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04080072 (3) CITY OF CUPERTINO 'v' r "SuYav&E£ �, BUILDING DIVISION p;CR CONTRACTOR�INE01 MA N:,4 � BUILDING ADDRESS: PERMIT NO.04080072 OWNER'S NAME: PERMIT MUE DATE RAIAAqTTP 'AMA A 11 PIIONE: SANITARY N ONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH +�+Oo LICENSED CONTRACTOR'S DECLARATION Job Description U C 1 hereby affirm that I am licensed under provisions or Chapter 9(commencing p zto withis e<L 7000)uf Divi' Baf0m Dus rTMP frssion Cfjode.andonylicensis 'aac mm anacrrcn. . l' ' NEW FRONT DOOR & SHED ROOF TO COVER W/6X6 SLAB Dam Crnvacmr CONTRACTOR: SPIEKERMAN CONSTRUCTION �/ CHITECTS DE A 1 4r4< 1undcomnd yplansshallheusda�u fc seats yU 3 0 Licensed Professional OWNER-BUILDERfora me C I hereby.('Gere that 1 1. eaempt from the Crnlrnenla :License Law for the . _o o which following mason.peorn(Secit 1.Co str5.Businessand!Psfeazinns Code:repair any nImmu county e tint which its smaapermit spumes the applicant improve, Perlia ore pair anYtoucans �'nthatheor incensed prsualso nttothe thrviciocant far mchpccmiuOicense aw(Chned mmcm thatmis ecingitPSecon uothc of Dixions of NC Con miner'sndPmctaw(C ode)or Sq.Ft. Floor Area Valuat�11079 �5 (cat he I,(Commencing Smcfmin add the Divla;nn 3 of the al eged cissmna m.Any Code)or c�_ that he is eaempt therefrom and Ne baso Tot to alleged exemption.Any violation of ���aaa ;;; Section 703 L.5 by any applicant fora permit subjects the applicant to a civil penalty of APN Number y — OCCu ane Type not mom Naznean five hundred dollars(S500). `R yp ❑I, owrarthe pmpmy,tar my employees with wag.sstoursom lecopenerion, 37518001 , 00 will do the work and to swmum is not intended or offered for sale(Sec.7094,Business and Pocesiona Code:The Commencer License Law does not apply to an owner of Required Inspections property,who builds or lmpsoves thereon,and who daessuch work himulfor through his - own employccs,provided district improvements arc not im ended oroRered forsire.If, UU4 however.the building or improvement is sold within one year of completion.the owner- L Z Wilder will ban the burden of proving that he did not mild Or improve for purpose of /� Ty�g�s�/�@y sale.). Ltll'9Iffi�'/M(y p® a� Is I,as Owner of the property,ed exclusively contracting with licensed contractors to �{q 1ry1� consumer La co project(Sepply.to an Business and Proproperty who builds Code:)The Cantremor's Li. Mil Y y�Vp®! Cease law does not apply Iran owner ofommerciny who bullas or improves centra,and who contracts for sato projects with a convanarts)licensed pursuant to tis contractors Li cru Law. I am eaempt under Sec. ,B&P C for this reason Owrc Dam WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty or perjury one of the following declarations: ❑1 have and will maintain a Ccmfieum of Consent to self-imus for Worker'sCumpen- .ndan.az pmvidcd for by Section]]00 of the labor Code,for to performance of the work for which this permit is issued. E]1 have and will maintain Worker's Compensation insunn¢,az required by Section g]BO of the labor Code,for om pnformanee or to work for which this permit is issued. My Worker's Compensation Insurance Cartier and Policy number are: Canner: Policy No,: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Ibis It.need not he completed if(be Permit is fortune hundred di lars(5300) or Icss) I certify tm in ti p bnmmnec of the work for which this permit is Iona,1 shall not employ any pc any manners azmbceomc subjceu Work uaLo t�a ion Laws of Cal ice.Dam F' Ap (lean N TICELI ANY:IE a r maks u�ntfsam of Excmpuon, should bee eubjca to the Workcri Compcn tion previsions of the lane,Cod yyou ou must Q z foMwith comply with such provisions or this permit shall be deemed mvoked. zO CONSTRUCTION LENDING AGENCY (--� I hereby affirm that there is a Construction lending agency or the Performance Lir �i the work for which this pemtit is issued(Sec.3097.Civ.C.) U Q Icndcls Name D z Lender's Addrras IL Q I certify that 1 have sac this city and Coon and sure that the above information is 0 t"' building agree to comply add with all nth and county ordinances adiverOf dna sum laws slating