04080072 CITY OF CUPERTINO 'v' r "SuYav&E£ �,
BUILDING DIVISION p;CR CONTRACTOR�INE01 MA N:,4
�
BUILDING ADDRESS: PERMIT NO.04080072
OWNER'S NAME: PERMIT MUE DATE
RAIAAqTTP 'AMA A 11
PIIONE:
SANITARY N ONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+�+Oo LICENSED CONTRACTOR'S DECLARATION Job Description
U C 1 hereby affirm that I am licensed under provisions or Chapter 9(commencing p
zto withis e<L 7000)uf Divi' Baf0m Dus rTMP frssion Cfjode.andonylicensis
'aac mm anacrrcn. . l' ' NEW FRONT DOOR & SHED ROOF TO COVER W/6X6 SLAB
Dam Crnvacmr CONTRACTOR: SPIEKERMAN CONSTRUCTION
�/ CHITECTS DE A 1
4r4< 1undcomnd yplansshallheusda�u fc seats
yU
3 0 Licensed Professional
OWNER-BUILDERfora me
C I hereby.('Gere that 1 1. eaempt from the Crnlrnenla :License Law for the .
_o o which following mason.peorn(Secit 1.Co str5.Businessand!Psfeazinns Code:repair
any
nImmu county
e
tint which its smaapermit spumes the applicant
improve, Perlia ore pair anYtoucans
�'nthatheor incensed prsualso nttothe thrviciocant far mchpccmiuOicense aw(Chned mmcm
thatmis ecingitPSecon uothc of Dixions of NC Con miner'sndPmctaw(C ode)or Sq.Ft. Floor Area Valuat�11079
�5 (cat he I,(Commencing Smcfmin add the
Divla;nn 3 of the al eged cissmna m.Any
Code)or
c�_ that he is eaempt therefrom and Ne baso Tot to alleged exemption.Any violation of ���aaa
;;;
Section 703 L.5 by any applicant fora permit subjects the applicant to a civil penalty of APN Number y — OCCu ane Type
not mom Naznean five hundred dollars(S500). `R yp
❑I, owrarthe pmpmy,tar my employees with wag.sstoursom
lecopenerion, 37518001 , 00
will do the work and to swmum is not intended or offered for sale(Sec.7094,Business
and Pocesiona Code:The Commencer License Law does not apply to an owner of Required Inspections
property,who
builds or lmpsoves thereon,and who daessuch work himulfor through his -
own employccs,provided district improvements arc not im ended oroRered forsire.If, UU4
however.the building or improvement is sold within one year of completion.the owner- L Z
Wilder will ban the burden of proving that he did not mild Or improve for purpose of /� Ty�g�s�/�@y
sale.). Ltll'9Iffi�'/M(y p® a�
Is I,as Owner of the property,ed exclusively contracting with licensed contractors to �{q 1ry1�
consumer La co project(Sepply.to an Business and Proproperty
who builds
Code:)The Cantremor's Li. Mil Y y�Vp®!
Cease law does not apply Iran owner ofommerciny who bullas or improves centra,and
who contracts for sato projects with a convanarts)licensed pursuant to tis contractors
Li cru Law.
I am eaempt under Sec. ,B&P C for this reason
Owrc Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty or perjury one of the following declarations:
❑1 have and will maintain a Ccmfieum of Consent to self-imus for Worker'sCumpen-
.ndan.az pmvidcd for by Section]]00 of the labor Code,for to performance of the
work for which this permit is issued.
E]1 have and will maintain Worker's Compensation insunn¢,az required by Section
g]BO of the labor Code,for om pnformanee or to work for which this permit is issued.
My Worker's Compensation Insurance Cartier and Policy number are:
Canner: Policy No,:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ibis It.need not he completed if(be Permit is fortune hundred di lars(5300)
or Icss)
I certify tm in ti p bnmmnec of the work for which this permit is Iona,1 shall not
employ any pc any manners azmbceomc subjceu Work uaLo t�a ion
Laws of Cal ice.Dam F'
Ap (lean
N TICELI ANY:IE a r maks u�ntfsam of Excmpuon, should
bee eubjca to the Workcri Compcn tion previsions of the lane,Cod yyou ou must
Q z foMwith comply with such provisions or this permit shall be deemed mvoked.
zO CONSTRUCTION LENDING AGENCY
(--� I hereby affirm that there is a Construction lending agency or the Performance Lir
�i the work for which this pemtit is issued(Sec.3097.Civ.C.)
