04040103 CITY OF CUPERTINO >
BUILDING DIVISION PERM* ^ ' �"
��CUNTRA.CTORMINFU�tMA. 1Y
m� �•:i sF n.'s"€ ->�.xs4 ?^Yv;,"`Ey?,xg�e� a'u ,
BUILDING ADDRESS: "'"""04040103
ERMIT NOhV 4 0 4 0 1 0 3
ER'S NAME: PERMIT ISSUE DATE
PHONE: SANITARY 0. CONTROL NO.
ARCHITECDENGINEER: - BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
+naoo LICENSED CONTRACTOR'S DECLARATION 70th Description
hereby affirm Ihot I am licensed under provisions or Chapter 9(commencing
wrN Seniors 7Qlu)af Dlvlsion Jof Na Buuncesa di, fusions Cede.andetylicenuis
nrullr an errors EMO PATIO/NEW WINDOWS
ZNZ Lic rove Can
'3m Dad�,Com r ONTRACTOR: SUMMIT BUILDING CONSTRUCTIONS
I understand my pins shall W used S pau-tik records START JOB WITHOUT PERMIT/BPERMFEE FEES DOUBLED
0
3 Cleaved Professional _
OWNER-BUILDER DECLARATION
1 heathy.them that I em exempt from the Cmrtnnara License Law for the
o O following revon.Permit
t 11ore ,.Business and ProImprove.
deiav Cade:Any city Structure roomy
9 which requlms a e.else tea c fires be elver.Improve,h Perm ffi,sur repair any ucal
prior m its lensed p rr u requires thnviSmappla O for such Permit to ficallle a Law hlcmnl
< Nuheucan¢dpuraanuo the pmviviamof Nc CommcmYsnd Prelate(Chapter;Code)
Sq. F[.Floor Area Valuation
,Sp$ (ort his 4nngwi thanian1000)o( basis n3 the
alegeinrandarn.miav Courn or
of
3� Nu he k exempt Nemfrom ntl Be,bola(m Ne alleged esempdn.My violation of
Section 7031.5 by any applicant for a permit subjecu to applicant to a civil penalty of APN Number Occupancy Type
nal mon done five hundred dollen(5500).
❑1,u owner or Ne propvey,or my employees with wages So their sok compensation,
will do the work.and One structure knot intended oroReed roraal.(See.10th,BusinaaRe Required Inspections
and Professions Code:The Conuactir's License Law does not apply In an owner of - q P
property who builds or Improves Nciedn.andwho dies such work himself or thmugh his
owgemployace provided rhmsmh improvemenu tie not Intended oroRered for Sale.If.
however.amWildinguimprovementgmrdwithinone year or happen will have the burden of proving Nu he did nm Wild or improve for purpose of
uk.).
❑I.as Owner of the progeny,am exclusively contracting with licensed contractors to /
construct tie project(Sec.7061,Business and Professions Cotler)The ConuaculaLi.
cave Law deal not apply in an Owner or property who Milds or improves Nenon,and, j
who contracts for such pmjecu with a conuanaRU licensed pursuant an NC Cnuaclah
License Law.
❑Iamexemplunder Seo ,B&PCfurth9mvon
tier Dau
WORKERS COMPENSATION DECLARATION
I hereby arrmn under penalty or perjury oro of tiw following declaratiovt
❑1 have and will maintain aCenlOeau of Covent to self-insure for WorlmesC,mpen-
ution.as provided for by Section 37M of the labor Code,for the performance of the
work for which this Permit is issued.
❑1 have and will maintain Workers Compensation Insurance.as required by Section
37W of Be Labor Code,for Ne performance of Ne work for which this permit is bound,
My Worker's wM utimn hisunnce rod cynumber aq
No
ERTIFlGTE OF E%EMPn N M OR ERS /
COMPENSATIONI ANCE
('Oils action recd ntbecamplewd Iftlm permit Is Carom hundmddollau(SIM)
or leu.)
I certify that in the performance of the work for which this permit is issued,l shall not
employ any person in my enamor an at to become subject to the Workeri Compensation
Laws of California.Dew .
Applicant
NOngE TO APPLICANT:If,after making this Certificate of Exemption,you should
become mhjmt to Ne Wahah Compcwdon provisions of Ne Labor Cecil,you muss
.`z forthwith comply with such provisions or this permit shall this rimmed reviled.
N CONSTRUCTION LENDING AGENCY
[—r I hereby alarm Net Nem is a convection lending agency fm Ne performance of
aiNe :ork for which this permit is wood(Sec 3091.Civ.C.)
