The URL can be used to link to this page

12050123 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10522 CYPRESS DR CONTRACTOR:-TtJ1Yl'0-65 PERMIT NO: 12050123 OWNER'S NAME: TAO YING YAU I I 1 G DATE ISSUED:05/1.1/2012 OOW{{NER'S PHONE: 3087252650 PHONE NO: g LICENSED CONTRACTOR'S DECLARATION JOBDESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lic.N '!� q 3 2�b� �, �� STUCCO REPAIR 200 SQ FT Contractor '!'J 0V� 2tA A V= f Dace E j )sit f LO�2 1 hereby affirm that 1 am licensed under the provisionsof Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 1 hereby affirm under penally of perjury one of the following two declarations: I have and will maintain a certificate of constrain,self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for whichlhis permit is issued. Sq.Ft Floor Area: Valualion:$1500 1 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 .NPN Number:31630051.00 Occupancy Type: permit i5 issued -T`L APPLICANT CERTIFICATION I certify that I have read this application and slate that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 0 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes- (We)agree to save ISO DAY OM LAST CALLED INSPE TI N. 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 Issued by: 7 Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RF.-ROOFS: Signature- ignatureAll roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection ❑ OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Lew for one of Signature of Applicant: Dale: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER h as owner of the property,or my employces with wages as their sole compensation, will do the work,aid the structure is not intended or offered for sale(See 7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to IIAZARDOUS NIATF.RIA S DISCLOSURE: construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Ileallh&Safety Code.Sections 25505,25533,and 25534. 1 will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the declarations: Health&Safely Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 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 Qualilp Management District l performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&Safely Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this (/i� �!7 permit is issued Owner or authorized agent: Dater L 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 laws of Califomiaa If,after making this certificate of exemption,1 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, w'ork'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 stale 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. ARCIIITF.CT'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-paint source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31630051.00 DATE ISSUED. . . . . . . : 05/14/2012 RECEIPT #. . . . . . .`. . : BS000016818 REFERENCE ID # . . . : 12050123 SITE ADDRESS . . . . . : 10522 CYPRESS DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : TAO YING YAU ADDRESS . . . . . . . . . . : 10522 CYPRESS DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : BEL BUILDERS CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . ... ... . . . . : CITY/STATE/ZIP . . . . , TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 1, 500 .00 1 . 00 .0. 00 1. 00 0.00 1BSEISMICR VALUATION 1, 500 .00 0.50 0. 00 0.50 0. 00 1BUSLIC FLAT RATE 1 .00 119. 00 0. 00 119 .00 0.00 1STUCOAPP SQ FEET 1 .00 457 . 00 0. 00 457 .00 0.00 --------- ---------- ---------- ---------- TOTAL PERMIT 577.50 0. 00 577 .50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 577.50 MC . --------------- TOTAL RECEIPT 577.50 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10522 cypress DATE: REVIEWED BY: bobs. APN: BP#: 'VALUATION: $1,500 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK 200 s.f. stucco repair SCOPE Pccb. Plan Check Plumb. /You ChecA /fie,:. Plan Chcek dlrclr, Permit Fee: PLanh. Permit rte.- F.lec. Per...it Foe: Odw, Herh. Imp. Ocher Plumb Insp. Li I Other rice. lay. dh:ch. harp. kee Plumb. hasp. Fre: Elec,brsP. Fcc. NOTE: This estimate does not includejees due to other Departments(ie.Planning, Public Works, Fire,Sanilmy Sewer District,School District,etc). These fees are based on the prellminat information available and are only an estimate Contact the Dept for addn 7 info. FEE ITEMS(Fee Resolution 11-053 Elf 7/11/1) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 D6fl s.f. Restucco Suppl. PC Fee: Q Reg. OT 0:0 hes $0.00 $457.00 ISTUCOAPP PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee>D Reg. Q OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cunswilclion Teo-. Achnirti.ca'mive lure: 0 Work Without Permit? O Yes (E) No $0.00 E) Advanced Plannine Fee: $0.00 Select a Non Residential Travel Documenialian Pecs: Building or Structure 0 Strone Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Blda Sids Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $1.50 $457.00 TOTAL FEE: $458.50 Revised: 04/01/2012 CONSTRUCTION-PERMIT APPLICATION COMMUNITY-DEVELOPMENT DEPARTMENT• BUILDING DIVISION ' 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333• buildino(dcuoertino.orl 12-3 ❑NEW CONSTRUCTION ❑ ADDITION.— ❑,ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERNaT p PROJECT ADDRESS I r.,s 7-` APN („J 0 !,5-1 OWNER NAME v �/L - PHONE m n E-MAIL STREET ADDRESSO JS� Z rj CITY. STATE.ZIP G V� -1 / (5 FAX CONTACT NAME Y PHONE EMAIL G Gvl�l-Y'�l—tr STREET ADDRESS CITY,STATE. ZIP FAX OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME I' ar sl( LJCENSEYUMBERJISI 5 LICENSETYPE BUS,LICd COMPANY NAME ` TZ 1-tVVI EMAIL L 13 6 (L l L you STREET ADDRESS/,{ VrV ;/y I CITY.STATE.ZI + 0 ql��(� PH l Ll MCHITECT/ENGINEER NAME V r I'� LICENSE`UMBER BUS.LICN COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE.