08070047 CITY OFCUPERTINO
BUILDING DIVISION PERMITCONRACTORkNI,OR1VIt1TIf�3.N"c-
BUI I KESS: PERMIT NO.
�L �a� LA RODA DR TBD - TO BE DETERMINED 08070047
OWNER'S NAME: PERMIT ISSUE DATE
CHUMG LOCHUM 07/07/2008
NE: SANITARY NO. CONTROL NO.
ARCHIT (ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
,OppLICENSED CONTRACTOR'S DECLARATION - Job Description
WE C 1 hereby aRtm Nat 1 w licensed under Provision of Chapter 9(cemmusing
�ZW wiNSection101fU)of Di li .3af the Business,am Pmfeasiov Cook,and my license is POOL DEMO
<o- in full fame rc G l 3Y
>qz tictooza. E LL.'o., RENOVATIO REMODELING PD FOR BUS LIC 7/7/8
am
e ARCHITELTSDECLARAT10N
e¢ 1 to dersund my Plans N>f1 be used u While accords
'WU
g Licensed Profc.lanal
5
OWNER-BUILDER mDECLARATION
y 1 hereby-(Sinn on 1 am eumpl from the Cmnuedors License Taw far 1,
ti pe O following reasons arch comae ""ou,' and Profession Cade:My city m county ,
rd m which requires a permit m ennsuucl alters improve,demolLM,or
repair.y swmure
prior m its issuance.also requires the applicant for such pumil m file a signed=Wmcnt
�0 wlhaalicensed puawarat to wa provisions of lha Contmcmrs l;crosa Law(Chapter 9 Sq.Ft.Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Business and Professions Cadc)or $4500
Wt he u eumpt thamfmm std the basis for the alleged c usaption.Any violation of
an, on,o faby m hu dredlMission,(SSW Int sebjecu the applicant m a civil penalty of 36933027 ?ff Number Occupancy Type
❑I.ma ofthepiW",mmywploymwiOw pswftk lc=pemuon,
will do thewmrs and themacnum is notintended ora@red formic sec.7066.Business
and Pro(nsious Cade:The Conescmh Liana Law does ret apply m an owner,of Required Inspections
property who Wilda or i m pmvw des a s s"nd who does such work him eelf ser through his
awn employ.,provided thermal:impmvnmmtts are trot intended oro@red fns sale If.
however,the building m improvement is sold within one year of cmmptuon,the Owner,
Wilder will have the Wadi of proving dust he did nes Wild or improve fur purpose of
sok.).
❑1.as owner of dm P.,n,.am exclusively contracting with licensed contractors an
cowwct the project(See.7044.Business and Prokavwu Cade:)The Coatracmla U. .
come law does not apply to an owner of property who Wilds or improves thereon,and.
who contracts for such projects witha mmatenr(s)licensed pursuant m the Contractor's
Ween.law.
❑Iron wwPl undo See ,BAPCfwlb4mamn
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby aQum under pevlty of Perjury roue of the folkwing doolaratiaw:
I ham and will Womain s Certificate of Covent m self-insure for Workn'sContact.
.tion,u provided fur by Section 3700 of the Labor Code.fns he perfmmaace of use
work for which Otis permit is heated.
❑I have and will maintain Workefa CampevNnn Inwrsnce.as metered by Section
3100 of the Tabor Code,fa the per(mman.of Ute work for which Nu permit is issued. '
My Worwes Compensation hasonmce canis and Polirynummaer H:
Cmder.SV N 1t'\ C a Pok,NOU/5er-Thug C 6'a. 5 / .2 /o/
CERTIFICATE OF EKEMMON FROM WORKERS'
COMPENSATION INSURANCE
CThisweden ted not he completed if the permit is formchundad dollars(SIM)
mr less)
1 certify that in the perfmmame of the work for which this permit 4 i.ucd,1 shall not
employ,anyperson in any m.vrso as In became subject on Ink Wonrers'Comprsustion
Laws of California.Darn
Applicant
NOTICE TO APPLICANT IC after making this Cenificam of Emospre n,you about
become subject un the worker's Compcusation pmvisiav of dun Lab.Code.you must '
Oforthwith aurally with such Provisions Or this P.Tit shall be,doomed soaked.
