06050132 (2) CITY OF CUPERTINO
BUILDING 61VISION PERMIT b, Q R� 1'�1, QR�+IATION«�
BUILDING ADDRESS: PAUL TAKACSI & KAISA HOL Mrr NO'06050132
10553 FARALLONE DR
OWNER'S NAME: PERMITLSSUEDATE
PAUL TAKACSI & KAISA HOL 05/16/2006
ONE: SANITARY NO. CONTROL NO.
ARCHRECl/ENGINEER: BUILDING PERMrr INFO
BLDG O PLO MEOCH
±op LICENSED CONIRACrORS DECLARATION Job Description
RHI I hereby affum Nat 1 am liaenvd under provisions or Clop co g(commmem, p
INSection7")or Division Joftho Busin and Rnfeanom Cndc.andmylkenseb
isrmlto=awefren RE-TILING SHOWER PAN AND REPLACING VANITY & SIN
j Z License Clues lJe.N
.2— Dam tr Le.#
.-Contractor
fyt•az vss ADDITIONAL LIGHTING FIXTURE
3
ARCHMICf'S DECLARATION AMERICON PAID FOR BL 5/16/06 IS THE ONLY CONTRA
I I underatanJ my plain Mall he used u public ranrJs
e and Licensed Professional
b OWNER BUILDER m ft Commences
ON
I Wmhy.(See w 1 1. exempt from Nc Cssions o :My Law for ft
county p O following moon.(Saito 7031.5. t,Waess and improve.
de nn Code:My city m roomy
whkh requires a perms ro romwc4 atter,improv,de ermit t m mash any structure
iy Priemiuiensedpatanntus ft Neasion o far Cosuch Penvu LNoasigned summcm
g (men he is commecinuithSeuan37030)ofDivision3oftCamfacros'andPralaW(Gapte9 Sq.Ft. Floor Area Valuation
p $ (commencing with Section at And of Division 3 car al eged auontl Prafas 0 HoonCode)or $4000
e Natio u 31..b themfmm and the baa4 far the alleged eaemgion Any rioudm of
Section Lim 1 by wry)replicons fon pewiuubjecu the aoplmam ro•civil penalty of APN Number Occupancy Type
nm roam Nan five hundred dollua(SSOOk
❑I,emvmr of uie ptopn[y,amy wployw with wgesu Ne'v sale rompewdon,
willdo thtru
e woL and the scture uma
nmmndod offoad rmuk(Sec.7044.Bar.
Required Inspections
and Profession Cade The Conua)wss 7070
Ya License law do3 apply an owner or q p
Property who Wildsaiceprowa thermn,am who daessuchwak hivurJfor througnhis
howemployen,progor improvements Nmsuehimpmwmenuwne year dedorocow.ffered fur salol(. '® ® qh ref
howewn the aw th Bordenofproving
within of year afrorvpkum.the owner• eRvE■�//MraL
build)will naw the When of proving thn he aid 703 W31tl w improve far purpose ar
sak.l.
CU
❑1.As caner a the Property.am=CWd"IY conuacting with IlavaW roreamarr to
contmn the pmjca(Sec.7044.Business and Professions,Code)The Conuaemts Li. J1 1N 91 t1 uLg006
armed Law m r law donot apply an oweor property who Wilds or Improves themtn,and, VV T
who contncu for trach pmjeeta with a eonuanof(s)licensed pursuant 70 the Conuaemfa '
Lice law. BUILDING a /7�y aa�
❑Iemnemptuntle Sea .BAPCfor Nisocum LfY■T®_/■���
Owner Dam U
WORKERS COMPENSATION DECLARATION
1 hereby alarm under penity,of perjury am of t m following daluadom;
I haw and will maintain aCeNfieate of Contact he aelf•Insum for Wormys Camper-
utian,u provided for by Suction 3700 of and labor Cade,far that performance of Ne
work for which this permit is issued.
❑1 naw aM will maintain Worker's Compensation Inunnce.u required by Section
370Daf the Labor Cade,fa the performance of the wart forwhkh Nu permit Is Issued.
My Worker's Compensation Ina nsuree carrier and Policy number am:
Cartier.F Y ��� Polity No.:
%A&—OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thu section need not be completed if Ne permit is farom hu r oBan(3100)
or kat)
1 arury Nm In NC puf c w k fa bleb 3 pe it ue41 slWl oat
employ anYPcmon' an W o osubl 33 3 Wa YCompenuuon
Lawn of Califs V
AlmI r
NOIiCE TO AP CANI`.I( Trot making Nu iRcam of Fa pan ,you ahold
me cut lect Ne worker's Comp)nNan iaJo u ar the Code,you moil
,JO forthwith comply with such provision a Nu pernitrholl W revokod.
,z., s~�+ CONSTRUCrION LENDING AGENCY
Ehereby affirm that Nem us,conation kndmS agency for the performame of .