U Q Icndcls Name
D z Lender's Addrras
IL Q I certify that 1 have sac this city
and Coon and sure that the above information is
0 t"' building
agree to comply add with all nth and county ordinances adiverOf dna sum laws slating e
QU buildingrtioncctlaq and forinytoPrcprcumatirmortis c;ry to cnmrupnn the
ahavLiderj dgin pourcry for inspection erea which m.
H G (We)agree to save,indemnify and keep harmless the City of Cupertino against
N in
of cons,
costsandupcmmmit. may in anyway accrue againstsaidCity /
Q inconsequence of UNDERSTANDS
granting of this permit.
APPLICAN'B UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOURC GULATIL
D /C Re-roofs
aro of ApplicantrUnin for
roc 0, �, m
HAZARDOUS MATE AIS DISCLOSURE Type of Roof
Will the applicant or future buildin occupant store or handle haardous material
az defined by the Cupertino Municipal Code Chapmr 9.13.and the Health and Safety
code.Section 2ss)2(a)?, All roofs shall be inspected prior to an roofing material being❑Yea 4�Na p p y g g installed.
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
Cold hanomus air contaminants az defined by the Bay Area Air Quality Management
District? all new materials for inspection.
❑yet
1 have sac the haaMnuz mamrials rcyuismenu under ChaPmr 695 of tc Califory
nimHcalc&SafnyCodc.Scctiansurroo25531 anJ2mm undcmmnd.95 Ih C.Ffag
dos n t curtntly hasp¢ora Na 'I' responsi hi ity m muly the occupant of the
reyu'c�nrenu wnich t e m;ssnancez rtifi.m Or Occupancy. Signature of Applicant Date
i0voor Or authonimd.Jr., ere All roof coverings to be Class "B"or better
I
r
. CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp : Rng: S,ub: Blk: Lot :
APN . . . . . . . . : 37518001 . 00
DATE ISSUED. . . . . . . : 08/10/2004
RECEIPT 4 . . . . . . . . . : 26617
REFERENCE ID # . . . : 04080072
SITE ADDRESS . . . . . : 18725 TILSON AVE
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . :
IMPACT AREA . . . . . .
OWNER PAUL KAO & PADMINI BAHASUBRAMA
ADDRESS 18725 TILSON AVE
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : RONALD SPIEKERMAN
CONTRACTOR . . . . . . . : LIC #
COMPANY
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
OTELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- - - ------- ------ ------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 1 , 079 . 00 83 . 16 0 . 00 83 . 16 0 . 00
BPLANCHK PERMIT FEE 83 . 16 110 . 98 0 . 00 110 . 98 0 . 00
BENERGY PERMIT FEE 83 . 16 39 . 92 0 . 00 39 . 92 0 . 00
BREMPOWER POWER UNITS 1 . 00 47 . 96 0 . 00 47 . 96 0 . 00
EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00
BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00
BSEISMICRE VALUATION 1, 079 . 00 0 . 50 0 . 00 0 . 50 0 . 00
BUSLIC FLAT RATE 1 . 00 100 . 00 0 . 00 100 . 00 0 . 00
-- -------- ---------- --- -----'--
TOTAL PERMIT ----------
422 . 09 0 . 00 422 . 09 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 422 . 09 2535
TOTAL RECEIPT 422 . 09
•
(Q- •TY OF CUPERTINO
CITYO A U d
CUPEI�TINO PERMIT APPLICATION FORM o c� 72
APN# L4 17,7- /e
Building Address: t Mailing Address (if different from building address):
Owner's Name: {�a K ,n Phone #:
Contractor^ � -� � License #:
C {/� t {V•tww--
Contac Phone: Cupertino Business License#:
�o � Fax:
Building Permit Info: z
Bldg ❑ Elect ❑ (Plumb nn❑ Mech ❑
Job Descriptio �k7a f w �p c„� UpC v t 5 n IC�� t ? C.C,�,C, P i� l,V zkl
Residential Commercial ❑
Sq.Ft. Floor Area: / C U $/Sq.Ft.:
Cost of Project: o Occupancy Ur p:
o
Type of Construction: p Please check t box if t roject is a
• / second-storyaddition:
Project Size: .Standard ❑ Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1 M Btu MECHANICAL
BBOILER4 Boiler> IM 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 <= IOOOA ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
Z66 ` 7
1 of 3 L 6 7
tTY OF CUPERTINO
CITY OF PERMIT APPLICATION FORM
CUPEkTINO
. Quantity Fee ID Fee Description Fee Group
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
13RESSPOOL 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 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 clip 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> I OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREN MISC 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 Heatin MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
2of3
r CITY OF CUPERTINI
CITY OF PERMIT APPLICATION FORM
CUPERTINO
Quantity Fee ID Fee Description Fee Group ,
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 Inspection 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 Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
•
3of3
CCG - F Y° RESIDENTIAL PROJECT COVER SHEET <v
� eZ`•L xa;.fr � .irs' kip x^�a✓ ;' - -- _x,♦ s ..
