03020020 CITY OF CUPERTINO
BUILDING DIVISION PERMIT . CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT No
21515 ADDINGTON CT Il3fl?0020
ER'S NAME. APPLICATION SUB DATE.
SETO BIT-LEUNG AND RUBY 02 /06/2003
PHONE: SANITARY NO CONTROL NO.
ARCHITECI'IENOINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MEOH
O`p
LICENSED d Mr, OEConsof'ION lob Description
I hereby ar he,1 am licensed under,CONTRACTOR'S DECnm o(Chapmr J(commencing P
wnh Seclian7(XX))of Dwssion 3of the BUsine lid Provernme CUlgand my lrtenrcis
G In u"Mmr iffier _ � 3 � KITCHEN/BATH REMODEL
o�q' oath c Can 'CONTRACTOR: BADGER CONSTRUCTION
F– AR HITECTSD ARATION Z >
KX 1 understand my plans shall be card as public records
J`
xO�O �G
se 3 4 Licensed Professional o
t.
`m OWNER-BUILDER DECLARATION
KKKK"iy<Y 1 hemby affirm that I am exempt from the Comranor's License Law for the
p 0 following mason.(Stttimn 7031 5,Business and Pmfessrons Cc&:Any city or county
§ which requires a Pesmu in construct aver,improve,demnikh.nr repair any stiumure
prior to its Issuance.also acquires the applicant for such permit to rive a signed statement
1'ssZ< that he is licensed pursuant o the provisions of the Conamcturk Lee rise Law(Chapter 9 Sq. Ft.Floor Area Valuation
X'$ (commencing with Section 7(XM)ofDwnum3of the Business and Professions Code)or $15000
teal he is exempt therefrom and the base for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom than flux hundred dollars(3500) 3 5622 0 2 7 . 0 0
0 I,u owner of Ibe property,or my employms with wages as their Mile compensation,
Will do the work,and the Mruwure isnm intended or offered for hive(gee.7064,Business R n^��r�
and Pmfessiona Code:The Conuacmrs License law dues not apply m an owner of 101 – FOUNDA7 1V1V d Inspections
properly he wilds Mamproves thereon,and who doessuch work himsel(m through his
ownemPluyces,provided ther such lmpmcements are not Intended or offered forsedr.If. 102 – PIERS
however,the building or improvement Is sold within one yxar of completion,the a eras.
wader will have the burden of proving that he did not Wild or improve for purpose of 103 - UFER
tam.). 104 - REBAR
01,as owner of Ne propeng am exclusively connecting wide licensed comranunto 105 - ANCHOR BOLTS
construct the project(Sec.7014.Business and Promromme Code:)The Centimeter's Li-
seem Law sure not apply to an owner of prnprny who wilds or lmpmvu theism.and, 106 - SEWER & WATER
who contracts for such projects with a convxcsor(s)licensed pursuant to the Convector's
rrnxeLaw. 202 - UNDERFLOOR PLUMBING
lam eX�"�t��oilye�rfc�c. B S P C far the reason 203 - UNDERFLOOR MECHANICAL
cr l/V�/U/� L��.� �2-4-03 204 - UNDERFLOOR FRAME
I WORKER' COMPEN T NDECLA N 205 - UNDERFLOOR INSULATION
1 hereby effuse under Penalty of do,one of the following declanboor
0 l ham and will maintain aCenificsm ofConscm to self-insure for Worker's Compn- 301 – ROUGH PLUMBING
taboo,as provided far by Section 3700 of the later Code,f the performance of the 3 02 – TUB & OR SHOWER
.,it far which this Perms is Issued. 3 03 - ROUGH MECHANICAL
10 1 have and will maintain Worker's Compnsauon Insurance,u required by Section 3 04 - ROUGH ELECTRICAL
377 of the laver Cade.for the performance of she wuh for which this permit rs island.
