04100089 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUILDING ADDRESS: THE OW BROKER e, PERMIT N04100089
133 PARK VILLA CIR
OWNER'S NAME: PERMIT ISSUE DATE
MIRENDA IS, HENRY YUNG 2385 LINCOLN AVE 10/13/2004
ONE: SANITARY NO. CONTROL NO.
(800) 639-4527
ARCHITHCTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
L� 0 0
LOO LICENSED OMRd under SDECLARATION
fChap
� 1 hereby affirm mall am Ommsee ander pmmdnaa of Chapter v mnmmraemg Job Description
�� with Sect (MA) IOivision 7ofmc Business antlPfcssinns Cndc,endmyliecnuis WINDOW REPLACEMENT �� ® L�®
n withs(r andcffec B'�
j Licenu lass - I Lie.Y
nF•w Dale Coal, or
££I ARCHITECTS DECLA11,1MON
ic k-r 1 understand my plans shall W used as public..,,it, NOV 2004
3`
0 Licenu)Pmfcssmnal
5 a OWNER-BUILDER DECLARATION
q I 1 hereby affirm that 1 am exempt from the Contractor's License Law Int the
i o O following reason.(Section 8131.5,Business and Professions Code:Any city or county
$4544
m� which requires a permit to construct,then improve,demolish,or repair any structure
to on prier to its issuance,also requires the applicant for such permit to file a signed statement
ESG
that he is licensed pursuant to the prOviMons of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
`4t-$ (cum mdncing wi m Section 7(M)of Division 3 of the B usiness and Professions Code)or7
y - met he is exempt therefrom and the basis for me alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of anC OCCU
not mote than five hundred dollars($50(d. Occupancy Type
❑La sownerof the pmpeny, re my untended withwagesastheirsol.compensation,
will dome work,and the he Core is not intended or.((ered tomato(Sec.)044,Business
and Professions Code:The Contractors License Law docs not apply to an owner is Required IDSpeCIIODS
own ewho builds or improvesch impub and who does such work himself offered
his
own employees,errthebuilding
that such improvements are not intended or leered for sale.IL
however,the building ar improvement is sold within one year of completion,the owner-
builder will have the burden of proving Nat he did nos Wild or improve for purple of
salt.).
❑ 1.as moner of me property,am exclusively contracting with licensed contractors to
construct the pmject(Sec.7044,Business and Professions Code:)The Contracmr's Li-
erase law does not apply to an owner of property who Wilds or improves thereon,and
who conmacm for such projects with a can intilor(s)licensed pursuant to the Contractor's
License Law.
❑ I am exempt under Sec. B&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION "
I hereby affirm under Penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 37W of the Labor Cale,for the performmee of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
37W of me Labor Code,for me Performance of the work for which this permit is issued.
My Worker's Compensation lnsumnc caamr and Policy number am:
Camyr,Lj k E-OFRX " Policy No.: O_
✓/% CERTIFICATE OF EXEMPr10N FR KERS'
COMPENSATION INSURAN
(This section need not he completed Race permit is for one hundred dollars(V00)
nr lcsx.)
I certify Out in the perro menee of the work for which this permit is issued,I shall not
employ any person in any manner an as m become subject a the WorkersCompensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,alter making this Ccdilicam of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
.J 0 forthwith comply with such provisions or this pr mi Ianal I W deemed revoked.
Z
CONSTRUCTIONLENDING AGENCY
04 work
by which thi OatWHOi isaed(Seetinnlending agency for the performance of
".0 r7 tender's orwhich this Permit is issued(Sec.3M,Civ.C.)
{Ll Q
Lender's Name
2
Undcr'a Address
U
U O 1 verify Out I have read this City
and c un and sure that the above ws rmaing is
C (~ cording l agree to comply with all city and county oNinaocef and stets laws relating e
QU buildingeonmard proentl hereby inspection imposes. of this city to enter upon the
0.1 shove-me e)agree
to ertysave for emnify an keep ha
ry (We)agree In save,indemnify and keep harmless the City ro Cupertino against
i1,.i rA incilltiesjue(c Ofth,cusuand cf this fsm iich theyinanyway accrue against said City
Uz APLIC NT NDERSTAN of this permit. /
APPLICANT UNDERSTANDS#ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
50 REG NS
10-1--S-04 Re-roofs
ignamrc of Applica'IVAZARDOUS MATERIALS DISCLOSURE Dad Type Of Roof
Will me applicant or future building occupant smrc or handle havarduus material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
erred,selves 2ss3z(arr � All roofs shall be inspected prior to any roofing material being installed.
❑eo
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
emit haaardous air cnnmminanm as defined by the Bay Arca Air Quality Managemcm all new materials for Inspection.
