02070078 (2) CITY F C DPERTINO CONTRACTOR" ....,.,.:.,,.:•'e,n.rt,--.,,,,.�..�r.,,,
PERNIII R`INFORMA Y:
BUILDING ADDRESS: PERMIT NO.
10213 S PORTAL AV 02070078
OWNER'S NAME: APPLICATION SUB DATE
RONALD ONG 07/15/2002
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Z LICENSED CONTRd under S DECLARATION Job Description
,Z4— 1 hereby eflirm shat 1 am licensed under provisions of Chapter 9(commencing P
wire Senion 7000)ofDivision3 of the Business and Professions Cade.and myliccnse ADD HALF BATH IN FAMILY RM
r. f is in full force and ellen. 1�0 ,Q®, a E
z m< Lice sec Class Lie.M ff SII br`1 him t�
K O a O Date Convenor
to 3 LL s' ARCHITECT'S DECLARATION (� Q
t=05 I understood my plans shall be used as public records SCP 0'9 2002
f�N
iO O Licensed Professional
c x o LL OWNER-BUILDER DECLARATION
._< I hereby affirm that I am exempt horrific Contractor's License Law for the BUILDING $4500
I-Z" following reason.(Section 7031.5,Business and Professions Code:Any city or county
Y E O which requiresa permit o conswn,alter,improve,demolish,or repairany stmcture.
aa 3 ac ,prior to its issuance,also requires the applicant for such perndno file a signed statement
m.lheislicepsedNuhnarjts vheprovisionsofineConvmtoesLicenmlaw(Chaptcr9 _ �` Lt,, t�,O t Valuation
(commcncingyith Seciism 71100)of Division 3 of the Businessand Profepssions Code) l'l) y,t `3,glj§vb aU�.$F6q�'y 1('sl•s l,v'•.
or that he is exempt therefrom and the basis for the al(cied d milit in.Hoy violation
of Section 7031.3 by any applicant for a permit subjects she applicant as a civil penalty
of and ream than five hundred dollars S500). 101 ApNI� ATION Occupancy Type
°1,as owner of the property.or my employees with wages as their sole compensation,
ing...wills the work. d the structure isnot brocaded in offered far sate(Ser 7044.' .. - ..._. _.. t
'Business and Professions Code The Contractor s License Law does not apply to an 10 3 — UFER Required Inspections
owner of property Who builds or improves thereon,and who docs such work himself
or through his own employees.provided that h improvements are not intended or 104 - REBAR .
..
offered for '1"Iflo everthetildingImprovement-- n Id within aneyim of ............. _.... ... _.-.. ....-. ...___._ ..... . . .-........_.. .. __.___..--._..
impletion.meowner-builder w II have the burden of proving that he did not build or 10 5 - ANCHOR BOLTS
improve for purpose of sale.). 106 — SEWER & WATER
202 - — UNDERFLOOR)d1j.as
chcrof the pro rtr.. exdus v Iycontractingwrah 1 erased contractors m
construtte ...,
_..._..__..
Forges(sec 7044 Business and Proress,ons Code)The Contractees 2 0 3 - UNDERFLOOR MECHANI CAL� .
License taw does not apply[on owner of property who builds or mpmves thereon,
and who contracts for such projects wlm,ocomoctor(s).licensed.pursaant tome. ._.....-204....=..UNDERFLOORFRAME..... ... . .. .._._..:...... ._.._.__-._ .........-_..
ntacto License law. ..