L
et,
Q cmkis Name
et z Landers Address
V 0 I certify that 1 have read this application and sou Nel the above Information is
I agree w comply with all illy and roomy ordinances and sou laws relating to
O building rostrum..,rod hereby mutation,mpmsemadvasaf this chyu entesupnn one
t27 aWve-(W) med agree or
for emnify an lacep es
fY es ju agree b cove,indemnify and keep harmless w City of paCupcnst S againstCty
�.y 4 liabilities ue grauinlg expenses which may In any way ccmc against acid City
V 7 A APPLICANT
of due granting of this per mit.
'7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALLNObiPOINT Issued by: Date
0 RCE REGULATIONS.
Re-roofs
igneture of Appli<aHUAZARDOUS MATERIALS DISCLOSURE w Type of Roof
Will the applicant or forum Wilding uceupnutore ar handle Ini allov mawrid
as defined by the Cupertino Municipal Code.Chapter 9.12,and tbe Health and Safety
de, E]ye �No
zss3z(a)a
❑ s All roofs shall be inspected prior to any roofing material being installed.
Ye
Will the applicant or future building Occupant am equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit harandov air conuminanu or defined by the Bay Mea Air Quality Management all new materials for inspection.
Disuia7
❑Yes Nu
I hevc mad Ne burou laterials mquiremem underChapter 6.95ortheCalifor-
niaHealth&SafelyGode,Scc6onsn505,25533 and 25534.I weans al NnifNc Wilding
does not currently hero a Mastic that it k my respavihility in notify Ne acceptor of One
rcqui ants which must me,pdoorrmi�ssunmafaCeniE. ofgccu ry, Signature of Applicant Date
LowneT rar.umorivndagent 2 All roof coverings to be Class "B" or better
i
® CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp : Rng : Sub : Blk: Lot :
APN 31602048 . 00
DATE ISSUED. . . . . . . : 04/16/2004
RECEIPT 4 . . . . . . . . . : 25211
REFERENCE ID # . . . : 04040103
SITE ADDRESS . . . . . : 10629 RANDY LN
SUBDIVISION
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER BYUNG W YIM
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2054
RECEIVED FROM . . . . : SOON T HONG
CONTRACTOR LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . .
® TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------- - - - -- ---------- - ---- - - ---- ---- ----- - ----- - - - - - ---- - - ---- - - ---- - ---
BPERMFEE VALUATION 4 , 500 . 00 214 . 00 0 . 00 214 . 00 0 . 00
BPLANCHK PERMIT FEE 107 . 00 90 . 95 0 . 00 90 . 95 0 . 00
BENERGY PERMIT FEE 107 . 00 32 . 10 0 . 00 32 . 10 0 . 00
BSEISMICRE VALUATION 4 , 500 . 00 0 . 50 0 . 00 0 . 50 0 . 00
PPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00
BUSLIC FLAT RATE 1 . 00 100 . 00 0 . 00 100 . 00 0 . 00
MPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00
---- ------ ------- - - - ------ - --- - - - -------
TOTAL, PERMIT 508 . 59 0 . 00 508 . 59 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- - -- ----- ---- - --- ------------ ----- -------------
CHECK 508 . 59 179
TOTAL RECEIPT 508 . 59
C ATY OF CUPERTINO o
�UCPTYOF O PERMIT APPLICATION FORM O (/_oq- o
APN # ( / 02—
Z U Date:
G /6 �v
Building AddrtbrO�� ilin Address i dif Brent from building address):
ASD �' /l:✓D
Owner's Nam /� ( Phone
Contractor: I /iyrjry)� c�G�d� Lidense #-.,6 �Z 3
tel!
Contact: / Phone• Cupertino Business License#:
�dO Fax:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Job Description-
;MV
Residential ❑ Q PJ ' ZCA�!?"mmerciallwp
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project-.— Occupancy Gr p:
Type of Construction: / Please check this box if the project is a
secon. -story addition: ❑
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
BELECI000 Elec 600V <= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BFLEC200 Elec Svcs 600V <= 200A ELECTRICAL
BENERGY Ener BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
I of 3
<( grY OF CUPERTINO
UP TYOF PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
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 Pblg 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 Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Stonn/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
ROW 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 Fumace MECHANICAL
BREMFURNOV Relo Furnace> 1 O btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
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
2 of 3
Sorno
tla
ITY OF CUPERTINOO
CITY OF PERMIT APPLICATION FORM
CUPERTINO
QuantityFee ID Fee Description__ Fee Group
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilklon S stemMECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRESeismic Fee Res "BUILDING
BSPECIAL '�S ecial'Itis action- BUILDING
BSWIM Swimming Pool- " BUILDING
BTEMP .-Temporery Power ELECTRICAL
BTEMPPERM Temporary Bldg Pe'r'mit BUILDING
BTEMPSVCS T5Lmp 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 pi,imhing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
•
3 of 3
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\al
10
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4 +i
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\ W\SN THE 1NAN
1N ACCORpA�0
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OAZE
and
sP c�?icalia a 1Mg o�
S\GN�! Plans SE nines an �dort!
jhis set n\hs l�h at SE
uc oh.tT
oosame Otn.