,zt y CONSTRUCTION LENDING AGENCY
[-+ Ikc,byafrmnn that Uem is s eommateurm conduct,agency fm weperfason.of
CYi > the work fm which Nis permit is usual(Sec.3097,Civ.C.)
Q Undcfs Name
z Lemder's Addw
U O 1 certify Nat I have read this application and sum thou the above Information or
ie.
correct-1 agree to comply with all city and county oNWnces and sone laws Rhone he
.Q building construction,and hereby smears representatives of this city to enurupmn the
(r"yahme-menumed pmpeny for ivpecuan purposes.
(We)agree W Saw,indemnify and keep harmtss the,Cly of Cupertino affairs,
h liabilities,judgments,casts and napema which may in any way acme against said City
U,z in wnscquercc of the granting of ads pumir.
^' APPLICANT UNDERSTAND ND WILL COMPLY WITH ALL NON-POINT Issued by: Date0�
SOU GEREGULATIONS.
Re-roofs
S gnuum of ApplinHAZA lor OUS MATERIALS DISCLOSURE Date, of Roof
Will de applicant or future building occopeaLsnore w handle ha>erdous material
w 111ad by the Cupertino Municipal Code.Chapter 9.12,and the Estill,and Safety
Code,Section 235324)7
❑Yes V. All roofs shall be inspected prior to any roofing material being installed.
NTLI the aPumon or future building occupant use equipment or denim which If a roof is installed without first obtaining an inspection,I agree to remove
D,h.20 s air contaminants u mad by the Bay Ams Air Quality Management all new materials for inspection.
❑Yes No
I have mal the ha.Mous materials 5,V3.d255 under Chalterd.95 ofde Wilding
niaFtolth de SafetyCotle,Sauov 23505.23 7and235J6.l undcrson"nnocro Wilding
Uses nm2 try ham a m>wil this"04
t u y�resWvibility m rwufY
the occupant or the
reyvii NO hkh man be met m of a CmtiOc
/ �` Signature of Applicant Date
O�nerm oriud agcm i D,te All roof coverings to be Class'A.a'or better
�r ooh
�( .
CITY OF CUPERTINO
DEMO
CUPERTINO PERMIT APPLICATION FORM
APN# & 93 ,5 0 -27, Date:
Building Address:
Mailing Address (if different from building address):
Owner's Name: Phone:
ChuvvnC, 0chU � W � 3 � � 19003
Contractor: Phone : 10 7—OZ- /0 / 7
�C- JJ) LJ FY l O �l�Wlo�l� (ln CavRtA�t12) 7
Fax: �u � a27i- S% 71"7
Contractor License #:
Cupertino Business License #:
Contact:_6A-\ t V) L i✓W S Phone: * � 2-,7- /0/ 7
PIS TG Fax:
Residential Sq Footage Commercial ❑ Sq Footage
Job Description: `�C11
J ` �-�W�,J 1t't-ion
Valuation: `/ 0 z>
Project Size: Express ❑ Standard ❑ Large ❑ Major ❑
Please complete relevant portions of the Green Building Checklist & attach it to the application
or if applicable, include on the plan set & the sheet index.
Quantity Fee ID Fee Description Fee Group Permit Type
IDEMORES Demo-Residential B 1SFDWL-DEM
/ 1DEMOPRES Pool Demo Residential B 1SFP00L-DEM
IBSEISMICRE Seismic Residential B
Revised 6/16/08
CITY OF CUPERTINO
DEMO
CITYOF
CUPEkTINO PERMIT APPLICATION FORM
Quantity Fee ID Fee Description Fee Group Permit Type
IDEMOCOM Demo-Commercial B 1COMML-DEM
1DEMOPCOM Pool Demo Commercial B 1CPOOL-DEM
IBSEISMICOM Seismic Commercial B
1BUSLIC Business License B
•
Revised 6/16/08
i
Single Family GreenPoint Checklist dab: Build ttGr 2n
`�.
The CxeenPoinl Checklist is based on the various green features incorporated Into the home and is the :-
balls Lor the GreenPoWl Rated program.A home on be considered green if B NIAus the premquWites,
dams at least 50 points,and meets the minimum points per category,Energy(30),Indoor Air Quality'
Health(5),Resources(6),and Water(9).Please contact Build It Green for a list of qualified GreenPoint
Raters 0 you ere interested In pursuing mirtparty,Verification.
