12010149CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10184 VISTA DR I IMPROVEMENTCONTRACTOR: BROTHERS HOME PERMIT NO: 12010149 I
OWNER'S NAME: CHEN CHING-YUAN AND CHU CHING YUE 12510 DOUGLAS BLVD DATE ISSUED: 01/2 /2012
OWNEI;'S PHONE: 4084463009 I ROSEVILLE, CA 95661 I PHONE NO: (408)295-0680 1
LICENSED CONTRACTOR'S [DECLARATION
License Class Lie. # (�(�
Contractor ° — Date�-
I hereby affirm that I am licensed under the provisionJ Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm tinder penalty of 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 tine
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source r ulat' is per tl€e Cupertino Municipal Code, Section
9.18.
Signature Date `
❑ OWNER -BUILDER (DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
will do (lie work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
1, as owner of the property, an€ exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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
perfonnance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws ofCalifomia. If, after making this certificate ofexemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
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
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep hamiless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
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.
r—— -
BUILDING PERMIT INFO: BLDG ELECT IPLUMB �
MECH'._ RESIDENTIAL COMMERCIAL'
JOB DESCRIPTION: SINGLE FAMILY DWELLING TWO-STORY;
FOUR(4)WINDOWS
AND ONE(I)PATIO DOOR REPLACEMENT; NON-STRUCTURAL
Sq. Ft Floor Area: I Valuation: $836
APN Number: 31624042.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: ---Date:—
rZ
RE -ROOFS:
All roofs shall be inspected prior to any rooting material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 695 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should 1 store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety bodeQ/etions 25505, 25533, and 25534.
Owner o nth gd agent:
... _ Date:---�y�%L.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Date I Licensed Professional
CITY OF CUPERTINO
fivs�iw_fflj FFF F!;%'TIMATOR - BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, tire, sanitary Sewer vistrict, acnooi
Irl. L -11 .—H"hia "Nd are iink an octimato- Cantart the Dent for addn't info.
r-- ----- -----
FEE ITEMS -7
i I (1115 31 i'll
ADDRESS: 10184 vista dr.
DATE: 01/25/2012
REVIEWED BY: bobs.
APN:
I BP#:
VALUATION: 1$836
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Dulex
USE:
PENTAMATION IGENRES
PERMIT TYPE: A
WORK
sfd 2 story 4 window and 1 patio door replacement non structural.
SCOPE
PME Plan Check:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, tire, sanitary Sewer vistrict, acnooi
Irl. L -11 .—H"hia "Nd are iink an octimato- Cantart the Dent for addn't info.
r-- ----- -----
FEE ITEMS -7
i I (1115 31 i'll
FEE
QTY/FEE-
MISC ITEMS
Platt Check Fee:
$0.00
= #
$392.001
Window Sliding Glass Door
IWINREP Replacement
J
Suppl. PC Fee: Q Reg.
$0.001
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -0 Reg.
0 OT
ED
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
E)
Work Without Pert -nit? 0 Yes (j) No
$0.00
Olanning 1-_,ccl�
$0.00
Select a Non -Residential
Building or Structure
0
stroMotion _F'ee
IBSEISAIICR
$0.50
Select an Administrative Item
U IBCBSC
fs Con-m-fl,"'sion F -e"_
$1.00
SUBTOTALS:
$1.50
$392.00
TO,
1 TAL FEE:
$393.501
Revised: 1/19/2012
40
CV
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: to wq (
PERMIT #
OWNER'S NAME: bt
PHONE # "' JOQ 3
GENERAL CONTRACTOR: { M
BUSINESS LICENSE #
ADDRESS: r
CITY/ZIPCODE: o
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECT N(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCON CTO HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
X atur Date
Please check applicable subcontractors and complete the following information:
� Z
Owner / Contyalctor Signature Date
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
� Z
Owner / Contyalctor Signature Date
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building3cupertino.org
aCA C-)) � 9
❑ NFW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/T1 ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS<
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APN # I),q
1
OWNER NAME r
'Max)
E-MAIL
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STREET ADDRESS_
CITY. �CATE. ZIP
FAX
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CONTACT NAMEPHO
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E-MAIL
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STREET ADDRESS
CITY, STATE, ZIP
_SJ1%C CA
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
NTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
C
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COMPANY NAS
E-MAIL
FAX
STREET ADDRESS
Igg &CITAOI,� VC
CITY, STATE, ZIP
-son
PHO
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAM
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
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L
Gi Q%1 C► t i
EXISTING USE
PROPOSED USE CONSTIL
TYPE
TORIES
7
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
AREA
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTALlk
NET AREA
/1�
^
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA DETACH
F]ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ❑NO
ADDITION? []NO
YES IF YES, PROVIDE COPY OF
PRE -APPLICATION []YES
IS THE BLDG AN 0 YES
RECEIVED BY: ^
TOTALV �UATION:
PLANNING APPL # NO PLANNING APPROVAL LETTER
EICHLER HOME? NO
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the prrperty owner's behalf. I have read this
application and the information I have provided ' ct. I have the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildi nstructigtvl-afi orize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: ) ��
SUPPLEMENTAL INFORMATION REQU1RED
PLAN CHECK TYPE
ROUTING SLIP
_ New SFD or Multifamily dwellings: Apply for demolition permit for
(1—oV--ER- THE-covNTER
BUMDING 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
❑ PuBLIcwoRKs
form if any Hazardous Materials are being used as part of this project.
❑ r.euGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp 2011.doc revised 06/21/11