0040082 CITY OF CUPERTINO PE Ir No.,
BUILDING DIVISION, PERMIT CONTRACTOR INFORMATION: U6 0 Tb b Q�
'- BUILDING ADDRESS u
.�� 44 SANITARY NO APPLICA ONSUBM RALDATE
OWNER'SNAME. \ S
'�(�U/�G•' �' lG L�'l. • _ q> NIC CONTROLk
fg�tt,� � (}= //�P5
�1GI III EC'f/ENGINEER � / ��/� � 1 .�' J y / f! I 1{I11.DING YL'RMI'1'INFO
i o y LICENSED CUMRACIOR'S DECLARATION '- ) ✓
Fo mz=c-ui
Job Description
wifu Sadon]OOo aion3ofthe Busmnaand Pmfeviov COde,and my L<cveu ' '
full force ape eff.,.Recs. tj�l ff
z a IACeve
Lit'
¢7 3 u g Dead.—Contiacuu " t q_ `. \v`
.' •fin eC' s
H w O RCHITSCI"S DECLARA sAx .J�VC_ f
1 uncommon my plans shall be used as public mmrds . . ' '•
NN a I A
a n O O Ilcaad Profeutovl
uaS OWNER-BU DECLARATION
3 a 1 hereby iinn that l am exempt from the Contractor's License law for the '
see followingg mamn'(Sauon 7031.5.Buslnns vd Pmfuaiov Code Any city or county
d s y which requires a Permit to construct,alter.Improve.danolish.or rtpNl any,amRture , Sy. FL Floor Area" Valuatiop•v
Prim m its msuanm,also tagmms the applicant rte such permit m file a signed statement o
ths'he1.licensed purswnun the provisions of the Cormacmr'e License law(Chapter9
tat is exempt therefrom and Division]close
eged exa and
ps... AamnaCde)or.,:j, ,� sPN Number Occupancy Type - '
Nis he is exempt any ant rr basis for the cts the exemption Any vmmuon of T`Ia0.`� Wile-will[''+ L_�'•�_L` ��j P Y YP
Section 0 LS by anydred drat(m a permit subpmu Nil apphvnt to.eivJ penal?of - S
not mom Ilan five hundred dollars 15500) -. _ '
I,aeownorofNeprnperiy.ormyemployaawiNwagwuNeiriolccompenmuon, ` .1 Required Inspections - -
willdothewmk,sontheswct re is not moodd or offered fmule(SW 7M.Bussyss
and Profeuiory Cods:The Contractor.Co...Law does rid apply to an owvr of
properly who l olds or improves Neuron,and who does such woh homulf or through
his own employees,provided that such improvements one not mmdd or oHcrd for -
We.If,however,the budding m tmprovemem is sold within ov Yexhof comptwon,Ne '
veer-budder will have the buden of proving Nat he did not build or improve for pur
pose of eahs).
I,u twos of mte pmpemy,ern sinm.nd commuting with I)a Ccuntmnon
mnstiuct Ne prv3at(Sec.]fibs,Bustncu and Profeulov Code)Dte Conbactm'a Li-
w Low don nut apply to v wnecuf property who sedds rconat vv Neeon,and '
L.c..contracts fm such pmJaa with amntranar(x)hcemd pumvmmN<Cantrumta
Lrtrnu law
1 am exempt under Sec. .B&P C for Nis reason
/ owner Dale
v
WO] .R'S O SATIRATION
1herebyill his tin rultyof ofConmmofeffolmwmg Wornse 11 \\�+••'^j� �Y'
❑Ihave and will for by eure37M ofCe,LaWr ml6imurt for Worker's entitled-
stood. {,U"v\•(,^�S/
� orkf r provided 1 for mi Section 3]00 of Nil Labor Coe.for Ne performance of she
01 have whichilla perrmiu ortic
❑1 have aria will maintain tie peff Compensation work hi h requued by bmion
ylyw NeaC Code,for Nil perronnumeofrluwork for which permit is issued.