My Worker's Compensation Insurance carrier and Policy number are: 3055 – FRAME
Center: Policy No.: 306 - HOLDOWNS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 307 - INSULATION
Me;section need not W completed lfthe Permit is forms,hundred dollars(Sti)(h 308 - SHEETROCK
a`l`as) 309 - EXTERIOR LATH
1 wmfy oral to the work fur whore this perms ts Issued,l shall rim 310 - INTERIOR LATH
employ any person n co Irelmlhe Wnrlsrs'C"mpenuuMn Laws. IMI � 311 - SCRATCH COAT
�L5!"�NOTIC P king this CemOcate m Exemption,you should 313 - ROOF NAIL
wemmr eel a tbe Worker's Commosalmn prbvumns of the Lever Cam,you must
OO fmthwit mplywnh each provisions orMusNor ishallMJamedrevnked 501 - FINAL ELECTRICAL ENERGY
z2 CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
(–i — IhemhyaRnn dust them I.aconswct inn lead tn gagenry far thePerformanceof 503 - FINAL MECHANICAL ENERGY
a > LewuABlrwmrnthlaPemrtislsstird(s .3097,civ.ca 504 - FINAL BUILDING ENERGY
z Lendrr's A40F«
505 - FINAL ELECTRICAL
U p I certify
ee that 1 have mad this application and stale that the shave information is 5 0 6 – GAS TEST
U Comply and with all city county ordinances and state laws relating to
Q building entlhertnyaushonp representatives ativesnrNiscitytocnmrupantha FINAL PLU
WehovcmrminncJ property for msPeCUOn purposes Q$ FIN L
(We)egret In save.indemnify and keep hamleas the City of Copan.against
U 4 inconeq judgments,gmatind expenses mit, mayor any way eccmc against salt Coy 5 A costs
in consequence judgmfthe granting of this permit,
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALI.NON-POINT Issued by:5 Date
'9pUR ULAIONS. .71Y –�L tiL PIrtYLll. WVKlIb /
,L '2n^OZ Re-roofs
Signalize of AppliclaRrCo trots r Dam.
HAZARDOUS ATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupent Mare or handle harardous material
efired by the CuPrnma Municipal Code.Chapter 9.12.and the Ilcalth and Safety
•gemnla 25532p)•'
❑ili t �Nn All roofs shall be inspected prior to any roofing material being installed.
Will the applicant nr future building oceupam use cyvipmcm or Jcncrs which If a roof is installed without firs[obtaining an inspection;I agree to remove
earn hvaNmus lie contaminants se defined by the Bay Area Air Quality Management all new materials for inspection.
Dwron/
DYrs No
IhuvermuHhchato ousm enalsmquirementsunder Chaptcr695ofOcCahfnr-
TooHealth&Safety Cole,Scwnns 25505.25533 and 25514.1 understand that the building
Jnes I currc tly hove a tenant NM n rs my resprnsrhtltty m nuuly the tacupant of der
rcyu tar ehmusswmmp miaauan,enracrmflcamy acs ancy. Signature of Applicant Date
12 Ow euthnrva agent �2. DO All roof coverings to be Class"B"or better
CITY OF CUPERTINOt:••r•u '^yw-a,t ' -�.' %:e•=^ • • '-'T•�
BUILDING DIVISION pCi j2Mj ATJW
+:'
BUILDING ADDRESS: PERMIT NO.
21515 ADDINGTON CT !).71P209()
OWNER'S NAME: APPLICATION SUB DATE
SETO BIT-LEUNG AND RUBY 02/06/2003
NE: SANITARY NO. CONTROL NO.
ARCHITEC iENGINEER: BUILDING PERMIT IWO
BLDG ELECT PLUMB MECH
p'u'p LICENSED CONTRACTOR'S DECLARATION
U 1 hcrtny aflhm that 1 em licensed under provisions
For of Chapter v(commencing Job Description
xmN Sxti,7plr,f of Dnision 3.f do BuvncVpnd Profmsiom Code,end my hearse is
roll rang ercm /v KITCHEN/BATH REMODEL
�S5k Lie c Lm.g �7 CONTRACTOR: BADGER CONSTRUCTION
Dan Cont r C k'
IM¢C R HITLC's D .ARATION �+
I understand my plane shall be used u public records ^Q.�
Pu�7 3 /Y V
n4 Lmcnsad professional
G5 OWNER.BUILDER DECLARATION /0.
1 hereby affirm that I an exempt from the Contractors License Law o fnr the
p o following reamua.(Saran 7 construct,Business and Professions Code:Any city tat county
$ which tons issuance,a permit re cnnawn,aline tmpmw,do Permit t ri e a sig any instruction
Se pnormmcensed moment us tie applicant fnr muchpermicsofnleaeLaw statement
�F< Oulhe taring wish Section mNo prvvnians of tree Bummh Ucemmament haper9 Sq.Ft.Floor Area Valuation
Zg (cumnisexewlNSectioa70ndofDasis aroftimBuumustNon.AnyuviGWC)of $15000
that k u exempt therefrom end the beau far W Waged essmprien.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy e
not mart than fiw hundred dollars($5007. p y Typ
❑1,u owner or the property.or my employees with wages U their sole compensation, 35622027 . 00
will do the work,end the NUmure ianot intended or offered for We(Sm.7041,4,Business Qp�LS�r�d Inspections
"Proteulom Cade:The Conumutofm Umme Law does am apply ro an mover of 101 - FOUNDA 1 5 p
Piapeny who build.or improves Merton,and who does such wank himse if or through his
awnemployecs,provided thatsuch improvements art not amended interfered towards.If, 102 - PIERS
howewa the building or improwment is sold within one year of completion,the owner.
