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05010059CITY OF CUPFlUf[NO BUILDING DIVISION PERMIT ;,CONTRACTORFORMATION: .` I• j r .Y6: 3 I LDING ADDRESS: PERMIT NOO50I0059 OWNER'S NAME: PERMIT ISSUE DATE MIKIO FUNAKI ONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO ' BLDG ELECT PLUMB MECH 0 0 0 0 j LICENSED CONTRACTOR 'SDECON 9 l Job Description P I hereby affirm that 1 am Incensed under provisionsons of of Chapter (commencing a with Section 7ux))of Division 3of the ❑usinemv and Pmfcssions Code, and my license is mfull force, and effect. REMODEL KITCHEN/BATHRMS License Class Lie. a i Dare Canlanor START JOB WITHOUT PERMIT/BPERFEE DOUBLED ($453. AR CHITECPSDECLARATION X Z) he k 1 understand my planxshall used as public records J Liccnscd Professional S OWNER-BUILDER DECLARATION I berchy affirm that l and exempt from the Conlnetais License Law for the efallowing reason. (Section 7031.5. Business and Pndcssioo Code: Any city or county .. which requires a fenot in construct, alter, improve, demolish, or repair any strucwm ^ prior to its issuanec.akar requires the applicant rorsuch Permit m file a signed.stammem that he is licensed the Law (Chripar9 Sq. Ft. Floor Area Valuation panManlloproviaiansofOccontraaor,Liecn:c (commencing with Secdan 70(10) oroivixion 3 of the Businry and PoEsslotu Code) tar that he u exempt therefrom and On basis for the alleged exemption. Any violation of $40000 APN Number Occupancy Type P Y YP Section 70713 by any applicant for a permit subjects the applicant to a civil penalty of not more Nan five hundred dollars(S5W). y ❑ 1, as owner of the pmperty, or my employees with wages o thin sole compensation, 3 U I U3,3 s will do the work and On structure is not intended or offered for sale(See 7011 Business sad Pmfcnions Cade: The Cmdamemes Likens, Law does Iwo apply m an awrrer of property who builds or improves thereon, and who does such work himself or through his " RequiredlInspeetions �, "r J/%/ �+.aJ Own employcca, provided that such improvements are not intended or offered far sax. If. �/� however, the building or improvement is sold within one year of completion, the owner- r builder will have the burden of proving Nat he did not Wild or improve fur purror of r�q� sure. 'u owner of the propenY• am exclusively contracting with licensed canuanors to conskiuct the (See. 704,L Business and Professions Cade:) The Comracmr's Li //Ifrl t�"ii project cense Law does not apply to an owner of property who Wilds or improves therean, and who contracts e such projects with a conachods) licensed pursuant to the Commetor's ' W. exam under Sec . B d: P C for Nis moon OncgJ Doc IO _ WORKER'S COMPENSATION DECLA TION Iberebyallirmunderpenapy ofpernnyooFof o"owing deelaraticame I haw and will maintain • CeNfieamaf COmard m self-imam for Workir seompcn. satiov, u provided farby Section 3700 of the Labor Code, far Ne pcdarmatce of Ne work for which this permit is issued. ' ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 37W of the Labor Codc. for the Performance of the work for which this permit is issued. My Worker's Compensation Insurance canner and Policy number ate: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE , [Ibissectlm reed not bo<omplmed If the permit is (Mone hundred dollars (51011) or beam) 1 certify that in the Performance of Ne work for which this permit is issued, I shall not employ any person in any manner m is Int become subject to the Workeri Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: IL after making this Cenificare of Exemption, you should become subject to the Worker's Compensation previsions of thc Labor Chic, you mot ronhwi lh comply with such provisions or this permit shall k decmm mvokcd. O CONSTRUCTION LENDING AGENCY 11f r tat Nat there is a construction lending gency for the perfwmamx of On work for which this permit is issued (Sec. ]097. Civ. C.) which 0 Under's Name � I<ndcr's Address - , 1 certify that 1 have read this application