CUPE
TY
':aa * '3 '; v ~ -
Assessor's Parcel Number: i crj- 2 ��1 1`y�`
Paul Kao e PcAt'�tiie�isub - QICx.Ji1\ I �/Ccf`
Name of owner. ti Ijaf tl" II�InIL, W)UL /
WU u �6 —
-7 /r � �
Project address. i / ���� I 0(� C&to c?d-k,� r1 C2, 11
Conta�p ^ Phone �l ��'•5 7�
Fax.
-Net square footage of lot.
Existing o•.• j�
Square footage: First floor: ���®®®®RRRd��� �- : wY"IC�e
Second floor: AUG
flf
Garage: /+ p�Itl —
TOTAL: CITY OF `iy
• �
Are there at least two 10 foot by 20 foot clear spaces insidelARPge age. "WENT 1
Is privacy protection planting required for the project? Y N �6t ,'
a
On what floor(s) is work being done? S i
Brief descriptio of work. irOU.�J �/1,Y)V` �/t 11n�U �� � ��� 66
Code editions: 2001 CBC (Y - N)2001 CFC (Y - N)2001 CMC (Y-N)
2001 CPC (Y -N)2001 NEC (Y - N)
Effective 11/1/02 APPROVED
IN ACCORDANCE WIT THE CITY
COURTINn JDES ,JD ar '„ CES
DATE
sic 1, _
T"s sn} plans and specifications MUS7
ept on the job at all times and it is un
lawful to make any changes or alteratiorrs
• nn same without written permis:'ion from
the building Dept., City of Cupertino. .
The stamping of this plan and specifications
SHALL NOT be held to permit or to be ar,
approval of the violation of any proviswns
,r ,,,,,, r;h, nrdmanM nr \rata taw
Plan Review Process Work Book Page-8-Revised 4/28/04
�. ((p, IFR SSED'PEAN,CHECK ITEMS
�q�
TO RESIDENTIAL PROJECTS
CITY OF
CUPEkTINO
w . The foil litl s e -on the-plan set.
Planning:
1. Fully dimensioned site plan.
2. Fully dim, sioned fl or plan and ele ations oentire' ouse':'(Not just=area of w rk). /(
3. Scale of all drawings indicated on the plans.
4. Assessors parcel number.
5. Privacy protection_measures (landscaping an ali r ance.
Structural: AUG 10 2004
CITY OF
1. Note/or detail shower lath paper requirementcknTQ,
M IVT
2. Show all header sizes and supports. (UBC CH. 23)
3. Show location of all hold downs and anchors. Note on plan all hold-downs to be installed
prior to foundation inspection.
4. CF-IR and MF-IR forms must be incorporated onto plan sheets.
5. Show all post beam connectors. All beams ,etc. must have positive connections. (UBC
CH. 23)
i l�6. Note that glue laminated beams must be certified prior to frame inspection.
/('1/ ,47.k47. Read soils report and/or soil letter. Record Soil Engineers finding/recommendations onto
/ plans.
8. Show note that pad height and set-back letter to be delivered to City prior to foundation
inspection.
Ey tS��—�_-onfirm with note or detail, egress/ingress window requirements from bedrooms. (UBC
• CH. 3)
�X Sbo 18" by 24" under floor access, and 22" x 30" ceiling access. (UBC CH. 23, CH. 15)
Plan Review Process Work Book Page -9-Revised 4/28/04
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RTINO ,
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