06050188 CITY OF CUPERTINO ;fix *.Y, 3.."�ate "• ` `
• BUILDING DIVISION PERNUT � NTRt`Cy1'OR I(NFO,RNIATION,"
BUILDING ADDRESS: GENIE POOL & SPA SERVICE ITNO-06050188
20
OWNER'S NAME: PERMIT LYUE DATE
MICHELLE KIM 3641C CHARTER PARK DA 05/22/2006
NE: SANITARY NO. CONTROL NO.
(408) 978-1948
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BQ ELECT PLUMB
MECH
O
±opLICENSED CONTRACTOR'S DECLARATION OF
1IObDBSCiI Description
1 thereby affirm that 1 sm licensed under provisions of of Chapter 9(mmmencing p
its Secdan 70fllBof DivUMm Sofdw Business and fnsmns Code.aha my liters,is
+ „ kBuferoeand,ne P _ �—� L�p /p REPLACE POOL PUMP AND TIME CLOCK
?M. License, a —
s Dam
Co.
7S DECer r
ARCHITECT'SDELARA i
1 I understand my Plans shall an mond as public records
hLicensed Professional
OatNEm exempt
DECLARATION
a 1 hereby maso .biro on I em exempt from the Catsdam Coca:
License Law for the
p o following uiurn.(Satan 7(01.5,Business roti Pr.dem ns Cade:Any M a county
S$ which angels,•permit w canwuc4 atter.hnPmw,d.molW,or repoir any StrUctmeummord n
-iy t1614
hem I..,=,also require Ne applieantfrrweM1 pemitrofile asignd wwmcm
<
that M is licensed pursuant to the pmvisiam of the Connemara License Law(Chader9 Sq.Ft.Floor Area Valuation
5E (commenting with Section 700Wof Division 3nftse Buslnessam Prowssions Cade)or
5 - Nat he Is exempt therefrom and don bash for the alleged exemption.Any violation of
Sedan 7031.5 by nay applicant for a Permit mbjecu the spPlkantlo a civil penalty of r Occupancy Type
nut moss than 0w hundred dollars(5500).
❑1,u owner of the pmpmy,a my mploycu wits wage a risk mlc mmpensadon,
will do the work,and the amuctum is notinueded or offered forsak(Sec.7044,Business Required Inspections
and Proksslona Cadc The Canonical License Law does roet apply m an owner of q p
properly who bulldsoimproses themon,uad who doessuchworkhimselforthrough his
ownempluyens,provided that such improvements are not intended arnRered far Wa lL r
however,the buildingor MProvement is mid within arm year of cmmPleti.,the owner-
me). will Mw the bobond.dof proving that k did not Wild o Improve far purpose of
build.
❑1,as"nor of Uro Property,am ecluively convecting wits licensed mnoacmre m
cnnstroct the project(Sec,7041.Business and Professions Cada:)The Conuanor'a U.
mount law dean not apply an an owner of property who Wilds or improves Hereon,ad.
who contracts for such projects with a cemmetcrUd licensed pumunt tothe Comsactor's
License Law. Q J
❑lam exempt under Sea ,B d PC for this mason
Owner Data-
WORKER'S
amWORKER'S COMPENSATION DECLARATION
1 money affirm uderpeulry,of perjury arc of the following dalaratiom
I haw and will maintain a CeNOeamaf Conserv to self4asure fo WakeesCompen-
sathm,an provided for by Section 3100 of the Labor Code,fo the Performance of thae
want for which this prmh is Issued. ,
1 On and will midmain Wormes Compensation Iaaoame,as acquired by Section
3700 of the Labor Code,far the Performance of the wok fowhich this permit is hawed.
My Worker's Connpeead an Ins�ur,ance�a��rti�crrg and Policy number are:
Cartier, Sr�� GrIMY/PaSc Na:O vr0:
CERTIFICATE OF PIION FROM W KERS'
COMPENSATION INSURANCE e
(This earl.reed Out encampment ifft permit h farom hunted drawn(SI00)
lir less.)
1 certify that In the perfomanm of the work far which Nis permit Is issued.l shall not
employ any person in any mannerm an no become subject to the Wok,n'Canummod.
Laws of callfamla Due
Applicant
NOTICE TO APPLICANn If,after making this Cenifiam of Exemption,you should
become subject an the Worker's Compemmilon provisions of the Tabor Code.you am
O forthwith comply with such provisions a this permit Mall be demand Invoked.
z= CONSTRUCTION LENDING AGENCY
[-v Thereby arm a.ft.h amnawcann ladingagemy far Ow Perform.of
R'
the work fur which tiVr permit Is issued(Ser.3097.Civ.Cd
W� Q Undoes Name
O z Lenders Address
U O 1 certify that I haw ted this application and slow wt the show information is
V[ t" comet.I agree to comply with all city and county Ordinances and sew laws minting to
0U building construction,and hereby antsoim mpmsenlotim oftho city to enter upon tsc
W above-memioned property for inspection purposes.
f�,.s pry (We)agree to an,indemnify and keep harmless the City of Cupertino against
i-�W liabilities,judgments,casts and expensm which may in any way accrue against Said City
U Z In cmnequenm of the granting of this Malt.
