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03110013l�Z OCpC IV'1 "o, ]� � F- f� as la :LL �O 0 <m u— _z D 7.. z 2t 1 y 7 J CITY OF CUPEwrINO INFORMA Ni BUILDING DIVISION PL RMi C CONTRACTOR I BUILDING ADDRESS: P PERMIT NO0 3110 013 OWNER'S NAME: P PERMIT ISSUE DATE KANG RIM & 4 4 2003 JE: SANITARY NO. CONTROL NO. ARCHITECT /ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMP MECH LICENSED CONTRACTOR'S DECLARATION J Job Description I hemby affi de rm the, 1 am licensed under provisions of Chapter 9 (c mm oencing with Section 7").1 Division 3 or NC Basin= and Professions Code, and my license is � �p g infuRmrmandofficer. B g Limosm Class Lic. a CITY OF CUPERTINO 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # : 3 Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35616053.00 DATE ISSUED.......: 11/04/2003 RECEIPT 4.........: 23683 REFERENCE ID # ...: 03110013 SITE ADDRESS ..... SUBDIVISION ...... CITY .............: IMPACT AREA ...... OWNER ............: ADDRESS ..........: CITY /STATE /ZIP ... RECEIVED FROM .... CONTRACTOR .......: COMPANY ..........: ADDRESS ..........: CITY /STATE /ZIP ... TELEPHONE ........: WE ID UNIT BPERMFEE VALUATION BPLANCHK PERMIT FEE BPREPIPE NO OF FIXTURE BPSEWAGE UNITS BPSEWER SEWER SYSTEM BPVENT UNITS BENERGY PERMIT FEE BPWATER UNIT PPERMITFEE FLAT RATE BREMPIXT NO. FIXTURES BREMRECEPT NO. OUTLETS BREMVENFAN NO UNITS BSEISMICRE VALUATION EPERMITFEE FLAT RATE MPERMITFEE FLAT RATE TOTAL PERMIT METHOD OF PAYMENT --------------- -- OTHER TOTAL RECEIPT • 11093 BEL AIRE CT CUPERTINO KANG RIM & JONG -IM CHOI CUPERTINO CA, 95014 -4701 JONG CHOI LIC # QUANTITY ---- - - - --- AMOUNT ---- - - PD -TO -DT THIS REC 20,000.00 - - -- 257.00 ---- - - - - -- 0.00 ---- - - -- -- 257.00 257.00 218.45 0.00 218.45 6.00 49.98 0.00 49.98 1.00 62.16 0.00 62.16 1.00 19.98 0.00 19.98 1.00 8.33 0.00 8.33 257.00 77.10 0.00 77.10 1.00 8.33 0.00 8.33 1.00 35.52 0.00 35.52 3.00 3.33 0.00 3.33 2.00 2.22 0.00 2.22 2.00 48.52 0.00 48.52 20,000.00 2.00 0.00 2.00 1.00 35.52 0.00 35.52 1.00 ---- 35.52 - - - - -- 0.00 ---- 35.52 863.96 - - - - -- 0.00 - --- - - - - -- 863.96 AMOUNT 863.96 863.96 NUMBER --------------- - -- VISA NEW BAL 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 i KI tCd., CITY OF CUPERTINO WITY OF CUPERTINOO PERMIT APPLICATION FORM o3i(° °1,3 N # � � � 0 Date: It o� 03 Building Address: Owner's Name: Phone #: 4aP)4-4 —qrRua3 Contractor: frccc fian License #: Contact: n: Cupertino Business License #: Building Permit Info: Bl Elect ( Plurribbb -S -' Mech Jo Description: Residential W z&M 1 ' .`.c Commercial ❑ Sq.Ft. Floor Area: $ /Sq.Ft.: i Cost of Project: Occupancy Group: i7 I !� Type of Construction: Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBLDGFEE Bldg Permits . 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/ComnV uasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax — Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC 1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING BMITIGATC Comm. Housin Mit. Fee BUILDING I of 3 CITY OF CUPERTINO WITY OF CUPERTINO 0 PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF &2F New Sf &2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BNUSFD New Single Family Res BUILDING BOVERTB4E Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING — BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pb1g Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers__ PLUMBING BPSPRINK Lawn S rinklerBackllo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Tr PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pi e PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVER A/C Unit > 10,000 clip MECHANICAL BREMAI .HAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Buswa s ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV elo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc A rats E ELECTRICAL BREMNRAPP m Non -Re A liance ELECTRICAL BREMPOLE ole/Platform Fixture ELECTRICAL U 2 of 3 CITY OF CUPERTINO WITY OF CUPERTINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BREMPOWER Power Device/Apparatus ELECTRICAL ` BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Sips, 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 Special Ins ection 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 _ A "_' 7 "_' 1 MPERMITFEE Mech Permit Issuance MECIANICAL PPERMITFEE Plumbing Permit Issuance PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chan Re BUILDING 3 of 3 1 J n U oh i „L9, ic.hA'% • - °�' ^DNS i r49 E NOV04203 By; / 5 0 f �/o73 0 �c' I APPROVED IN ACCORDANCE WITH THE CITY Ot CU41777-- D NCES . DAIS SIONThis suicattu' -its, Oa kept on tha Job u; as hmes ami it is un lawful to mace any L ian.,JS or alteration: on some wiiiiout w itten pennis, ion frorr. the building Dept., City of Cupertino. The stamping of ih;s plan and specifications SHAH NOT be held to permit or to be art