Ol am .g ander sec - " ,B&PCmrmismasm 205 - UNDERFLOOR' INSULATION
Owner
✓' - WO
301 ROUGH PLUMBING
Nw?ION DECLARATION
302 - TUB & OR SHOWER
I hereby affirm under penalty of perjury one of following declarations: 303 — ROUGH MECHANICAL
° 1 have End will maintain a Certificate of Consent to seR-insure for workers 304 — ROUGH ELECTRICAL
Compensation, as provided for by Section 37M of the labor Cade, for the
performance of the work for which this permit is issued; 305 — FRAME ,
°1 have and will maintain Worker's Coruperacquin Insurance,as required by Section 306 - HOLDOWNS
3700 of he Labor Carlo,feehe
d pt rr I h k foe which this permit is 307 — INSULATION
u My W kers C P s t Insure a er and Policy umber m:..
cirri Policy N , 308, �S{HEE,TROCK
CERTIFICATION OF EXEMPTION FROMWORKERS 3 9 •—. '.Li X'TERI'OR' LATH '
COMPENSA70K INSURANCE'
_ . 310 ,._,-INTERIOR_LATH., -. . . .
(Tho sect on need not be compleicd if the permit is for one hundred dollars 311 - SCRATCH COAT
(S IM m less.)
31-3 :_...,:ROOF NAIL
1«riryn,tnny m p'if of the for wh�eh ub)en to the Walkers 501 - FINAL ELECTRICAL ENERGY
his .if is issued.I
shall of employ y person in an hh W �/D'
Compcn t
Appl In 5 mowa 502...- FINAL PLUMBING-ENERGY _.
O rvoT1 DA uCANT a ti stn c rtre t fE pt yo 503 - FINAL MECHANICAL ENERGY
hecto jest to the Workers Compenout p 'ore of thelab Code,you
use
Ozformithoomplrwith such provsonsorm.pem,lt,naube,deemed reoked. 504 -...FINAL ..BUILDING_ENERGY ...... ._
Z .. ... ... .... ..... ..... .. .
F rn :•`CONSTRucf1ONLENDINGAGENCY 505 — FINAL ELECTRICAL . _
.,
I h by Rrm that there nsw t d g igen y f d perform
W ,�., of the ark fpr ncnm permit 3097 ev.C) 506 — GAS TEST .._.... ..
L [, Londe Name - .... .. ._ .. .. .. -....
Lena Aad 507 - FINAL PLUMBING
VO 508 - FINAL MECHANICAL
1 certify that 1 have read this application and sate that above information toe
tr F
to
comply
with II city andcounty ordinances
d statelwsretuning
509 — FINAL GRADE
O ontI g o dh by mhonap em tiesId goxtmiad property for inspection ofth crymimw pin 510 - FINAL PLANNINGWmen(we)agree'.s e.indemniP,andkeep homeless,theCty ofe Pertno against
fraliab I t e ) dg t.costsand eapeneea hick y n any ag;n:t aa 514 — FINAL UB C W
ORKS
in
City nc mq fm gmntng rdh P< t _ l
__
sPPLRICA _ ',D-ZSIANDs WILL COMPLY WITH ALLNONPGINr` Issued by: Date `
lSD
Ran
t o(ApplicanVCo actor 'Dae RC-COOTS
PAZARDOUEMATERIALS DISCLOSURE
i W11 hea Iet f arc uilding ilp t m rn ha,dle hahNous
material ._ TypeOf Roof.
as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
Ctk 255'2a
Dyes
y ...
..... .. ... .......�._ ..... . .
... -.. .........., .,.
N ,.. .
Alroofs shall be inspected prior any roofing material,being installed.
- Will flisdappluenstorfmam building occupantuse equipment or devices which ` If a roof is installed without first obtaining an inspection,I agree to,remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
Di trims all new materials for inspection.,Applicant understands and will comply wttb
°Ya mad all non-point source regulations.
1 A w Tth S,the'hu robes materials requirements tondo Chapter 6,95 of the
Cali buil Health S,Safety Code Sechave
a ns 25505,.t if is
y map.34.1 understandof mei
ifmc building does not curtend have4tenam,m !ism bil'n to notify me
6 Y Yrtpnsi y y .. . .
'dcsvp t of me requirements which oust be ren pr or m is unnce of e C nificet of '
O p nc
' . fp Signature of Applicant Date
or it mon=ee.,at, rv\f Data All roof coverings to be Class "B"or better
- OFFICE...
