03050151 CITYOFCUPERTINO
BUILDING DIVISION PERMIT rC01RA ' OY2TNFU a,y ATTO;,. ,,a
BUILDING ADDRESS: MIMI WONG PERMTTN003050151
1.0875 NORTHVIFW SO
FvR'S NAME: FERIAT"`bE31 Li9/2003
F_MI WONG LL
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
lOp
LICENSED CONTRACfOR'SDECLARATION JbDescrip tion
I hereby afllrm that I am licensed under provisns m
ioof Chapter 9(comercJob
with Section 7")of Division 3 of the Business and Professions Code,and my Iicesm is f�p1y�p fj�B�
in inn core and errs. PARTI-WALLS, DIVIDING RM fl—NN�Aa�aLEeD
,g Z LicenseClaas Lk.M
"FFF Date C.Ounhatu77SDECLARATION
JUN 1 3 2003
AR CHRECTS DECLARATION
1 untictaranJ my plain shall M used as public record, JUN
tad Licensed Professional -
OWNER-BUILDER DECLARATION BUILDING
I hereby nlfirm that I am exempt from the Contractor's License Law for the
I o O following reason.(Section 7031.5,Business and Rafnssions Cade:My city or county
$ which requires a Permit to cmrsh uct,alms,improve.demolish,ver repair my.=to.
_ZL^ prior m its issuance alga mquinu the aFpliant for such permit to rile asigned statement sec'
x< that W is licensed pumom m the poviaiom of On Contractor's License Law(Chapter 9 Sq. Ft. Floor Area $AiNtion
setF$ (commencing with Section 70M)of Division 3 of the B uBmass and Professions Code)at
that be 4 esempt therefrom and time basis for the alleged eump lot.Any violation of
Section 7031.5 by any applicant per a permit subjects On applicant to a civil penalty of
Omore man five hundred dollars(003). err Occupancy'Type
nt
❑1,as awav of rhe property,or my employees with wage as OteUsole compensation,
wit]do On.,k.,.d the structure is not intended ortuffered!foriadc(Sec.7044.Business tot - FOUNDe I d Inspections
ea
and Pmfessimu Code:The Commutes Liana Law does not apply m an owner of 10 2 - PIERS p
property who builds orimproves thon,and who dassuch work him alforthrough his
own employees.provided thalswbimprovements are not intended aoRered fasak.If. 103 — UFER
bawever.the building or improwmem is sold within oro yearorampledw,the owner.
builder will have the burden of proving mat be did not Wild or improve for purpose of 104 - REBAR
"4)' 105 - ANCHOR BOLTS
❑I,u ovine,of On Property.am exclusively convecting with florescent conuacton to 106 - SEWER & WATER
carutruct the project(Sec.7044,Business and Protocol..Code)The Communes Li.
cense law does not pply to on owner of property who Wilda or lmpmws memo.and, 202 — UNDERFLOOR PLUMBING
who contracts suchpm}ecu with aeonmaserortUtamw W
licensed pursuant
Contractor's203 - UNDERFLOOR MECHANICAL
am
exempt
under
Son BAs PC for No urn 204 - UNDERFLOOR FRAME
CN§LV WORKER'S SATIONDECLARDONs1 3 205 - UNDERFLOOR INSULATION
I
hereby amnn under penalty of perjury ow or the following declatations: 301 — ROUGH PLUMBING
❑Ihaw and will maintain a Certificate ofConsenuo self-insure for Worker's Compere 302 — TUB & OR SHOWER
"flan,as;provided for by Section 3700 of the Labor Code,for the perfamrance of the 303 - ROUGH MECHANICAL
work far which this permit is iasuet. 304 - ROUGH ELECTRICAL
❑1 hew and will maintain Worker's Compensation Insurance.as rtquimd by Section 305 — FRAME
of the Latour Cade,for On performance of ilk work for which mix permit is issued.