^�
APPLICANT UNDERSTASA WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU `REI ATIOy9
Re-roofs
Si{tfuurea APPI crosUCrnuacwDar Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the Applicant or future Wilding occupant amm orhadk haurdau material
as dellrted by the C.".Municipal Cad..Chapmr 9.13.and the Halts and Safety
Code,Section 25532(a)7L All roofs shall be inspected prior to any roofing material being installed.
[]Y. "fNo
Will the applicant or future building acupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
mit huasdow air mnuaninants as de0.d by tse Bay Arta Air Quality Management all new materials for inspection.
Di mict7
❑Yat Ad
1 have mad thehvadam ocamsialan lmmenuunskrChapwr6.95oftheCslifor-
niaHeal"5afetyCdc,Secdm2S .2
o5533md25534.1undem=dthaif0wbuilding
doe rude...III,haw a wnand, IS responsibility an ready the occupant of dw
regalremeats hkhm an m' of ac,rirteaseoff capnwy. Signature of Applicant Date
Own,ro mtharimdagent Dow All roof coverings to be Class nBn or better
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36935040 . 00
DATE ISSUED. . . . . . . : 05/22/2006
RECEIPT #. . . . . . . . . : 34509
REFERENCE ID # . . . : 06050188
SITE ADDRESS . . . . . : 20303 CLIFDEN WY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MICHELLE KIM
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : GENIE POOL & SPA
CONTRACTOR . . . . . . . : ALINE NICHOLS LIC # 27882
COMPANY . . . . . . . . . . : GENIE POOL & SPA SERVICE INC
ADDRESS . . . . . . . . . . : 3641C CHARTER PARK DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95136
TELEPHONE . . . . . . . . : (408) 978-1948
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BSEISMICRE VALUATION 1, 614 . 00 0 . 50 0 . 00 0 . 50 0 . 00
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
PPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
MPERMITFEE FLAT RATE 1. 00 38 . 37 0 . 00 38 . 37 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 150 .47 0 . 00 150 .47 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ --=---------------
CHECK 150 .47 9647
TOTAL RECEIPT 150 .47
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
-------- ---------------------------- -------- ----------------------------
204 UNDERFLOOR FRAME 301 ROUGH PLUMBING
303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL 514 FINAL PUBLIC WORKS
•
Community Development
10300 Torre Avenue
to
Cupertino CA 95014
Telephone(408)777-3228
aClOF Fax(408)777-3333
*UPERTINO
Building De artment
JOB ADDRESS: PERMIT /� SGl CFcP
03o L h U
OWNER'S NAME: rvt/t° 1 PHONE
GENERAL CONTRACTOR: 4 A-W1¢ v-s FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation
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 �
CITY OF
CUPEIZTINO - -
• PERMIT APPLICATION FORINT
APN# '
✓2�, — OtL,l Date: Il�i9Y 2Z! 2�c9`'p .
Building Address: � U Mailing Address (if different from uilding address):
0 30 3 t-_V41 F c�Pfe`1'itr/o �4 Y
Owner's Name: Phone#-
yote
,� ,.� c!py & - oZ z 3
Contractor: License#:
`07 (p 7--
Contact:
-
Contact: Phone /e1 `t-2$r t e/-* Cupertino Business License#:
c Csc Fax: Y;y 2,"? Z
Building Permit o:
Single Story Two-Story ❑ Three-Story ❑ Basement ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Proje !//4,(�
Type of Construction: /j�jOGq c,c 61aiL /4 ttttill0
.�4'2 'rim e1,
Project Size: Standard LR Laze ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
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
BMITIGATR Res. Housing Mit Fee BUILDING
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 Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
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4 T CITY OF CUPERTINO
CUPEf�TINO NEW SINGLE FAMILY DWELLING
PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE� , Repipe Of Fixtures tPLUMBING
BPSEWAGE Sewage Disposal PLUMBING
-.• BPSEWER,. _ Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo ` PLUMBING
,BPSTORM. ... Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
UVENT, %, Alt.of Drain&Vent PLUMBING
BPWATER • Install/Alter.Water Pie PLUMBING
BPWHEATER Water Heater[Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
V
PECT Reins ection Fee BUILDING
OVER A/C Unit> 10,000 cfm MECHANICAL
MIAN A/C Units<= 10,000din MECHANICAL
PPLI A liance Install MECHANICAL
MT Li htin Fixtures ELECTRICAL
URN Relocation of Furnace .,MECHANICAL
BREMFURNOV Relo Fumace_>.l0K btu . MECHANICAL
BREMHEAT Heater Installation.,•, MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL •
MBREMTHEATR
MISC Misc. Apparatus ELECTRICAL
RAPp Rem Non-Res Appliance ELECTRICAL
OLE Pole/Platform Fixture ELECTRICAL
OWER Power Device/Apparatus ELECTRICAL
CEPT Rc tl, Switch & Outlets ELECTRICAL
LOCA Relocation of Hood MECHANICAL
EPALT R air/Alter HeatingMECHANICAL
ESAPP Remodel Res Appliance ELECTRICAL
GNAD Rind] Signs Add Branch ELECTRICAL
IGNS Remodel Signs, Maz uee ELECTRICAL
Theatrical Li tin Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power - ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Tem Dist Svcs ELECTRICAL
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CITY OF CUPERTINO
CI YOF NEW SINGLE FAMILY DWELLING
CUPE TING
PERMIT APPLICATION FORINT
Quantity Fee ID Fee Description Fee Group
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERAUTFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGR Long Range Planning/Residential PLANNING
ZADDCHG Address Change BUILDING
•
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