y Worker's C pepe��auon Inmrave coma and Policy number tie: (\�A\`+ p%J\•'
poppe���������� Policy Na
me L'�RMF�A L3XBIION INN FROM WORKERS' -
a CY)MPIiNSATION INSURANCE
(This section ed rim becomPletedlfNe pcnnn is forovhudrddollam(S100)
m Ices 1 ��%% Js• /
IcemryN minary ansu wNewmkforsubl tto eewol M'e41du11
Croton Laus any Canon in any manor w m m hewme svh)ane Ne Wuhan'Compen-
ulion Lflwa of California Dam ' -
APphar, ., .0..
NOTICE ID APPLICANT,IL aBer mating Nu CertiEcne of Exemption,you should a
become subus, m the Workeda Compensation provisions of Nn I abor Code,you must:
fonhwiN comply with such provisions or this permit shell be cieemeA revoked.
CONSTRUCTION LENDING AGENCY
Q Ilmrtby affirm that Ncrtuacnnawcuon lending agency for the perfomuve of '
- z the work for which this permit is issued(Sec.309],ell.C)
<dert Na •
P > Under' m
a Addis•
. fz7 p I cemfy that I have mad this application and state Nm dm above information is e
�. correct 1 agree to comply with all city and county odivnces son sum laws mining to _
z 'building construction.end hereby amhove mpmenwlve,of this cayto enter upon the
C.7 C) aMVCmcmiond progeny for inspection purges.. '
e lira f~ (We)agree m save,indemnify and keep harmless the City of Cupertino agaonst
V Iix1uhh,x,ludgnrnu,costa and npenses which may in any wry accrue against aid City l
} Lit in consequence of the grading of Nn permit. '
F 6a APPLICANT UNDERS]ANDS AND Wit 1.COMPLY WITII AU[N-POINT ^9'
t..) z SO S URCE RFGU"DON
/// Si fA fi�tt'' V{{''hegctm I am
_. / LJy DOUS MATERIALS DISCLOSURE.
Will Neapplican mfitu re Wilding occupant store or handle hazadous material Re-roofs
as defined by the Cupertino Mummpal Code.Chapter 9.12,and the Health end Safety
Code,Section 25532p)' _� +r Type of Roof '
❑Yes cw-/ , .. ' •, `
Will the applicant m future Wilding occupant use egmpmem or devaes which All roofs shall be inspected prior to anyy'roofing material being
emit betandous anc i animance as defined by the Bay Arca Am Quality Mavgcmerm installed. If a roof is installed without first obtaining an inspection
I agree to remove all new materials for inspection. Applicant
❑Yea d
lhave rtaa Vte huardo r,/ un erstands and will comply with all non point source regulations.
�uisemenm under Chapter b 95 ofthe Cub-
forma Health&Safety Code,Secuov 25505,25533 and 25530.1 understand Nu if the s -
buddingdoesnorcurrentlyhaveatenant,NUnismyricponiibibty torrodytheoccupant _ - t,� O ,
yofd.rtyuvmrnuw hmum be mat primmsts.ofa Candice.of Occupancy { / f I 0 b
