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04050134CITY OF CUPERTINO ` yyoBUILDING RA4xk T``yA\p"V41M' /I'?IFj's:- DIVISION PERMIT A%Z . ,,LDINGADDRESS: 1 72 PARIETT PT, JAMES AHN/ELIZABETH PARK PERMIT "004.050134 OWNER'S NAME: PERMIT ISSUE DATE JAMES AHN ELIZABETH PARK E: SANITARY N0. CONTROL NO. 408 777-9090 ITECVENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing p with Section 70018) a( Division 3 of be Business and Professions Code. and my license is in full rains and effect. REMODEL -WINDOWS / CAB I NET/COUNTERTOP & License Class Dam Le. p Camraemr WATER HEATER ARCHITECTS DECLARATION - I understand my plans shall W used as public me oda Licensed Professional OWNER -BUILDER DECLARATION I hereby M. Out I am exempt from the Contractor's License Law per the following mason. (Section 703 1.5, Business and Professions Cade: Any city or county which requires a permit to consumer, altar. reprove, demolish, or repair any structure prior in its issuance, also requires the applicant for such Permit 10 file a signed smmmenl that he is licensed pursuant o the provisions of be Camracum's Limnse Law (Chapter 9 Sq. Ft. Floor Area Val u,$tg7g000 (commencing with Section 7000) of Division 3 of be Business and Prolamines Code) or that he is exempt therefrom and the bum for the alleged eaempdon. Any violation Of APN Number Occupancy e p y '7 p Section 7031.5 by anyapplicam for a permit subjects the applkant to a civil penalty of not mom Nan five hundred dollar ($500). 31626056.00 ❑ 1, u owner of the property, or my employee with wages u their sale compensation, will do the work, and theanucmin is set Intended or offered for sale (Sec. 7044, Business Required Inspections and Professions Cade: The ConuacmrLtcense Law does rat apply m an owner of e'a q p property wbo Wlldsor improveswork himselfed through his and who doenot ch impe in own employees, provided that such improvementsamnot ear mo@red formic.be of Own r. builder, Nebuilding improvement isoldwithin one year of be owner uimprove builder will have dm burden of proving Nal he did not Wild m impmvg for purpose of talc.). 1, as owner of be property, am exclusively contracting with licensed contractors to ',,/ construct the pmjcct (Sec. 7W. Business and Profusions Code:) The Connector's Li - ,CO. law doe not apply to an owner of property who Wilds or improv thereon, and j Whocontracts for each projects with a contractor(s) licensed pursuant m be Contractor's Laces L. ``^ under Se. , B& P C far this mason V 'DamWORKER'S COMPENSATION DECLARATION1 itexempt hereby OrPom under Penury of perjury am: of the following declarationsve and will maintain a CeNficate ofConsent to selpinsum for Workcr'sCompen- u provided for by Section 3700 of the labor Code, for Ne performance of dmr which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the labor Code, far be pertarmuce of the work for which dos permit is lamed. - My Workers Compensation Insurance carie and Policy number am: Cartier. Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section recd not becomple ed if be pctmitisfaronchundmddallue (SIM) or leu) 1 canify that in the perf erame. of be .,it for which We permit is issued, I shall rat employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Dam Applicant NOTICE TO APPLICANT: IL after making this Ccnificam of Exemption, you should become subject in the Worker's Compensation provisions of the labor Code, you must forthwith comply with such provisions or this permit shall W dcemed invoked. CONSTRUCTION LENDING AGENCY 1 hereby ORrm that them is a construction lending agency for be performance of the work for which this permit is issued (Sac. 3097, Civ. C.) Lender's Name Lenders Address 1 comfy that I have rad this application and sum that the above infortnadom is correct, I agree to comply with all city Nd county ordinances and state taws relating be Wilding construction, and hereby authoring reprammauv of this city to enter upon be shove-menudgm properly (arinspection (We) agree to save, indemnify and keep harmless the City of Cupcnino against whichpurposes. liabilitie.judgments.coats and expenses which may in any way accrue against mid City _ in consequence of Ne flooding of this permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date ' SOURCE REGULATION . Re -roofs Type of Roof =nz° f m of ApplicanunContmctar Dam HAZARDOUS MATERIALS DISCLOSURE Will du applic m or forum building necupamstom orhandlc harardom meuriai by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safetysoen JdOfincd 2ss3z(a)7All Ycs �NaWill 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 the applicant or fwum building occupant use equipment or devices which amoull air contaminants as refined by Ne Bay Area Air Quality Management all new materials for inspection. t4 p Dyes KN. I have mad the hmaadous materials requirements under Chaptar6.95 of the Callum. nia Hcahh& Safcty Cole Sec ore 25505,25533and25534. 