03030089 CITY OF CUPERTINO. -
BUILDING DIVISION PERMIT .: �°L';�RN�''® . $ ',;,,;,,t('�I: '
BUILDING ADDRESS: SUSIE YOUNG PERMTTNO.
OWNER'S NAME: PERMIT.s,"
SUSIE YOUNG
NE: SANRARYN 2MR94LNG.
ARCH1112=1ENGINEER: BUIIDINO PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACR3R'S DECLARATION lob Description.
o
i I Manby afllm IMI I am ImehM under provialeh of Gaptor 9(rommencln{ p
in
Anne 9d efecDlHalon7of the BudncuandPro(culoa Code..ntlmyllcenmb y �II V�,1/Yd Cv�L'Sact1 -
^ Ln full farts AM effect.
License Class 1x.» MASTERBATH REMODEL '
'
Dam-Comonector JUN 18 2003
ARCHITECTS DECLARATION
1 understood my plan Nall he moll a public records
Licensed Professional
5� OWNER-BUILDER DECLARATION BUILDING
1 hereby.frim that 1 am exempt from the Contraaofs License law for the '
O O
following mann.(Section 711115,Budncaa and Pmfenlom Code:My city or county
I$ which requires,a permh to construct,dor.Improve,demolish,or rural,any structure
a�^ prim W LU Issuance,also mqulres the applicant fonuch permit to file.signed moment
tharho1allcenodpursuant tothe provisions offtConuactorsUmoselaw(CMpmr9 Sq.Ft.Floor Area $��1 'on
d$ (commencing with Secllon7000)or Dlrialon3 or the Budueasad Profculeh Code)or
f rho he 4 caunpl therefrom and the basis for the alleged ewnpdm Any violdon of
Section 70315 by any applicant for a permit subjects the Appllant to a civil penalty of
ml mom than nw hundred dollars(000). 3 INIt 00 Occupancy Type
[r I.At,owno or the pmpmy.or my emplaysca with wage As Weir Auto compensation,
will do the work and the suaaum is mi ntended or olfnmtl fer sale(Sec.7044,Business 101 - FOUNDI1� Inspections
and Pmfeulon Thao Cade: e Contractors Limme Law dnot apply to an owner of
propenywhobuilds orimproves thereon,and who dueuueh wortblmselroromough his 102 — PIERS
own employees,provided that such Improvements are,not Intended oruRered formic.If, 103 — UFER
however,the building or lmprovemmd is mid within one year acompletion,the owner.
tool will Mw de burden of proving that he did net build or humane for purpose of 104 — REBAR
m •L 105 - ANCHOR BOLTS
L u owner or the property.rn the exclusively contracting Cod:)Thea contractors;a
rata mTpm)eapply 0Ism a. wnwofprpPywhobuids or
Contrmto.U. 106 — SEWER & WATER "
daamlchPlyman with
ofp,openywhe lWlNor Mpto th Conuacees 202 — UNDERFLOOR PLUMBING
who ronmN f nuTh pmjeas vith$eontnaor(a)licensed puruum to the Conuamot$
Lmeme law.f 203 - UNDERFLOOR MECHANICAL
❑pursue undersee. ,BRPCfmthmmamn
z 204 - UNDERFLOOR FRAME
Da 0 ENs ECu� / 205 - UNDERFLOOR INSULATION
1wh
arum an dty r r)uy of toe fe owing deelandnna: 301 — ROUGH PLUMBING
ill mAnwn aCew h fir nllaoif-IhumrorWmker'$Campen- 302 — TUB & OR SHOWER
ded rat by section 3700 of the labor Code,rot the performance of the303 - ROUGH MECHANICALfor ich this pemlt h lssue3
01 haw An!will maintain Workefs Compenmdo^Insurance,As required by Section 304 - ROUGH ELECTRICAL .