Tss green hwlUing practices liaed below are careened in the New Home Conslruclion Green Building
frooelines available aMnvw hndditnreen Om
:ENTER PROJECT & "e
NAME
V S
A.SITE
't PPdinis AvalleblB Pen Mea"sur`e:":�"
1.Protect Topsoil entl MlnMlu Dlsroption W Esbting Plants a Tree
e.Pmtetl Toped hoe,Erosion eW Reuse a her Construction
.... __....,..__..,._,_._i....
b.LlmB and Dalheeb Construction,FOoiprinlfor Masbram Protection p
L Dxvnstruct Lutaed of Dermolhldnp Eatsting BuIll On Sib p I 3
5.RsgcW Job She Construction Woods(Including own Man)
e.ifimman 50%Wssse Dhosirm by MON(Recy.&V or R.)Around 0 s i R '
...L._. i,_....
b.MNlmum65%Dlwrsbn by Wright(RecNiSq or Rewe) _...0 Z
c.kenimm 80%DNec ion by Mail a Rewe) 0
2
l Use Raryclad Content Aggressor(Minimum 8%)
s.WahrsayaMDrlvexey 0 ) I )
Ir.rrossovy j 1
Tabl PdNs Anton M SIb e 1 0
B.FOUNDATION
1.Sopbw Ppribnd Cement In Connor sold R.,ded Firmer or Bbp ,
a.M'nlrtum 2M Final or Slap 0 1 f 1 1
._...J..._.._..1...............
b.MVJmum B%Flynn or Slap 0 t
L Use FreabProbcord soldiers Feundstion In Cold Ares(C.E.C.Choose tom 16) 0 1 3
1 Use Radon Belabor ConsbucUon On A6Rbk Leolons ll 0 r p
e.Design and BulW Slri cWnl Pest Controls '
• e.Insurer Tonle Shed,A Sepreb Al Esedor WaabbCaiueb Cametlbm by W W or RctlW FesleriercNNWers 0
to.NI NewRenb Hew Trunt,Bue,or Sormtwled MLnsl361rhshom FwMeSon 0
Total Points Anal"in Foundsion•9 0
Per
e, I rels"Aveile6le Meal "i
C.LANDSCAPING. -R..; a
Pet
,,.
1.Construct saloons•Etficbnl landspps
e.No lreahe Species llslarl by Ca41PC Am Renard p t % 1
b.No Plenl Sprees Ym Require HMpirp
c.15%NPornb An OmgMHObraN Celtlomb laiden,Mediormmm�,a OWrAPaoprteb Spades ._.p�
L Use FIrolBale landscaping Techniques 0 1 I I
1 Minbntrs TW Areas In bndsop iporlled by Bulkier
e.As Turf V11 Nan a Warm Requimirent Less We or EaW to TY Fnaeyr.8 plant lector) D
(._2_.
b.iud 5Nl Nd Be Warted on Slopes Escaedinp llHLwWNmsLou than Feel WWe
oTW m3%Nlsrtlscaped small hood]points) 0 1 2
d.Tuff ldl0%ol LeMsupetl Ane lWW/pinbl 0 1
a.Plans Slab Trsw p
3
8.Group Planar by Waorr Nseds(Nydmzonlnp)
D 2
4.Install NlphEtBGancy lMpWbn SYatenu
A SysYm Uses Only LorFbso Ddp,Bubborrs,or Lox-fors Sprinters 0 I
b.system cos Small Controllers p - r__.....�..,,.._..
3
i.InmrporN Tro 1 , of Compost In the Top 6 to12Inches or 5011 0 3
1.YNch All Wntinp Bads W Use Grostar of 2Inches 0r local Water Ordbence aequlremost 0 I 1 2
9.J.50%SsMssd or Recycled-Contort soorob M 5096 W NorePhnt Us&cap Eemenb 0
10.Reduce 11gM POIIUUon by 6hlWdtnp FMum andl0r DlncUnp Upht DownwaN 0
TOW Potrib AnBeble b Wndsapbq.01 0
D.STRUCTURAL FRAME&BUILDING ENVELOPE:,,
'<•POInIbAmilebie Per Measure`Y"'::
1.Apply Optimal VWue Engineering
0 e.Rap Ross.aid!Sbsds.12a-Imh On CSNer Form,
U 1
O.lira DOOnM WIMnx Hmdan brlmd .0. �.-..__..y_—__'_.