1 undc m nd thetifthe building does rmt eumendy have a tenant. but it is my maramoihiliry m notify the occupant M dm requirements which ..at be met poor to issuance ora Cerufica¢ofaeyv Signature of Applicant Date > l4� / All roof coverings to be Class "B" or better Owaerorauthormedagent Date r CITY OF CUPERTINO((�� p ? p ofollowing y c .. }�j ��rm� �gq .g. 1111'Q M�AT� , BUILDING DIVI411 SION PER -ON BUILDING ADDRESS: JAMES ANN/ELIZABETH PARK PERMIT N004050134 NEW NAME: - PERMITiSSUEDATE JAMES AHN EL Z SANITARY NO. CONTROL N0. ONE: (408)777-9090 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affront Nat 1 am licensed under provisions of Chapter 9 (commencing with Section 7041 Division Star On Businmsand Pmlcssiont Codc.md my hear. I. in full force and effect. REMODEL -WINDOWS / CAB INET /COUNTERTOP & License Class Lic.k Data Contractor WATER HEATER l ARCHITECTS DECLARATION 1 understand my plans shall he used m public records Licensed Professional OWNER -BUILDER DECLARATION 1 hcnhy affirm Nat I am exempt from the Conlnetor's License Law for the reason. (Section 7031.5. Business and Professions Code: Any city or county which ¢quires a permit 1. eunamon. eller, improve. demolish, or repair any slructum Sq. F[. Floor Area Yalu 000 t�P prior as itsissuaneo,alsomquimstheapplicmtforsuchPermittofileasignedstatemem that he is licensed pursuant toNcprovisionsolthe Contractor''sLee.. aw(Chapler9 $ (commencing with Section 7")of Division 3 of the Businessand Professions Code)or 1hm he is exempt therefrom and the basis for the alleged exemption. Any violation o[ APN Number Occupancy Type aSection 7031.5 by any applicant fon panorksubiecta the applicant to a civil Penalty of not mom than Jive hundred delta. (S5W). 31626056.00 ❑ I, as owner of the pmpcnt . or my employees with wages az their sole compensation, Required Inspections 9 P will do the work, and dm sWcut. is nal Intended arafle.d(Or set. (Sec. 7044. Business and Professions Cede: T o, Contractor's License law does not apply A an owner or who does amhwork h or through hf. enywhers, rofeedmself providd OatsschImprove orofferedtheoformic. ownemployees,providedmat own ne vehentisS Soldwit in you of r.. howevm the building or improvement is sold within one year of mproe for the awned builder will have the burden of proving mat he did not builtl or improve for purpose of sale.). j I, as owner or the property. am exclusively contracting with licensed contractors to the (Sec. 7044. Business and Professions Coda:) The Contnemr's Li- O/ cause La cense Law docs nal apply to an awns of property who builds or improvesmemoend e, am _ D� who contracts for ouch projects with a contnnar(s) licensed uant pursm the Convacacmra License Lew. ❑ I am exempt untler Scc. . B k P C for tela msson cane C�'l']�_ C/---�— Date D a WORKER'S COMPENSATION DECLAWON I hereby affirm under penalty of perjury one of the following declarations: 1 haus and will mainmin a Certificate of Consent to self -insure rorworkcrscompen- sadon, m provided for by Section 37W of the Labor Code, for she performance of the work for which this permit is issued. ❑ I have and will maintain Workers Compensation Insurance, as required by Section , 3700 of the Labor Code. for tM performance of the work for which this permit is issued. My Workers Compensation Insurance carom and Policy number art: Carrier.Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ' frhismetion need notbecompleted lithe Permit is for one hundred dolls. ($100) .,less.) 1 certify 0.1 1. On performance of the work for which this permit is issued, l shall not employany Person in any mannm m as to become subject to the Workers Compensation Laws of California Date Applicant - NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should - become subiccl to the Worker's Compensation provisions of the Labor Cade, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY y hereby agency for the performance of issued Netmit 7.Clending > wharfvm Soo, work for which this permit Ice issued (Sec. 7097, Civ. C.) I La Lenders Name � Lenders Address ti1 Gentry that 1 have read this application and state Out the above information is comet. T agree to comply with all it, and county moi nances and state laws relating te Jbuilding Conswetion, and hereby anthorias representatives of Itis city to enter upon the ahow-nocntioned properly for Inspection purposes (We) agree to save, indemnify and keep harmless the City of Cupertino against 11 { /> 'f) liabilities, judgments, costs and exposes which may in any way accme against Said City Z in consequence of me standing of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. 