/ A` ' Signatureof'ApplicanD,, Date
Oavror euClRnad agen ,"-" Dam
All roof coverings to be.Class"B"or better
OFFICE
Ory. it Applicable Fee 10 Fee Description 'Fee Group
�I �BPEHM'r' E 18LOG PERMIT FEES IBUILDING II
• 1 ISCONSTAX ICONSTRUCtION"iAX IBUILDING
ISENERGY (ENERGY IBUILDWG
BENERGYADD JENERGY ADD MULTI IBUILDING
SOVERTIME (INSPECTION OVERTIME IBUILDING
BTEMPPERM TEMPORARY SLOG PERMIT IBUILDING
BMITIGAT HOUSING MITIGATION FEE IBUILDING I
SPLANCHK PLAN CHECK FEE IBUILDING I
ISPLANCKADO lPLAN CHECK ADO MULTI BUILDING
SPLANCKREP (PPLAN CHECK REPEAT FEE BUILDING
I ISREINSPECT REINSPECTION FEE BUILDING I
19SCSLVO ISEISMIC SCS SPECIFIC PLAN IBUILDING
I SEISMICOM COMMERCIAL SUILOING I
ISSEISMICRE SEISMIC FEE RES IBUILDING
I (ESPECIAL SPECIAL INSPECTION IBUILDING I
I ' ISSWIM SWIMMING POOL BUILDING
11ZADOCHG ]ADDRESS CHANGE IBUILDING
�I \k IEPERMITFEE IELEC PERMIT ISSUANCE (ELECTRICAL
v BELEC1000 ELEC 600V <-1000A ELECTRICAL j
I \ .IBELEC1001 �ELEC 600V>1000A (ELECTRICAL I
BELEC200 ELECT SVCS 600V <=200A ELECTRICAL
BNEWMULTI I ULTIFAMILY RES ELECTRICAL I
SREMSUSWAY REMODEL SUSWAYS ELECTRICAL I
BREMFIXT LIGHTING FIXTURES ELECTRICAL
. SREMMISC IMISC APPARATUS ELECTRICAL I
SREMNRAPP IREM NON-RES APPLIANCE ELECTRICAL )
I
ISREMPOWER BREMPOLE IPOLE/PLATFORM FIXTURE (ELECTRICAL
POWER OEVICE/APPARATUS ELECTRICAL
IREMRECEPT . IRCPTL, SWITCH &OUTLETS ELECTRICAL
I REMRESAPP' EMOOEL RES APPLIANCE (ELECTRICAL )
+ SREMSIGNAD IRMOL SIGNS ADD BRANCH (ELECTRICAL I
(SREMSIGNS REMODEL SIGNS, MARQUEE ELECTRICAL
IREMTHEATR EATRICAL LGHTNG FIX (ELECTRICAL '
SSF&2FAM ISINGLE &2 FAMILY )ELECTRICAL I
FISTEMP ITEMPORARY POWER ELECTRICAL
rEMPSVCS . ITEMP DISTSVCS ELECTRICAL I
IMPERMITFEE IMECHPERMITISSUANCE IMECHANICAL11
APFiLOTHEA OTFIER XPPL ANCES MtC9AN(CAL I
I ISBOILERI BOILER — 100,000 STU (MECHANICAL
I , SSOILER2 ISOILER >100KTO500K STU MECHANICAL'
BBOILER3 80ILER>500KTO 1M BTU MECRANICALI
SBOILER4 ,BOILER>1M TO 1.75M BTU MECHANICAL
BROILERS BOILER> 1.75M BTU MECHANICAL)
BREMAPPLI APPLIANCE INSTALL MECHANICAL I
I BREMHEAT HEATER INSTALLATION MECHANICAL I
SREMVENFAN VENT FAN SINGLE DUCT MECHANICAL
I ISMNEWMULTI NEW MULTI-FAMILY RES MECHANICAL
• I ISMNEWSF&2F NEW SF&2F RES SLOGS MECHANICAL
I oft
a<.�a uloAv
IG p l�.1avLIZ IAC UNIT >10000CFAd IiVI- nANICAL�
BRlMAlPHAN IA/C UNITS <= 10.00CCFiNI (MECHANICAL
)8REMFURN +RELOCATION OF FURNACE (MECHANICAL;
AkEMFURNOV IRtLU FURNACE > 10K BTU IMECHANICAL
dRCMWH000 INSTALLATION OF HOOD MECHANICAL •
I
1Ei EniRtLtICA RLL(J :A1lON OF HOOD IMECHANICALI MECHANICAL
/AI
�BHEMREPALT REPAIRLTERHEATING