3700 or the labor Cotlo,forW^pufomunce^rthe wart for which this persalt is loved. 305 — FRAME
MY Worke(s Gmpessadm Ihutsnce carrier and Paltry number sm:
306 - HOLDOWNS
Carrier. Policy
OF EXEMPTION FROM WORKERS' 307 - INSULATION
COMPENSATION INSURANCE 308 — SHEETROCK' '
orlon.(7h1toW^nrsdmt be completed lfthe permit isforone hundred dellmI$100) 309 — EXTERIOR LATH
ecawrylny pIn erson In m manor nada cannon,which this penult Wand,lawl nm ` 310 =� -INTERIOR- LATH
Lawsoanyperonin any maanerAuutobttome object tothe Women'Compensation 311 — SCRATCH COAT
Laws of Gllfomia Dam '
Applicant 313 - ROOF NAIL
NOTICE TO APPLICANT.IL after making thit Cenineam of Exemption.you shmhd
home subject Wthe Workerscompensation pmvinohoftinlaborCurieYOU most 501 - FINAL ELECTRICAL ENERGY
OZ forthwith comply with such provisions arthis remlt shall bedeemTtlrewk^d. 502 - FINAL PLUMBING ENERGY.
CONSTRUCTION LENDING AGENCY 503 - FINAL 'MECHANICAL ENERGY
1Mmbya111m that them Is.counmclion lending agency forth.pmrmUU ..f -
a� 504 FINAL BUILDING ENERGY
the work for which this pemitIamued(sec.3097,Ctv.C.) -
W Q Lender',Name 505 - FINAL ELECTRICAL
Dz Lenders Address 506 - GAS TEST
U0 I):dry that 1 haw read this Spplim ion and cam then the move Infmmmlon Is
U. MUMMtagreetocomplywithalpcityandmanlyoutdinancesandsumpawsrehdngto 507 - FINAL PLUMBING
0 building cmunuetion,and!hereby Authorize of this city to cow Upon he — FIN MEC ICAL
W dmw•mentioned property four purposes.purpa
O, (We).gree to saw,indemnity and keep harmless the City of Cupenim&pial
OA 9 "1
v.h Tn IhNlldes,judgments.eosts and capon',,which may In any way&mue agaiht cad City
UZ In consequence or the gutting of this permit. Issuedb 5 NG Date
'^ APPLICA UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
yWORKS
SOURCE ULATIONS.
e-roofs
nowHAZA oto MATERI SCLOSUR ecru Type of Roof
Will thoappllcammfu Ilding upon Ion or Mntllc hnudow matodtl
As de0mCod
d by the Cupertino Mu I e. Aur 9.11,and the Health and Salcey
Catlo,Section 35372(.)7 All roofs shall be inspected prior to any roofing material being installed,
❑Yat o
Will the applicant or
rmlum ilding occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
hp-rdeus air contominants u ticnnW by the Bay Arca Air Quality Management all new materials for inspection.
icl7
Cyus bra
I hew mW he barAN w/L�mtemrW,mquimm m undcrCt4v h.95 ofd)Gpifor.
