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01040104 CI nu LDFNG DIIVISSIIONNOPERMIT CONTRACTOR INFORMATION: BUILDINGADDRESS: PERMIT NO. 22811 SAN JUAN RD 01040104 OWNER'S NAME: APPLICATION SUB DATE 7EREK FLUKER 04/20/2001 �� TONE: SANITARY NO. CONTROL NO. Rai ARCHITECT2NGINEER: BUILDING PERMIT INFO ee ,UF BLDG ELECT' PLUMB MECH �t- <n u C_I L:_J ( I i z L' I hemby affirmEhmED COPTRaCTOR'Pr vismat DECLARATION 9 ,mi mencmg Job Description �_Cw with Section]000)of Division 3 of,he Business and Prom"imm Code,and mybcene 2431 SQ. FT. LIVING SPACE, Y is in full force and effect. y:.- tea�u Lic,nrc Class co.�C1er 522 S Q. FT. GARAGE. Data_1 a WO fir ARCHITECT'S DECLARATION ,n 1 undersanJ my plans shall Ie used as puhlic records 3 i 0 O Lseemed Professional r, O.t I ma UILOER DECLARATION s '�- 1 hereby affirm,hat I am exempt from the Commnor's License Law for me ' t?G following reason,(Section 7031.5,Business and Professions Cale:Any city or county which requires a pewit to construct,alter,improve,demolish,or repair any structure k 1 3$ prior to its Its uance,.1.requires Rte applicant!orsuch pewit to file a signed eatemem.. m51 he is liaruja pbimam to Me Pmbisionx of the Contramors License law(China,9 whhsecbon 7000 of Division Bupiness end Pru(euions Code •: - .Sq..Ft: gloo AI'6' zc. , ,•+--_\ a ation ((commencing ) ) a- s_ . ,[ ts,-. nhai be Is exiaipt thmcrmm-and the basis for the allitged eiemp,ion.Any violation of Section]031.5 by any applicant fora pewit subjects the applicant to a civil penalty49 - ,o(nm.more then five hundred c(((urs(5500). 99 A -APNNulnbL6U ._ l Occupancy Type C I,as owner of the property.or my employees with wages me heir sole compensation, -will do the'work:'and this structure is not intended or offered for sale(Sec.T(FW, Cl 1' `Business and Professions Code:The Contractor's License Law does not apply to an 102 - PIERS Re p'eetiens i'� owner of property Who builds of improves thereon,aad who does such work himself or through his own employees.provided Nat such improvements arc no,intended or .1.0 3- _...UFER -offired " _..... __ ._- _.. __ __....__._ ..._. come for sale:wnerwever.then hav t or tin en of Prov n sold tha he did one year of ,r, ..... ,:�, ; , --- completion,the owner-builderwillhnvethehurdenofproving,hothedidnot buildor 104 - REBAR "" improve for purpose of sale.). Y 105 ANCHOR BOLTS- _. tr herofinepmpeny edinessa contracting mf- nsTheCornnunro 106 - SEWER & WATER h li.' - c nswct the project(Sec.]gaq,Business and Professions Chea The Comac,or's � - apply,o an owner of property who builds se improves thereon, ' License Lo aces not e I _ h. c and wator', uaztseL h prolats-with.a commctogs),Ice srd p rs nt.mme. -"---- "'204 - UNDERFLOOR' MECHA IC - 01am exempt 203"=-",UNDERFLOOR -MECHANICAL - -""'----- - "" ❑Ian a pt nderSc - B&PC fo ,his re so _ ^' er '4 �5�02 " 205 UNDERFLOOR INSULATION W KER'S COMP A`20 DECLARATION I herebyaffirm under penal, r fthe fmlewin declarations: 301 - ROUGH PLUMBING yocim,of'aneo g 302 - TUB & OR SHOWER C 1 have and willpr o provided by Section o(37M o lh uLa or for Worker's �.". Compensation, n orkf r for by Section .3]uB of me labor ceae, far me 303 - ROUGH MECHANICAL p umn anti wnrkr(rwnichmi.pwhiais.aea. ,. 