builder will haw the burden or proving Nat he did not build or improro for purpose of 103 - UFER
late') 104 - REBAR
❑I.u owner of the property,am taclusively contracting with licensed contracmrs to .105 - ANCHOR BOLTS
cmmuum the project(Sec.7040.Buttress anal Profatlom Code:)Mae Contractor.U-
cetae Law dots amt apply to an owner of Property who Wilds or nmprows thereon,and, 106 - SEWER & WATER
who contracts for much projects with a conuactor(q licensed pursuant to to Contrecmra
llll....mense Lew. 202 - UNDERFLOOR PLUMBING
Iman r as I nor .04PCrorNmosman 203 - UNDERFLOOR MECHANICAL
7/jp- —gr4(Q'A 204 - UNDERFLOOR FRAME
WORREa' ComPENFA NDECLA N 205 - UNDERFLOOR INSULATION
hereby a R m under penalty of perjury am of the following declarations: 301 - ROUGH PLUMBING
I hew and will maintains Contrasts ofComenl to selfdnsum fm Worker's Compen.
udon,as provided for by Section 3700 of the Labor Code,for the performance of the 302 - TUB & OR SHOWER
work for which this permit I.issued. 303 - ROUGH MECHANICAL
❑1 haw and will maintain Workers Compensation Insursncc,u required by Section 304 - ROUGH ELECTRICAL
3700of the Isbm Code,far W performance of the wodt far which this permit is issued,
My Workers Compensation lmursnce carder and Policy number are: 305 - FRAME
Carden: Policy No 306 - HOEDOWNS
CERTIFICATE COMPENSATION IINSURANCE ORKERS' 307 - INSULATION
Obit mallon need not be completed iftie Permit is foram hundred dollm(5100) 308 - SHEETROCK
eft`lly 309 - EXTERIOR LATH
I aM1ify Net In the P"m once of om work fnmrgwhich this Permit B Iuued,l shell not 310 - INTERIOR LATH
empleyany person m one, to hear suyjact:o the Workcfi Compensaron
Laws of Calif ' fGLllNy y-- 311 - SCRATCH COAT
Applicant
NOTIC P GANI:if,a r makingNltCenifnamofEsemptlan.youshnuld 313 - ROOF NAIL
become t to the Workers Compensation prbvisiuns of the Labor Code.you mot
OZ fonhwl emplywithsuchprovisions orthispermitahallbedeemedrevoked. 501 - FINAL ELECTRICAL ENERGY
7q CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
t-�
4 Ihenny affirm Nn them its convection lending agency for the performance of 503 - FINAL MECHANICAL ENERGY
a z the warl,for thupemoBUUed(sec.3097,Ch,c.) 504 - FINAL BUILDING ENERGY
{5f Q tenders Nam^
a Z Icnder1Addrer 505 - FINAL ELECTRICAL
U O' I certify ran 1 haw reW this application and sum Net No show information is 506 - GAS TEST
{Tr ;"! contact.l agree m comply with all city and county ordinances and mute laws relating m r/
O ICJ budding construction,and hereby someone,rtpreenrs0erts of thisclty to enter upon the FINAL PLUMBI G
{2) above-mendoned Prepeny for inspection pear suet O B FIW
(We)agree m saw,indemnify and kecp har alcu the City of Cupertino against
rV7 IIab1110u.judgmcnu,cuuand asperities which may in any way attme agaimtseid City S 6/
U F77 in consequence of the granting of this Permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:5 NG Date
SPUR ULA IONS. Wult
R— T'�A-f?Z Re-roofs v
nmurt of pp n< Co I r ���� Dam
HAZARDOUS ATERIALS DISCLOSURE Type Of ROOF
Will the applicant or fulum building occupant mom orhandle haardoua mammal
at defined by the CIPerllno Municipal Code,Chapter 9.12.and the Health and safety
Code,Section 25532m7 - All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
Will Ibe applicant or futon building aceupam use cquipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air conmminmu as defined by the Bey Area Air Quality Management all new materials for inspection.
ashes?