nil HealthS:Salcey Cmk,Sadmts25505.25533 and 25534.1 untluwntl thmifthe building
ductrot molly Mw.mornthenhtserymapendefiym fytheoceuponofthe
require towbkhmucts, rto4sm CuWicam roecmpanry. gnature ofApplicant Date
All roof coverings to be Class"B"or better
0 0
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 34248007.00
DATE ISSUED. . . . . . . : 03/17/2003
RECEIPT #. . . . . . . . . : 21359
REFERENCE ID # . . . : 03030089
SITE ADDRESS . . . . . : 22662 OAKCREST CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SUSIE YOUNG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-0830
RECEIVED FROM . . . . : SUSIE YOUNG
CONTRACTOR . . . . . . . . LIC # *OWNER*
COMPANY . . . . . . . . . . : SUSIE YOUNG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-0830
TELEPHONE . . . . . . . . :
�E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL
______ _____________ __________ __________ __________ __________ __________
BPFIXTURE UNITS 4 .00 33 .32 0.00 33.32 0.00
BPLANCHK PERMIT FEE 117.00 99.45 0.00 99.45 0.00
BPSEWAGE UNITS 1.00 62.16 0.00 62 .16 0.00
BPERMFEE VALUATION 6,000.00 117.00 0.00 117.00 0.00
BPSEWER SEWER SYSTEM 1.00 19.98 0.00 19.98 0.00
PPERMITFEE FLAT RATE 1.00 35.52 0.00 35.52 0.00
BPVENT UNITS 1.00 8.33 0.00 8.33 0.00
BPWATER UNIT 1.00 - 8.33 0.00 8.33 0.00
BSEISMICRE VALUATION 6, 000.00 0.60 0.00 0.60 0.00
__________ __________ __________
.TOTAL PERMIT 384 .69 0.00 384.69 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ _______________---
CHECK 384.69 4590
TOTAL RECEIPT 384 .69
Own cu®r,��j
MAR I L200
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t CDD �D 0 G175"t)
go
31 s@t a —
ba hPPr on f, . • tw ,P�pitcaDa
,ide
.4es d�ittiS�tlff
thq L l d or. atteiot,6:
1 i."•stu -. G p._, }t� r Permissioli fro
;1t;gL1 MOua�Lr(hs�•an aodaRarGno. �
Tr ,rouoF okttye Vapid to Pe;r�,i or robe
� ions
env Ci ton qt a an
N d nance or State aprovisio}a i
I
I ( I
PITY OF CUPERTINO
CUPER-TINO PERMIT APPLICATION FORM 8�
N# Date:
Building Address: y Z ,0
Owner's Name: O PUEA p
O
Contractor: License#:
/U
Contact: Cupertino Business License#:
Building Permit Info:
..BldgDC Elect ❑ Plumb ech ❑
Job Description: r
Residential Co r al
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project Occupancy Group:
Type of Construction:
r
uanti Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits .foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL
BBOILER3 Boilei> 500K to 1M Btu _..._.. ._.. . .. MECHANICAL _. ._. . .
BBOILER4 Boiler> 1M to'1-75M Btu MECHANICAL
qEBBOMER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/ uasi BUILDING
BCONSTAXB Con. Tax for B Zone BUILDING
CONSTAXH Hotel and Motel BUILDING
CONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V <= IOOA ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Ener BUILDING
BENERGYADD Ener Add Multi BUILDING
BINVESTIGA Investi ation fee BUILDING
BMITIGATC Comm. Housin Mit. Fee BUILDING
1 of
CITY OF CUP,ERTINO
CUPEkTINO PERMIT APPLICATION FORM
uanti Fee ID Fee Descri tion
BMTTIGATR Res. Housin Mit Fee Fee
BMNEWMULTI New Multi-Famil Res, BUILDING
BMNEWSF&2F New Sf&2F Res 131d s MECHANICAL
BNEWMULTI MECHANICAL
Multifamil Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical' MECHANICAL
BNUCOM New Comm Plumb . PLUMEING
BNUMULTI New Mliltifamil Res I PLUMBING
BNUSFD New Sin le Famil Res BUILDING
BOVERTRyffi Inspection Overtime BUILDING
BPBACKFLOW Atmos heric Vacuum PLUMBING
BPCESSPOOL Cess ool PLUMBING
BPERMFEE Bld Permit Fees BUILDING
BPFIXTURE re 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 Ikepeat FeeBUILDING
BPREPIPE Re i e Of Fixtures I PLUMBING
BPSEWAGE Sewa a Dis osal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Tra PLUMBING
BP NT Alt of Drain&Vent PLUMBING
BP TER Install/Alter Water Pie PLUMBING
BPWHEATER WaterHeater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reins ection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL
BREMAIItHAN A/C Units <= 10,000 c$n MECHANICAL
BREMAPPLI A liance Install MECHANICAL
BREMBUSWAY Remodel Buswa s ELECTRICAL
BREMFIXT Li tin Fixtures ELECTRICAL
BREMFURN Relocation ofFumace MECHANICAL
BREMFURNOV Relo Furnace> 10K btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc A aratus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
2 of 3
1 - LRTY OF 'CUPERTINO •
CITY 1) -PERMIT APPLICATION FORM
CUPEkTINO
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 Lighting 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 BUILDINGM
BSWIM Swimming Pool BUILDING'
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC '•Electrical q foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE I Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fees foot PLUMBING
ZADDCHG Address Chane BUILDING
•
3 of 3
JB
Y OF CUPEWrINO. + tee°&'': 'zag""^' '•`�='�•r a ''�'''"�' 6 *'��'
UILDING DIVISION PERMIT �kONaTRACICOR TNQ$Maa4CG ADDRESS: SUSIE YOUNGPERMIT N0.
