03040030 CITY OFCUPERTINO "s c � 'b� `m°' - ''"'t`
BUILDING DIVISION PERMIT �COYC`P:OR2TN ` - A= Tdht
BUILDINGADDRESS: PERMIT NO.
i 10272 COLBY AV BAY AREA HAULING & BOBCAT SERV 03040030 .
OWNER'S NAME: PERMITLSSUEDATE
DAVID SU & KATHERINE YU 1151 SPENCER AVE. 04/07/2003
E; SANITARY NO. CONTROL NO.
(408) 592-9755
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECTO PLUMO O
app MBCH
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 w Ikemed under p vWam of Ch.pter 9(commencing Job Description
with Sadon 700p)of Division 3 often Buur¢yypProf .n�Code,mAmylieenmis
In full forte and Meet. �/`e oCL1- I-7 S
C�F a._k Cleo (�4 �a^" REMOVE POOL PINAII,.ED
AR HITeirrsD ATION
undentsnd my plans altsll be used a public records 1
ea crnmdPndcuonal St� 5 2003
5 OWNER-BUILDER DECLARATION '
I hereby affirm that I w exempt from the Contractors License Law for the
0o following Mimn.(Section 703L5,Buseasand ProfesdonsCode:Any city mcounty BUILDING
13 2 which enquires•pewit to construct,niter.Improve,demoliah,or mpalr any nrocwre
�1^ prime,itsWuence.a1wrequirathe applicant foraueh permitto Rlcasignedsuument
< thaine lakoursod pmmemtodmprovi,lounftlenemtractors Lica.law(Ch roei9 Sq.FI. Floor Area C Valuation
z❑$ (commencing with Scmion 7000)a(Division 3 often Business and Profeodons Code)or $1370
a that he is ommpt therefrom and the basis for the alleged exemp ton.Any violNun of
Section
e tome than Arc hundreddelta.f r a permit subjects the applicant to a civil penally of ppppm�N bl5e Occupancy TYp
3T62�J Z� 00 Occas ane e
❑1,as owner of the property,a my employees with wages as dseiraule compensation,
will do Newark and doc.tructum hoot intended osu@end fertile(Sec.7011,eutlrcu Required Inspections
and Profeesians Code:The Court is License Law does not apply to an owner of 704 - DEMO q P
propeny who build,m I mproves th emon,and who does such work Idmsel f or trough his
ownemployces,provided that inch improvements w not Intended oraaerml for sale If.
however,the Wilding or Improvement Is mid within one year of completion,the Owner.
builder will have the burden of proving that he did not Wild or improve for purpose of
ale.).
❑L as owner of the property,am exclaively conuaning with licensed centncton to
construct the pmject(Sec.IDU,Business and Profusions Code:)The Contractor's Li.
came Lew does not apply toan owner of property who Wilds or improve,Neaten,and,
who cowaN for such projects with a contractor(l)licensed Punuanl M the Contractors
LL�jclrm Law.
❑Iw plunder Sac. ,B&P C for this rramn
p S LA, I Data OZO)
WORKERS COMPENSATION DE
ON
I hereby afRrm under p erWly of pednry one of the ^"..g dalarati^m: -
hive and will maintain a CenlBumof Consent to self-losum for Worker.Cw)ten•
on,in provided fa by Section 3700 of the Labor Code.for the perfordnanct of the
woe for which this permit is inued.
❑1 have and will maintain Workers Compensation hourance,u.quired by Section
37M of the Labor Code,for the pert....of the wee for which this munit Is Wend.
