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08030054
CITY OF CUPERTINO n ++w777;7-77,Y BUILDING DIVISION PERMIT BUILDING ADQqRESS: PERMIT NO. 20619- SHELLY DR FOREST BUILDING 08030054 OWNER'S NAME: collstRUC11019PERMIT ISSUE DATE HO JEAN C AND GILBERT D PO BOX 183 03/11/2008 ONE: SANITARY NO. CONTROL NO. (650) 862-0742 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT 0 � PLUMB MECH D 0 30 p LICENSED CONTRACTOR'S DECLARATION Ib Description r� F 1 Mreby.M.mat 1 me licensed under provisions of ChapmOf SCrIp r 9(commencing nTj withSccdon70M)ol'Divlame3ofthaBusinesaandProfessiontCode,and myIkeet,is RMV EXT HSE EXTER SDNG, INSTL NEW EXTER WL D se in full forte end erten. 4 uaense Clea Lie.# INSTLTN&NEW SHEAR WL 9 Dau Canlraclar ARCHITECTS DECLARATION 1 uMco and my plans shall be used u public records lsvon Licensed Profc sdam.1 - hg OWNER-BUILDER DECLARATION 4 5 1 hereby alum that I em exempt from the Conuacmfa License Law for the s O D following reason.(Section 7031.5.Budncss and Professions Code:Any city or county $ which requires a permit to construct.alter improve,demolish,or repair any strunum zy prior m its issuance.aim requires the applicant forsuch permit to file a signed suumot that ha is licensed pursuant to the provision of me Contractor's Liccnse Law(Chapter 9 Sq.Ft.Floor Area Valuation €s (commencing with section 7000)of Division 3 of the Business and Professions Code)or 10000 t.3.. that be Is cement therefrom and the basis for the alleged exemption.Any violatun of Section 7@313 by arty applicants for a permit subjects me applicant to a civil Penalty of Number Occupancy Type rot mm man love hundred dollars(SSW). 3 5 9110 21 . ❑1,u owner of cele property,ar my employees with wagon u their mle compensation, and do Yom Caddo:The Canvxtneintended Liana law don rot appy y to 7044.Business of Required Inspections property who builds"impmvv thereon,and w ho dons such work himself or through his awn employ=,provided that such improvements sm not intended oroQcred forsala If. however,the building orimprowmmt is mid within one you of completion,me owner- builder will have the burden of Form,that be did sat build a improve for purpose of sale). N�Lyy I,u natter M the property,am eaciuslvely contracting with licensed conta corm m 11 rtmct the project(Sec.7004,Buehuas and Profeaslam Coda)The Caovacmts Li- _ cease law does not apply on an owner of property who builds or Improves;mermn,and who contracts for such prefects with a conuacur(s)licensed pursuant to the Contractor's Lieerrm law, ❑I sem Caere" der unB k P C for this moan se 1 - -Date ' WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following decumbent: ❑I ham and will stamens a CeNfrate of Consent to self-Insure for Wart es Cmpem Minn.u pmvided for by Section 3700 of the labor Code,for the perf rro men of me work for which this permit is issued. ❑1 have and will maintain Workers Compensadon Insurance,as required by Section 3700 of the Labor Cade,fm me performance of me wart forwhich this permit is Issued. My Workers Compensation Insurance artier and Polity,number me: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section used not 6m completed if lem permit is form hundred dolim($100) or esu) I comity that in the performance of the wart for which mis permit Is issued,l shall not employ anypermn i.........mbecame mbject t9the Workem'Compensation Laws of Califomia.D m - Applicmt 4 'r NODCE TO APPLICANT:If,after making mu CeNrrate of Exemption,you should become subject to the Worker's Compensation previsions of the labor Coda you most .J O forthwith comply with such provisions m this permit.hall W deemed revoked. 