92r(;2 CAKCREST CT
S NAME:SUSIE SANITARY NO _ 2AML
A0.CHITECVL'NGIyB3ER: - BUILDING PERMIT INFO
- - BLDG ELECT PLUMB MECH
u00 LICENSED cchm ACR)R'S DECLARATION lob Description -
1 hereby in.that I am licensed under P.vitlou of Chapter 9(ormmeneing -
with Scott..7").f Division 3 of the Business and professions Code,and my license Is
in full forte and effect.
n'qz
License Class ue.0 - MASTERBATH REMODEL FUNALED
Data Contractor
ARCHITECTS DECLARATION
I understand my plum ShNI he wed our public records- JUN 1 8 20 013 '
b
s Licensed Pmrcedanel - - - - - '
5 N .. OWNER-BUILDER DECLARATION
I hereby.(Sinn on I am exempt from the Cssion% o License taw for the B 1'Y DING
0o following uirenn.(Smdon 7(13su Bueincaaand
we.d.mll Code:Any city or county ,
$ which its lug"..&I t to convert,elkt Improve,dcermit t or repair any manure -
-Z>•
polar to itsiensedpsivantto the the
ovisio or forthe SucCo muses tfile o [A. atemmenl
0 that hoes licensed pursuant to the of Divisioof the eBusinoraLcenselaw(ChapterCode)
Sq.FI.Floor Area �f$Illa[IOn
.� tham a Is ingexempt
pth herefiSection 71100)the
but$n 3for of the Business and profession.Any
Code)of o v UV UU
Nat be a nempt Nuefrom ontl N.beta for Ne alleged exemption.Any vlolauon.f
Salon 7031.5 by any applicant fon permit subjects the applicant o A civil penally.( 3/EIlNNWg* 0 0 - Occupancy Type '
not mom than Ove hundred dollars(M).
❑I,uownaafthepmpeny,mmyemployeuwlow gnutheirmlec=Mnudon, M
will do the work,and On Structure ls.uinendod or offered lonale(Sm.JOas,BusinesslO1 — Fi'OUND�e`,x l9AU*fll`B Inspections
and Pro(wiom Codc:77e Co mwre Like.law don not apply m an owner.(
pmpenywhobulldsorimprovesthereon..ndwhodmss=hworkhimutfortluoughhe 102 - PIERS
own employa;Pmmded thetsuch improvements vena intended.r.BeeA(orSaIC If. lO3 — UFER -
however,the building or Improvement Is sold Whin oro r.of COMPledonowner-
,the
, builder will haw the buNm of proving that he did not build or improve fa Purpose Of - 104 — REBAR -
91O5u J..
I,uowmr of the property,am exclusively contracting with licensed contractors,to
'— ANCHOR BOLTS
. iroctth.project(Sec.70aa.Business.adProfessionalcode:)TheContraewr'aLi• .106 SEWER & WATER' -
e w does not apply to an mom of property who builds or Improve direction,and 202 - UNDERFLOOR PLUMBING
who contracts!rauc open Mwith,conuaemr(s)licensed pursuant m the Convectors -
Linnre ase. 203 - UNDERFLOOR MECHANICAL
rune tender Sec. .B k PC for Wsmason -
? �� 7� 204 - UNDERFLOOR FRAME
OR 0 eNs ECLARA ty / 205 r UNDERFLOOR INSULATION
Ihere efnVM dty f rjury neofN^folV'owIngdeclantions: 301 - ROUGH PLUMBING
;11.n,,
wandwillmeinulne Cetyl leaf munself-inumfwworkeesC.mpen- 302 TUB & OR SHOWER. ,
u provided for by Section 3700 of the Labor Code,for the perfnfinenm of the 303 - ROUGH MECHANICAL -
workfarwhichthisPermitlaIssued.