My Workers Cement,nntion Insmance carrier and Policy number a.:
Cartier. Policy No.:
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE -
(this.avimenced not be conplemd lithe pewit U for ane hundred d^Ilaun m0)
M LGL)
I certify that In the performance of the wart for which this persalt Is Issued,I shall not
employ any person In my manoran as to became subject to the Worken'Compensation
LAWS of C1l fOMIL Dam
Applicant
NOT1gS TO APPLICANT:IL after making this CeniOote of Exemption,you should
become subject to the Worizes Compensation pm bions of the labor Code,you rmw
0 Q forthwith comply with such provisions or this permit shall W deemed mvokcd.
z CON IMUCDON LENDING AGENCY
[.n r Ihwby aMm thatthem B.cortuuctnn lending agency for the perfuramon of
the work for which this permit ts ivatl(Sec.3097.Civ.C.)
aQ Isnder's Name
zLender.Addmo
U Q I certify that 1 hove mad this application and Rude that the shove info mNon Is
Id,E ewer l apse to comply with all city and county ordinances and,uu Is"relating in
0[U^ building convection,and hembymthodmrepretentatives of dots city to enter upon the
W ,how-mentioned property,for Impaction puq.mL
(We)Agree to save.indemnify and keep harmless;Ne City of Cupertino against
In IiebllWeLjudgmenu,costs andammea which may In any vny same agaloslmld City
C)7 In consequence of the grmling of this Permit.
F7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUg�EOUL4T7ON
7�kC-tJf Std Re-roofs
" S' roof AppliantCan cter Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant m future Wilding occupant nam or handle hazardous material
an defined by W Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
Cade,Scenic.S531(e)i All roofs shall be inspected nor to an roofing material being installed.
ptio Na/1f P P Y g g
Will the applicant or Inter Wilding occupant tea equipment m devivcs which If a roof is installed without first obtaining an inspection,I agree to remove
It,htt N"u oar contaminants u dennrd by than BAY Area Air Quality Management all new materials for inspection.
rich
❑Ya �N.p s
I haw mwl the bn-Nnmmatedah mquimmcnu under Chapw6.95 of the Califor-
nlaHmlth&Safety Code.S=d m255D5,15533ud7533a.lunductualdoatifdoe Wiming
dila not cuwntly have a=ml mad 11 h my wpomlbility w notf ten oaup ret of the
reyvim w�hic�`a mel�dLWuanoeohCCNOcemaf ay. Signature of Applicant Date
own -)authorized Asem S oam All roof coverings to be Class"B"or better
aclor
CITY OF CUPERTINOCUI PERMIT APPLICATION FORM D 3
N# r Q� '� Date: /0 3
Building Address:
� vz7 ,z— Cdfb A-vv� CLA Pek- 'n4CSI 91-E04—
Owner's Name: Phone#:
1)aU�d s & K � r40 Lk l ) 777- 3-3
Contractor: License #:
6 AycA 6c13430
Contact: Cupertino Business License#:
Kobe. ltt
Buil Permit Info:
d e P1 ch .
J . ption: evwo v c c�uu�kbuy p uo
Residential v 'Lb Commercial ❑
Sq.Ft. Floor Area: 2-0/ $/Sq.Ft.: 31
Cost of Project: } 3 Occupancy Gro
Type of Construct �f
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILER1 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
BMITIGATC Comm. Housing Mit. Fee BUILDING
; / 21r24
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XL CITY OF CUPERTINO
CUPEIZTINO PERMIT APPLICATION FORM
Ask
Quantity Fee ID Fee Description Fee Group
BMrrIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI Multifamily Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res PLUMBING
BNUSFD New Single Family Res BUILDING
BOVERTHAE 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
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 din MECHANICAL
BREMABUiAN 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
BREN20LE Pole/Platform Fixture ELECTRICAL
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CITY OF CUPERTIN0
CITY OF PERMIT APPLICATION FORM I
CUPEI,TINO
uanti Fee ID Fee Description Fee Group
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT pnrptl, Switch& Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heatin MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Si az s,Marquee ELECTRICAL
BREMTHEATR Theatrical Li tin Fix ELECTRICAL
BREMVENFAN Vent Fan Sin le Duct MECHANICAL
BREMVENSYS Ventilation S terns MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Insection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Tem orary Bld Permit BUILDING
BTEMPSVCS Tenm Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical so foot ELECTRICAL
EPERMITFEE Dee Permit Issuance ELECTRICAL
WOEEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chan e BUILDING
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