04050083 CITY OF CUPERTINO k 44, ;'Fra+ a 79551-a�'Yf^�"fi`z"r r,AXa'*^%'
BUILDING DIVISION PI RMIT I CONCRACTOR INFORMATION.:.,
BUILDING ADDRESS: RICHARD KOCH PERMIT'904-050083
OWNER'S NAME: PERMIT ISSUE DATE
Ahk RICHARD K
11 .E:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLOC ELECT PLUMB MECH
0 0 0 0
yOp LICENSED CONTRACTOR'S DECLARATION JbDescription
C I herby affirm that 1 am licensed o
under previsions of Chapter 9(commencing
U with Second 7")of Division J of Ne Businessand Pmfcssions Code.and my license is
in mu force and effect. REMODEL MS BEDRM & BATHRM
License Class Lie.N
n � Dau Contractor
ARCHITECTS DKLARATION
�� 1 undersand my plans Nall be used as public rtrnNs
�C.
3Q� Licensed Professional
S OWNER-BUILDER DECLARATION
.�<y I herehy affirm that 1 am exempt from the Contractors License taw for the x/
0 o following reason.rSuuun 7031.5,Business and Professions Code:Any city or County
H
ff which¢quirts a permit to eOnswer,alter,improve,dcmnlish.or repair any someone
u prim to,its issuance,also mquims the applicant for such permil to file a signed statement
h�< that he is licensed pmmonuo Nc pmvisiov n(Nc Cmdracor's Lic. .•Law(Chapter 9 Sq.Ft. Floor Area �alua 'on
x
,1-$ that M as ingwtroamfon70W)of Diviaiofr nfthe
eged caro Panfen v Code)orI�
..
that he u exempt thmefmm and thee bora far the alleged csrmpuon.Any violation of V
Section 7031.5 by any applicant for a permit subjects Ne applicant o a civil penalty of 3 51$7bHQAriber0 0 Ocdtrpaky Type
not more Nan five hundred dollars(5500).
❑1,as owner of the property,or my employees with wagon ss their sole compensation,
and Pr Ncwork.and Ne Contractor-,
a totimm�ded orowred Tortola(Sec.too an Bum¢
and enywhobu Code:The wsdoe on, ndwho Law dose or apply lf an owner is Required Inspections
own em who builds or ed tat such impr improvements
whodoes himself OfNrough his
ownver.meuiprovided Natsuchimpm old wit am not oufodoroRored theporowner.however,me building orimprovementis sold within one yeti of completion,the use of
.to
o I. will oars the burden of proving Nu he did not Wild or improve for purpose of
sale.).
❑I.an owner of de propeny,am exclusively contracting with licensed contractors to
consumer the pmject(Sec.7060,Business and Profusions Code:)The Conuacors Li.
cense law does not apply to an owner of property who builds or improves themon,ad.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
L*C.taw.
1 son eaemq undo B&P C for Of.mason
Owofr
1./ WORKER'S COMPENSATION DEC ION
1 hereby affirm under, perjury penalty of pery oof ft following
g declarations:,
1 have and will maintain a Ccrifiom of Consent o self-insum for WorkersCompen-
urion.as provided for by Section 37M of NC Labor Code.for the performance of the
work for which this permit is issued.
1 have and will maintain Workers Compensation Insurance,as required by Section
J700 of Ne labor Code.for the performance of Ne work for which Nu permit u issued.
My Worker,Compensation Insunnm carrier and Policy number,am:
Carver: Policy No.:
CERTIFICATE OF HEMP ION FROM WORKERS'
COMPENSATION INSURANCE
mous it.need nonnecomplered limit,permit Is for onchundrcd dollars($100)
or Toss.)
I certify Not in me fm�manec of the work for which this Permit is issued.l shall not
employany perm _,_ anner su}s�o bCc me subject o theWorkers'Compensation
TAWS OI Californiaof
Applicant j c� n'/ r
NOTICE PLICANT:IL afar making this Ceniftcam of Escmption,you should
become s t to Ne Workers ComNnn ion previsions of Ne tabor Code,you must
.JZ forthwith comply with such provisions or this Permit shall be deemed reveled.