and sus n that the i Ww information is cotrea 1 agree to comply with all city and county ordinances and sate laws relating to Wilding concoction, and hereby authorim representatives of this city to enter upon the abovcmentiuned progeny for Wifecdon purposes. Li (We) agree m save, Mccrio ily and keep harmless the City of Cupertino against / O liabilities. Judgments.cos¢ and expenses which may in any way acerae against mid City I in can Mance of Nc grantin �oofthispermit. G/ NOES NOS'AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale SOUR E REGULATI NS. > /O Re-roofs I /O / !t S n C. Dam ria an r HAZARDOUS MATERIALS DISCy�-13 Type of Roof Will the applicant Or brute building occupant store or hand ararduus material efined by On Cupenin0 Myniciryl Code. Chapter 9AZ and Inc Health and Safety _aJc, OLIO. zss3z(,)'! All roofs shall be inspected to any roofing material being installed. Na prior If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future Wilding occupant tau cquipmcnl Ordevicn which it hammous air contaminants u defined by do Bay Area Air Quality Management all new materials for inspection. Disrict7 ❑ Ycs �QdJu I have mad the ormus nis materiels requirements under Chapter 6.95 of the Califon nix Health A Safety Code. Sectitms 75X15.15577 and 1553. l undersand Nu if the Wilding JoctigI currently have a t that it is my mspomihilay b nosily the eccupant of the �y dmmc 'hicnmMs Musci urmissuanmaCacenifjcamo kMn>"w Signature of Applicant Dale All roof coverings to be Class "B" or better owner, r at onyc agent ate 0 crrY or curFtrr(no 'l T�!TS C0NTRA- 7OREINFOR SON ItUILDING DIVISION LER � BUILDING ADDRESS: PERMIT 1400 5 010 0 5 9 OWNER'S NAME: PERMIT ISSUE DATE MI O F A PHONE: SANITARY NO. CONTROL NO. 911THC1'/ENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH LICENSED CONTRACIOR'S DECLARATION ' IOb Description 1 hereby affirm that 1 am licencd under provisions of Chapter 9 (commencing wish Scction ](XNn of Division 3 of Nc Ousincss and Pmfcssiuns Codc. and my license is infull foreeandeffect. REMODEL KITCHEN/BATHRMS License ClassLica Dam cmductnr START JOB WITHOUT PERMIT/BPERFEE DOUBLED ($453. ARC] HTEC'S DECLARATION X 2) Iunderstand my plans shall he used as public mcmda Licensed Pnsfcssional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's Liecnsc Law for the i following mason, (section 70315, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, nr mpair any shuctum prior to its issuance. also mquires the applicant for such Permit In rile a signed sUlmor.l Law 9 Sq. Ft. Floor Area Valuation C (hal he is licensed pursuant n the provisions of the Commuor's License (Chapter o (commencing with Section 70r)(0) of Division 3 of the Business and Professions Code)or 3 Nat he u exempt ❑emfrom and tc basis for the alleged exemption. Any violation of $40000 APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant 10 a civil Penally of not more than five hundred dollars ($500). ❑ 1. as owner of the properlq, or my employees with wages as their sole compensation. Required Inspections 9 P will do me work, and the structure is not intended or offered for sale (Sec.]04C, Business and Professions Code: The Contactors Lice= Law ones not apply to an owner of property who builds or improves Nercon,and who doessuch work himself or through his awn employees, provided (hal such improvements no not intended or offered for sale. If. however. the building or improvement is sold within one year of completion, the owner - Miller will have the burden of proving that he did not Wild or improve lot purpose ofarle s Owner of NC pfoperty, am exclusively Contracting with licensed Contractors In �I,ion cen Sun the project (Sec. ]tld4, Business and Professions Cotle:)The Contractors Li - c se Law does not apply to an owner of property who Wilds or improves thereon. and ctor(s) licensed protection, to to Contractor's who eonuac(s oasuch projeeu with a contractor(s) urs LiccnseLaw.