DeP\ City �a
P a mLpo <o !R
the puld�n8 �s t.
s� AGO
o[ ���
�\ snY C�hl
4o�s�
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ry
Q ML
APR 16 2004 I .3
CITY Ur CUPER I' .I®
BUILDINrt k r)FPAr"T a ENT
v
i
I
' ,� � � .�s�ecstcab°ns
---- _ ��-i job aFa ••QS°t e t fion
Da 'twmake any Gkacn V aiss
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to PatmanY omai¢t�
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30424 SAN ANTONIO OXXXXT
HAYWA 2, CALITOR2AIA 94544-7190
• tMYbr� hrrdaol (SlO) 797-%.22 (5348'-2234
Aumbum4wPww"^rSIIiLWEHDW
.C4N
4 '3 �
C, of FlRMkTl0N
200294
200.194 MISSION MASI
HISSION GLASS 3088 EL CANV
3088 iL CANINO RZAL SANTA CLARA
BANTA CLARK CA 95051
9 q b Kc 8 296 1 9
ry,'ACMAl�R!1lDE1t N(IM SC1t TAPL>� l.A.
Q 'UA'ft pryTAC.T' .
CAiy I
cc, 'c X=,,,Qx 308 82000.00
NO COD%'pl fE CALLA
!w-!w_wu____
----r----_-_-_---
5320W D/0 NAIL 4N VII4YL ALIl38Wf �l'Tt
107-3/8 x 93-3 8 xOR
MEN
UV �p� gOC . 3200 NFT .5800 r
SIT
•• ;lS320t�rDfG NAIL-ON~VINYL-9LI)SR -WHITS
9-3 8,1L52-3/8 x.07c W/ 9caSAN 5
GL f I 1: `
• VY .9700 AMOC .3200 v?. .5800
0ZT UP CHAROE 'x
ywwwwwwww w.__wwwww_wws wsro-ww assw`!1 ww Y.wwww �� ; /
53204 D/O 1V?►IL ON VINYL $Iali?'E?k' \VMIT e
35-3/8 x 13-3/8 xQ W1 SGRUN
CLARK / Os®cu" APR 16 I-JU4
CV .3500 swc ..6104. VT .6400
erg vF CRAMS _ CITY OF CUPS* u INN I I
I: :& OR TfiIM AV:AII+ASL i
1 $4A YIMYL HLVBH 8I1� WIhLCW& IN WHITE OYiLY
4 12' 9/L 621 .80 �? ^ -14
RISI 61'113W-194 ("t" AWLS)
12' SA
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COMPIRMINS 20=1=82"
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• 71.4613-00
CITY OF CUPERTINO � ,`CT0 TN. ''�RMATIpPC �?
BUILDING DIVISION PERMIT * ,
''n.r.e.� 54R�'•IB✓.'�.�"'3 .�iv$f.'bn �.i<v:'E'f.
BUILDING ADDRESS: PERMIT N00 4 0 4 01 0 3
WNER'S NAME: PERMIT ISSUE DATE
E; SANITARY 0. C ft101 NO.
ARCHTIEC IENGINBER: BUILDING PERMIT INFO
BLDG ELECT PUMB MECH
k
>3op LICENSED CONTRACTOR'S DECLARATION Ib D0CrIIOn
1 hereby inform Net 1 am licensed under provisions of amour Description
r 9(commencing p
with Section 7aM0 of Division 3 of the Business sInd Profe.alom Code.and my llcenv:is
in full( an oReeL '
n1 C..uap��f EMO PATIO/NEW
R: SU WINDOWS
DE�-A NTRACTOR: SUMMIT BUILDING CONSTRUCTIONS
underwnd my ptam shill he�imtl u public records START JOB WITHOUT PERMIT/BPERMFEE FEES DOUBLED
Licensed Professional
5� OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Lew for de
o following fusion.(Smdon 7001.5,Business and Profexalons Code:My city or county
s$ which acquires•Permit to.n fusel.sheaf,improve,demduh,err repo:'soy atratare
prior m its issuance,also require the applicant(omen permit o file asigned statement
Il< IMtheullmnaJpunuanttaNcprovielomofNeCpmramrilJernselaw(Chepter9 Sq. Ft.Floor Area Valuation
60 (eummeneingwithSmtimn7=)af Divulon3pfthcBainmmd Rafnsimm Code)or
a Nat he Ise exempt therefrom aid the basis for the alleged exemption.My violation of
Section 7031.5 by any applicant for a permit ubjects Ne applicant to a civil penalty of APN Number Occupancy Type
not mom Nan Bn hundred dollen($500).