304 - ROUGH ELECTRICAL C I hove and will maintom Workers Compcmmion Insumace,as required by Section 305 - FRAME 3]00 of th'rLaMr Code;for the performance of the work for which this peiinlf is 7. issued.My Workers Compensation Insurance carrier and Policy number are: 306 - HOLDOWNS (Sme`r Tt i'L� s2 -` a 307 - ',1INSULATONYoimyN , -.. ...-- - - - - !t CERTIT•ICATION OF EXEMPTION FROM WORKERS ,' n . - ' t t � - - '°unt ONINSURANCE' 308 SHEETROCK P ._ _.... ._....._... . _ _ it _ ' COMPENSATI on dead not lz coin Ieged tf the Permit is for one hundred donus 3 0 9 : •'EXTERIOR" LATH -- tsI00)orins.) 310 - INTERIOR LATH' >, I ca.ph that m e in any.ca ohne nrk r men ii e nse d i 31 T - SCRATCH COAT, - Cml en tion L any person m any mann so as to become su61ec,to the Workers' ` Compcnsatton Laws car cmuemin.'Dam 313 - ROOF NAIL O PP 3 ANT.IL after malmgthis CExemption ,„ be�meEub�a oche ... ,-. ._- '--- �--'--- --- --- ---- '- --- -. _._ 501--- - FINAL -ELECTRICAL- g sions o of Exe p, n you u armaj . . . . t mnhwtmco I nhW hp Compensationionsor pro,mohall a Labor Cade,you muni 502 - FINAL PLUMBING ENERGY z py su<hpovunsorthnpewthllbedeemed revoked. . . ._..503- -- FINAL- MECHANICAL-.ENERGY-. - - -- ti ;c�_ {y CONSTRUCTION LENDING AGENCY - lhercbyaffrmthatm ac nirac, lading agency for me perfowexe' 504 - FINAL BUILDING ENERGY,.,,-. .. r. aY cififiewmic 5.0.5 - .FINAL ELECTRICAL a�Q 'under Namet .' `.._ '_ '-. - .._ __ ..._. ._._..."_. .. Lance Adeas . 506 - GAS TEST U O 1 ryfythtlhe scam ppbca,o d state bo information is 507 - FINAL PLUMBING W gree w agnMY ,h ell ty -d c u ry rtlinances d ,, I relningg tit ,on,non bjemhe pre. auvea(fort tyt marupon 508 - FINAL MECHANICAL „n ed prprryrp, p ro pqm 509 - FINAL GRADE ) gee,o as dem ry tick eph I nM1eC tyof Nperiindit ai,)dgmems,c t d<xpe ses h ch m y,n any ey az gamst seta 510 - FINA P ING 6.1 M nuq nee of m granting of rots pc hGULATRS?A �DNPLV WITH ryL�NOty�IZIssued 14r_. N IC Y']ORKS Date14 ///(fApplicSnJ tit wr —T /�l// /'Dmq:',:- ' Re-roof6 3 - ROOF BATTENS `:, �,': HAZAftDOUSMATERIALS DISCLOSURE, - . '. ','11 me applicammf,bri buileing oceupem smsc or haiWle timrdooI maithal ...'Type OfB0417.. ROOF. IN.-PROGRESS by m Cupen n M netpel Cad CheWe 9 IZ and me Healm end Safety tim 25532(ra)"4 ( a ` kt rt 'r t t f _; ,• All roofs shallbe inspected.prior to any roofing.material being.installed. Will theapplicant or future W Id g pan use equipment or devices wh¢h PIf a roof is installed%without first obtaining an inspection; ('agree to'remove w hezeMe u commandants u defined b ,he Ba A Air Quality 1 ty Menageme t ac, all new materials for inspection Applicant understands and will comply.with L _11 a r:. q y `all non-point source regulationsl zeadithe hoz dou. malaride rc utrcmems under Chapter 6.95'of thealm&Safety Code.Semions 25505.25533 and 25534,I undersandthe, g don nm cuuemlY hoveh,ehom.that i,is my responsibility to notify heh Te"marr ts inmos,bemetpr o t nceofaCertificateof wu m zedagemSignature of Applicant Date r ,e All roof coverings to be Class"B" or'betier ._ -'.. 