• 9 c.Um up J.di snd Crippesma Reamed son used
1.Us.Emoss red Wmbu
a.Bernard!Headers
i
b.InsWated Eryineemd Hpdae
C,Wood hlobb or Web inoses ter Fears
C 2007 Build It Green Single Family GreenPoint Chaddlst 2007 Version Page I of 7
as
:;ENTER PROJECT NAME
�.Use SoIM WOII 9ysYm Anduaa SIPS,ILFs,l My NOn-Stich Fnma Numbly) •
b.Wage ............ ....�.._..
..... .__,_2._ __._ z
cRoots
D
5.Reduce Pollution EnWat No.Home from the Ganpe
a.TpMySW tlp NBaMer beeanGe�ape Mb lMat Am 0 1 I I
b.Install Garage ESlet.1 Fen OR Bunt a 0eYdned folate ._.O
S Dealgn Energy Neale on Tnuea(75%date,Insulation Height at Outide Edge of Eslador Wall) 0 1 1
T.Deal,Roof Tmses Y Accommodate Ducta.rh 0
e.Use RecydeatContent SUNNI Studs for 90%M etedor Well Famine 0 I
S.Tbemul Maas Wells:Muh Dryaall on NJ lnba l Wena or Wells Weighing man than/O rVm t 0 1 I
10.Install NorhaWs and Gut4n
a.Miumml64rchOndaps antl Guam 0 __ • __.j__�__:
b.MNdmum 24-Inch Overhangs and Gunen p 1
TCW Pads available In Sbuceual Wits,Fmim entl Envelop=D 0
E.EXTERIOR FINISH �'; f; PolelaAveeable PerMeasure ',''.fr
1.Uu Marycebtomeht INo Wryla PWik)or FSCLadIrW Wood Mckliq 0 i 2
i Install a Raln Scnen Well System 0 2
1 Use Durable and NonwmbusnbN SIUInp MSYnah 0 1
I.select DYnbesnd NoncembuaUEY Floating Meledah 0 2
Tidal Points Available In EMedor Finish+ 0
F:INSUI.ATION>S;,�o. :✓�5.,.' 1 -�?,. .a'4:,'"'. - , ,.
1.Install Insulation adM 75%RerycMd Content
a.Was,eiWa FMMs0 1 I 1
■ b.Calm, 0 1
I install I..WUon that Y LoweEndill(CeNnad Sed tint 01150)
a.Was,.n Fbas ...�_.. .._.._.,
b.CetWe 0
I.Insmd Quality M Insulation lmhlMUon Man Applying Drimeall 0 1
Total Points AwltabY in 1,.uYlion+ 0 •
G.PLUAIBINC '. `' -.' `. .';' : .`,,:', Points Aedable Pe'r Measure .i..'..'
1.Doodbut,DomsUc Not Water Efficeldy(Maslmum i POInYI
.
A.inseltte HM WBbr Rpu horn Waiter Heater to yJWen 0 1 1
b,Instate All Not Water Pipu D
a Use Enp'roeW Panbl Plvhn D ..._.._.....,_ `
tl.Use EnpYUW Paned RPhq wM Demand CenpWed CMatlon loop
e.Use Stnchne l PYmphq ellh Dentinal Conpceed Gmtall-Inca,
I.the Contend!Con RumNp 0 11 1 2
11natall Ginty High Eftidency Tobts(Ou.Wlush o,St.n gpA D ' 4
ToW Painds Avatable Y Planing•TOW 1 0
H.HEATING;VENTI LATIO N&AIR CONDITIONING, ',;{� ` '.:.'p'E1 1 :: i5:" T<:-,o= `< -..:-;`, I ;'�`=P61nY AJelleDle Peiwastiiet"M.