My Workers Compensation Insurance carrier and Policy number am: 306 — HOLDOWNS
Carrier: Policy N.: 307 - INSULATION
CERTIFICATE MPENSAnoNloNSURANCEEORKERs• 308 — SHEETROCK
(This section wed notxampleted iflhe permit is Intern hundmddollara(Sim) 309 - EXTERIOR LATH
ir1st) 310 - INTERIOR LATH
1 certify mat in the performance of the work for which this Kiml,4luted,10.11 nm 311 - SCRATCH COAT
employ any peon in any mennerm as to become subject to On Workers'Com wmation
Laws of California.Dow 313 - ROOF NAIL
Applicant
NOTICE TO APPLICANT:It.after making this Certificate of Exemption.you shoultl 501 - FINAL ELECTRICAL ENERGY
become subject to the Workeri Compensation provisions of On labor Code,you must 502 - FINAL PLUMBING ENERGY
.)Z forthwith comply with such provisions or this Permit hall be deemed ro odued.
z� CONSTRUCTION LENDING AGENCY 503 - FINAL MECHANICAL ENERGY
I hereby affirm that Nett its comuction lending agency far the performance of 504 - FINAL BUILDING ENERGY
Y> On work for which this Permit 4issued fSa.3097.CN.C.)
11LomersN,me 505 - FINAL ELECTRICAL
2, O Z 1<naersAdd. 506 - GAS TEST
Q I certify that 1 have read this application and sum that the shoe information is 507 - FINAL PLUMBING
L correct.1+gra to comply with all city and county ordinances and slow laws relating to
building construction.and hereby authorizerepresentatives of this city to enter upon the FINAL MECHANICAL
a+W alutw-mentioned property for inspection purposes 0 9 FIN
r gga (We)agree k use,indemnify and keep harmless the City of Cupertino against
IA liabilides,judgments.cow and expenses which may in my only accrue:against sold City I G
)Z in consequence of the Starting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL ON-POINT Issued by:5 WORKS Date A,2
SOURCE GULATIONS
Re-roofs
t{namun,of pplicanVCu Dow
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant ver future building occupml comm or handle hvallous mamdal
Rood by the Cupertino Municipal Code Chapter 9.13,and On Health and Safety
Sec7 Yea IyNea zss3z(25532107❑ ��J//u All roofs shall be inspected prior to any roofing material being installed.
\\ If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future Wilding by she Bt taw equipment or Jevity which
emit District? us air conuminanu u JeOneJ by me Bay Area Air Quality Management all new materials for inspection.
Diavicm?
❑Yes *No
I haw road On huardrw,reamrialucquirtmenu under Chmmr6.95 of robe Califor.
ria Hcalth&Safer,Calo.Sections 25505.15533 and 35534.1 tamerm nd deurthe building
doss not currently hew a mnm4 Ow It 4 my mpomihility m wdfy me oecu t of Jw
requi nu mstbemet wissuvxcafaccmficamof p 7p/ Signature of Applicant Date
ncr or mthomaJ egcm Daw`'� All roof coverings to be Class "B" or better
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDING ADDRESS: - MIMI WONG PERMITN003050151
10875 NORTT4VTRW SO
PERMIT 155B,�,pg3E�
OWNER'S NAME: 613n9 2003
IMI WONG
{ONE: SANITARY NO. CONTROL NO.
ABUILDING PERMIT INFO
RCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
0 0 0 0
uop LICENSED CONTRACTOR'S DECLARATION Job Description
1 hemby affirm that 1 am limnsed under provisions of Chapter 9(commencing
a3With Section 70o)of Division 3 of the Business and Professions Code.and my license Is
y .hCall Demerara!effeet. PARTI-WALLS, DIVIDING RM
j E2Z License Clara Lic.Is
ECQ Data Csntaemr
ARCHITECTS DECLARATION
�y s4 I understand my Plans shell he used as p.hlie retards / `'
Ocre
ILlecnled PNICSSInaOI /A/
S enI..OWNER-BUILDER DECLARATION J
1 masa affirm that I am exempt from the Csntrns Co License Law for the v�
p O following massa(Section To su Business and Professions Code:Any city or county
e
which requires a...1s.ua times tha alter,improve,demolish,or repair any structure
—iy thHer at hniaissusdpursomquims theapplicanl los Cmitrarmitmicensle ae awpChtemenl .I�� bi Ion
'££zzeo IhathcnWJpuatSection7 )ofDivismnfthcContrulessandenseLaw(Cude)or Sq.Ft.Floor Area $2�b1D�i
Y F$
(commencinge,I. sempa hsorf on And 0 basis
3 of the Busaged ass and Praon.An inn,Coon.of
�...
that io r exempt ta"applicant
and Ne aper for the alleged exemption.Any it Platiun of
not
than five
hundred
for a permit subjects the applicant a civil penalty of Occupancy Type
not more than fiw hundred dollars(5500).
