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11110093 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 839 SEPTEMBER CT CONTRACTOR:SP HOME IMPROVEMENT PERMIT NO: 11110093 OWNER'S NAME: LAU ALLEN KA-LING AND KWONG CARISA 1030 WINDSOR ST DATE ISSUED: 11/16/2011 Os" ER'S PHONE: 4083960163 SAN JOSE,CA 95129 PHONE NO:(408)777-8918 LICENSED CONTRACTOR'S DECLARATION r r f Q o BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class ice— Li,.8 O j 1 3? 3 r r r MECH RESIDENTIAL COMMERCIAL Contractor S�4m ph&) Date I/-16 '-7.0 It I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SINGLE FAMILY DWELLING BATHROOM (commencing with Section 7000)of Division 3 of the Business&Professions REMODE(40SQFT);NON-STRUCTURAL Code and that my license is in full force and effect. 1 hereby affirm under penalty or perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued, I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$3800 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36212008.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued y Date: /(✓r Signature----� 9l+rr-r—Date ri—t 6 OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material berg installed.If a roof is 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: Business&Professions Code) 1,as owner of the property,a n exclusively contracting with licensed contractors to construct the project(Scc.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& 1 have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(x)should 1 store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,l shall Health&Safety Code,Sections 25505,25533,and 2.5.534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I Owner uthor' a agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Dater —r L—t/ forthwith comply with such provisions or this permit shall be deemed revoked. s CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affum that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the. ARCHITECT'S DECLARATION tg of this permit.Additionally,the applicant understands and will comply w,. all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9,18. Licensed Professional Signature Date • CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Elk: Lot: APN . . . . . . . . : 36212008. 00 DATE ISSUED. . . . . . . : 11/16/2011 RECEIPT #. . . . . . . . . : BS000015328 REFERENCE ID # . . . : 11110093 SITE ADDRESS . . . . . : 839 SEPTEMBER CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : LAU ALLEN KA-LING AND KWONG CA ADDRESS . . . . . . . . . . : 839 SEPTEMBER CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : SAM S PAN CONTRACTOR . . . . . . . : SAM PAN LIC # 24647 COMPANY . . . . . . . . . . : SP HOME IMPROVEMENT ADDRESS . . . . . . . . . . : 1030 WINDSOR ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95129 TELEPHONE . . . . . . . . : (408) 777-8918 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 3, 800 .00 1.00 0. 00 1.00 0. 00 1BSEISMICR VALUATION 3, 800. 00 0.50 0. 00 0.50 0 . 00 1REMRESBAT SQ FEET 40. 00 588.00 0. 00 588 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 589.50 0. 00 589.50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 589.50 VISA --------------- TOTAL RECEIPT 589.50 • CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION • 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333-buildinGflilcuoefto.orn ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/11 ❑ REVISION/DEFERRED ORIGINAL PERMIT q PROJECTADDRESS 839 5E TEM13e/� GT. AP"" - - O OWNERNAME ^�fL='�'„ L• ^j 2 CITYPHONEOF-3 6- 0/63 F-MAB, STREET ADDRESS 7 35EPTC-M(5W 67-. .STATE,ZIP / ” &RT1A)O 4AIS'014 FAX CONTACT NAME �,nIe �`, 1 Q , l PHONE^r�'l./F'-' 3_13?� yMIAIL T STREET ADDRESS /C l..( VTI�/ CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENr CONTRACTOR ❑CONTLMRAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME 5AA1 PAA/ LICENSE NUMBER 8// 393 LICENSE TYPE 4 BUS.LIC0 ✓(j0Mc COMPANYNAME` IMT ROVEME.V7 "'s V FAX r /AIG �EPN�..f�c/c G� YarJoo, coN 408- .77- 891 S STREET ADDRESS 3p 4J1A/DSDI� ,sT, CITY.srATE,nPS foSL !�{ 9S/2 PHGN�B--�OS-O2tZ ARCHFFECr/ENGINEER NAME LICENSE NUMBER BUS.LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK 7 R00,011 Rt-MDPZ-L EXISTINGUSE PROPOSED USE CONSTR.TYPE I NSTORIES USE TYPE OCC. SQ.FI'. VALUATIONS) EXISTO NEW FLOOR DEMO TOTAL AREA AREA AREA NEFAREA a r--3 _3 /W BATHROOM KITCHEN OTHER RMODELAREA 4.05F- REMODEL Ut AREA REMODEL AREA PORCH AREA I DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ATTACH N DWELLING UNITS: IS A SECOND UNIT UyEs SECONDSTORY OYU BEINGADDED? C]NO ADDITION? []NO PRE-APPLICATON ❑VES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVF.DBY: /� TOTALVALUATION: PLANNINGAPPLN []NO PLANNING APPROVAL LEITER EICHLER HOME? [3 NO •�J OO By my signature below,l certify in each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information 1 have provided is correct. 1 have read the Description of Work and verify it is accurate. I agree 10 comply with all applicable local ordinances and state laws relating to buildi construction. 1 authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of ApplicanttAgent: Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for L9�VPR-TIIF.COUNTER Ur-- PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a Completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS Tom if any Hazardous Materials Bre being used as part of this project. ❑ LARGE ❑ FIRE DEPT _Copy Of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_201 Ldoe revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION • ADDRESS: 839 september ct. DATE: 11/16/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$3,800 "PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: PERMIT TYPE: WORK bathroom remodel non structural. SCOPE 1/r/r. Plus Check Plumb. Wan Chec* Eet. plan 4h rck Mech. Permit Pae: Plumb. Permit Fbtr h3ec. Permit l:rc Otlw"Ateell.btap. Orher Numb,Insp. Other Ehcr. lnsp. Li tNad,.Iny. Fee: 111wnb. lnq"f'eer Me,.Imp, Fee: NOTE:This estimate does not Include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District etc. . These fees are based on the prelindina In ormatlon available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution /I-053 Eff 7/Z/W FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 40 s.f. Remodel,Bath(<=300 sf) Suppl. PC Fee: (F) Reg. 0 OTT0.0 hrs $0.00 $588.00 IRBMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. 0 OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tox Aelminisiroti1v Fee Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning;Fee: $0.00 Select a Non-Residential 0 9'rr vc(D,xaonenintion Fres: Building or Structure 0 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item kBIld .Stds Commission Fee: IBCBSC $1.00 "SUBTOTALS: $1.501 $588.001 TOTAL FEE: $589.50 Revised: 10/01/2011 � (D \ \ 2 j > / \ j \ � � ■� � �� � � / R \ k7 . } $ & % © rZ ? 2 \ / } } f \ § _ , 2 » § \ « , ■ . & K* s E 8 } a « � § $I ) G ®$ ,% ® %, ) E a 7 \_ \\} %/ i � k k �� 5 Sao2 N \ 5 . o » \ k � # I ® Al i c > f § § {}\ $ yaa \ } pa. , ! ƒi }f\\ 22 \ \ ¥ ) 7 ) kie « \ 1109 . Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 «U P E RTI N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: e39 T E/t L?.W 7iN0 PERMIT# OWNER'S NAME: A{[ PHONE# - -2--2-2— GENERAL '2-LGENERAL CONTRACTOR: lFf RoV BUSINESS LICENSE# 921013 ADDRESS: !D D WIN Sofit 57, 3'+11.) JoX e fS CITY/ZIPCODE: *Our municipal code requires all businesses working in the city have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE. GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: ✓ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum / Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date