08120084 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ,zCONTRACTO 'O-R1VlA'�I
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: PERMIT ISSUE DATE
A CONTROL NO.
(408) 838-2388
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u 0 o LICENSED CONTRACTOR'S DECLARATION O O O O
mC 1 hereby affirm that l am licensed under provisions of CMpwr 9(commencing Job Description
IW with Section 701111)af Division 3oflhe Business and Professions Code,and my license is
_n=ser Inrmlrorecandcffcc t INSTL NEW A/C & FURNACE ,
D224 Z Licanx cla, Lic.is
eC=pp� Date RCHTIELTS DECLAMT C�CLi **REWND BUS LIC 12/9/8
t C I moderated my plans shall be used as public records
JyU
g m0 t; Licensed professional
OWNER-BUILDER DECLARATION
E 1 temby aM m that I am exempt from the Cormacmrs License Law for the
OO following mason.(Section 1031.5,Business and Profcaine Code:Any city or county
K @ r which requires a permit to construct alter.Impmve,demolish,or repair any structure
02 y pd.,41 its iammat.alta mgWfe{Iht appllCNt(.,Such perrttit la file,aligned attement
pthat he is licensed pursuant to do,provision of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
y(t0 (commencing with Smdon]000)of Division J of the B usinea and Professions Code)or
Yy 0 that he Is exempt thetcrmm and the baso for We alleged exemption.Any violation of
Section 1031.5 by arty applient for a permit subject,We appl¢ant m a civil penalty of APN Number Occupancy Type
not more dun five hundred dollars00)
(35 . P y yp
01.aawlrr serotic ptopmy,ser my eroplayw wird wagesa time tom competasation, 32651044 . 00
wi8dotheworkandthemuctme4notimm�d moacmAfa,sale(Sec.1014,Business
and Professions Cade:The Conmcmes License Law dors net apply to an mvnerr of Required Inspections
property who builds or imposes Recon,and who dues such work har scl f m through his
own employees,provided the such impmvemencs are out intended oroRernd for ale.If. -
however,the building or improvement is sold within one year of completion,We owner-
builder will have the burden of proving chat be,did not build or improve for purpose of
1,as owner of the property,am exclusively contracting with licensed ro...in
cortmct the project(Sec 1044,Business and Profession,Code:)The Contractor's Li-
ecese,Law does not apply as an owacr of property who builds or improves thereon.Md.
wbocontact for such projects with a ca uscard.)licensed pursuant m Ws Convectors
Liana Law.
❑1 am exempt under Sec .B&P C for this reason
owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury one of the fallowing declamuo ere
ham and will maintain a Certificate of Conant to self-Insum for Warlmes Compen- '
on,as provided for by Section 37M of the Labor Code,for the Performance of We
work for which this permit is issued.
❑1 have and will maintain Workers Compmauon Insurance,as raquimd by Suction
3100 of the Labor Code.for de pedo...of the work for which this permit is issued
My Workers compens uon Insurance.Oder and Policy number art:
Carver. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This mcdon need not he completed If We Permit is fmonc hundred dollars(5100)
or los)
1 pproy Wet in We Performance of the work f Latch Wu u sh t
Lawsoanyprsan l0 Ny m81111ei ssut erbjma do.
Laws or California.D+m
Applicant u�+ua—'�
NOTICE TO APPLICANr.If.aper making this Certificate of Eamption,you should
became Mocm in the Workers Compensation provisions of We Lather Code,you most
.J z forthwith comply with such Provisions or this Permit shall Ito deemed n.sked.
z`+ CONSTRUCTION LENDING AGENCY
[r r 1 herby affirm that them is•cortruNnn lending agency for the performance of
the work for which this Permit is issued(Sce.3091,Civ,C.)
GQ Landers Name
=z Lenders Add.
L)Q I certify,that I have rod this application and sum Thal the above information u
tL ror¢m.1 agro,to comply with 01 city and county ordinances and sum laws relating to
� building consvuction,and hereby authmir reposentuves ofthu city to color upon the
r W shove-mentioned property for inspection puryoses
(We)agree,to save,indemnify and keep countess the City of Cupenino against
mF.m h liabilities,judgment,costs and expenses which may in any way acerae against said City
n consequence of the granting of this Form'.
" APPLICANT UNDERSTANDS AND LL COMPLY WITH ALL NON-POINT Issued by: Date �--
SOURCEREGULATIONS.
Re-roofs
Signaure of Appli mnDam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will theeCultreor future Wilding C.&.chapter
ser handle hasardoanmaterial
u dn.Sed io We 32(.)? Municipal Code.Chaplor 9.11.and the Health and Safety
Cak.Section 255J2(a)?
❑Yu D(No
JJ All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment m dcvims which If a roof is installed without firs[obtaining an inspection,I agree to remove
i,havaNnus airconuminant,as dcOncd by the Bay Area Air Quality Managcmenl all new materials for inspection.
II IctT"
❑Yes XNu
1 have read the hvardmt remdals requiremcnt,undcr Chapmrb.95 of the Gli(m-
nuHcalthhSa(nyCade,Srnimu]5505.25577 vW 2S53d.l uaWcntnE Uxifdc Wilding
does not earned,Lame•mem,then it t malleability to noury Nc axuan,of We
tcgmimmcnt,which run be mct pier maim Ota cmtiha ser paney.f Signature of Applicant Date
ra/G�' All roof coverings to be Class'%"or better
Owner or authomcda m Dam
CITY OF CUPERTINO
7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . 1 - : 32651044 . 00
DATE ISSUED. . . . . . . : 12/10/2008
RECEIPT # . . . . . . . . . : BS000006799
REFERENCE ID # . . . : 08120084
SITE ADDRESS . . . . . : 22212 BITTER OAK ST
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MASAAKI HIGASHITAHI
ADDRESS . . . . . . . . . . : 22212 BITTER OAK
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-0105
RECEIVED FROM . . . . : HANK WOO
CONTRACTOR . . . . . . . : HANK WOO LIC # 25731
COMPANY . . . . . . . . . . : HANKS' S MECHANICAL
ADDRESS . . . . . . . . . . : 1377 GLACIER DR.
