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07110056 CI TY OF CU PE RT IN O T1 BUILDING DIVISION PERMIT I BUILDING ADDRESS: PERMfr NO. 21535 ADDINGTON CT TBD — To BE DETERMINED 07110056 VER'S NAME: PERMIT ISSUE DATE ROAN JYUE—MIN ET AL 11/13/2007 PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT� PLUMB � u p`O LICENSED CONTRACTOR'S DECLARATION Job Description affirm I hereby arm that I am licensed under provisions of Chapter 9(commencing z with Section 70()0)of Division 3 of the Business and Professions Code,and my license is REPAIR 3 HTRC K, I N S LTN, LIGHT FIXTURE DU TO WTR =% in full force and effect. 3yz License Clan Lle• DMG, REPLC WTR CLOSET r-p Dam Contractor ARCHITECTS DECLARATION I understand my plans shall be used as public records 0. W, Licensed Professional n y-< OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county K Pi which requires a permit to construct,alter,improve,demolish,or repair any structure y Z} prior to its issuance,also mquires the applicant for such permit to file a signed statement r r Valuation X x< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 •q,Ft.Floor Area t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $4100 y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of AR Number Occupancy Type not more than five hundred dollars($500). 3562202 -. CJ ❑I,as owner of the property,or my employees with wages as their sole a mpensadon, will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of (1 P property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If. however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ld i•as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon,and• who contracts for such projects with a coniswor(s)licensed pursuant to the Contractor's License Law. rl I am exempt under Sec B&P C for this mason ner ,cam'` ��CJ Dam I) 3 O ��WORKER'S COMPEN ATIS ON DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑f have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Phis section need not be completed if the permit is for one hundred dollars($100) or less) I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to bcco n b1'ect`o the Workers'Compensation Laws of Caliform�p ate f //Z /� '7 Applicant M�c NOTICE TO APPLICANT.if,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must 0 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 4 I hereby affrm that there is a construction lending agency for the performance of py> the work for which this permit is issued(Sec.3097,Civ.C.) W A Lendces Namr az Lender's Addrr•• U 0 I certify that I have read this application and state that the above information is LL H correct.I agree to comply with all city and county ordinances and sure laws relating to 0 construction,building consction,and hereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes n W W (We)agme to save,indemnify and keep harmless the City of Cupertino against Hy liabilities,judgments,costs and expenses which may in any way accrue against said City y U Z in consequence of the granting of this permit r+ Issued by: Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT �-v7 SOURC�,REGULATIONS. ( -� / 7 Re-roofs Q Signategs'of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of R(mof Will the applicant or future building occupant store or handle hazardous material defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety t,Section 25532(a)? y� All roofs shall be inspected prior to any roofing material being installed. ❑Yes (>d'tvo 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 hazardous air contaminants as defined by the Bay Area Air Quality Management all new mz terials for inspection. District? ❑Yes b"No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cade,Sections 25505,25533 and 25534.1 understand that if the building does riot currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a Certificate of gCCapa�cy. Signature(if Applicant Date )e�C'-. l3 0 Owner&authorized agent Data All roof coverings to be Class"B"or better z . 0-711 0 5(0 CITY OF ��UPERTINO of PERMIT APPLICATION FORM CUPEkTINO APN# Date: Building Address: Mailing Address (if different from building address): Owner's Name: L H - I k/ 6" Q G/a�� Phone#: , Contractor: D P-' O.1 IN LL " r" v <, License#: k)C- PL-r, Qizzo I l� Contact: Phone: Cupertino Business License#: Fax: Building Permit Info: +(J P U x 1 �'r►_ t: Bldg a" Elect Plumb Mech ❑ Job Description: Residential ® Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: Occupancy Group: _ 'z Type of Construction: Please check this box if the project is a q�ML second-story addition: ❑ Project Size: Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Bciler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boi:er> 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 Cc n. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 E lec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING ' BENERGYADD 13nergy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING ] of 3 CITY OF ('UPERTINO CUPEI,TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL ]Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME 1�,ew Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING ) BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Almospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE ) 13ldg Permit Fees BUILDING j BPFIXTUR.E ) Pblg Fixture ) PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP ) In3 Waste Interceptor PLUMBING ) BPLANCHK ) Plan Check Fee BUILDING BPLANCKADD ) Plan Check Add Multi BUILDING BPLANCKREP ) Plan Check Repeat Fee BUILDING BPREPIPE Repipe Of Fixtures ) PLUMBING BPSEWAGE Sewage Disposal ) PLUMBING BPSEWER Sewers ) PLUMBING BPSPRINK Lawn SprinklerBackflo PLUMBING ) BPSTORM :itorm/Rain Water PLUMBING BPTRA.P Kitchen Trap PLUMBING BPVENT ) A It of Drain &Vent PLUMBING BPWATER Install/Alter Water Pipe ) PLUMBING BPWHEATER Neater Heater/Vent PLUMBING BPWSVCS ) Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/c'Unit> 10,000 cfin MECHANICAL BREMAI HAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Rely Furnace> IOK btu MECHANICAL BREMHEAT heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL ) BREMPOLE ' Pc le/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rcptl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT ) Ri;pair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF CUPERTINO CUPEI�F PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMSIGNAD Rrr dl Signs Add Branch ELECTRICAL BREMSIGNS Reriodel 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 3pecialInspection 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 mechanical sq. 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 of 3 ._...__.,.-:�," :.., �^_�:._�•..-.;��,:�-sx.��e✓ar.Y., �-'rr7x.--� ..ac5a_.'.a�"x`:a^�":`�-•��'r_ '�;,r„�a _ �a .....r-.y..✓� ^:^t",^C✓";'... «... �.�..n<h.. �..�,`�� �:`.1i".".`. :.�.�.. -«w�.�'(S'�^t -- _ �rya}l" w�.':'S'�- `e'...�.:�.��,.::..�..�. n,.w r....a. :a...;,« .i.e:..-.t-5c�i.r'_z,•.ww+prM1� .v�«.«..�..Y.. V("'<,li.e: y., 5.��:�a.�A�t''.=? .:SM �''"ems u ':!"" ....P: s......:.;:.a ..r_.,�.,''.j�ty,_, •,':.k�'�c,,,._y. y ..x i ::.�-.. �` •Q�k: �°mod'''^•� ,.a•,'r._..._;s.;..,.: ..s�;�"r''°x��r�,�-x��tu ,� r�,n�.w�$�� �"<' �; �^..."�,�`•,x,:. �',.>M-n:.i ,sa:" ��":.��� ,.; „R� ,;_ A_a�,�:�'�;r.•i,,.�",wn•, s=•�-�.n Uk. 2. ..a y..fir� .;fir..,' "�''.4_..� .. ....,s;. .:.,; '�-"�. "'aim..=3=�..:..:::•ra,�aN�.,'.:a'�*? xj '� -�d. - T gw '�R' £i, r`tk7~.b:'.'°',�.3« d�'. '.',.xY ny'•"•Xyi.'1`:9 &-myor CUPEkTINO .. �• _�� n� i M. .;.:...+.:.rr .�w: _ Assessor's Parcel Number: S Z Z-b 2(j- d 0 Name of owner. Y U EH .rA/(fi R0,k/\ Project address. el- , l Contact person. JO Kt)/ AIL, Phone. Fax. Net square footage of lot. Exi stirs Proposed Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spices inside the garage? N Is privacy protection planting required for the pri)ject? Y N On what floor(s) is work being done? Brief description of work. X�e,� � _ �(- /� �.'1/L4�`Y\; � Y�-v� � 1.1.��/\ I�'V�S�LL�G-1 4_(.'f1/1 J G'VYtc�C �L•:`}'c.L'�I�-w i/.t�.., .} i JC (.`LY—' Code editions:2001 CBC -N)2001 CFC 4D N)2001 CMC (Y-N) ,. 2001 CPC -N)2001 PC -N) Effective 11/1/02 Plan Review Process Work Book Page-8-Revised 8/22/05 2 -*Crry � 'CUPEkTINO A Assessor's Parcel Number: S 6-2-Z-b 0 0 Name of owner. YU E-H IN6i R(Di k Project address. AuC 11 .. " � Contact person. J0 e, Qf)A, Aq, Phone. Fax. Net square footage of lot. Exi tin Proposed Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spices inside the garage? N Is privacy protection planting required for the project? Y On what floor(s) is work being done? -1 �_ V /C Brief description of work. Y�etaV-tc-c- Code editions:2001 CBC N)2001 CFC N)2001 CMC (Y-N) 2001 CPC N)2001 NEC (0-N) Effective 11/1/02 4�/ �C1, 04 Plan Review Process Work Book Page-8-Revised 8/22/05 CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN . . . . . . . . . 35622029 . 00 DATE ISSUED. . . . . . . : 11/13/2007 RECEIPT #. . . . . . . . . : BSC00003212 REFERENCE ID # 07110056 SITE ADDRESS . . . . . : 21535 ADDINGTON CT SUBDIVISION . . . . . . CITY CUFERTINO IMPACT AREA . . . . . . OWNER ROPN JYUE-MIN ET AL ADDRESS . . . . . . . . . . : 21535 ADDINGTON CT CITY/STATE/ZIP . . . : CUFERTINO CA, 95014-4847 RECEIVED FROM . . . . : JYL;E-SHIN ROAN CONTRACTOR . . . . . . . : TBE - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBL, - TO BE DETERMINED ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY PMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 115 .56 55 .47 0. 00 55 .47 0. 00 BPERMFEE VALUATION 4, 100. 00 115 .56 0. 00 115 .56 0. 00 BPFIXTURE UNITS 1. 00 9 . 00 0. 00 9 . 00 0. 00 BSEISMICRE VALUATION 4, 100. 00 0.50 0. 00 0.50 0. 00 EPERMITFEE FLAT RATE 1. 00 40.79 0. 00 40.79 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 221 .32 0. 00 221.32 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 221. 32 --------------- TOTAL RECEIPT 221 .32 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT # 10 R'S NAME: PHONE # c GENERAL CONTRACTOR: H FAX # I am not using any subcontractors: Si,,,,-nature 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