1.coupe and Instill HVAC System W ACCA Manual J,D.and 8 RscanmsMations 0 q
L Install Sued CmnSudin unha
a
p.Webr HeaYn 0 Z
1.Install Zoned,Hydronlc Radiant Had,rI0 Seb Edge Insulation 0 1 1
I.Irutell High Efndemy M Condltloning Mtth Envinmentely Responsible ReldgesaMa 0 1 1
5.Dolgn and Install Effective Dudwork
■ a.InMaI HVAC UnnaN DlKteWkxltldn CMWWnetl spam 0 j 3. �._._.
b.UO Mad Matic once Oud Jeilb end SeMm 0 ' 1Y— _; , _
c.Inuall Dutool, MNUC InsMalbn(gurW Duds) ...,�.._ _..._I,_1..!.._. ;...__�.,...__..._
d.Pieswn ass.the Dar SYdmn 0
I.Prated Duds tluhnp Comwdlon and Clown M OucY been Ocpryamy
0
S WWI man Mcanoy HVAC Filter(MERV N) D ( j 1
■ T.Dont Isnhll Flnplece or WWI U W Gu Rnptaw edUi Man,RaMg Not too Than W% 0
Wap CSA SlendM4
S,WWI Moi Eshaust Systems In BMroms end Wtchem
■ e.Instill ENERGY STAR SaUvmm Fens Venal Y Me(ulslde �__ _._i..__._.:.__1_ -- •
b.M BathI Fans M on Timer W HumMbW
c.InsW Kitchen Range Hood Venal Y W Nestle 0 I 1 1
9.Install Madunal V..UWYn System for coolirs(Maslmum s Points)
■ e,Instead ENERGY STAR Caling Fem&Win Ks,N Living Ams S Badmom
b.how INhde Hone Fan aM Vehabe Speads ._�__ _..._ 1_.—.._L._._—•.__..
C 2007 Build It Green SingleFemiy GreenPdnl Checklist 2007 Version Page 3
LE ENERGY,-�,
MIS vew
RENEW
. .. --.- - , �,��,;.Pcni' A' able Per lvleasuuo1.1n
Nosb for Solar Not Wider 11.11, 0 40
ballSoleftburil..01SIxtern 0
11-11,Vann,Conoult nor Future PhoWoftoc InstelleUm IT P,o,lds 20 If 0 SoufflrFsclrrp Roel a 2 l
Plulsoecubsk(PV)Perot&
6
lo,30%N cloosm news;W 2.41W(W 12 pes) 0 1 6
c.V%of slectio prel OR 34 ION(WW 18 poses) D i-5
Total Abbe Ports h Re.ble Energy=2B D
J.BUILDING PERFORMANCE.-,.-�-.�,'-,"'
b.hceim Pa...('i 0111busb31 Safely Sackdraft Tee 0 i
He..-% trov.Me 24- Inh..151W.,ireof 0 230
5 2
3.N....Opens ENERGY STAR Oth never All P.1urge CdM.Up-Pilot hsps.(Total 45 p.lnR;reed comment) 0
Tells!Aveltatele Poem In Subding Prviorrnmew 3S 0
K FINISHES .77777777
P61n6AvaRSlllS'P6r Mae"
i.D@Wgn Eftyamp To Rasuce Traclemol In C.neentrue.te 0
L Use Low-VOC or ZerPVOC P.Int(Maximum 3 Points)
W VOC Inum.WaliXelve;Points(ISO Opf VOCs(Flan One 41M go VOCs nlon. lan)
b bro-VOC:nourirr Ws!]/Celllng Point(S go VOCs(FW)) 3
3.Use I.cv,VOC,W.Um4humel Wood Finishes JQSC gpi VOCs) 2
4.Use I.ave-VOC C..1k end C.ndructlo.Mh..N.(00 got VOCs)to,All Aelfrosiv.. 0
S.Use RscyM .rflont Penn 0
G,Use Erurtrommentally PrAmbi.Akelerfift for Interior Finish:A)FS".rTned Wood,B)RedNnW,C)Reoce,lhomerleble,DI R.cyck"onlant or E)
FhgrJNnbd
b.Intoo.T.(M stores.)
■ c.SMMM(50%Knenum)
C D.(5e%Iduarnuen) ------
a Counwftjm(50%MUnImum) .......
T.W..ForTmilfthynk in lonledor Flnlsh(CA Sect.01350)
e.Sbeftere,&Sure Tram,(50%lCelnerm) 0
b Calow I Coursersx;(50% 0
c.Inbrbr Tree 150%MInin.)
d.Shwln,;1506 Utnersa.)
LO &Aftrinablbtionafnnkm,,T..taind.,A ShowaFamidehyde4.IQ7ppb
0
LFLOORINGI .'
C)Rapidly R...bW,D)Rerycbd "KE)Eryow
C.c.M.FlooftAdlo.lutesslifterf1hrew,50inuIVOC4.