0
CITY OF CUPERTZNO
I 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp : Rng: Sub : Blk: Lot :
APN . . . . . . . . : 36909002 . 00
DATE ISSUED. . . . . . . : 07/15/2002
RECEIPT # . . . . . . . . . : 19051
REFERENCE ID # . . . : 02070078
SITE ADDRESS . . . . . : 10213 S PORTAL AV
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : RONALD ONG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3349
RECEIVED FROM . . . . : RONALD ONG
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
�E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
----- - - --- -------- ----- ---- ------ ------- - - ---------- ----------
BPERMFEE VALUATION 4 , 500 . 00 107 . 00 0 . 00 107 . 00 0 . 00
BPFIXTURE UNITS 2 . 00 16 . 66 0 . 00 16 . 66 0 . 00
BPREPIPE NO OF FIXTURE 1 . 00 8 . 33 0 . 00 8 . 33 0 . 00
BPSEWAGE UNITS 1 . 00 62 . 16 0 . 00 62 . 16 0 . 00
BPSEWER SEWER SYSTEM 1 . 00 19 . 98 0 . 00 19 . 98 0 . 00
BPWATER UNIT 1 . 00 8 . 33 0 . 00 8 . 33 0 . 00
BENERGY PERMIT FEE 107 . 00 32 . 10 0 . 00 32 . 10 0 . 00
BREMFIXT NO. FIXTURES 2 . 00 2 . 22 0 . 00 2 . 22 0 . 00
PPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00
BREMRECEPT NO. OUTLETS 2 . 00 2 . 22 0 . 00 2 . 22 0 . 00
BREMVENFAN NO UNITS 1 . 00 41 . 63 0 . 00 41 . 63 0 . 00
BREMVENSYS NO UNITS 1 . 00 8 . 33 0 . 00 8 . 33 0 . 00
BSEISMICRE VALUATION 4 , 500 . 00 0 . 50 0 . 00 0 . 50, 0 . 00
EPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00
MPERMITFEE FLAT RATE 1 . 00 35 . 52 0 . 00 35 . 52 0 . 00
---- - ----- - --------- --- - ------ --
TOTAL PERMIT 416 . 02 0 . 00 416 . 02 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- --------- --- -------- ------ ----
CHECK 416 . 02 145
TOTAL RECEIPT 416 . 02
•
(QTY OF CUPERTINO o Z v o
CUP TYOF O PERMIT APPLICATION FORM
—7 Date:
BuildingAddress: / 0 , S - f'oPIL) L AV€ GL�Pf�T/�v� GN X15O/y
i
Owner's Name: Phone#:
W"-r^:3> G o
Contractor: FAs`r k B-Fs-r (f�ST2uG77aN CO . License#:
Contact: /o y Cl��uAI G Phone#:
Applicant/Contractor: Fax#:
Bui Ing Permit Info:
Bld Elect Plumb Mech
escriptiAD� r o f NAF BA i}� /N{Rout y �Q6aM
Residential: Commercial:
Sq.Ft.Floor Area: $/Sq.Ft.:
Architect/Engineer: Valuation:
Type of Construction: Occupancy G oup:
•RB
Fee ID Fee Description Fee Grou
APPLOTHER Other Appliances MECHANICAL
CONSTAX Construction Tax BUILDING
CONSTAX Ind/Off/Comm/Quasi BUILDING
CONSTA)M Con. Tax for B Zone BUILDING
CONSTAXH Hotel and Motel BUILDING
CONSTAXR Constax—Resi/Mobile BUILDING
ELEC1000 Elec 600V<= 1000A ELECTRICAL
ELEC1001 Elec 600V> 1000AELECTRICAL
ELEC200 Elec Svcs 600V <=200A ELECTRICAL
ENERGY Ener BUILDING
ENERGYADD Ener Add Multi BUILDING
INVESTIGA Investi ation fee BUILDINGMITIGATC Comm. Housin Mit. Fee BUILDING
MITIGATR Res. Housin Mit Fee BUILDING
MNEWMULTI New Multi-FamilyRes MECHANICAL
113 TI New Multi-familyRes ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
13NUCOM IP New Comm Plumb PLUMBING
•
1of3 # 1 �6 I
� �6 . 09
1 VIiQ IG. 1/-1 I V
10,_x„
I
I
GFRIX CUPW
• o DINING ROOM
I
APPROVED
130-01. M ACCORDANCE WITH THE CITY
— B - A CUPER INO D ORDINAN
OAT
SIGNE
This set of lan'
and specifications S1
be kept on the joy at allgimea and it s uk
lawful tcNOOIU changes es or alter t orib
on same without w.ltten permission o
D he bu,.ding Dept.. City of Cupertino.
