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06040183 (2)
BUILDING DIVISION PERMIT CCSN .C `'QRTI !C^:1tMATION""•' 14,R" •s^ ",'..4.r n€'fid t ' BUILDING ADDRESS: MI LLE KIM FERMIT N0.06040183 20303 CLIFDEN WY OWNER'S NAME: PERMIT ISSUE DATE MICHELLE KIM 2006 NE: - SANITARY NO. CONTROL NO. ARCHr1ECTENGINEER: BUIL.DINO PERMIT INFO BLDG ELECT PLUM O ;op LICENSED CONTRACTORS DECLARATION Job DBSCilpt100 i I kroby affirm that i rn licensed under provisions of Ckpur 9(,ammentlm{ with Secdon7CM)orDivision3aftho Businestand Professium Cok,andm licenxis >> in full force and effem. SERVICE UPGRADE 200AMP ELECTRICAL ;qz ucens "Ll Licnl.grecbr I LIGHTHOUSE ELECTRIC HAS PAID FOR BL 4/28/06 Dau _ G �' .�` Ca ARCHITECTS°1 public TI I understand my Plana shall be used rs public retort" U e Lk:erseJ Professional o� ON DECLARATION 9 1 Wrathy affvm dun I am cumin from the Conuacto's Lleonas Law for the O O following moon.(Section Business;,Busincand Professions Calc:Any City atonality 5$ which requ ms,a permit to Construct,alter,impmw,demolish.or repair my structure Zi prior m its issuance.also requires the Applicant(orsuch permit a file a signed etsbooml < dwk is licensed pursuant to the provisions of the Conlncmr's License Law(Charter 9 Sq.Ft. Floor Area Valuatix000 e�s (commencing with Sedan 70D0)ofDivision 5 of the Business and Professions,Code)or r�.. Net k is except dominant and the bub fa the allgcd emmption.Any violation of Section 7031.5 by airy applicant for a permit subjects the applicant in a civil penalty ofpp7y�}7}s,7�lmber Occupancy Type not mare than low hundred dailan(5500). 3 6 9.I 7 040 . 0 0 ❑1,as owner of site property,.my employees with wages as unchaste manse,Jon, w10 do thework.and thes,wcture bnotimembodaralfcred forsalo(Sec.7014,Business Required Inspections Md Proressiom Code The Conuacmn License Law dam tet apply e e an owner or q P property who build,orimpromthereon,and whodoessuchwork himselfor Luough his ham owever. the iprovided than such Improvements are We year o cd scattereddon.for as e.mer. however.Ne Wilding or improvement 4 sold within of year of mproe for the ownm- builder .will kw she burden of pouring than k did not build or Improv far puryom of sole.). Q ❑1,m ower of the property.am exclusively conmMing with licensed nownwaera m construct the project(Sec 7044,Business and Professions Cade:)The Communes Li. terse Law does not apply m an owner of property who kllde or impmw demon.red. who co ensclafor such projects with a controcror(q licensed pursumt in the Contraaer's Lkems Law. ❑I Ma exempt under See .B B P C far this moan Do. Dau WORKER'S COMPENSATION DECLARATION I hereby affirm under porosity of perjury accordion following dedaratims: ❑I haw and will maintain sCartifrcare ofCown4 in elf-WumfaWorkeesCompen- nation,as provided for by Section 3700 of the labor Code.for the performance of de work for which this permit is issued. ❑1 haw and will maintain Worker's Compensation Insurance,as required by Seeks 3700 of the lab.Code,for the PeKam sues of the work for which this permit is issued. My Worker's Cnmpe Amon Insurance eerier and Policy number are: Carrier. Peery No.: CERTIFICATE OF EXEMPRON FROM WORKERS' COMPENSATION INSURANCE r rnm account mused mtkcanPlcted lfthep foam hundred dolsr($100) or less) 1 certify,Leon in the Performance v�rk b its issued.I shall ret employ any permnin any men ra b' u the Workers'CompussWon Laws of califomis Dause Appll NOTICE TO APPLICANT:If.after makin this CaniRcate of Exemption,yrs"to become object be the Work.',Compensation provisions of the labor Cade,you muss .,O fonhwith comply with each provisions.this Permit Nall be doomed evoked. ,ZCnCONSTRUCTION LENDING AGENCY [—t I kmby affirm Nat Nem isacomrmctim lending agency for the performanceaf nr.> the work for which this permit Is inued(Sec.3097.Civ.C.) QLarder's Name Z)z Lender's Address U O 1 cCNfy than 1 haw read this application and suss des the show information Is w(✓ cormea.I agree to comply with all city and county eminences and Nu laws relining in 0 Wilding construction,and hereby sutharire representatives of this city to enter upno the above-mcmiued property for inspnCimn Puryaes , (We)agree in saw.indemnify and keep harmhss Inc City of Cupcmno against nFy y Iiabilides,JWgmenu,casts andmpenes wM1icM1 wry bans'way accrueagsinstsaid City U Z in cc th {untie{a' Is /7 6L?