CITY/STATE/ZIP . . . : SAN JOSE, CA 95118
TELEPHONE . . . . . . . . : (408) 838-2388
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 4, 300 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40.79 0 . 00
1MPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 .79 0 . 00
1MRRAA UNITS 2 . 00 122 .38 0 . 00 122 .38 0 . 00
1PPERMITFE FLAT RATE 1. 00 40 .79 0 . 00 40 . 79 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 .79 0 . 00 40 . 79 0 .00
TOTAL PERMIT 400 . 04 0 . 00 400 . 04 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 400 . 04 MC
---------------
TOTAL RECEIPT 400 . 04
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------
505 FINAL ELECTRICAL 507 FINAL PLUMBING
508 FINAL MECHANICAL
•
of O,q
J �`^ GLENOAKS PARK VILLAS ASSOCIATION
10902 Sweet Wk Street • Cupertino.Califomia 95014
e
EXTERIOR MODIFICATION PERMIT
/
Applicant (homeowner) Name !'t !-S A-A IG I Ml C' A'5 i TAT I
Address r21�-I
Phone !{ 'i 9 . JSj 12 Lot Number 51y
Nature of modification
The Architectural Committee has reviewed your application received on
APPROVED X DENIED ❑ PERMIT NO.
Conditions of Approval:
Full maintenance of modification will now and ever after remain at your expense or that of any
future owner of this property.
You or a future owner may not change or alter this modification without prior approval of the
�{ Architectural Committee.
• Jdl You must submit this permit to obtain a building permit from the City of Cupertino.
❑ You must submit a copy of the drawing as approved by the City of Cupertino_
Upon completion of the modification and after the City has done its final inspection and granted
approval, you must notify the Architectural Committee so it may inspect for its final approval.
❑ Additions/repairs must be painted to match original structure.
Wood trim: Kelly-Moore 1245 Acry-Shield Wood Moss#197
Stucco: Kelly-Moore 1240 Acry-Shield, Oyster#26
❑
Approved by
Architectural Committee [e Board of Directors Date
}
Owner agrees to conditions of approval Date
Final Approval—City of Cupertino (Date)
Final Approval—Architectural Committee (Date)
Glettmks/ExtModPemrit rev 0806
Community Development
r 10300 Torre Avenue
! � Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: PERMIT # r / O U e
11 2,/2 j5 0
OWNER'S NAME: f} y(/ PHONE #( Z3
GENERAL CONTRACTOR: i FAX #
I am not using any subcontractors:
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
o�lav ��y
CITY OF CUPERTINO
OO � FURNACE/AC
�OCUPEkTINO PERMIT APPLICATION FORM
APN# 2a &.5 /U L/ q. U U Date: _ G
Building Address:
.21242 BJ774k OAK
Owner's Name: Phone #:
ZIMMAW fOL/- k3eZ
Contractor: Phone #:
W-3 L Fax #:
Contractor License#: p Cupertino Business License#:
/Uv /
Contact: Phone#: (ASP) Zxp
bmh 0LID Fax #: VFf�� —�2
Building Permit Info:
Elect Plumb Mech
Residential Commercial
Job Description:
For Residential Installations: /
Attic I" floor ❑ 2"a floor ❑
Adhere to minimum setback requirement
For Commercial Installations:
Replacement same weight ❑ Additional weight (structural c_alcs) ❑
Structural Calculations required for new installation ❑
New installation Planning Approval Required ❑
Cost of Project;_ ��/1 Type of Construct (Usage Class):
+¢(� V
Strapped On Platform Bonded ❑ New Location Replacement
Project Size: Express ❑ Standard fK Large ❑ Major❑
Valuation:
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set & the sheet index.
Revised 6/16/08
CITY OF CUPERTINO ,
�� � FURNACE/AC
CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Group
FURNACE FURN/AC
1MCRAA Commercial-Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system;incl
installation of controls regulated by this
code.
1MCREPALT Commercial for the repair of alt/add to M'
ea heating appliance,refrigeration
unit,cooling unit,VAV boxes,
absorption unit or ea heathing, cooling
absorption,or evaporative cooling sys,
incl install of controls regulated by
this code.
1MCSUSHTR Commercial Install/Relocate ea M
suspended heater,recessed wall htr, or •
floor mounted unit heater.
IPGASCOM Commerical for ea gas piping System P
1-4 outlets
1BPGAS For each gas piping system of 5 or P
more er outlet.
1MCAPPVNT Commercial for the install/relocate/ or M
replacement of ea appliance vent
installed ¬ incl in an appliance
permit. _
1BSEISMICO Commercial Seismic B
1MRRAA Residential Repair/Alteration/Add to M
ea heating appliance,refrigeration unit,
cooling unit,absorption unit,or ea
heating,cooling,absorption or
evaporative cooling system,incl
installation of controls regulated by
this code.
1MRSUSHTR Residential Install/Relocate ea M
suspended heater,recessed wall htr, or
floor mounted unit heater.
1MRAPPVNT Residential for the install/relocate/ or M •
replacement of ca appliance vent
install ¬ incl in an appl permit.
Quantity Fee ID Fee Description Fee Permit Type