the stamp.ng of this plan and specificat ons
D KITCHEN ;HALL NOi be herd to pe.mit or to b ar,
oniovai of the violation of any provi I m
O - •-�/
C. n d,nanre or State law
• I---- --- -----------------------------
n 1f 11
I �JIJL. 15 2002 �l
Flourescent 5-5118" _
Bar Light
FAMILY ROOMY
[V
Sink O 1/2 BA Translucent
Overhead Glass Blocks
Exhaust Fan �,t (in wall)
N ty/
^q T-71/8" _
Toilet
N
a WH -
0
zo
ZD D 10213 S. PORTAL
• CUPERTINO, CA 95014
Ronald Ong
6-0" June 23, 2002
Scale: 1/4" : 1' 0"
1a-o°
O TTT
m
DINING ROOM
13,_0„ APPROVEP
IN ACCORDANCE WITH THE CITY f
CUP r D ORDINANC
DATE I �v
SIGNED
I IR n This set of ns and specifications Sl
�+BMITTA<_ la kept r`ry00j at all times and it i nfq
be
to r. e 'n changes or alterai n�
t4 1 J on same without written permission m
the building Dept., City of Cupertino.
KITCHEN The stamping of this plan and specificati rm
SHALL NOT be herd to pe,mit or to be
O rpproval of the violation of any provisr
"V Oa 0 6nence or State I.Am,
-------------------'r
• ------ —_ —
p � (� CD �'�! CID
JUL
15 2002 I
i3y
N
FAMILY ROOM
N
BAR
iN
rwTjWH
0
CD
❑p 10213 S. PORTAL
• CUPERTINO, CA 95014
Ronald Ong
June 23, 2002
PERTIN
sUI DPERMIT BUILDING DIIVISSION O CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
10213 S PORTAL AV 02070078
OWNER'S NAME: APPLICATION SUB DATE
RONALD ONG 07/15/2002
PHONE: SANITARY NO. CONTROL NO.
°Mn O O ARCHITECr/ENGINEER: BUILDING PERMIT INFO
z m- BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
O Z H°- 1 M1emby aRrm that I am licensed under provisions of Chapter 9(rommencing Job Description
-°„� widhSection7Boo)of Division 3ofthe Business and Professions Core.and mylicense ADD OF HALF BATH IN FAMILY RM
y f is in full force and affect.