- Order ❑lam eacmp enders¢. ..am for Nis reason - Jam` O c Da¢ O 4 O :/Wy/ WORKER'S COMPENSATION DECLA ATION S 1 hereby from under Focally of perjury oK ooIhw allowing dsciaratmel: 1 have and will maintain aCcniOcam of Cnnscm to uif inSY2 for Worker's Cont ss provitictl for bySeniva 7]00 of Ne Labor Code. far the performance or Om rk for which ,P,,Iiuou d. ❑ I have and will maintain Worker's Compenvtion Insunnee, ss requited by Section 7700 of the Labor Code. for Ne pecoormmre or Ihm work (us which this p emit is Issued. My Worker's Compensation Insurance carrier and Policy number am: Cartier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' . COMPENSATION INSURANCE (This section need net W co nplohma if the Permit is fortune hundred dollars IS 100) 1R ms.) - I certify Nat in Ne performance of dac work for which this Permit is issued. I shall not employ any person in any manner sit az m become subject to the Wmkefi Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: IL after making Nis Certificate of Exemption. you should become subject to the Workers Compensation provisions of IM labor Come, you most Z forthwith comply with such provisions or this Permit shall W deemed revoked. ' CONSTRUCTON LENDING AGENCY M affirm that there is a construction lendiagency for thperfurmnsx of I hereby j > to work for whichThis pmt is issued (Sce. 3097, Cis. CJ % aLender's Name � LeeAddress Olmis � 1 certify Nat I have road this application and sure that the above information is t' correct. 1 agree to comply wit all city and county oNirunces and some laws relating to U building eonstreclion. and hereby amhorim representatives or Nis city to enter upon the r W above mentioned properly for inspection purposes. gL (We) agree to save, indemnify and keep h rmuless the City of Cupenim, against fn Liabilities,judgments. costs and expenses which may in any way see= against said City i v / Z in con{ryucnce or the granting of this permit. ^r APPL AAT-UNDERSTANDS'AND WILL COMPLY WITH ALL NON -POINT SOUR EREGULATI N5. ) I /6 C /)0A Issued by: Date �' r Re -roofs / sin rSi n r -A It r an on�' Date HAZARDOUS MATERIALS DISC QSI`8-7 Type of Roof Will me applicant or future building Occupant slate orhandle hesaNuus material at defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Cod, Section 25532(a)? U Yes �Nu 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 apprcanl or romre building occupant nae egaipmcut m devices which emit ha>amnus air Contaminants as relined by the Bay Area Air Quality Managerecm all new materials for inspection. District? `/ u ❑Yes I how mad Ne hazardous maerials requ immcnts under Chapter 6.95 of the Cali for M. Health S: Safely Code Sccduns25505,25533 and 25534.1 undmsund that if do Wilding dr l currently haw a Imam that it is my responsibility to notify de Occupsm orthe ''�mena'whichmust(bemn.pdutoismorecofaCcnificatef-acenmy S Signature of Applicant Date All roof coverings to be Class "B" or better Owner, rout true agent 'Dalt CITY Of CUPERTINO CITY OF CUPERTIN# PERMIT APPLICATION FORM APN # 3S7 Fee Description Fee Group Date: uilding Addrq5y.. /�� CLtS Ce - Mailing Address (i differe from buil mg address): Owner's Nam4 U N kl � L10 Boiler <= 100,000 Btu Phone #: � _ �' _ 04 l �-b Contrk II II V-�O e MECHANICAL License #: COntflGt;� — _ Phone: BBOILER4 Cupertino Business License#: b Building Permit Info: Bld 2 Elect ❑ Plumb Me h ❑ Job escription: Residential ❑ "�� o rcia -Sq.Ft. Floor a• BCONSTAX Ind/Off/Comm/Quasi BUILDING Cost of Project: O / 1 lJ BUILDING Occupancy. Group: � Type of Construction: BUILDING BCONSTAXR Please check this roject is a second-stor -additionF1 ❑ Project Size: Standard ❑ Large ❑ -Major ❑ - LA 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 — 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 1 of 3 1 CITY OF CUPERTINO 0 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 BOVERTBAE 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 j 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 BREMA U -IAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT . 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 i BREMRECEPT Rc d, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood 'MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 0 2 of 3 CITY OF CUPEI�TINO OITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Groum BREMSIGNAD Rdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel SiMarquees, ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL 1 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 Inspection BUILDING BSWIM. - -- Swimming Pool BUILDING - BTEMP Temporary Power ELECTRICAL / BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS ' .: = Ternp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING 1 ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance.: _' :- _ ELECTRICAL: _ MPERMFEE _ Mechanicals . foot MECHANICAL. .. MPERMITFEE Mech Permit Issuance. _ -_ _ MECHANICAL - PPERMITFEE _ Plumbing Permit Issue:. '.. PLUMBING • `• _ PPLBG _ PlumbingFees foot_-= _- PLUMBING - • Address,Chane-.�-:_� BUILDING 1 LJ 0 -1 City of Cupertino Plan Check Transmittal 0 Permit# Project Address Owner 05010059 Control# Plancheck# 1 FileDate 1/10/2005 RES. REMODEL 10168 CASS PLACE FUNAKI Description RES. REMODEL Plan Check Status (attach comments and return to Building with pian set) Dept Plan check# Date Due Date Staff Comment Date Approval? Building 1 11/10/200511/24/2005 SENT POH 10/10/2005 7 Assessor 1 11/10/200511/24/2005 Additional Plan Check Fee ❑ .Hours Planning Fees Housing Mitigation Fee Amount Heart of the City Specific Plan Fee Amou SENT 1/10/2005 Additional Plan Check Fee ❑ .Hours Planning Fees Housing Mitigation Fee Amount Heart of the City Specific Plan Fee Amou • pwa�k4% (CA Ce, \b FNACCONCE"QITHTHECIiYOutl Pt�PiS. %--CUPWTINO CQD , N RDINA i i SIGNED~ i ' P This set r plan — a s eC�kations M ST De kept a job at all times and it is un lawful to make.�any +changes or. alterations he �711i d' g DeptCIn same d o k up(pee n � otps The stamping of this plan and � cif;�'�aabonsj SHALL NOT be held to permitb�°to be ar. jipproval of the violation of any pmwsta,� f t j ,F ^_._Ctv..^�Sr.L•e'or-rte'law.._--._____-----_._._.-.__-- 1 t IJ �Tre` Cj✓, pyal�-� � �'. it �: vj ,P. V � AA�1,R!1� �iU t" -Y 1 � ✓ Z" � ' f 0 Ll 0 CITY OF CUPERTINO Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # : 3 Sec: Twp: Rng: Sub: Blk: Lot: APN 35701033.00 DATE ISSUED.......: 01/10/2005 RECEIPT #.........: 28234 REFERENCE ID # ...: 05010059 SITE ADDRESS .....: 10168 CASS PL SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: MIKIO FUNAKI ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, 950.14-2728 RECEIVED FROM ....: JUNKO FUNAKI CONTRACTOR .......: LIC # COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP .... , TELEPHONE ........: EE ID ------- UNIT ------------- QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL BENERGY PERMIT FEE ---------- 453.60 -------------------- 217.73 0.00 ---------- 217.73 ---------- 0.00 BPERMFEE VALUATION 40,000.00 907.20 0.00 907.20 0.00 BPFIXTURE UNITS 12.00 108.00 0.00 108.00 0.00 BPLANCHK PERMIT FEE 453.60 605.33 0.00 605.33 0.00 BPREPIPE NO OF FIXTURE 12.00 108.00 0.00 108.00 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 BPVENT UNITS 1.00 10.79 0.00 10.79 0.00 BELEC200 METERS 1.00 29.43 0.00 29.43 0.00 BPWATER UNIT 1.00 9.00 0.00 9.00 0.00 PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 BPWSVCS WATER SERVICE 1.00 9.00 0.00 9.00 0.00 BREMFIXT NO. FIXTURES 6.00 7.20 0.00 7.20 0.00 BREMINHOOD NO UNITS 1.00 10.26 0.00 10.26 0.00 BREMPOLE NO. FIXTURES 4.00 4.80 0.00 4.80 0.00 BREMPOWER POWER UNITS 4.00 101.93 0.00 101.93 0.00 BREMRECEPT NO. OUTLETS 12.00 14.40 0.00 14.40 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 BSEISMICRE VALUATION 40,000.00 4.00 0.00 4.00 0.00 EPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00 TOTAL PERMIT 2332.23 0.00 2332.23 0.00 THOD OF - --- ----------- PAYMENT AMOUNT --- NUMBER ------