12030165 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21837 LOMITA AVE CONTRACTOR:ELITE I TOME PERMIT NO: 12030165
DEVELOPMENT
OWNER'S NAME: JERRY LIU 2787 MOORPARK AVE DATE ISSUED:03/30/2012
OWNER'S PHONE: 6508571501 SAN JOSE.CA 95128 PHONE NO:(408)848-8370
❑ LICENSED CONTRACTOR'S DECLARATION JOBDESCRIPTION: RESIDENTIALU COMMERCIAL
LJ
License Classy 2— Lic,q �� �? CONSTRUCT 7 FT FENCE
Contractor ��C /1 Left Yir-- Date 03 X30—/Z
1 hereby affirm that I a licensed under the provisions of Chapter
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
1 hereby alarm under 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 the
performance of the work for whichthis permit is issued. Sq.F1 Floor Area: Valualion:$1000
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for die performance of the work for which this
APN Number:35716063 21837 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and slate laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned properly for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against l iabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ��f)r�
granting of this permit, Additionally,the applicant understands and will comply Issued by: Z41::i.zJ Date: 3. 30 -lo-L
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
/ RI:ROOFS:
Signature Date 0All roofs shall be inspected prior to any roofing material berg installed.If a roof is
installed withma first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BIIILDF,R DECLARATION
I hereby affirm that 1 em exempt from the Contractor's License Law for one of Signature of Applicant: Dale:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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,
Business&Professions Code)
I,as owner of the property,not exclusively contracting with licensed contactors to ILA7.ARDOUS MATERIAL S DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Ilealth&Safety Code,Sections 25505,25533,and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Ilealth&Safety Code,Section 25532(x)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area.Air Quality Management District
performance of the work for which this permit is issued- will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Dale: 03—30—
permit is issued. �
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person many manner so as to become subject to the Worker's
Compensation lases of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is
cored.1 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, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEI�TINO
Building Department
JOB ADDRESS: AvC PERMIT #
2/ 3 4ht
OWNER'S NAME: ¢ U PHONE #
GENERAL CONTRACTOR: FAX#
I am not using any subcontractors: Llre-0 414
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
Owner/Contractor Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 21837 Lominita Ave DATE: 03/30/2012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: $1,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: PERMIT TYPE: Al
WORK Construct 7 ft tall fence 170 ft Ion
SCOPE
Udelr. P/..i C'hrck !'lrrrnh. Ph...(31oe6 1--lec. Plan(Jwck
Il."h, l',noir I2-.•: Nwnh. Permit 1 hl.:r_1'..nnir h�,e:
t Ilher,I/rrh. /rnp. (hoer flunk 1n,ep. Urher lilcr. /arp.
El
.Ildclr. Ate/,. l'rr: l'hwrh. 6t,p. 19c lilrr, lnep. l4',::
NOTE: This estimate does not include fees due to other Departments(ie. Planning, Public Works, Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS Lhee Resolution 11-053 Eff 711111) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 170 1.f. Fence
Suppl. PC Fee: (F) Reg. O OT FO.0 Vhrs $0.00 $457.00 IFENCE>6FT I Fence,Non-Masonry>6
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Feele Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
("r,if,ro if,iion T,n.
,idnvini.,vr,nh c( l4u': Q
Work Without Permit? O Yes (j) No $0.00 0
Advanced Plannine Fee: $0.00 Select allon-Residential
/)ncunt,ununr,n he('e" Building or Structure Q
Stro ,6 Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.50 $457.00 TOTAL FEE: $458.50
Revised: 1/19/2012
U ANW
PROPOSED NEW FENCE AT 6-FOOT HIGH WITH 1-FOOT LATTICE ON TOP
g2EC EI VES 21837 Lomita Ave, Cuppertino CA
MAR 3 0 2012
By:1. Scope of Work: Remove old rotten 6-foot fence and install 170 feet of NEW 6-foot high
redwwith 1-foot lattice top (per 2010 CRC Code). _
2. Person who Draw: Lucas Nguyen—General Contractor . 2T&3 vloovrgik Sc✓� �
3. Dated: March 27, 2012 CA t-'c e llc`# t�-
SITE ALAN (sheet 1 of 3)
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COMMU DEVELOPMENT DEPARTMENT
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BUInLOIG DIVISION-CUPERTINO
P0 F��CE COPY APPROVED
This set of plan end specifications MUST be kept at thB
y [ rjob site during onstructio . It iq unlawful to make any
�1 o a eraaons j0 saDie,or to deviate
therefrom,witl out approval from the Building Official.
The stamping o. his plan and specifications SHALL NOT
be held to I it or to be an approval of the violation
of any provisions of any City Ordinance or State Law.