e w¢ DteLicense Class . Lio.tr rc-a n des
M3.y Dale Contractor 1III�— II
O< ARCHITECT'S DECLARATION
1 understand my plans shall be used as public mcoms
<= SEP 0 9 2002
i d O O Licensed Professional
Oat I am exempt
form
DECLARATION
X•;m 1 hereby affirm that 1 am exempt from the Contractor's a Licenm law for @c
CZafollowing reason. erm(Section]o3L5,eusinusandProfessionsCockAnycity orcaunry BUILDING s4500
2�° which requires a permit m consumer,eller,improve,demoli,h,or rc W v my swaure
naw Priormitsissvance.elso,equircs tW risimmf far suchmove Lices La lChame,9
IW1lltiviaasedgialarttgqUU��pryMsions of the Contmnols License law(ChaperY Cp,{,� (p�” [r;sp- ' Valuation
(c6racri ciriewiNSe<don.q.)6rDivi,km3ofthmQ im:,,apdProfssionsCods) `:i)Ll•l�l��Y.:v. .`a.Y. `N'w..%.l; i:�Tli)ia•
or thai he ii exempt thcrefroio and the basis fnr Ne alt4d.Qmninjoh.pny violation
-of Section]036.5 by any applicant fo.o permit subjals the applicant m a civil penalty
�ornm mem man Iry<Wnarta eonars(ssoo>. 101'aPNFb 5ATION 1m.,%Uts'r Occupancy Type
❑1,as owner of the property,or my employees with wages as their sole compensation,
-will-dothe vwrlr-and'the swomte it not imemccd'or'offered'for mla-(Sec:-]641,-
'Besiness'sual piofesstom Code:The Contractor's License Law does not apply to an 10 3 - UFER Required lnspec[ions<,'+srB;:.Tf
owner of progeny Who Wilds or improves themon,and who does such work himself y
atthroughhis own employees.Pm„deeem-such improvements arcnot inmWeaar 104 - REBAR
:nlfcrFd foF shlif lChowcvir:Ifie WilJidg or imyrvvemem ii sold'withinone➢<iiir6r --'-'105ANCHOR--BOLTS ---"— '--
'completion,the owner-Wilde,will have the Wrden ofpmvir,that he did not build or 105 - ANCHOR BOLTS ,� .`Il:n >n 1p:•r':": co
improve(a,porpoise,ofmle.). 106 - SEWER & WATER l
1:"i:b�Zr artne property.ante.<waivelycnmmcnngwim a«nxa conuamonm 202" - UNDERFLOOR PLUMBING rel_. r�rsrle r'ro
rstract the project(Sec.]BCD,Business and Professions Cale:)The Contracmra2 0 3 - UNDERFLOOR MECHAN'I CAL" PIT P"'''r: %1;X
License law docs not apply to an owner of property who Wilds or improves domain.
)..c
--mad-who contracts-for-such projects with,a.convanoosLlicensed,pursoanLa.the. .._...._._2.04..___
tilt ` / ndcr5 cz.° ^s i- 4 I r. S4' B'&PCImmi..ason 205 - UNDERFLOOR'' -INSULATION
0
W ( D l3 .�2 301 - ROUGH PLUMBING
�1 O O. PE ION DECLARATION 302 - TUB & OR SHOWER
I hereby affirm d pe_hy.1 , rYI. nneru ga declarations 303 - ROUGH MECHANICAL
❑ I h e will hatilujin a cenrecme fc ent to Ir for workers 304 - ROUGH ELECTRICAL
Compensation ., providad for by Section 37W of the Labor Conde.for the
p<rrarmanceof do'work for which this Permit.is issued.,,,•, 305 - FRAME
0 have and will moinmodirw'k s Croupoisidim In6ronii,li acquired by Semi on 306 - HOLDOWNS
3700 of the labii Code,far the ictfyrmarre of he work,for which this part,bit is 307 - INSULATION
's d My w k i Compen.ai on Insurance carrier and Pol cy n ber a
ig as a - INSULATION
Policy No d n 1. ..,,I'y. } n �. �•.. Y 1:.fd�Pn
ri tCERT1FICGIONOFEXEMPTION FROM,WORKERS,1 'ti.Q:'t`i! 3O9' 2- EXTERI•bR1rDATHNI' 1
COMPENSATION INSURANCE' "N �' _4.•. ,,,_ 1
dbe 3'1'0': INTIERSOR 'LATH —"ri` _•
"•1 (Th s secuun eJ not be'compla a'I the permit Ls tor one hundred Dollars I311 - SCRATCH COAT 1 1
($1001 :.) 1. r , i
3'13 - =ROOF-NAIL
Ie nfy lhvii a prf tn' r'fth kf' hhth Pu i .'i. dl vse;♦; -
ihall of empl yany pe a. o b3mm maw-kra 501 - FINAL ELECTRICAL `ENERGY
...-'n o.pen mid r �p _ ��55�2 " '' -. 5.02 _- .FINAL. PLUMBING- ENERGY
"
LUMBING -ENERGY -- --
O PPIc t _._ . .
