04080062 (3) CITY OF CUPERTINO ; "' ' '>s '
6UILDING DIVISION PER y C NIRA STORM
BUILDING ADDRESS: PAUL POON PERMIT No.04080062
21074 TAHINA r' _ PERMIT ISSUE DATE
W NER'S NAME:
PAUL POON
ONE: SANITARY NO. CONTROL NO.
ARCHITEC rENGINEER: BUILDING PERMfi INFO
BLDG ELECT PLUMB MECH
0 0 0 0
=oo
LICENSED CONTRACEIR'SDECLARATION Job Description
w I hereby affirm Thal l am licensed under provisions of Chapter 9(commencing
z� with Section 700(hofDivision3 nfmc Business and Pmfcssinnx Code.and my license is
a a in lull force and effect.
�h REVISION--RAISE UP FLOOR
j�ds Dunton C1ua co#
_�� Dam cSDECL NO NEW PERMIT ISSUED/ ORIG. #03070130
ARCHITECTS DECLARATION
I understand my plans shall W used as public raorJs
7yU
Licensed Professional A
` 3 OWNER-BUILDERDECLARATIONCe Cmdo DN
1 hmhy affirm shot 11.1. exempt'rum sW essita,Co Liceme Law for the \
p o following mason.(Scctiun]031.5.Business and ve de io demolish,
Cods:Any tiny Jr county
id m which requims a pertnis w cnnsvucr,alma improve demolish,err repair any snmerurt
ut—w
our to its issmnce.alsu oN.un meapplicamforsuch permitw life a sigmUstammcnl
2�a that he is licensed forward In the promem of the Conuactori License law(Chapter Sq.Ft. Floor AT /A ValUatl9$115
a,FC (commencing with Section 71100)of Division 3 of the Business amt Pmlesaions Code)or �V h' .
i Nat he is exempt thcmfrom and the basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Notify of APN Number Occupancy Type
not mom man five hundred dollars(1500).
❑l,uowncraf the progeny,or my cmploycuwith wagesu dein sole campcn-don, 32608027 . 00
willdo Use work and thcswaurt is our intended oroffercd forsale(sec.70sq Business Required Inspections
and Professionntr
Code:The Coeaofersm s Liclaw docs not apply m an owner of 9 P
property who builds or improves thereon,and whodoes such work himseRor through his
own employees provided that such improvements are nor intended or offered for safe.If,
however,the building or improvement is sold within one you of completion,the owner
rudder will have the burden of proving that he did not build or improve for purpose of
salt.).
❑h as owner of the progeny,am exclusively convicting with licensed cantmcmrs to
consumer the project(Sec.7044.Basinea and Prufnsimm Code:)The Convacter's Li
dead,Law does not apply m an owner of property who Wilds or improsca demon.and
tw�ho contracts far auch projecu;with a contractors)licensed pursuant m the Cemomerm's
Q lamexempt antler w/ Bk P C for this mann
Q 7
let � 'LLT Dam
WO RS COMPEM-A-rION DECLARATIO
I hereby affirm under penalty of Perjury one of the following declarations:
0 1 ban and will msncen a CerliBcae of Comenuo Self-insure for Worker's Common-
-tion,u provided for by Section 37W of the Iadar Code,for the per(ormamv of me
work for which this permit is issued. .
0 1 have and will maintain Warkcra Competi-tion Inurancc,as acquired by Section
3700 of the labor Code,for the performance of em work for which this renin u issued.
My Workei s Compensation Insurance camicr and Policy number art:
Cartier. Policy,NO.:
CERTIFICATE OF EXEMPTION FROM WORKERS' '
COMPENSATION INSURANCE
(Thisexction need not W cpmptced gibe permit is fortam hundred dollars($1IX9)
less.)
1 unify that in the performance of the work for which this Permit is isswd,"a'
not
employ any person in any yyWerso ss nebeCgmc subject WWtetCompemadon
Laws of Califomim.Vm!�'
Applicant l' '/i ••
NOTICE TO APPLICANT'V.after making this Cc ate of Exemption,you should
ticturat subjccs to to Walker's Compensation provisions of the Labor Code,you must
,Jz rrrthWt omply with such provisions or this Permit shall W deemed mvoked.
zO CONSTRUCTION LENDING AGENCY
[-. 1 hereby affirm Nal there is a construction lending agency for one Performance of
!Yi > the work for which this permit is issued(Sec.3097.Civ.C.)