BY Y, ✓ELl/✓ LIST
DATE '/S2 `
PERMIT NO. 1ao3O��J -
-� L 2-U�'�i o v► � 'a�'l C S �-e�l 2 � -� '.��
21837 Lomita
East Fence Sketch
1 ft triple weave lattice A7.ft 4x4 PT posts
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a
1 ft x 6 ft redwood planks 1 ft deep concrete Surface Line
PROPOSED NEW FENCE AT 6=F00T HIGH WITH 1-FOOT LATTICE ON TOP
21837 Lomita Ave, Cuppertino CA
1. Scope of Work: Remove old rotten 6-foot fence and install 170 feet of NEW 6-foot high
redwood,fence with 1-foot lattice top(per 2010 CRC Code).
2. Person who Draw: Lucas Nguyen General Contractor
3. Dated: March 27, 2012
DETAIL§PLAN (sheet 3 of 3)
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CONSTRUCTION'PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333• buildino(dcuoerlino.Ora /a)—O36
❑NEW CONSMUCIION - ❑ ADDITION TERATION/Tr ❑ REVISION/DE-U= ORIGINAL FERWr p
FROJECr ADDRESS die 7 Low w Ar- APNR 35-1 l co (.03 .0-0
OWNPRNAME - — f7 / PROt+E 6.0 - �s] s' E-MAIL
STRWr ADDRESS 2/gK3 L��/ A-✓E CRY. STATESFAX
A�0
ZJEY �E S-MAIL
�'�`N,�m LU lYu G!fEffo.•s� DS• g3 -g5`
STREETADDRESS 2712OU AQY ✓c CIIY,STATB rs FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWM .Aman ❑CONTRACrOR ACPIR ❑ Aacm= ❑PNcwsm ❑ DEVEJDPFA ❑TeN
CON-MACTORNAME ^' LICENSE NUMBER LICENSE TYPE BUS.Uc#
COMPANYNAME 1 ,✓ E-MAR FAX
L/ ruE
STREET ADDRESS CrrY.STATE;rB PROK
ARQRTEC UENGRIEER NAME LICENSE NUMBER BUS.UC/
COMPANY NAME E-MAM FAX
STREET ADDRESS QfY,STATE.W PHONE
DESCRDRTON OF WORK.
EXISTING USE PROPOSED USE CONSTIL Y S SSlORDS
5 USE TYPE OCC SQFf. VALUATION(S)
E=O NSWFLOOR - DEMO TOTAL
AREA AREA AREA NSTAREA
BATHROOM IOrCHEN Onfr]t - /�"L••
REMODELAREA REMODELARFA REMODELAREA
PORCIS AREA D=AREA IOTALOWWORCH AREA GA GE AREA: DE
TAG"
ATTACH
O DWELLNG UNrrS: ISA SEWND DNR U M SRCONDSTORY YES
SIONG ADDIDI [PO AWMOW.. IpIvo
PRE-APPLIGIION ❑YES AYES,PROYmE WPY OF .IS TBR BLDG Al '❑YES RECEIVED BY: TOTALVALUATION:
P[.=GAPPLI gI'O PLANING APPROVAL LET= RCBIAt ROME: RNO
/' fin/ /Oop
By Dry sigoatme balOW,I certify to each of the following. I am the property oW¢er or anthoriud aeeat to act m the prypwtyovmeeq hehalf. I have read Ellis
application and the mfo�on I have provided is correct. I have read the Dac iptiea of Work and verify it is accurate. [
and=cw and state laws relaaog to ' g cousaacdM I earhorize agree to comply with all applicable fecal
representatives of CupaTmo to met the above-identified property far iaspecdou purposes.
Sig¢alme of ApplicanNAgmt Date: 3 0 —! -z—
SUPPLEMIRITrAL INFORMATION REQUUUDFrax �cHTYrE Roam c sL8
New SFD or Multifamily dwellings: Apply for demolition perimt for 'ISd OVER-THEICOUrrm ❑ BUILD G,PLAN RXVWW
e Sting build-mg(s). Demolition permit is required prior to issuance of building T-
permitfaraewbuildmg. ❑ ❑ PLANMG PLAN REVIEW
Commercial Bldgs: Provide a completed 13aPmdous Materials Disclosure ❑ SrArmARD ❑ POHLIC WORD
farm if any lTwnrdous Materials are being'used as part of this project ❑ LARGE ❑ mz bm r
_Copy ofPlarming Approval Letter or Meeting With Plammg prior to ❑ altsoR ❑ atraxaxx SEWER olsrxter
submittal of Building Permit application.
❑ RNVmotm>ErTrALHEALTH.
Bld&A 2011.doc revised 06/21/11