'z CONSTRUCTION LENDING AGENCY [-i iN+ I hereby aRirm mat them 4amuuucorm lending e,ne,for the verfwmanceuf C(i ti me whack for which Ws permit Is fumed(Son.3097,Co,C.) _ Q Landers Name .7. z Lenders Address U 0 1 certify rest I have mad this applicuim and suss mal the above infomsatiun is LL coned.I agree to comply with all city and county eminences and sum lawn relating to 0 building comuuction,and hcmby mtbarim repcommads,of this city m enter upon me W above-mentioned property for Inspection purposes. (We)agree to use,indemnify and keep harmless the City of Cupertino ag2WL ti y IiabilWu,judgments.core and"ponm which may in my way amen against mid City C)7 In consequence of the grmWg of this permit. r� APPLICANT UIII1DER ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date ( It W t, SOURCE IjECUf/ATI S v p Squaw afA 4oetleanummr j /f f b�p Re-roofs te U HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or futon building oceupmtstorehandle hauNaus material as dcOncd by the Cupertino Municipal Code.Chapter 9.12.and the Heeler and Safety otic.Section 25532(.)7 CYa 9t a All roofs shall be inspected prior to any roofing material being installed. WIII the applicant or future building occupant um equipment or dcvicnt which If a roof is installed without first obtaining an inspection,I agree to remove emit huwdaus air cmuminmu n dclined by the Bay Area Air Quality Management all new materials for inspection. Disuicrf ❑Peau I have mad the hunmwu materials requirements undctChapter 6.95 ofthe Califor- nia Health&SafelyCode,Sectiaas 25505.25533 and 25534.1 understood muif the Wilding - does not currently haw a mnspt.mu It is my responsibility ue notify the occupmt of me requimmemsphich be et Fiarmiaauma.faceniratearoccupsoq. .7— Signature of Applicant Date 'l � All roof coverings to be Class" 'or better Owner or authari egenC� Dau- g • CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35911021.00 DATE ISSUED. . . . . . . : 03/11/2008 RECEIPT # . . . . . . . . . : BS000004130 REFERENCE ID # . . . : 08030054 SITE ADDRESS 20619 SHELLY DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . .. . . . . . : HO JEAN C AND GILBERT D ADDRESS . . . . . . . . . . : 20619 SHELLY DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2923 RECEIVED FROM . . . . : HUNG CHEN CONTRACTOR . . . . . . . : LAM CHAN LIC # 29890 COMPANY . . . . . . . . . . : FOREST BUILDING CONSTRUCTION ADDRESS . . . . . . . . . . : PO BOX 183 CITY/STATE/ZIP . . . : RIO NIDD, CA 95471 TELEPHONE . . . . . . . . : (650) 862-0742 i FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- --------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 10, 000. 00 1.00 0. 00 1.00 0. 00 1INSPREIFE HOURS 1 . 00 122 . 00 0. 00 122 . 00 0. 00 1SIDEOTHER SQ FEET 1. 00 367 . 00 0. 00 367 . 00 0. 00 ---------- ---------- --------- ---------- TOTAL PERMIT 490 . 00 0. 00 490 . 00 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 490. 00 VISA --------------- TOTAL RECEIPT 490. 00 affl- CITY OF CUPERTINO • CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM APN# :3 .5- 9 •- / f ._ O 2 / , 00 Date: 3 / / I / O t)t7 Building Address: 2 v 6 i cJ S.1-16LL%r C,U P&P- -r//J O , C/) y.-0 / Mailing Address (if different from building address): Owner's Name: J&/A N H © Phone#: Q it O l 014AR .D CH &IJ Contractor: Phone: �A 'y CHC-1%) FORC-ST eul4!-nlNG C0/J57R0CT/0Fax: Contractor License#: Cupertino Business License #: • Contact: H U A) CT CH EN Phone: *15— �7 Fax: Residential Commercial ❑ Job Description: Peit'ioVe ey. sf,'v 40". l exce1-1101- S-ioQN .� // fJ ttTT Ihs'ltl,/' i'l �eh') eX/Itl'ripl- Wt.1/! il.St( (qi�Gl7 Building Permit Info: Bldg [7r' Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1 FR, 11FR ❑ 11, 111, V-lHR ❑ 11, 111, 1V V-N L Valuation: Square Footage: OD Project Size: Standard ❑ Large ❑ Major ❑ CITY OF CUPERTINO CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1BTEMPPER Temporary Building Permit (good for B 30 days) 1BBOILERI For the installation or relocation of ea M boiler/compressor to &including 3 horsepower, or ea absorption sys to & incl 100,000 Btu/h 29.3kw I BBOILER2 Installation/relocation of ea M boiler/compressor over 3 horsepower to & incl 15 horsepower, or ea absorption ss over 100,000 Btu/h 1 BBOILER3 Installation/relocation of ea M boiler/compressor over 15 horsepower