1 _ .OFFICE CITY DI.c DIVISION N PERMTCONTRACTOR INFORMATION: BUILDING ADDRESS: PERMIT NO. 22811 SAN JUAN RD 01040104 OWNER'S NAME: APPLICATION SUB DATE EREK FLUKER 04/20/2001 NE: - SANITARY NO. CONTROL NO. I -• ar or ARCHITECTIBNGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH z e L- •1 C -1 l,l F, '�' LICENSED CONTRACTOR'S DECLARATION 'O so 2 1 hereby Arm that 1 am licensed under provisions ol'Chapta 9(commencing Job Description Yt!I -C with Section 7(100 e f Division 3 of the Business and Proftssiorls Code,and m hccax istnfull force n700leffect. y 2431 SQ. FT. LIVING SPACE, o License Class Lie- '522 SQ.FT. GARAGE. i 3 O Date Contractor ECLA ARCHITECTS DECLARATION ,l1 • N 1 understand my plans shall In used as public records r p Licensed Professional '� r OWNER-BUILDER DECLARATION r I hereby affirm that f am exempt from the Conunetor's Lkcm Law for the - ?q following reason.(Section 7031.5.Business and Professions Cotle:Any city or county �••✓ / S5a.,F o which requires a Permit to construct,alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to rile a signed swtement_ / n ._ _ __._.._ _- ttsai he'Is li ih!pd Ob4tiam to rhe piovisiomof the Comractars License Law(Chapter 9 5 Ft-.p}bo AI6 s }Vt . a anon (commenemg withSetiwn.7000j of Division 3 of rhe Hwinacand Professions Code) y �•� i(••s q••f or that tee li cQmpt thcrmrruiri and the basis for the olljged eriemptioti.Airy violation ••of Section 7031:5 by any applicant torn Permit subjects the applicant to a civil pennhy- 3 4p y,�P ,af not.hsom than five hundred dollurs($500). U b ' .?'7 ' `•- O'ccll anC e ❑I,as owner of the property,or my emptoyam with wages as their sole compensation, -Will'do the'wortt"end the'structure*Is not intended or offered'for sate(See.7044,' `1#usineis and'Professions Code:The Contractor's License Law does not apply w on 10 2 - PIERS Re pection§ uwncr of property Who builds or improves ilrercon,and aha titres such work himself �/ or through his own employees.provided that such improvements arc not intended or ._..... __ .1.0 3_._ UFER.... 6lracd fw`snk:lf;howcva the building ii improvement is sold'iv(thin one year of completion,the owner•builda will have the burden of proving that he did not build or 104 - REBAR ' rmlaovefor purpose ofaale.). ._ •105 - ANCHOR BOLTS W3 project owrra.of,hepmperty,amexclusively contracting with licenudcamractonto _ b.li.t ':' I'!,r'i:,:'•': c nstruct the (Sec.7044.Business and Professions Code:)The Contractor's - 106 S EWER tic WATER :r r - license Law docs nit app)y to an owner of property who builds or improves ftmort, 202 - UNDERFLOOR PLUMBING :. and-who.con[racu.for_such.projecis.wirh.a.eonttactor(s).licensed.pursuant.ta the. ._..__._... ConiractoesLkt*c,Law., 2.0.3 -_•UNDERFLOOR MECHANICAL' -- ---- ----- - ❑1 am exempt under Sec.' �' t' 1,. B,&P C for This mown 204 - UNDERFL•OOR' FRAME',1•. "G DE OZ 205 - UNDERFLOOR INSULATION KER'SCOMP AT)O I hetebffirm under DECLARATION • a 3 01 - ROUGH PLUMBING ' y penalty of perjury one of the following declamtians: 302 - TUB & OR SHOWER I have and will mainwin''o'Certifitate of'6risent to self-insum for Worker's Compensation, As provided for by section 3700 of the Labor Code, for the 303 ROUGH MECHANICAL ar(orma�oe°rine,w°rkrorwnicl, i>prY,r,ttiaiaxaea. 304 - ROUGH ELECTRICAL ❑1 hove and will r uintain Worktt;a Coinpensat{on'Ihsuranee,ss required by Section 305 - FRAME 3700 of tie-Libor Code;for the I crfbmamc'e of the work'for which this peiiih is issued.My Wa 5i Compehsaiton]murine cairieT 46d Polky'number aril 306 - HOLDOWNS Cartier.'�' 'l :'�' �'a:. 'Policy-Na.:'• .e. .. _.._i r:'307:;:- :'INSULATION CERTIFICATION OF,EXEMPTION FROM.WORKERS'{ 1 COMPENSAT)ONINSURANCE`..:.'