forthwith ' oly,n;nwo h<pscom �n � o-uemtLabor cwk , a — 503 - FINAL MECHANI CAL`ENERGY
NOTI A LICA" If 61h s C n Team I E puny h l IJ
Z Iw P
x 504 .c_FINAL- BUILDING ENERGY.
.(n CONSTRUCTION LENDING AGENCY 505 - FINAL ELECTRICAL , I LI a 1'v"' 1
j' IM1 hyR Ih uh "e nt tnl dngg yf the perf ce
o'b" rkrr 506 - GAS TEST
Le ter Nam
L-•
'Iknu sAad,. . 1 r � 507 - FINAL PLUMBING
v0. ' 508 - FINAL MECHANICAL
I comfy thin I h e d Iti s eget t d t m Ih nh W formation rs
fL:[ti �toim<t.1agreeto,romply In Il city aeo ryodiwnc -d. t laws rete ng 509 - FINAL GRADE
do builJing c
unsvEcuon.anJ hereby autM1onu rcprcscmntivcs of this city me nm,uPon
w .m ap p tyr pttt p r 510 - FINAL PLANNING
(We) g t .a e_ndem fy ant k<ep,barml es ilieCty of Cupertino g nn
rn
Lida,
,dg Is t. a d p us hch.maynnpny y cc c gpin.t.aiJ 514 - FINAL UB C WORKS
.f, Z Cry rte equcdce Tth g ning nfM p i
HPPLICA 'NDER$TANDS WILLCOYIPL�'WItHALLNfON'POINTI Issued by: r Date
snu c y
gn t l'Appl,o uco acmr J ( Dae Re-roofs •�
p.l1 HAZARDOUS MATERIALS DISCLOSURE
w
n m< PPlica t r m W'mi g acupa t
store.,h axle InraNno,m h I _Type of Root .. .._ ..._-_._ . .--___.--._-----_.
,asd f dbyth Cupemn M nbpol CWe Chapmr9 i2. dth H hh ❑S f ry t ] :,,,; •,
Code 5 1 n255j2( 1 2 1 '., I' h {T t.sy lA.[
4oY a r ' /'' "°; .' ' t'"'!t(o r` t
All roofs shall be_inspected prior to any roofing material-being installed,
71
W111h I t f t W IJ occupant sec mens rJ vice which -a roof �- t
- PD 6equipment If a roof is installed without first obtaining an mspecUon I-agree'to:remove
man h.micAus firsontamicandsststs defined by the Bay Area Air Qvility Manage t
0D t ct )No all new.ma[enals for inspection. Applicant understands and will comply with
°Y 'all non-point source'regulations'..
t '1 Wve.rtad'the haanrdousmacnals requirements under Chapter 6.93 of the
CSlifomid Health&Safery CWc:Sections 25505.25533 and 25531.1 understand that
tf lheWldt Bd nmc JYh cam mthatlsmY spons,bdiry mnoufythe
occ p t !ffiereuovxhih re t W i p w f a 0.Eca1 of '
>
/ p 7 /,$�jp Signature of Applicant _ _ Date
f x All roof coverings to be Class "B'• of better
Verormnss
auod agent," !" _ .Dam
OFFICE