ion prow thereon,and who masa arch work hlmatf er thmuglt his
ovaemr,the iNingaIpre ii.Is semmuin not Ieumadel r.fcmaBered far setae!•
builder ,the MitringmImProwoenttssok M0,k arc year ofmproeforpaowner-
MRder sew Nsw de Mram o(proving On M roti nm bvik or Improve for purpose of
❑1,as Owner of the property,w exclusively cmusmng with Rttmed well tteea b
omareuct the project(Sec.7044.Business sod Professions Coda:)The Conummes U.
cenm law does not apply to an owner of propmywM Mika or Improv demur,Md.
who contracts for such projects with a mntrmurtO Ilcen cipursuanttothe Contractor's
License Law.
❑lamuemounderSee .B•PCfbutent sea
Owner Dau
WORKER'S COMPENSATION DECLARATION
I Mseby aRim uiWer pend,y of peejtuy oro of the following declared=:
I ham and will main Wn at
Certinom ofcomenl m selfdnsum fm WarL-esCOnpen-
awm,as provided Per by Senior 5700 or de labor Cade,for the pe kmatitt of de
wart for whim oda perch is issued.
❑1 have and will maintain Worker's Compensation Imurutt,an required by Section
57M of the Ube Code.for the peRamatine often work for which tour permit u word.
My Worker's1Cmmpuw7y-m buuratee carnia and Policy.umber ase:
Cartier: L t+r t a M- Palley No.: Zin V;ar2O�
CERITFICAIE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Than malon need mtbecompkted if the permit Isfm onehundseE do0®($100)
or sea)
1 certify dont In the Performance of the work for which this permit an word,I mail nm
employ any person in any mmierse as to bernma subject to de Workers'Compensation
Laws of CaRmmia Date
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption•you should
become subject m the Worker's Compcwdm provisions of the labor Cade,you mute
Oforthwith comply with much provisions or this permit shall M deemed revoked.
'Z= CONSTRUCTION LENDING AGENCY
F 1thereby&M.dor mere is a conauoNnn lending agency for the Perfommtee of
CL
Has work for which this permit YIssued(Sm.]W7.Civ.C.)
{ail 0 Lender's Name
a z LmdmraAddmn
L)Q I modify that I have read this application ask me that the also"information is
IL coefmL I mime m comply with all city and county ordination and sok laws mladng m
Q Melding consuuelion.and hereby authorise representatives of this city to enter upon the
{rl sieve-mmtiomd property for inspection purposes.
e)agree m ave.Itkcmnify and keep homeless the City of Cupertino spiral
ilidea gmmk.taats Ndea awe'hmay In any my accroe agsiml fold Cly
U APPLL CA in cceUf th AN o AND ILL COMPLY WITH ALI.NON-POINT Issued by: Date
SOUR EGU
-� Re-roofs
71 :11j,
umarApp( nADOU MATTRIALSDISCLOSURE Due Type of Roof
WIII tie app torfm MIIEingompuumrc orhandlc huudow material
ss mcDmd by the peNno M 'dpal Cao.Chapter 9.13,and the Health and Sanity
ode'Section 5T(+)7 All roofs shall be inspected prior to any roofing material being installed.
Oyu t7�
Will the applicant or future building aaupant use equipment or dcvtm which If a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous aircanwil w u defimd by the Bay Area Air Quality Muagcmenr all new materials for inspection.
District?
❑Yon 8t�
I Mw mad the haumoumaterials tequtommus Order Chapter&95ofthe C difm-
nu I0,&Arety ,Sccd 75 =."?