Z O CONSTRUCTION LENDING AGENCY
�-. I hereby affirm Nat Nem is a couvucunn lending agency,for Ne terforman.of
C Ne work for which this permit is issued(Sec.3097.CO.CA
W Q Lender's Name
6. Lendesi Addmsa
O Q 1 Ceniry that 1 have mad this application and sou that the above information is
ty,^r Correa 1 agree 10 Comply with ill city and county onlirunces and sum laws relating to
0 building contraction,and hereby wNorma representatives of this city to enter upon the
ab(OC-memo ned property for Inspection purposes.
1
WC)agree to save,indemnify and keep homeless;Ne City of Cupenino against
liabilities,judgmen¢crisis and 0.1.,which may in any way C.against said City
U Z in consequence of to granting Of Nu permit.
^ APPLICANT UND AN N WILL COMPLY
\WIT IfH ALL NON-POINT Issued by: Date
SOURC A V
e �}o" Re-roofs
gnawrc of Apps Contract
HAZARDOUS MATERIALS DISCLOSURE Contractor Dam Type of Roof
Will Arc applicant or forum building occupant atom or handle huudaus material
as defined by the Cupertino Municipal Code,Chapter 9.13.and the Health and Safety
Code.Section 35513(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yea �Au
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
n Mvamn rs air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
District?
E]Yes
I have read the hasardous materials rcquircments under Chapter 6,95 of the Cxlifor.
is Hralas&S cry,Calc,Scours 25505.ISSJJ and25510.1 undcrsuM Nuifthe Wilding
docs t e sly have a tenons Naut i my rcnporuim ity an notify de occupant or dm
rtyvi� Swnm x t ssummeef.eenieamef aspp-�cy. Signature of Applicant Date
-/r3<Y All roof coverings to be Class "B" or better
Owner or aoboeived Spent
Date
CITY OF CUPERTINO + ;'' ''•"�' "" _., x "� +
BUILDING DIVISION PRRMID ON-,,
BUILDING ADDRESS: RICHARD KOCH PERMIT'904-050083
ERS NAME: PERMIT ISSUE DATE
RICHARD
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Loo LICENSED CONTRACTOR'S DECLARATION Job Description
inC 1 hereby affirm that I am licensed under provisions Of Chapter 9(commencing P
_iw with Section 7")of Division Sof dac Business arta Profes-cions Code,and my licenc is
'a"N mfull fame and effect. REMODEL MS BEDRM & BATHRM
5 Z
Date Date Class Lic.p
i r w Contractor
ARCHITECTS DECLARATION
�e IundcrsunJ my plans shall Wused azpublic arnNs
iw~
ad
Licensed Pmftwional
�-t OWNER-BUILDER DECLARATION
to
1 hereby affirm dant I em exempt from Nc Contractor's License law for the
pD fallowing resume.(Secum,7031.5,Business and Profectluns Code:Anycity or county
K m which rtquira a permit I,,consumer,Atin,improve,demolish.or repairanynmctom
_Iy pnmmits icsuanee.ei.m(equimalheapplicant for such permiuo file axigneJ mammem
< Oat he is ficcriscul pursuant 10 the rovisimisof the Croboarar',Licem.Law(Chapter 9 Sq.Ft. Floor Area 2 Valuation
(commencing with Section 7")of Division 3 of Ne Business and Professions Cnde)to
that he is exempt therefrom and the basis for the alleged cxcmptiom.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicmn to a civil Family of 3 5d9V30_4aer0 0 Occupancy Type
not more than Eve hundred dollars(5500).
❑Las owner of the me SmUc,or is employees with wages as Nei(sole compensation.
will Pr the work,and Ne awctureis roti Livens,Lew closer
sale(Sec.10 In
and rroreaom,code:The CO..,.,',u.ense hum sues nor apply to en Own.(0r Required Inspections -
propeny who builds or improves thereon,and whodo es such work himself or through his
Own employees.provided that such imprmvemcnts are not intended oroRered for sale.if.
however,the building or improvement is sold within one year of completion.the owner-
builder will has Ne burden of proving Nat h<did not Wild or improve for purpose of
sal..).
❑I,as owns,of the propeny,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li.
cense Law does not apply to an owner of property who Wilds or improves daemon,and
who contracts for such projects with a commercials)licensed pursuant to the Conmctors
Lies.law.