I,As owner of the property,or my employees with wages As their sole compensation,
will do the work.and the swcate is not intended oraffered forsale(Sac.7044.Business e I dInspections
and Professions Code:The Contractor's License Law does not Apply m an Owner or 102 - P I ERS
property who builds orimpraves thereon,an lwhodoes ouch workhimself orthrough his
own employcea,provided Nat Such improvements are not intended oraRemil for sale.If. 103 — UFER
however.IN building or improvement issold within ore year of completion,the owncr-
builder .will have the burden of proving that he did not build or improve for propose of 104 — REBAR
sal..). 105 - ANCHOR BOLTS
❑1,as Owner of the property,am exclusively contacting with licensed contractors m 106 - SEWER & WATER
construct the pmKct(Sec.7044,Business and Professions Cade:)The Communes Li.
came Law does not apply As an owner of property who builds or Improves thereon,And, 202 — UNDERFLOOR PLUMBING
who contracts for such pmjecu with a contractor(s)licensed putamen to this,Contractor's 203 - UNDERFLOOR MECHANICAL
nu Law.
I am exempt under Sec. B&PCTs this mason 204 - UNDERFLOOR FRAME
Ow ( E 205 - UNDERFLOOR INSULATION
1WORKER'SS;O NSATIONDECLAR ON 301 - ROUGH PLUMBING
I hereby aRum under penalty of perjury,one of the following declamolons: 302 — TUB & OR SHOWER
1 have and will maintain a Certificate of Comem to self-insure for WorkersCompon-
mtion,as provided for by Sudan 3700 of the labor Code,fm the performance of the 303 - ROUGH MECHANICAL
work for which this permit is issued. 304 — ROUGH ELECTRICAL
❑1 have And will maintain Workers Compensation Insurance,As otyuired by Section - 305 — FRAME
37W of the labor Code,for roc performance of the work for which this permit is Issued.
My Workers Compensation Insurance carrier and Policy number am: 306 — HOLDOWNS
Carver PolicyNo.; 307 - INSULATION
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 308 - SHEETROCK
miss Nation need not he completed ifthc fermi)is for one hundred dollars(SIM) 309 - EXTERIOR LATH
"rlCm) 310 - INTERIOR LATH
I really that in the perfamance of to work for which this permit is issued,I&hall not 311 - SCRATCH COAT
employ any Person in any manner sin as in become subject a the Workers Compensation
Laws of California.Data 313 - ROOF NAIL
Applicaal
NOTICE TO APPLICANT:If,after making this Ceniftcatc of Exemption,you should 501 - FINAL ELECTRICAL ENERGY
become subject m the Worker's Compensation provisions of the labor Code.you must 502 - FINAL PLUMBING ENERGY
Z forthwith comply with such provisions or this permit shall N deemed invoked.
y O 503 - FINAL MECHANICAL ENERGY
CONSTRU —
CTION LENDING AGENCY
E-. .. Ihereby afrmthat them isaconsttubuinlending agency for INperformance of 504 FINAL BUILDING ENERGY
Cliff IN,work for which this permitisissued(See.3097,Civ.C) 505 - FINAL ELECTRICAL
Aender',Name
Leader. —
'sAddress 506 GAS TEST
V O 1 certify that I haw read this application and ram that the above Information is 507 - FINAL PLUMBING
building 1 agree a comply with all city rri county ordinances or and sate laws relating tobuilding ( )
corret, ca&=intioasnd hereby a city And mprcscounty ordinmaf this city lawsruponthe FINAL MECHANICAL
� � above-mentioned property for inspection purposes. 09 FIN
(We)agree to save,indemnify and keep harmless the City of Cupertino against
tih liabilities,judgments,costs and expenses which may in any way accrue against said City I AN NG
U Z in consequence of due granting of this permit.