� I(„ ^t APPLICA STANDS D ILL COMPLY WITH ALL NON-POINT Issued by: Date �^ g— souR p�Ns. A ,,/ Re-roofs Si !� /t Appb HAZARDOUS MATERIALS DISCLOSURE D.ta Type of Roof Will Le applicant or fuure building acupantstem or handle hazardous material as defied by tic Cupertino Municipal .Chapter 9.13,and the Health ad Safety Cade.Section 25533()7 All roofs shall be inspected prior to any roofing material being installed. 0y. a Will site applicm4 or for=building=upmt aac equipment.devices which If a roof is installed without first obtaining an inspection,I agree to remove emir haallom air conuminsnts u deb by the Bay Area Air Quality Management all new materials for inspection. Diwkt7 OYa I haw mad thF.L, materials one omautuferChapterQ95oftleCalifor- maHcaI"Safety255033 537 255N.IwWerswd thnifLe building Jaen rot c � ute 'f W ilinY b ratify the axupant of Ue regmrementsw o: tr rtee candisese or occupancy. S ignature of Applicant Date Z�Owner or auavad agent All roof coverings to be Class"B"or better Dau" CITY OF CUPERTINO am 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36935040 . 00 DATE ISSUED. . . . . . . : 04/28/2006 RECEIPT # . . . . . . . . . : 34182 REFERENCE ID # . . . : 06040183 SITE ADDRESS . . . . 20303 CLIFDEN WY SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : MICHELLE KIM ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4404 RECEIVED FROM . . . . : ALAN FORTIN CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : MICHELLE KIM ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4404 TELEPHONE . . . . . . . . : EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00 BELEC200 METERS 1 . 00 29 .,43 0 . 00 29 . 43 0 . 00 BSEISMICRE VALUATION 2, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BUSLIC FLAT RATE 1. 00 105 . 00 0 . 00 105 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 208 . 16 0 . 00 208 . 16 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 208 . 16 VISA TOTAL RECEIPT : 208 . 16 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- -------- ---------------------------- 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 505 FINAL ELECTRICAL • £ - Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 WUPEI�TINO Building De artment JOB ADDRESS: n� PERMIT # 20 3o 3 ez-el or¢r, w l!/P% O Y Dl &7:2 OWNER'S NAME: PHONE # vo } U -7X-6 GENERAL CONTRACTOR () ?XS Z FAX.# qp Z —0c4doy I am not using any subcontractors: 11 Y 7iO� Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical I-161eV7 USIZ c� 7 rr Excavation Fencing Flooring: Carpeting • Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contrac r Signature Date n CCITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM N# 36 ! - 3 $l 0�/d- ©Q Date: ey- :z C� Building Address: Mailing Address (if different from building address): �03v r?c - Owner's Name• Phone#: 7v/ w, Contractor: License#: Contact: Phone: c(pQ S Qm-7t& Cupertino Business License#: C!M( �d/2r7 i Fax: Building Permit Info: Bldg ❑ Elect Plumb ❑ Mech ❑ Job Descripti—on:/ O d ��1, Residential L7 �E/LuIC<L !/!�G<2�t�°C 2 Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: 2 drty f Occupanc Group: Type of Construction: Please check this box if the project is a second-story addition: ❑ ro•ect 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 IM 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 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 1 of 3 CITY OF CUPERTINO CUPEf�TINO PERMIT APPLICATION FORM QuantityFee 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 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 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 BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Ligting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Furnace> I OK 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 I Relocation of Hood MECHANICAL BREMREPALT I Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 • CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM uantity 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 Mecb Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING • 3 of 3