to & incl 30 horsepower, or ea absorption sys over 500,000 Btu/h to & incl 1,000,000 Btu/h 1BBOTLER4 Installation/relocation ofea M boiler/compressor over 30 hosepower to & incl 50 horsepower, or for ea absorption sys over 1,000,000 Btu/h to &incl 1,750,000 Btu/h 1BBOILER5 Installation/relocation of ea boiler or M refrigeration compressor over 50 horsepower, or ea absorption sys over 1,750,000 Btu/h 1BAPPLOTH For ea appliance or piece of equip M regulated by this Code but not classed in other appliance categories, or for which no other fee is listed in this code. IELECINSP Other Electrical Inspections (per hour) E 1MECHINSP Other Mechanical Inspections (per M hour) 1PLMBINSP Other Plumbing& Gas Inspections P (per hour 1MEETINGIHR Application Meeting B (t CITY OF CUPERTINO • CUPEI�TINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1 GENCOM ACOUSTICAL REVIEW 1ACOUSFDW SFDWL/Duplex New B IACOUSRESAD SFDWL/Duplex-Addition/Alteration B IACOUSCOM Multi-Family/Commercial B CHIMNEY'S 1CHIMNEY Chimney B 1 CHIMNEYR Chimney Repair B FENCES 1FENCE>6FT Non-masonry, over 6 ft in height B 1FENCEMAS>6 Masonry, over 6 ft in height B FIREPLACES 1FIREPLMAS Fireplace Masonry B 1FIREPLFAB Fireplace Pre-Fabricated/Metal B 1FLAGPOL>20 Flag pole (over 20 ft in height) B 1MODUSTRU Modular Structures B FOUNDATIONS 1FOUNDREP Foundation Repair B 1PILECAST Pile Foundation Cast in place concrete B 1PILEDRIV Pile Foundation Driven(steel, pre- B stressed concrete 3 of 5 CITY OF CUPERTINO CUPEI�TINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1 GENCOM RETAINING WALL(CONCRETE OR MASONRY 1RETSTN Standard (up to 50 ft) B 1RETSP310 Special Design, 3-10' high(up to 50 `) B 1RETSPIO Special Design, over 10' high (up to B 50' 1RETCRB< Gravity/Crib Wall, 0-10'high (up to B 50 ft 1RETCRB> Gravity/Crib Wall over 10' high (up to B 50 ft SIDING 1 SIDESTBK Siding, Stone & Brick Veneer B interior/exterior 1 SIDEOTHER Siding all other B SKYLIGHTS 1 SKYL<10 SF Skylight less than 10 sf B 1 SKYL>1 OSF Skylight greater than 10 sf or B structural 1STAIRS Stairs-first flight/ea addt'1 B STORAGE RACKS 1 SRACKS<=8 Storage Racks 0-8' high (up to 100 so B 1 SRACKS>8 Storage Racks over 8' high (up to 100 B st 1STUCOAP Stucco Applications (up to 400 sf) B additional stucco application • 4of5 CITY OF CUPERTINO CUPEI�TINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1 GENCOM 1 WINREP Replacement windows/sliding glass B door ea 8 windows) 1WINMEWSTR New Window-structural shear B wall/masonry includes plan ck fee IEPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit Fee P IELCPLNCK Stand Alone Electric Pln Ck (hourly) E ilk 1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMPLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone / 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1TRAVDOC Travel &Documentation B 1BUSLIC Business License B � /tip LrtsPd� .rF¢� 5 of 5 ' 'M5 F -P-W, El 'A 7 i� M ,LA tINC R 0 Assessor's Parcel Number: 0 Nameofowner. JG1110 HO HQtJ.6R-A et-lc-li Project address. 2 o 6 0 SH &LZY DR Ca-P&RTI/Jc) , CA Contact person. HU/J 4 C ILI 15A) Phone. Fax. Net square footage of lot. 7 x ExistinR Proposed Square footage: First floor: Second floor-'----_ Garage: TOTAL: N ec there at least two 10 foot by 20 foot clear spaces inside the garage? Is privacy protection planting required for the project? On what floor(s) is work being done? F100 Brief description of work. /2CMOV� e,X �t r,i-- S7 11 It'CL/ I L;2xt,2w.'Ut, Q,41I1, 2) t 11 ct,11, Code editions: 2008 CBC !V- N)2008CFC (Y - N)2008 CMC (Y- N) 2008 CPC (Y - N)2008 NEC (Y- N) Effective 1/1/08 Plan Review Process Work Book Page-8-Revised 1/1/08 Community Development 10300 Torre Avenue ✓' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPEPTINO Building De artment JOB ADDRESS: PERMIT # -,? X11 OWNER'S NAME: 9'Q PHONE # '(-((-r -2-Z ( -!2 1 t-/ GENERAL CONTRACTOR: Z,0" Ckari -w,y AX # I 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet.Rock Tile r W-v er/Contractor Signature Date