^s APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL ON-POINT Issued by: WORKS Data 21A?
SOURCE GULATIONS. _
Re-roofs
ignamrc of pplicaHA✓CZARDOUS MATERIALS DISCLOSURE Date Type of Roof
Will the applicant or furore building occupan SIOM orbandlc hazardous material
As defined by to Cupertino Municipal Code.Chapter 9,12,and the Health and Safety
Code,Section 25532(&)? All roofs shall be inspected prior to an roofing material being Installed.
C]yo.
P P Y g S
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
cmlt hazardous air contaminants As defined by the Bay Area Air Quality Management all new materials for inspection.
District? � /
❑Yes *No
I have read the hanalouuss``mawrials requiaments under Chapter6.95 of the Califsm
nip Hcalih&Safcty Cade,Scctms 25505,25533 and 25534.1 undersand that if the building
does not cuacmly have a tenant that it is my responsibility m nndl'y the w:eupam.f the
rcquir cru h' mstbc IpC1 to issuance of a CenifcamoI Oc'cypa1fT729/`I5' Signature of Applicant Date
{ I J(/1ste U All roof coverings to be Class"B" or better
ncrorawhnri'r�cm ,.�'o Date
OWNEBUILDER VERIFICATION•
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
performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information(reverse snide). ( A
Property Owner's Signatur� �/'- `�", D
Job Address o `7�/oGt✓PIt eHMo, 6 Permit# (5- 2
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
j C*Y OF CUPERTINO p3 (1 h(V
CITY OF PERMIT APPLICATION FORM
CUPERTINO
N# 1ST Date: `
Building Address:
j QCs II(o AA UI- Puy S ire Cu Prfr ko 6� �!
Owner's Name: 0 1 1 Phone #: �f
Z
Contractor: License#:
�W liPil'
Contact: Il/hl Wd Cupertino Business License#:
Bng Permit Info:
Bldg E c Plumb ❑ Mecb ❑
Job ription: �
ential ❑ omme is
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: �O Occupancy Group:
Type of Construction:
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K 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> IOOOA 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
1 of
0�d
flu CYTY OF CUPERTINO •
c'TM° PERMIT APPLICATION FORM
I�TINO
CUPE
Quantity Fee ID Fee Description Fee Group
BMITIGATR 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
BOVERTI M 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 hiterceptor 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 cfm MECHANICAL
BREMAIRHAN 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> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
13REMMISC Misc Apparatus ELECTRICAL
BRENMAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
2 of 3
i CITY OF CUPERTIA
oF' PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs,Marquee ELECTRICAL
BREMTHEATR Theatrical Li hting 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 Insection 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 Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
3 of 3
NORTHPOINT
• "'^001:
10880 Northpoint Way, Cupertino, CA 95014 . (408) 996-3734
Mimi Wong
10875 Northview Square
Cupertino, CA 95014
May 21, 2003
Dear Mimi;
In response to your inquiry regarding interior modifications to your unit, I can provide the
following information. The Association must approve modifications that affect the exterior
appearance or the structural integrity of the building. Provided that your planned renovation do
not involve either of those two things, you have permission from the Association to proceed.
However, it is your responsibility for any damage that may occur due it
is your further responsibility to comply with any building coder utremen t e
. involved. MAY E 9 2003
Sincerely, -
n OGER WERT
On-Site Manager
cc: Board
File
4
• w
197.0"
96.0" 108.0" —�
ME
48.0" —N
J u
r1Gq
14 26.0" H
N
® Dividing the Bedroom
Scale: 1/4" = V-0"
Project Designer:
Mimi Wong Self
Project Contact:
Self
10875 Northview Square Project# WO#
Cupertino.CA 95014
(408)310-9125
Date: Rev.Date:
Amok
e ° o Ul/U1YW l:l 6 9 6WYJ
aji r e
1