57 am1255 .I undceatmk thulfde building
circa n too., y e a t.th my msponsi IiIY m mdfY 0,e ceeupant of tho
requl mtswit use Imo wuamear d0nse r7cvp. �, Signature of Applicant Date
tersethoriacd em L 11 Dam' All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
w/ Cupertino CA 95014
Telephone(408)777-3228
' CITY OF Fax(408)777-3333 UPEI�TINO
Building Department
JOB3 Ii,ESS
S. � / PERMIT #
(ADOWNER'S NAME: C ee PHONE # 66
GENERAL CONTRACTOR: M 'n F #
I am not using any subcontractors:
tore Date
Please check applicable subcontr ors and co2fnplete the following information:
SUBCONTRACTCFR 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 r o 4
Roofing
Septic Tank
Sheet Metal
Sheet ock
Tile
O er/Cont or Signature Date
CITY OF CUPERTINO
f CUP TYOF O PERMIT APPLICATION FORM C„ rl lo07d
Adilk
N # Date:
Buil 'n d ess• Mailing Address (if different from building address):
Ow er's Name: Phone#:
r o 3 lid sro� 3
Contractor o^ License#:
Contact: Phone: Cupertino Business LiceCnse#:
Fax:
Building Permit Info: -
Bldg ❑ Elect C•}' Plumb Mech 9
Job Description: .eP r P C w + / to Copper
Residential AMo , Commercial ❑
Sq.Ft. Floor Area: q.Ft.:
Cost of Proi ect: O m� Occupancy Grou%
C _ 3G Q
e of Construction: Please check this box if theproject is a
a I^ second-story addition:
ro'ect Size: Standard Large ❑ Major ❑
uant ity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> IM to 1,75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75MBtu 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
Iof3 J 1( l 3 7
I Y`�
IS CITY OF CUPERTINO
CUPEiZTINO PERMIT APPLICATION FORM
QuantityFee 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 Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste lnterce for PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUnIBING
BPSEWAGE Sewage Disposal PLUMING
BPSEWER Sewers PLUMING
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 PLUMING
BPWHEATER Water Heater/Vent PLUAOING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reins ectionFee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMARUTAN A/C Units <= 10,000 cfrn MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY .. Remodel Busways ELECTRICAL
BREMFIXT Li ting Fixtures ELECTRICAL
BREMFURN Relocation of F=ace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREAUNHOOD Installation of Hood MECHANICAL
BREMMISC .MiscApparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPONVER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Re air/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Ap liance ELECTRICAL
2 of 3
` =
CITY OF CUPERTINO
QTY OF PERMIT APPLICATION FORM '
CUPEfI;TINO
Quantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHBATR 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
BSSwimmingPool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEAIPPERAI Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electricals foot ELECTRICAL
EPERNIITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicalsq. foot MECHANICAL
A TERIVIITFEE Alech Permit Issuance MECHANICAL
PPERMITFEE Plumbin Permit Issue PLUMBING
PPLBG Plumbin Fees foot PLUMBING
PLLONGRNGC Plannin LR Comme/Multi-Fam PLANNING
PLLONGRNGR PlanningLon Ran a Residential PLANNING
ZADDCHG Address Change BUILDING
3of3
CITY OF CUPERTINO p zs
BUILDING DIVISION PERMIT TxC,`ONuCT0VISid A`Tf6"
BUILDING ADDRESS: AKEENA SOLAR PERMIT NO.O 5110078
21120 CANYON QAX WAY
.R'S NAME: PERMIT ISSUE DATE
STEVE YOSH
PI NE: SANITARY NO. CONTROL NO.
(408) 867-0558
ARCHOECTIENGINEER: BUILDING PERMITINFO
BLOG ELECT PLUMB MECN
0
rum Oat
LICENSED DECLARATION n.
4 1 hereby effmm Nat 1 am licensed under provision of Chapter 9(commencing Job Descri Ili 3Su9?Yff 4�t13]�t('{_
with Section 70(111)of Division 3 of the Business and PruiEllouns Code,andr,y,�menm6 FUf'SY
in full rnrceand e�ffinst. 0�-�� `> INSTALL SOLAR PANELS
Dam se C ARCHTIEM DECLARATION- /A
I O demand my plans shall M used as public rccnrN �k{{fryryy rrffff g/ "' �ooU
Licensed Pmfcealonal �,t�p @�x ((��1
3
OWNER-BUILDERDECLARATIONCe Commnc IQr ri�Jvl1 III/9�p pk
0 I hereby.Rent Net 11. exempt from the Cssions o License Law for the fes/ y
00 which
moron.(Station](131.4 Business and ood.demolish,
e Professions Code:Any city or county lI
$ which rtyvircsapermit reh tabes Improve,h Permits ore a sig my edsuucmre OO
prior tat he its issuance,sedpar u requires ut he provision o far sucCon Month es filcrow Law statement
< (tom iactt withSrwmttatheprDiviovnfNcConusiness niccnselsw(C COO)or Sq. F[. Floor Area Valuation
,Spy that be is
Senion70nd the
basis for
nrtWeged exempton.and Any
Cale)of
3� that he la esempt Nertfran and Ne buts fm dm alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit abjcou the applicant in a civil penalty of r To Occupancy Type
not mom than Ove hundred dollar($500).