approval of the violation of any prpvrsio", if any City Ord State State Caw 1` 're ( L?sd /�/- z Z 0 z >_ Y � �z �o �U ,a J BUILDING DIVISION PERMIT BUILDING ADDRESS: NAME: I hereby affirm That 1 am licensed under provisions of Chapter 9 (commencing with Section 71X10) of Division 3 of the Business and Professions Code. and my license is in full fume and effect. License Class Lie.N Dam Commuter ARCHITECTS DECLARATION I understand my plans shall W used as public records Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm 'hat 1 am exempt from the Contractor's License Law for the following reason. (Section 703 1.5, Business and Professions Code: Any city or county which requires a pemti' In construe', alter, improve, demnli la, or repair any interim, prior In its issuance, also requires the applicant for such permit to flea xi,ned.var sent that he is licensed pursuant to the provisions of the Contractor's License taw (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profcoinm Code) or Nat he is exempt therefrom and me basis for the alleged exemption. Any violation of Section 7071.5 by any applicant for a permit subjects the applicant to a civil penalty of not more man five hundred dollars (S50R. ❑ 1, as owner of the propeny, or my employees with wages as their sole compensation, will do the work, and theawctom is not intended or offered for sale (Sec. 7000, Business and Professions Code: The Character's Licnnse Law does not apply to an owner of property who builds or improves thereon, and who does such work himulfor through his own employers, provided thouuch improvements are not intended or offered for sale. IL however, the building or improvement is to within ale year of completed. me mme, builder will have tle burden of proving that he did not build or improve for purpose of sale.). K . as owner of me progeny. am exclusively contracting with licensed contractors to rucl the project (Sec. 7040. Business and Professions Code:) The Conrisc a's Li. tense Law does not apply to an owner of progeny who Wilds or improve mcrcon, and who contracts for such projects with a com a nor(s) licensed pursuant to the Contractors License Law. 0 l not esempl under Sec. B k P C for this mason of perjury mm of the fallowing declarations: W 1 has and will maintain a Certificate of Catsem to self -insure for WorkeesCompen- sauon. as provided for by Section 3700 of me Labor Codc, for the performance of the work for which this pernis is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Seemed 3700 of the labor Codc, for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number arc: Cartier: Pol icy No.: _ CERTIFICATE OF EX EM MON FROM WORKERS' COMPENSATION INSURANCE (This salon need not W completed if use permit is for one hundred dollars (S IUD) or less) 1 cenify Not in the performance of the work for which this permit is issued,( shall or employ any person in any manner an as to Wcome subjen to mC Workeri Compensation Laws of Califomia. Date Applicant NOTICE TO APPLICANT: If, after making this Cenificam of Exemption, you should become subject to the Worker's Compensation provisions of the tahnr Code. you must forthwith comply win such Provo m ,see this Icm ak shall W deemed mveked. CONSTRUCTION LENDING AGENCY 1 hereby affirm mat mere is a construction lending agency foe the performance of Re work for which his permit is issued (Sec, 3097. Civ. C.) Under s Name Lender's Address «11116I6j#, PERMR ISSUE DATE Job Description BATHROOM REMODEL R3 ri" PERMIT FINAL`® Required Inspections 1 certify that 1 have read this application and some that the above information is torten. 1 agree to comply with all city and county ordinances and sum laws rotating to Wilding eonstrvction, and hereby amhoei at mpreunmi es of this city to enter upon he above- mcntiuned Property for inspection purposes. (WC) agree to save, indemnity and keep numbers the City of Cupertino against liabilities, judgments, costs end expenses which may in any way accrue agamal said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: SOURCE REGULATIONS. o HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle haver kn s material fined by the Cupertino Municipal Codc, Chapter 9.12, and he Health and Safely . Section 25532(x)? ''//'' C] Yes RNo Will the applicant orfuture building occupant use equipment or devices which harardous air contaminants as defined by the Bay Area Air Quality Management el? ❑Yes p NU I have real hehvammancmrialsmquimmcroaraderChaapptee6.95ofhCCalifor- :a1hASafcty Code SCCVaw25Y) 5 ,25533and25530.1undcmlmtdhwifmc Wilding not curtcnty has a ¢rear, real it is my respatsihllity m nouly IW w:cuPanl ofhc imCn451'fhlLh mu51 W reel goer lu iyrNCC of ] CcrllBCaN of (Ynmanry Re -roofs Type of Roof MAR 5 2004 Date / //Al All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. of Applicant Date All roof coverings to be Class "B" or better