04040170 CITY Or CUPER'PINO ""'� ` a
BUILDING DIVISION PIrRMIT �.:CCINTRAGT![IR INTO RMA' N ,
BUILDING ADDRESS: 9JURMAN CORP PERMIT N004040170
65 NORMANDY WY
'ERS NAME: PERMITISSUEDATE
MENG-KUN LEE SHIN- 4
PHONE: SANITARY NO. CONTROL NO.
(831) 726-1203
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MEC"
0 0 0 0
u o o LICENSED CONTRACTOR'S DECLARATION
rd F1 hereby amrm that 1 am licensed under provisions of Chapter 9(commencing Job Description
`j with Section?0qq of Division 3 of Ne Businesimad Professions Code,and my license is
% infor boom andeffect. DRMO (E) POOL
jn'? Lhmmo Class Lic.p
sty Dam Contractor
C ARCHITECTS DECLARATION
So' I understand my plana shall W used as public records
Dau
L O y Licensed Professional
OWNER-BUILDER DECLARATION
aS 1 hereby affirm that oto exempt fru.tht Contractor's License Law for the
20 following reason.(Seeman 7031.5,Business and Potim,sions Code:Any city ,or county
e m� which requires a permit m construct,alter improve,demolish,or repair any structure
LZ) prior m its issuance,also roquims the applicant for such permit to File.Mined statement
that heiaran=edporava.mmeProvisions ofthe Crudic m's License Low(Charter 9 Sq.FL Floor Area Valuation -
,4 (commencing with Section TONd of Division 3 of the Business and Professions Code)or
y Net he is exempt therefrom and the basis for tht alleged cumption.Any violation of
Section 7031.5 by any applicentfor a permit subjects to applicant to a civil penalty of 3 689 11 darbef00 Occupancy Type
not more than five hundred dollars(E500). P Y YP
-]1,as owner of the property,or my employees with wages as their sale compensation,
will do me work,and the structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
awn employees,provided that such improvements are not intended or offered for sale.It. 27
however tire
avetngurden ovememiscold hathe did not year of completion,the owner
builder will have me burden of proving mer he did not build or improve for purpose of
Ef1,as owner of the property,am exclusively contracting with licensed contractors to
consman the project(Sec.7044,Business and Professions Code:)The Contractors Li.
cense Law docs not apply to an owner of property who builds or improves thereon,and, .
who contracts for such Foci with a cantractor(s)licensed pursuant o the Contractors
License La .
korm
ex raptunderSeeB&P C for this reason
Date 04-�a3r)WORKERSC PE A EC ON
I hereby affirm under Penalty of perjury one or the following declarations:
❑1 haw and will maintain a Certificate of Consent to at binsum for Worker's Compere
sedan,as provided for by Section 3700 of the Labor Code,far me performance of the
work for which this permit is issued
❑I have and will maintain Worker's Compensation Insurance,as required by Section
37011 of the Labor Code,for the perfoemance of me work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number art:
Cartier: Policy Nr.: '
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSU RANCE
(This section need not Mcompleted If the permit is for one hundred dollars(Sla)
at lass.)
1 cenify that in the performance of the work for which this permit is issued.I shot l not
employ any person in any manner so as to become subjec0o the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making Nis Certificate of Exemption,you should
become subject mine Worker's Compensation provisions of the Lehor Code,you most
�z forthwith comply with such provisions or this permit shall he deemed revoked.
.zu O CONSTRUCTION LENDING AGENCY
`G+ I hereby affirm that mere is a construction lending agency for performance of
�i> be work far which this permit is issucd(Sec.3097,Civ.C.)
Lender's Name _
z Lenders Address
C)Q I comfy that 1 have read this application and ream that the above information is
ry (~, correct,1 agree to comply with all city and county ordinances and state laws misting to
O V Wildi ng consuuelion,and hereby suthorim reprcumatives of this city to enter upon the
W shove-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
ti 0 liabilities judgments,costs and expenses which may in any way secret against said City �{
C) his permit.