e QU buildingrtioncctlaq and forinytoPrcprcumatirmortis c;ry to cnmrupnn the ahavLiderj dgin pourcry for inspection erea which m. H G (We)agree to save,indemnify and keep harmless the City of Cupertino against N in of cons, costsandupcmmmit. may in anyway accrue againstsaidCity / Q inconsequence of UNDERSTANDS granting of this permit. APPLICAN'B UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale SOURC GULATIL D /C Re-roofs aro of ApplicantrUnin for roc 0, �, m HAZARDOUS MATE AIS DISCLOSURE Type of Roof Will the applicant or future buildin occupant store or handle haardous material az defined by the Cupertino Municipal Code Chapmr 9.13.and the Health and Safety code.Section 2ss)2(a)?, All roofs shall be inspected prior to an roofing material being❑Yea 4�Na p p y g g installed. 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 Cold hanomus air contaminants az defined by the Bay Area Air Quality Management District? all new materials for inspection. ❑yet 1 have sac the haaMnuz mamrials rcyuismenu under ChaPmr 695 of tc Califory nimHcalc&SafnyCodc.Scctiansurroo25531 anJ2mm undcmmnd.95 Ih C.Ffag dos n t curtntly hasp¢ora Na 'I' responsi hi ity m muly the occupant of the reyu'c�nrenu wnich t e m;ssnancez rtifi.m Or Occupancy. Signature of Applicant Date i0voor Or authonimd.Jr., ere All roof coverings to be Class "B"or better I r . CITY OF CUPERTINO Item 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp : Rng: S,ub: Blk: Lot : APN . . . . . . . . : 37518001 . 00 DATE ISSUED. . . . . . . : 08/10/2004 RECEIPT 4 . . . . . . . . . : 26617 REFERENCE ID # . . . : 04080072 SITE ADDRESS . . . . . : 18725 TILSON AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : IMPACT AREA . . . . . . OWNER PAUL KAO & PADMINI BAHASUBRAMA ADDRESS 18725 TILSON AVE CITY/STATE/ZIP . . . . , RECEIVED FROM . . . . : RONALD SPIEKERMAN CONTRACTOR . . . . . . . : LIC # COMPANY ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , OTELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - - - ------- ------ ------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 1 , 079 . 00 83 . 16 0 . 00 83 . 16 0 . 00 BPLANCHK PERMIT FEE 83 . 16 110 . 98 0 . 00 110 . 98 0 . 00 BENERGY PERMIT FEE 83 . 16 39 . 92 0 . 00 39 . 92 0 . 00 BREMPOWER POWER UNITS 1 . 00 47 . 96 0 . 00 47 . 96 0 . 00 EPERMITFEE FLAT RATE 1 . 00 38 . 37 0 . 00 38 . 37 0 . 00 BREMRECEPT NO. OUTLETS 1 . 00 1 . 20 0 . 00 1 . 20 0 . 00 BSEISMICRE VALUATION 1, 079 . 00 0 . 50 0 . 00 0 . 50 0 . 00 BUSLIC FLAT RATE 1 . 00 100 . 00 0 . 00 100 . 00 0 . 00 -- -------- ---------- --- -----'-- TOTAL PERMIT ---------- 422 . 09 0 . 00 422 . 09 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 422 . 09 2535 TOTAL RECEIPT 422 . 09 • (Q- •TY OF CUPERTINO CITYO A U d CUPEI�TINO PERMIT APPLICATION FORM o c� 72 APN# L4 17,7- /e Building Address: t Mailing Address (if different from building address): Owner's Name: {�a K ,n Phone #: Contractor^ � -� � License #: C {/� t {V•tww-- Contac Phone: Cupertino Business License#: �o � Fax: Building Permit Info: z Bldg ❑ Elect ❑ (Plumb nn❑ Mech ❑ Job Descriptio �k7a f w �p c„� UpC v t 5 n IC�� t ? C.C,�,C, P i� l,V zkl Residential Commercial ❑ Sq.Ft. Floor Area: / C U $/Sq.Ft.: Cost of Project: o Occupancy Ur p: o Type of Construction: p Please check t box if t roject is a • / second-storyaddition: Project Size: .Standard ❑ Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> I OOK to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1 M Btu MECHANICAL BBOILER4 Boiler> IM 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 BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V <= IOOOA ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING Z66 ` 7 1 of 3 L 6 7 tTY OF CUPERTINO CITY OF PERMIT APPLICATION FORM CUPEkTINO . Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING 13RESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg 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 rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING • BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain & Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 clip MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT _ Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREN MISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl, Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heatin MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2of3 r CITY OF CUPERTINI CITY OF PERMIT APPLICATION FORM CUPERTINO Quantity Fee ID Fee Description Fee Group , BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel 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 Special Inspection 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 Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING • 3of3 CCG - F Y° RESIDENTIAL PROJECT COVER SHEET <v � eZ`•L xa;.fr � .irs' kip x^�a✓ ;' - -- _x,♦ s .. CUPE TY ':aa * '3 '; v ~ - Assessor's Parcel Number: i crj- 2 ��1 1`y�` Paul Kao e PcAt'�tiie�isub - QICx.Ji1\ I �/Ccf` Name of owner. ti Ijaf tl" II�InIL, W)UL / WU u �6 — -7 /r � � Project address. i / ���� I 0(� C&to c?d-k,� r1 C2, 11 Conta�p ^ Phone �l ��'•5 7� Fax. -Net square footage of lot. Existing o•.• j� Square footage: First floor: ���®®®®RRRd��� �- : wY"IC�e Second floor: AUG flf Garage: /+ p�Itl — TOTAL: CITY OF `iy • � Are there at least two 10 foot by 20 foot clear spaces insidelARPge age. "WENT 1 Is privacy protection planting required for the project? Y N �6t ,' a On what floor(s) is work being done? S i Brief descriptio of work. irOU.�J �/1,Y)V` �/t 11n�U �� � ��� 66 Code editions: 2001 CBC (Y - N)2001 CFC (Y - N)2001 CMC (Y-N) 2001 CPC (Y -N)2001 NEC (Y - N) Effective 11/1/02 APPROVED IN ACCORDANCE WIT THE CITY COURTINn JDES ,JD ar '„ CES DATE sic 1, _ T"s sn} plans and specifications MUS7 ept on the job at all times and it is un lawful to make any changes or alteratiorrs • nn same without written permis:'ion from the building Dept., City of Cupertino. . The stamping of this plan and specifications SHALL NOT be held to permit or to be ar, approval of the violation of any proviswns ,r ,,,,,, r;h, nrdmanM nr \rata taw Plan Review Process Work Book Page-8-Revised 4/28/04 �. ((p, IFR SSED'PEAN,CHECK ITEMS �q� TO RESIDENTIAL PROJECTS CITY OF CUPEkTINO w . The foil litl s e -on the-plan set. Planning: 1. Fully dimensioned site plan. 2. Fully dim, sioned fl or plan and ele ations oentire' ouse':'(Not just=area of w rk). /( 3. Scale of all drawings indicated on the plans. 4. Assessors parcel number. 5. Privacy protection_measures (landscaping an ali r ance. Structural: AUG 10 2004 CITY OF 1. Note/or detail shower lath paper requirementcknTQ, M IVT 2. Show all header sizes and supports. (UBC CH. 23) 3. Show location of all hold downs and anchors. Note on plan all hold-downs to be installed prior to foundation inspection. 4. CF-IR and MF-IR forms must be incorporated onto plan sheets. 5. Show all post beam connectors. All beams ,etc. must have positive connections. (UBC CH. 23) i l�6. Note that glue laminated beams must be certified prior to frame inspection. /('1/ ,47.k47. Read soils report and/or soil letter. Record Soil Engineers finding/recommendations onto / plans. 8. Show note that pad height and set-back letter to be delivered to City prior to foundation inspection. Ey tS��—�_-onfirm with note or detail, egress/ingress window requirements from bedrooms. (UBC • CH. 3) �X Sbo 18" by 24" under floor access, and 22" x 30" ceiling access. (UBC CH. 23, CH. 15) Plan Review Process Work Book Page -9-Revised 4/28/04 , I 1 1 I f I I ------------ I SPARK Ati I I I I REQUIRED I I I E C , . a 1 I 1 U i f 1 Vi E Dl,,,' = AUG 10 20x4 i CITE OF CUPERTINO I = S ; 1. 31 .1 4 I i I I ' d Y G IIIbUy nv , 13 i Ana p I - «SPARK RESTE��REUIRED KtC E AU C Ty pp .. WENT- 31 gs ici►�inir ' � S 1 - I o� tC 9 I j, I_ ! _ i j' 1 i i i l � 1r _ It L RKARRESTER NRRESTER REQUIRED - TEL AUG I o 20S IL ---Ir---CITY.-OF CWERTIN�/ monima-pr F F 7 p n bp wo -f-7- - I C ' LL ' - coi L . L--- T oil I_ Aft RESTER REQUIRED I I t I -4- 1- IAN I AUG 10 2^301 . I COFU i i11ACP 4 rs RTM'F T l : I , , l a �.. LL 1 Y rr i I I If r- "f I •• li , , I I I I i 1 I I I - - - - AUG1 202 C RTINO , I t1116i. . , _ ..: MENT 0 I ' I I I I I I I I car i I I •s L _ � I I I , I � 1 I � � I .I FF �►' '-- --SP ESTER �EUIRED y , I