❑Yes No
them readdeharardnu.mrimsmgviementsundc,Chapmt695aflhe Califon
niaHaith&Safety Cock.Smdou25505,25533m M534.IunMrstsM if NC Wilding
dam t cumgtly hews¢mean,Nn i1 is my ropunsibility ts Wdfy the aocupmt of the
tarot vpichm art W at jinasummeofaCcrifcto �Occumay. Signature of Applicant Date
L/6o� I � --Dam All roof coverings to be Class"B"or better
Ow euNana agent Dem
,
•
i .
Lag,
I
i
f�oG
i
+
:
I as-51ui -Ai3out-
- -- -
----------- -'•- --- - -= - ---- --PA U
n
I
- -- - — =-- ---- - - --- - - -- -- --- - - o- ---
' VTS L
I '
,
1
2-4 1,4 ,
- I
1 E
J
I
_i
pp ,
TF
I I I #'FHEG �.
' i C41 El DiORDINANC61 i
✓� V i- P,y - - -- - '
xay
o
I
This set of s' Xllleddicajiona' R1u5.
• I — . oel kept ion tfi ja64 an limos�a a Is un
�7to�
' ---—- --
cn-, ' ,.LZ' 2ag R / !
--- " --- - — --- '�,'.- --=— -- I me with it; i n (lermssiop fnt�,—
-------- A4`f� -- -:-- i - +^ aoa -s llie:buddm P �[; C fy df iupoi i v �,
71. scam
" --- -- - _ -- ------=--•---'"--`--- - - -- --�-- -- '�>l�en�1111_s�cdiha - ' ---- -- - ---"-- `- -i
v ; + ;HILL fJ� 6. held t purnit Sr tolhe a� 7 G ( i
- - -- 6003- - - ----- --- - - --- - —, - " - -
i �*v of 6a viaTaT1 of uri pidvisio
--- - ip n of t. k R' �� - --:`Y
:
CL- ---;—` ---- - - slit}! ante oc.S,tate.Lel�i--- - - o---- -- -
-"- -- - - --.r -- - - r ,1-
_
3 Atr�
Q.0
ARA
c2 15t 5: ,
:
,
+
' ~ I
,
I
_ -
CUP ,eto
CA,
s tea'
a _ -- -- - A� 3 ?. -- -- - - - --_ z- -- - -- - - - -
S 3 �lnss I I Tel-�- - - - ----
q,
i
BBuc_; ���-! 'rot K%tx'� -
:
A
---------- ------ ------- -
$ AT!
1
rgc4e'S CAT%
it
-Ro
APP
-B-4-
I-E I i IN ACC RDA DANCEr TH E
DA! •
T- SIGNE6
hoc
lot
W
rMAM
aRy
:_zTn (of
'IBM
11 f Man
Not.
i—T
AT-
'Cry Q4170
ASO
KA JA
01 *3 q ipi
•
4
` - PITY OF CUPERTINO
CUP TYOF O PERMIT APPLICATION FORM 63 o a
APN# � �rJ � Date:
Building Address:
Owner's Name: P�,one�
gi�L,Rua� SET-o ( �o : 63
Contractor: Llcens(e#:
B4r3heR CcyJs,-eac.,770N
Contact: �
Cupertino Business License#:
(,�r�ol✓ g�r�C��i� oK� �g7-4oQ8
Building Permit Info:
Bldg Elect Plumb Mech
Job Description: kn-C+EN 6q-rN KEMpDEL
Residential V, Commercial 7
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: 151 000 Occupancy Group:
Type of Construction:
R�NtoD�L /V
Quantity Fee ID Fee Description Fee Group I
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permit sq. foot BUILDING
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 I
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V <= IOOOA ELECTRICAL I
I BELEC1001 Elec 600V> 1000A ELECTRICAL
I / l BELEC200 Elec Svcs 600V <=200A ELECTRICAL I
I / / BENERGY Energy BUILDING I
V 13ENERGYADD Energy Add Multi I BUILDING
BINVESTIGA Investigation fee I BUILDING
•I BMITIGATC Comm. Housing Mit. Fee I BUILDING
1 of 3
717- z
i
�ITY OF CUPERTINO
CUPEf�TINO PERMIT APPLICATION FORM
•I Quantity Fee ID Fee Description Fee Group j
I BMTTIGATR Res.Housing Mit Fee BUILDING
I I BMNEWMULTI New Multi-Family Res MECHANICAL j
I I BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