ISNEMVENSYS VENTILATION SYSTEINIS IMECHANICAL
P'PRpI-"M F)=E _ JPLUMBNG PERMIT ISSUE IPLUMBING I�
'MULTI N MULIFAMILY RES I�LbMbING I
BNUSFD NEW SINGLEFAMILY RES PLUMBING
I BPBACKFLOW ATMOSPHERIC VACUUM IPLUMBING )
BPCESSPOOL
CESSPOOL PLUMBING
IBPFIXTURE PBLG FIXTURE PLUMBING
IBPGAS GAS PIPING SYSTEM FEE PLUMBING
SPINTERCEP IND WASTE INTERCEPTOR PLUMBING
I �BPREPIPE REPIPE OF FIXTURES PLUMBING I
PSEWAGE SEWAGE DISPOSAL PLUMBING
IBPSEWER SEWERS ' PLUMBING
I IBPSPRINK LAWN SPRINKLER/BACKFLO PLUMBING
BPSTORM STORWRAIN WATER PLUMBING
�BPTRAP KITCHEN TRAP PLUMBING
I I�PVENT ALT OF DRAIN &VENT PLUMBING
IBPWATER INSTALL/ALTER WATERPIP )PLUMBING
PHEATER WATER HEATER/VENT IPLUMBING
SVCS MAIN WATER SERVICE IPLUMBING I
)ZDEVAGREE DEVELOPMENT AGREEMENT (PLANNING I
ZDIRTM DIR TENT MAP PLANNING I
ZFULLHR FULLAPPL BASE+HR (PLANNING
ZFULLTM FULL APPL TENT MAP I PLANNING
ZFULLUP FU LL APPL USE PERMIT PLANNING
I ZFULLZONE FULLAPPLZONING IPLANNING
ZGPAMENO GENERAL PLAN AMEND PLANNING
ZUMAMEND LIMITED AMEND IPLANNING
ZUMTM LIMITED TENT MAP IPLANNING
IZUMUP LIMITED APPL USE PERM( IPLAN NING
IZMATEMPUP MIN AMEND TEMP USEPERM (PLANNING
IZMINHILLEX ]MINOR APPL HILL EXC IPLANNING
IZMINSIGNEX MISC SIGN EXCEPTION (PLANNING
ZMINTM MINOR APP TENT MAP IPLANNING
ZMINUP MINOR APPL USE PERMIT (PLANNING I
ZMISCASA MISC ARCH SITE PLANNING 1
ZMISCEXT MISC TM AND UP EXT +PLANNING
ZMISCFENCE MISC FENCE EXCEPTION (PLANNING
ZMISCGEN MISCELL APPL GENERAL IPLANNING )
I ZMISCPCINT MISC PC INTERPRETATION PLANNING I
ZSIGN SIGN PERMI PLANNING I
ZTEMPSIGN ITEMPORARY SIGN PLANNING
I
VARIANCE +DIRECTOR VARIANCE PLANNING
2 oft A
Rsvisw ally 9
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
— CITY OF CUPERTINO
•� • BUILDING PERMIT INVOICE OPERATOR: karenb
Sec: Twp: Rng: Sub: Blk: LoC:34244004.00
INVOICE DATE......: 04/12/2000
REFERENCE ID # ... : 00040082
SITE ADDRESS .....: 22714 ALCALDE RD
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA ...... .
OWNER ............ : KIM YOUNG
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-3905
CONTRACTOR .. .....: LIC k
COMPANY ..........:
ADDRESS .......... :
CITY/STATE/ZIP ... . ,
TELEPHONE ........:
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
_______________ ___ _________ ____________ ___________
BELEC200 P 22.20 0.00 22.20
BUSLIC P 90.00 0.00 90-00
EPERMITFEE P 35.52 0.00 35.1552'
_________ ____________ ________
147.72 0.00 197.'!2
V ID _----.-`DESCRIPTION -.-..- VOICE ID DESCRIPTI)GY
.. ...... ........ ...... ..
4 ROUGH ELECTRICAL 501 FINAL EL ICAL
505 FINAL ELECTRICAL
•