❑I hove and will maintain Worker's Compensation Insurance,as required by Section 304 — ROUGH ELECTRICAL
37M or the labor code,for the performance ordue work for which the Permit is issued. •3.05 — FRAME
My Worker.Compensation lmunnce carrier and Policy number art: ,306 — HOLDOWNS
Cartier. - - Policy N..: -
CERTIFICATE OFEXEMPTION FROM WORKERS' 307 ' — INSULATION
COMPENSATION INSURANCE 308 - SHEETROCK'
Tfbis it.need not bemmuned lflhe Permit is forone,hundred dollars,(SIM) 309 — EXTERIOR LATH
a,lose.) _ _
leenifY Net in the perfnmance of the work for which this Permits iuved.I shall not �. 310 ,— INTERIOR LATH
emplaysny person many mannefmu.become subject to de Workers'Cotnremadon 311 — SCRATCH COAT
Laws of Cellfomia.Dem
Appliunt 313 - ROOF NAIL
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you Nnmd 501 - FINAL ELECTRICAL ENERGY
become Subject to the Workers Compensation provisions of the labra Code,you am
0z mnhwith Comply with Such provisions orthis ermushallhedamWrevakcd. SO2 — FINAL PLUMBING ENERGY
ZNCONSTRUCTIONLENDING AGENCY 503 - FINAL 'MECHANICAL ENERGY
f~
I hereby affirm that Share Is a construction lending agency for the parromenco or 504 - FINAL BUILDING ENERGY
C'> the waft for which this permit Is Issued(Sec.309E Civ.Cd
W q Lender.Name 505 - FINAL ELECTRICAL
az anderaAddmsa 506 - GAS TEST
U Q 1 nlfy u 1 have fad this appllutiumnn and tthu Ne above ro
ceNfmmatin is4. '
coma.I agree to comply with all city and county ordinances and Sue laws misting to 507 - FINAL PLUMBING.
C) building construction,and hereby authorie representatives or Nie city to enter upon the — _ FIN MEC ICAL
W .hve
o -mcnliuned Property for impecdon purp sk s.
Ly, gy. (We)Agree to Saw,indemnify sed keep homeless;the City of Cupertino against 0 9 F I
t;y IA liabilities,judgments,costs and expenses which may In any way a come against Said City 5 NG
U in consequence of the Sterling of this permit.
APPLICA UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 Date
SOURCE ULATIONS.
e-roofs
;dinlixef HAZA ROU MATERI SCLDSUR ee Type of Roof '
Will Neappliumur fm aiding upon nom or handle hauedoue material' -
mctl by Ne Cupertino Mu el Cotle, .r 9.11,and the Health and Sorely .
Section 25533(gT All roofs shall be inspected prior to any roofing material being installed.
❑Yu u
Will the applicant o
future piling on:u)um tae equipment err devices which If a roof is installed without first obtaining an inspection,I agree to remove
L hanWnw Sir conummants u d.Oned by the Bay Area Air Quality Management all new materials for inspection. _
ntrial?
❑Yea u -
IhawmWthehwAid .dalsmquimmenuunderChapur6.95ofthe Celifor-
ri.HcelN'Ssfely Cab.S .25505,25533; 2553q.lwdentsndthvifthe WiWing
dura Trot nemly Mw a unapttheitumytomoulbilllyu 'fy a.neopran of Ne
nervi. uwhichmuslbomel ' 'tousen Ctrult" rOcmpaney. . gnature of Applicant Date
w rxAll roof coverings to be Class"B"or better