Uride,'s
Nene
Un
der s Address
U Q I ecrufy that 1 have reed this applicalmn and sate Nn the W w information is
Iy P cornet 1 agree m comply with all city and county ordination and sum laws relating to
0U building construction.and hereby authorize mpiesenarivm of this city m enter upon the
UQ
Qabove-mentioned progeny for inspection purpma
e
CL (We)agree to saw.indemnify and keep harmless the City of Cupertino against /1 7
F' rn liabilities.judgments,costs and expenses which may in any way accord against said City C
U in consequence of the granting of this permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REG AnQblSO A J
Re-roofs
Signa. ed'Applicrodc.7torem,
HAZARDOUS MATERIALS occup DISCLOSURE ou Type of Roof
Will the eCu,partnr future buildingoccupant steno.handle Health and
az defined by me Cupertino Municipal Code.Chapter 9.11,and she Health and Safely
Code,Section 25532m)? All roofs shall be inspected prior to any roofing material being installed.
Ym 'dNu
Will mea applicant o,future building ant nae equipment err devices which If a roof is installed without first obtaining an inspection,I agree to remove
pct g«cup
emir haxasdnus air contaminants as JchncJ by the Bay Arca Air Quality Management all new materials for inspection.
Disvict? s(
❑Yes yL No
I have read the h trardtmsmaerials rtquimmcnra under Chapmr 695 of the Califon
ria Healthh&Safcly Codc,Socuom 25505.25533 am125534.1 undersand thmirmc Wilding
docs otcmrrAtly haw )¢nQnu that it is my msPmmibitiry to notify rW document Of the
mglf cnai hichmu r orwi-uancedra CcrtihcauOdf Clc ao y. Signature Of Applicant Date
Owvmrauthnri..cdaFent ' DafT All roof coverings to be Class"B"or better
CITY OF CUPERTINO
lem 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 3
Sec : Twp : Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32608027 . 00
DATE ISSUED. . . . . . . : 08/09/2004
RECEIPT 4 . . . . . . . . . : 26594
REFERENCE ID # . . . : 04080062
SITE ADDRESS . . . . . : 21074 LAVINA CT.
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER PAUL POON
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : PAUL POON
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : PAUL POON
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------ - - -- ------------- ---------- ---------- -- -------- - --- - ---------
BPLANCKREP HOURS 4 . 00 348 . 56 0 . 00 348 . 56 0 . 00
---------- --- --- - ------ -- --------
TOTAL PERMIT 348 . 56 0 . 00 348 . 56 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- ---------------- ---------- -- -- ------- ---------
OTHER 348 . 56 AMEX
TOTAL RECEIPT 348 . 56
e
• s
Date: Au ..9, 04 �
To: Mr. Massoud Modjtehedf, [� I
From: Paul Poon VD�`�'�
FW iT � 0 3 01� 0r3o
Subject: Raising up the family room to about 6".
AUG o 9 24-14
Dear Mr. Masofthi Mtter is edi, GA l Tlll�""'
The objective of this letter is to submit the floor planEVONO
11
my old garage to family room floor by 6" for your CVA;h �r
T&P pipe from the water heater can go out of the building under the floor.
The subfloor size is 422 sq. foot. The existing floor in my house is all
concrete slab. Floor joists 2X6 pressured treated woods are used spacing at
16 inch on center. Sleepers are used to raise the 2x6 to level with the family
room. Because of the slab floor around the south and east side of the garage
and the concrete foundation wall on the west side, cross air ventilation
cannot be available. All woods sitting on the ground are pressure treated.
Some non pressure treated wood is used for shimming and spacing which do
not touch the slab floor. All 2X6 pressure treated wood attached to the
concrete is secured with red head concrete anchors bolts (1/2" X 41/4")
• every 2 feet at the ledgers.
3/C" CD T & G prime wood will be used for sub-floor material. R19 thermal
insulation will be installed between the floor joists.
A summary of all the materials used is listed in the appendix page.
The floor plan with the details drawing in the appendix page will provide
you with the information how the floor is built. I wish that I had provided
you with enough information for your evaluation. Please el ow should
your have any questions.
I can be reached at 408 255-4013.
,;Sincerely,
V00 006
• 0k Paul Poon
O�tio(v b�
3a
Summary of material used: RECEIVED ,
Bolts size: Red head concrete anchor ''/z" X 4 'A"
Spacing: 2 ft at the ledger AUG 0 9 2004
Embedment: 2 '/2" into the concrete. CITY OF CUPWINO
Connection spacer: 2X6 R11 tntmr v)FPAMMENT
Connection joist: LUS26 for 2x6 P.T.
LUS46 for 4X6 P.T.
Joist spacing: 16" O.C. „
Type of material of all wood:
2X6 or 2x4 P.T. wood for all floor joists, ledger, sleepers
Non PT wood used for non ground contact such as shimming on floor
joists or spacing between two 2x6.
Subfloor wood material: '/4" CD T & G.
Blocking: Every 32"
Attachment: two 16D nails are used for attachment on each side. S e �>
Total subfloor area: 422 Sq Ft.
Type of subfloor size/connection:
</= 9 ft per connection with LUS 26
insulation type: R19
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