Dinrin? n /
❑Yes
1 have read the havaNnus materials requirements under Chapter 6.95 of the Cali for.
ria Health&Safety Codd.Sections 25505,25537 and 25534.1 understand Out if the Wilding
dos not currently have a tcnam,Out it is my responsibility In and I HW Occupant of the
mgairemeamw c moan mil Pd o issuance of s Cermet¢of Occ Pony' Signature of Applicant Date
19— — rJ
ncr ar numorised agen, - All roof coverings to be Class "B" or better
CITY OF CUPERTINOC.CIhL'ktAC�'C1RINk'OA2M ON
BUILDING DIVISION PERMIT
BUILDING ADDRESS: THE WiNJUW BROKER PERMIT"04100089
JJ133 PARK VILLA CIR
NER'S NAME: PERMIT ISSUE DATE
MIRENDA & HENRY YUNG 2385 LINCOLN AVE 10/13/2004
PHONE: SANITARY NO. CONTROL NO.
(800) 639-4527
BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH
0 0 0 0
cep,
, LICENSED CONTRACTOR'S DECLARATION
p I hereby air,,.that I am licensed ander provisions of Chapter 9(commencing lob Description
Asa with Secmi IXMBofpivision Sof theBusincxs and Profcssinns Code,ane mylicensc is
_ lnnrs`°� derrec WINDOW REPLACEMENT
Lican c lass t Lic.N
Dates — r6' Cummcor
f� /—` ARCHITECTS DECLA .TION -7-
aI untlerstand my plans shall W used a public records �
3 o y Licensed Pnafessimaud �l ��
i OWNER-BUILDER DECLARATION
aS I hereby affirm that 1 am cacmpt from the Cnnlracom's License Law for the
p 0 following mason.(Section 7031.5,Business and Professions Codc:Any city ar county
%exm t which requires a permit to construct,alter,improve,demolish,or repair any slractum $4544
.y_y prior In its issuance.also requires the applicant forxueh permit to file asigned statement
REa that he is licensed mouratto the provisins
ooftheContmctor'sLicenseLaw(Chapter9 Sq.Ft.Floor Area Valuation
yFa (commencing with Section 7")of Division 3nf,he Business and Professions Cnde)o,
y that he is exempt therefrom and the basis for Ne alleged exemption.Any vinlalfon of
Section 7031.5 by any applicant for a pernil subjecu the applicant to acivil penalty of be Occupancy Type
not more than Five hundred dollars(SSW).
❑1,as owner of the property,or my cmployces with wages as their sole compensation,
will do Ne work,and Nestructure ismat intended proffered for sale(Sec.70 ,Business
and Professions Code:The Cenuactor's License Law docs not apply 1.an Owner of Required Inspections
properly who builds or improves thereon,and whodoessuch work himself or through his
awn cmployces,provided mia such imptovemenu arc oat intended or offered forsalc.If,
however,the building or improvement is sold within one year Ofcomplclion,the owner-
builder will have the burden of proving that he did not Wild or improve for purpose of
salt.).
❑1,as owner of lie property,am exclusively convecting with licensed contractors to
convect the project(Sec.70".Business and Professions Code:)The Contractors Li
cense Law does not apply 10 an owner of property who Wilds or improves thereon,and
who contracts for such projects with a contramor(s)licensed pursuant to me Contractors
License Law.
❑Iamexempt Order See. ,B&P C far this reason
mer Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of Perjury one of the following declarations:
❑I have and will maintain a Cenifcme of Consent to self-insum for Worker's Curried-
cation,as provided for by Section 3700 of Ne Labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Suction
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation lnsumnecarrier and Policy number am: s
Policy No.:
CERTIFICATEOFEXEMPTIONFROW KERS'
COMPENSATION INSURAN
(This asedhas need not hccomple ed irlhe mmil is!prone hundred dollars($I00)
less.)
1 certify,that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner an m to become subject o the Workers'Compensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:It,alter making this Cenilicaue of Exemption,you should
become subject w the Workers Compensation provisions of the Labor Code,you must
,J O forthwith comply with such provisions or this permit shall W deemed revoked.
Z
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency lin the performance of
ai J me work for which this permit is issued(See,3097,Civ.C.)
W Q Lender's Name
z I<nJer's Address
C) Q 1 comfy that l have read this application and sure that the above Iafkarolinn is
ly (~ coral.I ag,ce to comply with all city and county ordinances and slate laws rebring to
0 U building construction,and hereby authorise represenutives of this city 10 enter upon the
LU ahove-mentioned property for impcclion purposes.
(We)agree to save,indemnify and keep harmless the City o(Cupc,tinO against
f�A liabilities,jmgmcntscosts and expenses which may in any way seems agammand City
U z in cnnuyucncc Of the graining Of this permit.
^+ APPLICANT UNDERSTANDS ND WILL COMPLY WITH ALL NON-POINT ISSned by: Date /
50 REG NS ( o_`3-Oq
mf< Re-roofs
'r ignnwrc of ApplirnH onRDO Dam
HAZARDOUS b MATERIALStsomoSUR Type Of ROOF
Will me applicant o,rMuni building e,Chapter
store nr and th hasalm andS.Rmaterial
es ticfined by the Cupenina Municipal Code,CM1apmr 9.13,and the IIca11M1 and Safely
Codc,Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Ycs
Will thea applicant ar foure building ecu t use e t Or deice,which If a roof is installed Without first obtaining an inspection, I agree to remove
pp go pun aAirQn
crit baaamnpa m,apntanmmanta as defined by me nay Area A;,Qaahty Management all new materials for inspection.