I em exempt under, d/yc)' _.6&PC for this rcazon
WORKER'S COMPENSATION DECIAA A710N
I hemby affirm under penalty of perjury one of the following declerationa,
I have and will maintain a Certificate of Consent to self-insure for Worker's Compcn-
es ion,az pmvided for by Section 3700 of No labor Code,for the perfom mna of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Immnace,az required by Section
3700 of the tabor Code,for Ne performance of the work far which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Carries Policy No,
CERTIFICATE OF UEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tris section aced not hecmmpleted it the permit is for one hundred dollars($101)
or less.)
I cro fY Natin the
anforename of Ne work for which Nis pe(mir u issued.1 shall nm
employ ypersnnnm ncn, m
sL ecomesubjccrmthc Workcts'Compensation
Laws of CaBfornia�- t m !rA Li.
Applicant -�
NOTICE Tp/tPPLICAW If,afar making this Certificate of Exemption.you should
become srlC]f(:I res Ne Worker's Compensation provisions of the labor Code,you mum
.Jz forthwith comply with such provision,or this peons,shall M deemed myoked.
z O CONSTRUCTION LENDING AGENCY
I hereby aRlm that then is a construction lending agency for the performance or
G' the work fur which this permit is issued(Sec.3097.Civ.C.)
D] Lenders Name
�z Lcndcr's Addrrss _
U Q 1 mortify that 1 have(cad this application and stale that the above information is
F cooea 1 agree to comply with all city and county ordinances and sum laws rtlating in
0 building conswetion,and hereby euthorim reprosourives or this city in enter upon the
r W above mentioned property,for inspection purposes. r
(We).,me to save,indemnify and keep harmless the City of Cupertino against
t,t liabilities.judgments.costs and aipenses which may in any way accmc against said City 1�-„
U in con sequence of the granting of this Permit. j
'^ APPLICANT UND TAN ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO)E N�N� I _
�t Z/' Re-roofs
1 gnawrc ofApphc°rYCommator HAZARDOUS MATERIALS DISCLOSURE Dam Type of Roof
Will the applicant or future building Occupant store or handle hazardous material
az deGncd by Ile Cupertino Municipal Code,Chapter 1,11,and the Health and Safety
-ode.Section 25532N)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes tgNu
Will the applicant or comm building Occupant use equipment or deice,which If a roof is installed without first obtaining an inspection,I agree to remove
mil hazardous air contaminant,as defined by the Bay Arca Air Quality Management all new materials for inspection.
Dkoict7
OYcs \
I have mad the hanimmamamrials requimmem s under Chapter 6.95 of the Califm-
nim Hcalh&Safety Codc,Sections 25505.25533 and 8534.1 undcmaad Nal iftha building
dens nm coolly have a wnanL Nat it i;my responsibility las nnuly Ne wcupam or the
re .mm wnmh 0stx er „aam..0raccmE.awnraetr cr. Signature of Applicant Date
g � tr �3/
ow'ber 0r anmodeed us IAll roof coverings to be Class"B" or better
®��„� ��SI®���E Richard Koch and Eva Tsai
20693 Cheryl Dr, Cupertino
BATHROOM/BEDROOM REMODEL Tel: 408-253-7848
Project Scope: Remodel one bathroom and attached bedroom/closet to update the plumbing fixtures, shower
enclosure, windows and traffic flow. No load bearing walls will be structurally modified. Most work to be done
by the homeowner.
WITN THE CITE' =tt
i 1N ACCDRDAN ESAND RDB�At`GE�
CUPERTIN c
SIGNED
ns and spa atioirt-i$z
Thrs on the job at all trrn?,S and it is ua
—————I d Rt'make any
Res or alteret or>5
oe @ a w1.h,+'o pe.rmissian roR
�t ohzr6f Ccl:eranp.
I Iav� �iiout , ei
on
the bu i I of th!S Purl and specifica i0i's
The'stamB
- 'ir " I al
,
N6T`e heid t..' g rlt
� jaNALl..e-pfitttF Viutit:;i! of "', i4w s,Urs`
eoc6va te Lay.
f .�j n•aIYACC^.;li
,J
i i I I i
J Ii Master bedroom,
II { bath, and closet to
i V I be remodeled.
.. ' MAY I J 004
Figure 1: Existing lot and house layout
vw
DO
Il Cn
?50) F Y
L
51-ALE,
I:LrCfRtCAt-LEGEND I
-Y) 5votch
='Q Oude.