❑1.u Ownes of the property,M my amployces with mgea u their ale compermdon.
will do the wort and the strcta
uure is not intended or offered for saw(Sec.70thes
,Business
Required Inspections
and Prefsell Code:ITe CoactOrs License law does trot apply m e an owner of q P
propertywho bulldsorimpmves themon,and who doesach work himself or through his
ownemployers,provided Nat such improvements are not intended muttered forule.If,
however,Ne Wilding or improvement is mid within one year of completion.On comer.
builder will have the burden of proving that he did not build or Improve for purpose of
ate.).
❑1,as owner of the property am exclusively contracting with licensed commotm rs On
comtmct the pmjca(Sec.7044,Business and Prof udons Code)The Commetori Ll.
cense Law docs not apply to an owner of property who builds or Improv thereon.and
who contracts for such projects with a convacdr(s)licensed punuam in the Contractors
License Law.
❑Iamesemptunder Sec. ,B&PCfm Nlsmaan
Dote
WORKER'S COMPENSATION DECLARATION
I hereby,same under penalty of perjury oro of me following dectsndoa:
❑1 hero and will maintain a Certificate of Consent to self-imams for Workers Compen-
ation,as provided for by Section 3700 of the ISWr Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Imunna,as required by Section
3700 of we IsWr Code,for the performance of the work forwhich this permit is laved.
My Workete Cam vdoon Into carticrand Policy number am:
Carder. S�GI PoRq No.: 46SroS
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
Olds¢ctlon need net Wcompicted If ile permit Is foronehundred dollar($1010)
or less)
1 certify Out In the perfurmenm of the work for which orb permit is Issued,I shall not
employ any pawn in my manerso as to become abject in the Workers'Compenation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If.after making this Ccnificate of Exemption,you should
become subject in the Worker's Compensation provisions or the Labor Coda you must
.J Z forthwith comply with such provisions or this permit shall W deemed mocked.
?O CONSTRUCTION LENDING AGENCY
t~ I hereby afrum Nat Nem is construction lending agency roe the performance of
C'
we work for which this permit is issued fSec.3097,Civ.C.) '
Lendces Namc
=z lender'.Address
U Q 16cnify that I hem read this application and sum Nat the allow information I.
w F correct I all to comply with all city and county ordinances and slow law miming m
pU Wilding construction,and hereby authorize representatives of this city in enter upon the
117 above-mentioned pmmriy for inspection purposes.
fY (We) one to an,indemnify and keep harmless the City of Cupertino against
rn liabilities,judgments,costs and expenses which may In any way ac se against said City
U ZZ, in consequence of the granting of this Permit.
APPLICANT UNDER ANDS A ILL COMPLY WITH ALL NON-POINT Issued by: Date � 7 -e�
soURCE tEGUL
Re-roofs
Signamroo p' V nt ter Dem
HAZARDOUS M ERIALS DISCLOSU E Type of Roof
Will else applicamorfutum Wil ing oxupant More Ortundle haardous material
as defined by the Cupertino Municipal Code.Chapter 9,12,and the Health and Safety
e Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
Oyu mNo
Will the applicant or future building occupant use equipment at devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
emit haardous air contaminants as defined by the Bay Area All Quality Management all new materials for inspection.
Disaict7 Jyyr
❑Yes ®No
1 hem mad the hvardr/ms`mau+pas rtquirtmenu under Chapmrd.95Ofshe Califor-
nfsH.I"Sd.tyCode.S.d.a 305.25533amd25534.1undersandthaifdx:building
dors not currently haw kaergam.that It is my res nobility m nadfy the=.p rt of me
requirements ch mu met pd mismanceoreCcnifcateof cups Signature of Applicant Date
ow
OvoidalnuNorirc0 Wet t 1 Dam All roof coverings to be Class "B"or better