E4
> No work for which this permit•4 issued(Sue.3097,Civ.C.)
a0 tendert Name
7 z Under's Address
U Q I anifY that I Mw read this application and sum that the above Inforradun is
{3.F correct.l agree As comply with all city and county mUl upas and sum laws relating to _
Q U buiidingconawction and hereby authorize representatives of Nis city to enter upon tho
0. above-mentioned p pen far inspeedon Purpoms
(We)Agree .indemnify aM krep harm) City of Cupertino againt
tF—t H liablliunjudgmo u, u and expenses which y y yeccroc PC All-
U z in cornrgmme ranting of this perm it
^� APPLICANT N STAND AND W P WITH AL NON OIM Issued by: Date — r(-p
SOUR ONS.
Re-roofs �—�
Sigma a ppll 'tlConu r
xAZorf US MATERIAL Type of Roof
u the a Copect m come building aavpanluom ams1 t e h ealdh a mamrtal
sa ticOmd by tiro Cupenlne Muctcipal Cadc.Chapter 9.@.aM the HnIN anJ Str(esy
Com.Semon 25733(x)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes tltl No
Will Na applicant or future Wilding occupant net equipment or devices whim If a roof is installed without first obtaining an inspection,I agree to remove
emn huardous air canumimnu u de0nct!by Ne Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes N
Ihaw mM a rdunmemriabrequim n r After of the URfao
nu Health ASafn ,Sacam 3,2533 .I thwiflo Wilding
doe not cu cat h a inn 4 It u my any mufy ane up t of the
mgmmmn win aux t runiss a to at of Signature of Applicant Date
Own tar tharbcdgcm Dam'
All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
i. Cupertino CA 95014
I Telephone(408) 777-3228
CITY OF Fax(408)777-3333
WUPEkTINO
Building Department
JOB ADDRESS: PERMIT#
OWNER'S NAME: I PHONE # y •2:-1
GENERAL CONTRA OR: PtsF # yb% .Gc?I _ 8(Q\
I am not using any subcontractors: 5
Signature Date
Please check applicable subcontractors and complete the following information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
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/Contractor Signature Date
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CUP INO CODES AND ORDINANCES °
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)ATE;IGNEI .
This s of pians and specifications MU
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oe ke on the lob at all times and it is u
IayAul make any Gha^;es or atteratio
on Sal without written permission iron.
he b ing D,Qpt„ City Qf Cupertino.
The s pittg Qt thls plan and sor ifi aeons
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CITY OF CUPERTINO
!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36939034 . 00
DATE ISSUED. . . . . . . : 05/16/2006
RECEIPT #. . . . . . • • . : 34423
REFERENCE ID # . . . : 06050132
SITE ADDRESS . . . . . : 10553 FARALLONE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : PAUL TAKACSI & KAISA HOLMAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : AMERICON CONSTRUCT.
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : PAUL TAKACSI & KAISA HOLMAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
4kEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 4 , 000 . 00 104 . 76 0 . 00 104 . 76 0 . 00
BPLANCHK PERMIT FEE 104 . 76 139 . 80 0 . 00 139 . 80 0 . 00
BENERGY PERMIT FEE 104 . 76 50 . 28 0 . 00 50 . 28 0 . 00
BREMFIXT NO. FIXTURES 6 . 00 7 . 20 0 . 00 7 . 20 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
BREMRECEPT NO. OUTLETS 3 . 00 3 . 60 0 . 00 3 . 60 0 . 00
BSEISMICRE VALUATION 4 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT : 411 . 14 0 . 00 411. 14 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 411 . 14 2104
TOTAL RECEIPT 411 . 14
•
CITY OF CUPERTINO Q(�Qj013 2-
OF PERMIT APPLICATION FORM
CUPERTINO
FLPN# -?-.) 5cl- p'� Date: INI 14Y 16 , 0L Uvto
Building Address: Mailing Address (if different from building address):
1 f)5- 141 o sw
,Owner's Name: Phone#:
L T l ISA YUAN
Contr torr t eM P License#: ":&1 $ D
Y
Co act: Phone: Cupertino Business License#:
YL 1l.lY Fax:--4n-;n I-(>2tv I (
Building Permit Info: �Rit:w 6 -s*bwoz 1%,K1 Av.lA U,EQ1.aC' A(s V A W-r4 -t S1*1�4
A'�a�ttoNAL Llkrrifi�Nk c'ixrUvr.
Bldg ❑ Elect $1 Plumb [RJ Mech ❑
Job Description:
Residential [9 Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: t I ' �� Occupary Gr3oup:
^�> IL
Type of Construction: — Please check this box if the project is a
Ih waow oz. V-A-TILS -6)-MWE l5econd-storyaddition: ❑
ro'ect Size: StandazdX Laze ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler>500K to 1M 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<= 1000A ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V<=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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CITY OF CUPERTINO
CUPEf�TINO PERMIT APPLICATION FORM
uanti 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
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 din 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 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
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`
W1R0F
CITY OF CUPERTINO
CUPPERMIT 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 Swirruning 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
PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG I Address Chan e BUILDING
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