APPLE'uNTeUNDER57ANDSof he grand ng of tAND WILL COMPLY WITH ALL NON-POINT Issued by: Date J
SOURC RE ULATION
q-0 JD" Re-roofs
gande.of pp anVConlractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building worpant same or handle hmardous material
cEned by the Cupeninn Municipal Code,Chapter 9.12,and the Health and Safety
c,Section 25532(a)?
E]yea, Na All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or home building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Wait monodnus air contaminants"defined by the Bay Arca Air Quality Management all new materials for inspection.
Diwmt7
❑Yes t5Q'u
I have read the hmarlu is materials requ i.mcros under Chapter 6.95 of the Califor,
nia Health k Safety Code,Sections B505.25533 and 25534.1 undersand But if the building
U
not currently haw a tenant,that it is my responsibility m nod ly the occupant of the
rey 'monotx which most be met prior to issuanc ora amide. of Occapanncc _ a igna[ure of Applicant Dale
cr araruhmise agent pate
All roof coverings to be Class"B" or better
CITY OF CUPERTINO
DEMO
• CUPEPTINO PERMIT APPLICATION FORM
APN# 3 6 l I I G Date: _ a 2oo
Building Address:
665 I�/oYman t.)
Owner's Name: Phone#:
1A -kart L ee , Sh;�- tic_ L Lk 408- 253- 33 d'3
Contractor: License#:
NW(mar. Cor ora-hoh 7462
Contact: Phone#:
h, ( 650 - 06- 75 3
Applicant/Contractor:
B=, rm
eit Info:
Elect Plu
escripbon:
Residential: Sw'.,W;m w o Lt vl Commercial:
Sq.Ft. Floor Area: v $/Sq.Ft.:
Architect/Engineer: Valuation: 0 00
0
Type of Construction: Occupancy Gr u
4Tcabl Fee IDFee Description Fee Group
% BPERMFEE Bldg Permit Fees BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
BSEISMICRE Seismic Residential BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
• BUSLIC Business License BUILIDNG
• CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : :Twp: Rng: Sub : Blk: Lo
p g t
APN . . . . . . . . : 36611164 . 00
DATE ISSUED. . . . . . . : 04/27/2004
RECEIPT # . . . . . . . . . : 25319
REFERENCE ID # . . . : 04040170
SITE ADDRESS . . . . . : 7665 NORMANDY WY
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER MENG-KUN LEE/SHIN-YU LIU
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5252
RECEIVED FROM . . . . : MENG-KUN LEE
CONTRACTOR . . . . . . . : PHILLIP O BJURMAN LIC # 23653
COMPANY . . . . . . . . . . : BJURMAN CORP
ADDRESS . . . . . . . . . . : 71 RICARDO CT
• CITY/STATE/ZIP AROMAS, CA 95004
TELEPHONE : (831) 726-1203
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---- ------ ----------
BPERMFEE VALUATION 5, 000 . 00 107 . 00 0 . 00 107 . 00 0 . 00
BPLANCHK PERMIT FEE 107 . 00 90 . 95 0 . 00 90 . 95 0 . 00
BSEISMICRE VALUATION 5, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 198 . 45 0 . 00 198 .45 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- - ------------ --------------- ---
OTHER 198 .45 M/C
TOTAL RECEIPT 198 . 45
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
704 DEMO
•
Community Development
10300 Torre Avenue
.y Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRES PERMIT#G C7
')b6 5- Nv,(vYland Vol/,\/ r/Il`7QYL v10 CA�jSuI
OWNER'SNAI vi _YCN t, i e IQ
PHO c�'t5) >5333
GENERAL CONTRACTOR. , rm,,A FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavatio
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 �,
ya o�
ner/Cr Signature Date
7665 Normandy Way, Cupertino, CA 95014
Swimming Pool Demolition scope:
Demolish swimming pool in the back yard. Pool deck ,filter ,heater and pump will be removed.
Electrical wire will be disconnected. The pool will be filled with clean fill from a loca j, WE pa%w%
excavation. The final ten yards of backfill for thepool will be screened topsoil. Theret�� UP
and/or fence replacement required.
24f f 3"
Swimming Pool sf
16f Water pipe
15,000 gallons
IF
L�u1�D0�� - Electrical
switch and
Water pipe 8f 7" wire
u
House fill
' Gas pipe
i •