.,:',r.. _....'.;,,. -........... 30'8 = •SHEETI20CK ' _-__----._--.-•---... _.___...._..._.-..__ 't(l0'`f77tis utifoa aced da be cdmptcted if the permit is for one hundred dollars ...J.Q..9, �F-'ITER T OR...`I;ATH--•--'! ::.,>) l?�,:t i T?: h: (sl0oloriess.) 3170_ - INTERIOR LATH; „ •;s•I Gentry,that In the performance of,hd work for which this permit is isgued,'i - '"2` - CRATCH t•COAT.n I� U` _';i;.. `_..L.4, r .-.,.-,. 311 �.S shbll not employ'any,person to any'mantier sa"as to became iulijen tithe'Workers' 3 13 - ROOF NAIL'"".'" Compensation LAWS of Califomie:pate ' AppSetrii:' `' , --''' -' '-_-: -- =-'-._ _ .:: 501-•- FINAL- -ELECTRICAL---ENERGY-. -- _. __..- _- -• _-- :NOTICETOAPPLICANT:ILAfter makiat<this CenificaeofEumption:y- ihould (d Z: becoirie subject to the Workies Cornpensmion prDLisionsof the Labor Code,you must 502 - F I NAL PLUMBING ENERGY Q O fonhWith'cornpfy with such provisions orthis permit shall be deemed revoked. . . - . .._..- _ .. - ... .. . . _._.... - . . ---50.3•. - FINAL- MECHANICAL---ENERGY..:-..... ;... _;._.... .. ;" ~'�q CONSTRUCTION LENDING AGENCY"'r --' ' ''r' "^ 'a1 hereby off mi that Thom is-P rnniiructitin lending agency for the perfonmen«' 504 - FINAL BUILDING ENERGY,-(•,, w. ofUeworkforwhich humpirm(tis zixd'(SeP.3097,cis:c.) ' __.5.0.5 - .FINAL .ELECTRICAL Q •finder's rime ..c. s�..:..ul.._.:�.:. Lender's Address' „t `z 1; ;i..;_' ' f 506 - GAS TEST U•p v 1,,1 certify that I have read this application and state that ch.above information is 507 - FINAL PLUMBING Lir,[r coraco,I agree to eomply.with all city erid county ordinances.and state laws relating 508 - FINAL MECHANICAL /J , the ab6 mientionetionnry(r inipe ionpcpnesemativea ofthis city to enter upon IQ the above-numtionrd propttry Tor inspersion purposes,• 509 - FINAL GRADE iy fWe)agree to wva;indemnify and keep homeless the Ciip ofCtiperiird nyainu • -'in liobiliiies,judgments,costs and expenses which may in any way aecfue,against said 51 O - F INA P ING U•Z City iii consequence of the gr'anti'ng of this permit.' ''' ' f✓ `-� ~ APPLICSOUR( R cULDA WIAM, AAN'DDWIL�L 1tO4IPLY Wf7/`F{ �L N0tt�.•:POINT Issued 14 r-. N I C WORKS Date IV�?,Cnat ofA ]ico`�or` 7 •T� ax� R - 'HAZARDous')iAiEfafai3')ilsclosuep.' •- • e-roof6 3 - ROOF BATTENS :i 11 tho a pt wn1 or Tone tuildvig«dnp;k stoic or riardk bas>rdobs mairrial . - Type of t04f. -_ ROOF. .I N--PROGRESS•- • -•• 45 deftncd by the Cupertino Municipal Code,Chmpter 9.IT,and the Health and Solely """'' _. '" _'-• _ - "' tion 532(a)? ,:. a ,...b t r R•• i L.3._•!�...{,. ,.n .,ft7 r. C3Yes't,'.y•'r•,V:h;C{g o ;,:+.1'}• a a ! < ! ^ .• t ',I.a : %�••it ' r'•t ' :AIl.rooA shil.i•5e.ins ('clad riot to an roofin material bein installed. ioI a the' cls iii orfuture tlefitngbythe nUse yAeaAir nioraev;aswhich If a roof is installed without first obtaining an inspection;I agree:to'remove it hazudous eat contimirants as defin by the Bay Area Air Quality hfanaQemens trriat'' all new materials for inspection. Applicant understands and will comply,with 1.°Y" all nori- of �;3 '.;ti ;;,ia;a;• . ;,,,,,_r.;..:�:'•,it : ;;•,:'t , 1 p nt source regulations:: t.. . . .. nl'havc n:ad;the i:..ydaui matcriili rcquircmeols witicrsChapter 6.95'of 4'ic ' Califtimis Health&Sarcty Codi;Seaborne 75505.25333 and 25534,I understand that if ihdbuilding don not currently hove a tenant,that it is my responsibitiry to Rmify the dceupant of the requlmmcnts'w,ch rout hal incl Iifior to issuonee of a Ceriilieate of o x f. [� $� Signature of Applicant Date neroraudorizedaaent to All roof coverings to be Class"B" or'betier ' 4,s 1 OFFICE _ _.. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22811 SAN JUAN RD CONTRACTOR:CIVITAF CORP PERMIT NO:01040104 OWNER'S NAME: KELVIN B C LOW&BEE YIAN LIEW 270 E MAIN STREET DATE ISSUED:04/08/2002 OWNER'S PHONE: 4088734711 LOS GATOS,CA 95030 PHONE NO:(408)399-4949 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIP'T'ION: RESIDENTIAL 11COMMERCIALE] License Class Lic.# 2431 SQ.FT.LIVING SPACE 522 SQ.FT.GARAGE. REC.6/1/04-GAVE LTR TO GREG REVISION--03050079,NO Contractor Date NEW PERMIT ISSUED I hereby affirm that I am licensed under the provisions of Chapter 9 r� G/�� . (commencing with Section 7000)of Division 3 of the Business&Professions / /o'j �, Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the.Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$247892 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:34222077.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application:and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS AST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the _ 'Y � f l3 granting of this permit. Additionally,the applicant understands and will comply Iss Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 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 all new materials for inspection. 1117( OW NER-BUILDERDECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will. I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9:12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance;as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date permit is issued. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point soWrgullationse.Cupertino Municipal Code,Section Licensed Professional 9.18. Date Signature l �� CITYOF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 228'11;SAN JUAN RD DATE: 04/24/2013 7 REVIEWED BY: MELISSA APN: 342 22 077 BP#: 0I0 *VALUATION: Iso *PERMIT TYPE: Building-Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex, PENTAMATION USE: p PERMIT TYPE: i woRK RE-OPEN EXPIRED PERMIT AS PER LARRY SCOPE - q , E _ � a tech.flan Check Plumb.Plan Check Elec..Plan Check Fli>chPermit Fee: Plumb.Permit Fee: Elec. Permit tee: Fe' ,�fech.Insp. Other Plumb Insp. EIFL_ Other Elec.Insp..In.y.I'ee: Plumb. hap.Fee: Elec.Insp.lee: NOTE:This estimate does not include fees due'to'other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the 'relimina information available and are onl an estimate. Contact the Dept for addn7 info. FEE ITEMS(Fee Resolution 11-053 E . 711/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure Suppl.PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-0 Reg. Q 0' 2.0 hrs $266.00 PME Unit Fee: iSUPINSFEE $0.00 PME Permit Fee: $0.00 Consir-ttction Tax: Adtniuistrative Fee: —10 Work Without Permit? 0 Yes IS No $0.00 G Advanced Plannin&Fee: $0.00 Select a Non-Residential 0 Building or Structure Travel Documentation Fees: Strong:Motion Fee: $0.00 1.0 1 hrs PC/Permit Extension Bldg Stds Commission Fee: $0.00 $174.00 IEXTPCAP I Plan Check Application $266.00 $1Elm N " F � $440.00 �rl � Revised: 04/01//2Q2013 ( 117