I I BNEWMULTI Multifamily Res ELECTRICAL J
I I BNUCOMME New Comm Electric ELECTRICAL J
I I BNUCOMMM New Comm Mechanical MECHANICAL J
I I BNUCOMMP New Comm Plumb PLUMBING J
I 13NUMULTI New Multifamily Res PLUMBING J
I I BNUSFD I New Single Family Res BUILDING
I . I BOVERTIME I Inspection Overtime BUILDING
�I BPBACKFLOW I Atmospheric Vacuum PLUMBING
I / i BPCESSPOOL I Cesspool PLUMBING
I �/( BPERMFEE I Bldg Permit Fees BUILDING
I \I BPFIXTURE I Pblg Fixture PLUMBING J
I I I BPGAS I Gas Piping System Fee PLUMBING
13PINTERCEP I Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING J
BPLANCKADD Plan Check Add Multi BUILDING
�\ I BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE I Repive Of Fixtures PLUMBING
•I ( 1 I BPSEWAGE I Sewage Disposal PLUMBING J
I V > I BPSEWER I Sewers PLUMBING J
I BPSPRINK I Lawn SprinklerBackflo PLUMBING
J BPSTORM I Storm/Rain Water PLUMBING J
BPTRAP I Kitchen Trap PLUMBING
BPVENT I Alt of Drain &Vent PLUMBING
BPWATER I Install/Alter Water Pipe PLUMBING
I J BPWHEATER Water Heater/Vent PLUMBING I
J BPWSVCS Main Water Service PLUMBING J
I BREINSPECT Reinspection Fee BUILDING
I J BREMACOVER A/C Unit> 10.000 cfm MECHANICAL
I J BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL
J BREMAPPLI Appliance Install MECHANICAL I
I I BREMBUSWAY I Remodel Busways ELECTRICAL
I I BREMFIXT I Lighting Fixtures ELECTRICAL I
I BREMFURN I Relocation of Furnace MECHANICAL I
I J BREMFURNOV I Relo Furnace> 10K btu MECHANICAL I
I BREMHEAT I Heater Installation MECHANICAL
�) I BREMINHOOD I Installation of Hood MECHANICAL J
J BREMMISC I Misc Apparatus ELECTRICAL
J BREMNRAPP I Rem Non-Res Appliance ELECTRICAL
•� I BREMPOLE I Pole/PlatformFixture ELECTRICAL
2of3
CITY OF CUPERTINO J
CUPE(�TINO PERMIT APPLICATION FORM
Quantitv Fee ED I Fee Description Fee Group J
�\ BREMPO R Power Device/Apparatus ELECTRICAL
I BREMREC9 T Rcvtl, Switch&Outlets ELE=TRICAL J
BREMREL CA Relocation of Hood MEC CAL J
I BREMREPALT Repair/Alter Heating MECHANICAL I
I I BRE �W Remodel Res Appliance ELECTRICAL
BREMSIGNAD 1 Rmdl Siggns Add Branch ELECTRI AL
I I BREMSIGNS Remodel Signs,Marquee ELECTRI AL
I I BREMTHEATR I Theatrical Lighting Fix ELECTRI
BREMVENFAN I Vent Fan Sin le Duct MECHANI AL J
I I BREMVENSYS I . Ventilation Svstems MECHANICAL
I I BSC LVD I Scb Specific Plan BUILDING
I BSEISMICOM Seismic Commercial BUILDING
B �jj{{S1V)( RE I Seismic Fee Res BUILDING
J
I vSPEC I Special Inspection BIN
I BSWIM I Swimming Pool BUILDIN I
I ' J BTEMP I Temporary Power ELECTRICAL
I BTEM M PPER I Temporary Bldg Permit BUILDING J
I BTEMPSVCS I Temp Dist Svcs ELECTRICAL
BUSLIC I Business License BUILDING
ELECTRIC I Electrical so foot ELECTRICAL
EYERMITFEE I Elec Permit Issuance ELECTRICAL
E E Mechanical so. foot MECHANICAL �
/ MPERMITFEE I Mech Permit Issuance MECHANICAL I
PPERMITFEE I Plumbing Permit Issuance P�eUMBING I
PPLBG Plumbing Fee so foot PLUMBIN6 I
I ZADDCHG I Address Change BUILDING
•
3 of 3