Disuict7 f
Cl Yea �fm
I have read the hasnnloos materials requirements under Chapter 6.95 of Ne Califon
nit Hcalm&Safely Codc,Seeduns25505.25533and25534.1undcrsundthatlfthc Wilding
does opt curtently bave a catch Nat it is my responsibility m notify the occupant of the
acquirement, at melpri 'lniasaancearacertr",daidacp.ncy. Signature of Applicant Date
a ma / (� _ icy All roof coverings to be Class "B" or better
s mer or aumprued.ecm oar
• • Community Development
_ 10300 Torre Avenue
�,.-✓ Cupertino CA 95014
Telephone(408) 777-3228
�JPEI�TINO Fax(408)777-3333
Building Department
JO ADDRESS: PERMIT # oG
33 e,r Ii o YsnlL
OWNER'S NAME: rucle. I� ti u� PHONE # 39- q5
GENERAL CONTRACTOR: -TI e ;
a FINAL MEASURE
2385 Lincoln Avenue, Hayward, CA 94545
s ❑ 1871 So. Chris Lane, Anaheim, CA 92805 DATE 10-13 l}
�� Phone (800) 639-4527 4�7 83
r ' WMOW BROKER Fax (510) 723-5065 JOB#
CA LICENSE H 785713
OWNERS: �'^ `^ � RES PHONE: DATE:
STREET. RI`s �2 Y,.O'rr'� Ul l "j l,'P BUS PHONE
CITY: �'ey l` ` 0 STATE: CJn:S ZIP CODE: �Syf
e1 y Bay Window
® Single story: ❑ ood siding: �0'VObtft9 indows ❑ Pa i ): projection: (in.)
❑Two story: ❑ iny19Iding1 3 ZpjQlumi um windows: ❑White s of pe: ❑ Enclosed
❑ ® o: ❑ Steel indows: Inside trim: ❑Slope
Security bars - Re-i o ❑ Stain grade ❑ Paint grade Angle: ❑30° ❑45°
No. days � Retrofit ❑ u r mes ❑ Lawn sign okay Color: IM White ❑Almond
NO. LOCATION TYPE APPROXIMATE SIZE TEMP e2 GLASS GRIDS COMMENTS
• WIDTH HEIGHT OPTIONS
1
2 J'7 E.YW� 1
3
APPROVED
4 K
INO CO S AND- I 09
6
TATE
� NEU
7 This set
B ,�. }p Ce oe kept a the job at all times and it is un
t
lawful
srron same I ithoLit written permission f ont
I P. hili!r1ir
` rhe Stam i i of this Ian akinnd s� Ino.
10ek T p g p Pacifica '
11
v, approval of the violation Ofmit or b
anr s ar,
,lance or state law,
12
13
14
15
16
17 Li I I
Special Instructions: Total U.I.
Windows:
Doors:
The type and operation of each window have been fully explained and I accept the win761w
entified on this Bays:
measure sheet as being the windows I am ordering.
Customer signature: Measured by: �
Apn12W3
l *CITY OF CUPERTINO*
CUP
CEPERMIT APPLICATION FORM
APN # Date:
356 10'052 to - 13 - cab
Building Address- Mailing Address (if different from building address):
3 _
Owner's Name: Phone#: .
a� vlY
Contractor: License
�o
Contact: Phone: (51o)$'?3-5823 Cupertino Business License#:
AVAV Fax:
Building Permit Info:
Bldg ft / Elect ❑ Plumb ❑ Mech ❑
Job Description: 1
Residential LSI' ,,914o� s ve to `w �etvo 1 Commercial ❑
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: , , Occupancy Group:
Type 6f Construction: Please check this box he 'r is a
/
second-story addition:
Project Sizer Standard L7 Large ❑ 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> 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<= 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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- = OCITY OF CUPERTINOS
CUPEI�TINO PERMIT APPLICATION FORM
uanti Fee ID Fee Description Fee Group '
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMNM New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmos beric 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 cf n MECHANICAL
BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIXT Ligbting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Fumace> 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 He ing MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
2 of 3
WITY OF CUPERTINO*
*Y 0 PERMIT APPLICATION FORM
CUPEkTINO
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 Insection BUILDING,
BSWIM Swimming Pool BUILDING
BTEMP TemporaPower ELECTRICAL
BTEMPPERM Tem ora Bld Permit BUILDING
BTEMPSVCS Tem Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electricals foot ELECTRICAL
EPERMITFEE . Elec Permit Issuance. ELECTRICAL
N MRMFEE Mechanicalsq. foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbin .Permit Issue PLUMBING
PPLBG Plumbin Fees foot PLUMBING
ZADDCHG Address Chane _ _ BUILDING
3 of 3