❑I,u owmu of Na property,army employes With"Sam f Omit compensation,
wBldothemk,mdNetwnamisnatinmndedoro@redfcnale(See.7044,Bualteu 31602Q18 . 00Required Inspections
and Professions Code:The Contran mes Liceme Law donot apply m an owneer of q P
property who builds or improv.themon,and whe dom asses work himalf tar through his
own employers,provided that such improwmenu art not InetMrd ormUrard(oras]-It,
builder,the itheWilding m improvement is aid within oro year of mprove for
6e poser-
builder w10 haw Ila burden of proving that he did Inst build or improve for pugose of YYY
ale.).
❑L an oxen of the Property am exclusively c.trning with licensed conuamms to
construct the project(Sec.7014,Business and ProfcOalON Cade:)The Cmuam.Li.
whoconLaw dounoupplYman itha ofproPerY who snrimprowe themCoom,mod.
who conwcufor.anply man
WNeeonpaler(a) ho Wilpontiff mNe Come . o.
License Law.
0 1 not exempt under Sec. .B&P C for N4 men
ser
Data
WORKBR'S COMPENSATION DECLARATION
1 hemby affirm under penalty of perjury cane of the following mchusu pm
1 haw and will maintain aCeelfinu of Come.to self-imum for WorkerYCompen-
sation.u Prmidcd for by Section 3700 of the labor Code,fer the Performance of Ne
work for which this Permit i.issued.
❑1 haw and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,far tho performance of the work forwhich this permit Is Wed,
My Worker'. nation Insurance d ry number at'
road
er. p' 0�
ERT(•GTE OF E%EMPn N OR ERS'
COMPENSATIONI ANCE
(ru seed.need rot W completed Ifthe permit H foram hundred dolun(SI00)
or kis)
I certify that in the performance of the work fm which this permit is issued,I.hall net
employ any person in my manes an to bemmcabject to tie Workcri Compensation
Laws of California.Dail
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject to the Worker's Compensation pavilions of the labor Cade you mm
OZ Forthwith comply with inch provinces Or Nu Permit shall be deemed rooked.
'Z y CONSTRUCTION LENDING AGENCY
(-t (hereby affirm that them iso construction lending agency for the Performance of
CY�•� Nc work for which Nu Permit k is.uW(Sec.3097.Civ.C.)
a0 L gimmes Natnc
P z Lander:Address
U 0 1 unify Net 1 haw mad this application and them Nat the same information is
LL comet.I epee to comply with W city and county ordinances and sum lava miming to
0 building mnswnimn,and hereby audamia reprnenupws of this city to enter upon the .
W alevcmmtioed progeny for WPemianhi
(We)agree m sows indemnify and keep keep hamlw the City of Cupertino s against
I,y(ajl mealgqll¢¢GqquteacceOU.emLLandexpen.nwhich may In my Way cmc against said City
() APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALLNO POINT Issued by: Date
0 RCB REGULATIONS.
9
Re-roofs
igmum of AppliMVCompamr te
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the Applicant or future building occupant atone arbandle hazardous material
u&Rncd by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
^sale.
Section 255320)7
[3 Yen No All roofs shall be inspected prior to any roofing material being installed.
�
Will the applicant or future building=open[use equipment or device,which If a roof is installed without first obtaining an inspection,I agree to remove
emit lumardom air co main.nu u dented by Ue Bay Arta Air Quality Management all new materials for inspection.
District?
❑YesNu l \
I has rend de umatoriau reptiremcras under Chapter 6.95ofthe Califor-
nklimlNa safetycadc,Sections u505.25533 and!25534.1 anMruad timiNe wading
does not cummtlj hew a utnne that it u my responsibility to musty the occupmt of Ne
regalnt,wnrpta eh masithemetpfiarmi or nca
rp d1 Signature of Applicant Date
7 04 r or auNorimd agentM ate All roof coverings to be Class"B"or better