5 — orf Re -roofs Type of Roof t atu of Applicant/Contmcmr Dam HAZARDOUS MATERIALS DISCLOSURE Will me applicant or future building occupant Stmc or handle hs.Oms material az defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)7 yyy,��, Cues 1UNo 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 thea applicant or futum building occupant use a ui ment or devices which rr s by the q r emit hazardous air contaminants az defined by the Bay Arca Air Quality Management all new materials for inspection. District? �p ❑Yes pj No 1 have read the hamolol(usmmaterials requirements under Chnptar 6.95 of mccalifor. .is Halm & SaRlyCode, Seet om 25505,25533 and 25534.1 undersund mat if the lailding does not currently ham a tenant Nat it is my maim sibil ity to notify me wcupmt of me roquimmcnts which most be met plot to issuance or a Ccrdream oracupmcy./ Signature Of Applicant Date �_ s/f 4�a All roof coverings to be Class "B" or better 0 OF CUPEkTINO OT'Y OF CUPERTINO 0 PERMIT APPLICATION FORM N #o U 0 . � 2--oo , Date: �� M+W Iq12-004 Building Address: Mailing Address (if different from building address): 10112. PAP -LC -TT PLACE CQQC-931W CP* q50 14 Owner's Name: Phone #: 3AmCS AON ELi-2"ET+4 P/kKK (4-0-0 25�-2845 Contractor:.P Miwr64- co oveT * CartST License #: 174,119 t/CIUA-1rok w1 dao 0,,4- Do -of 6 614a31 Contact: Phone: Cupertino Business License#: Fax: MECHANICAL Building Permit Info: 11 P •Bld Elec Plumb 1!5Mechc Job escrmtion: (D REPLACE witiDdwj Residential ® ® REPLACE CA,6196T Wo IOONTL-Q.JoP Commercial ❑ ' Sq.Ft. Floor Area: $/Sq.Ft.: Z 100 •pt Construction Tax Cost of Project: Occupancy Grou . Ind/Off/Comm/Quasi BUILDING Type of Construction: Please check this x if the project ' a BUILDING second-storyaddition. ikoject Size: Standard ❑ Large ❑ Ma'or ❑ BUILDING Quantity Fee ID Fee Description Fee Grou BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . foot BUILDING BBOILER1 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/MWELECTRICAL ING BELEC1000 Elec 600V <= 10RICAL BELEC1001 Elec 600V > 10RICAL BELEC200 Elec Svcs 600V <=RICALBENERGY EnerINGBENERGYADD Ener Add MuINGBINVESTIGA Investi ation fING 1 of 3 ams an o CUPERTINO Y OF CUPERTINO PE IT APPLICATION FORM AhQuantity Fee ID Fee Description Fee Group qw BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING . BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g 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 Dis osal 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 BREN AIRHAN A/C Units <= 10,000 cfrn 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 BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non -Res A liance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL 1 BREMPOWER Power Device/A aratus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Re air/Alter Heatin MECHANICAL LJ 2 of 3 *CITY OF CUPERTIN® MY OF PERMIT APPLICATION FORM CUPEkTINO Quantity Fee ID Fee Description Fee Grou BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rind] 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 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 Issue PLUMBING PPLBG Plumbin Fees foot PLUMBING ZADDC, Address Change BUILDING 3 of 3 1 J • 5 H 1 CITY OF &UPEkTINO BuildinLy Department v _ — • "_ Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 JOB ADDRESS:" IP&"IT # 6 loll? QA�t PLACe AA 1..z 11 1. OWNER'S NAME: 3AwLe5 A (+N, ELkz-M sM ?ACK, ' PHONE # o) LS - 28'F GENERAL CONTRACTOR: FAX # l" I am not using any subcontractors: Signature. Date Please check applicable subcontractors and complete the following informaHnn- er/ Contr 'Ct�r Signature J W1, 14, 2aoy- Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork MAS�� CAB�aE(A curl —1yu21r,' Cement Finishing Electrics t r � iuc .. i��.4�1Lwbt .. .. acavahon Fencing K, Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation �T �'2"O&Pfhg QU L♦ wwoao ANO ooze, Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering 'Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile er/ Contr 'Ct�r Signature J W1, 14, 2aoy- Date OB IN (his set of plans - Pe kept on the job at all hm 4 and it 9S urt, lawful to make any changesJ!, alteration pp same without written permissiort tmm lbs building Dept., City of Cuperlino0 " The ste Ping o lit oc to ba x 3MA4L of be held to pe M Of the viobom of M P ,t any ordmenm 0, E nl �3 - � s9�i4 x38 u�u.wo6N B��Qaar1 opMi«,K To 3 et• c�oi 4 gED door -1 SQdax3$ 2 WILAL w , OPiNaaG To H8f1f coos f�AS1L� RSD Ecyvw� 11 3�'�9x S1Y� 4AL-L- Vw nASZ W W 0 0 W,$ , f n. MAY 2u44 �E + �OOfn SJ 34 x 33 Y2 twfs C c)rN(N(S 1200 tA lon2 PARcC-TT PL - CUP C-0-1No, cls CA,50 )q 70 r/J K S7 FArA�Lq KOo M SCS 4Ox 011 Krrct-G N� L. —..r i ® 0 34 X 4S BAT -.H I i 1 34YtX`49' ® i VAX UPPEe- otj� I v ,I L2 r w 4 0 46 ---- 2g„ —1 46 ---- 2g„