M.1snuo 15%of Fees AM
le,Moreneve 30%of%W A. ........
c.MWOruen 50%of Fee Ansm ---4-.---
D
d.Mini.75%of Floor Arm __._y.___..,..._._..-i....._._.
n..l ft..Floors:Floor Cov.drq;Oftr We C"t an 50%or Mm.1 C.W Flocers 0 1 i
3.I'looring Issue Serction 013M or Cal Green Uleal Plus Requirement;(M Molreurn)� 2 1
Told AvabosPoholefTeares,.]
M.APPLIANCES AND LIGHTING f
77,
1.Insteff Water end E.W Efficherfl Mousses,
a.ENERGY STAR(eW I Pot)
In.Nreeminew Uses No Won,noun 6.5 Ca0wulCycw(total 2 Posse)
I Install ENERGY STAR Cluffess Wastrel;Machine MM Water Never 06 w Use
a.Mens Energy Slar and CEE Ter 2 requeerneirts(mDatfied energy leetoe 2.0,Waste Facer eal(Ural 3 pe"le) 0 1 1 2
b.MMisErergy Sort arel CEE Tier 3 requirements(nex0fled energy factor 21,Water Fector 4.5 or less)• -------;-.—
OnAl 5 Penn) a 2
3.In.tatl ENERGY STAR Rerfrimrster
a,ENERGY STAR Qualiffied 6<M Cubic FmI Cap*
LENENGY STAR Quailse,It<M Cup,Feel Capacky
0
Rqdln,Cents, a
a.W"Recydrig Users 0
02007 Build It Green Single Fahy GoseenPoint Cheddist 1007 Version Page 5 of 7
�7------- -------------
-F,
ENTER PROJECT NAME
--- -------
MUNI
Erar druilre.m.,entl ants,pirls irislade for inwevre In wpmpMw iawlpenei in,re right 0 0 0 0 D
............... .......
Enbr EsaMpLon Mn,andeft,p0o,awdiiinle Ir Iniarproxnernali,,orin to N NhL
O 0!
0
4.Innovation:List innovative measures that meet the green building objectives of the Guidelines.Enter up to 4 Build It Green Checklists and
maximum combined total of 20 pts.See Innovation Checklist for suggested measures,using the link to the right.
Inna,,ininin InCominurilly.Enw decree hem,W inWr pones sinidade for rneasun In urpriorlue wthii Nnit. 0
herioniflan In A(Plialth:Uniir dLwWn lim,are afti points enitailti tw rneasurri in approvia,onswrier b W right. 0 0 0 D
0 10a
In"Vindieri InWahr:Ernardesalplai Nei.OW enlar pones sansible bnwrar,In apmpree mtKorlits W his rlhl, -_0_.0_..
0 0
TW Anihoi,Pero h Oew4 0
Total Available Points In Specific Categories' 4+ 96+ 42+ 66+ 43+
Minimum Points Required in Specific Categories 0 30 5 6 9
Total Points Achieved 01 0 1 0 0 0 1 0 �1
Project has not yet met the following recommended minimum requirements:
- Total Project Score ofAt Least 50 Points
-Required measures:
-A3a:50%waste diversion by weight
-.12: 15%above Title 24
-Nl:Incorporate Green Point Rated Checklist into blueprints
- Minimum points in specific Categories:
-Energy(30 points)
IAQIHealth (S points) •
-Resources(6 points)
-Water(9 points)
•
0 2007 Build It Green Single Family GreenPoint Cheddlid 2007 Version Page 7 of 7
CITY OF CUPERTINO
• 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36933027 . 00
DATE ISSUED. . . . . . . : 07/07/2008
RECEIPT # . . . . . . . . . : BS000005360
REFERENCE ID # . . . : 08070047
SITE ADDRESS . . . . . : 10605 LA RODA DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CHUMG LOCHUM
ADDRESS . . . . . . . . . . : 10605 LA RODA DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4430
RECEIVED FROM . . . . : RENOVATIO
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 4, 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1BUSLIC FLAT RATE 1 . 00 110 :00 0 . 00 110 . 00 0 . 00
1DEMORES SQ FEET 0 . 00 .490 . 00 0 . 00 490 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 600 . 50 0 . 00 600 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 600 . 50 #1157
---------------
TOTAL RECEIPT 600. 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
704 DEMO
•