=0' GFI Outlet
L.cjht Future
Figure 2: Existing bedroom, bathroom and closet layout
MAY 1�SU4
1 P=05
S,
I L-
0
U L
5CALE.
ELECTPJCAL LEGEND
—0 Outlet
-oc
. GFf Outlet
Z- L,
,3ht Future
Figure 3: Proposed changes and final layout
MAY 2004
Proposed Materials:
Description Specific Model Number
Bathroom window Milgard vinyl non-operable picture window, Undetermined
obscure glass.
Bedroom bay window Anderson 400 series wood clad bay window. TW45-3442-18
Center picture window meets egress
requirements. White/white.
Shower enclosure 12" porcelain tiles laid on diagonal on cement Casalgrande Marte series
backer board
Shower floor 4" porcelain tiles laid on a mortar bed with PVC
liner
Shower door 3/8"tempered glass, frameless with polished
chrome hardware
Shower controls Thermostatically controlled. Separate hand Undetermined
shower head.
Toilet 1.6gpf Toto Ultramax in Sanagloss white. MS854114S
Lavatory bowl Kohler under mount-white
Lavatory faucet Single handle control. Undetermined
Vanity top Silestone or Zodiaq quartz surface
Bathroom floor tile 2" hexagon porcelain tiles-white Daltile
Bathroom wall the 6" square laid in running bond pattern on Daltile
bottom 40"of wall. Base board to be cove
tile. White with black accents.
Paint Upper walls to be satin taupe color. Ceiling to
be satin white. Trim to be semi gloss
white. All paint to have mildecide added.
Doors Solid core 30"wide doors. Pattern
undetermined.
Vent Fan Panasonic or Fantech remote location fan.
M 1 3 2004
OTTER-BUILDER VERIFICATIV
1. (Check one) I or my immediate family (parent,spouse or child) will perform:
• A. All the work authorized by this permit
B. _ A portion of the work
C. None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work .
B. A portion of the work (complete section below)
Contractor Address/City. Phone # State License # Type of work to
be performed
• 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer(see reverse side). A
Certificate of Insurance covering workers compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
erformed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverseside).
Property Owner's Signature
Job Address( ev �� �!S ��% Permit# O `105 003
Any chanties to the information provided on this form shall be submitted to the City of Cupertino Build
® Department.
City of Cupertino Building Departan
CITY OF 10300 Torre Avenu
C U P S RT I N O Phone: (408)777-3228
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself,you
may protect vourself from Possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you-
should be aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family,and the work
(including materials and other costs) is$200 or more for the entire project,and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
If you are an employer,you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding, federal social
security taxes,workers' compensation insurance,disability insurance costs, and unemployment compensatios
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers' compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish,the U.S. Small Business Administration). For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor, only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit, erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
1
Very truly yours,
Building Department, •
City of Cupertino
Printed an Recycled Paper
aoa% *ITY OF CUPERTINO 0
•CUPH�F PERMIT APPLICATION FORM 54
APN# �f_ (� a �2— Date:
Building Address: Mailing Address if different from building address):
Owner's Nl n Phone #:
�' ,c. oc
Contractor4 Sc/� �n` /F(� ac / License #:
Contact: s� o f' f Phone: Z53-7Fy Cupertino Business License#:
,VT+-FPIIP Fax: .16-3 -7,FYF
Build' Permit Info: /�
Bld 7❑ Elect& Plu Mech`�l�
Job Description: !,
Residential 4n- W 61 rd 111K�, 9.14,1 ./91f mmercial ❑
.Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: j` sG� Occupancy Group:
Type of Construction: Please check this b t oject is a
second-stor addition:
Project Size: Standard ❑ Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BB01LERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1 M 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 <= 1O00A 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 / / ��
C GXTY OF CUPE•RTINO40
CITY OF PERMIT APPLICATION FORM
CUPEPJINO
q'vQuantity 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 Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Cbeck 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
Ask BPSTORM Storm/Rain Water PLUMBING
IMF BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER WaterHeater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit > 10,000 cfm MECHANICAL
BREN AIRHAN 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 > 1 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
2 of 3
AM
1 WITY OF CUPERTINO*
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BREMRESAPP Remodel Res Appliance ELECTRICAL
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 Inspection BUILDING
BSWIM 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
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Change BUILDING
3 of 3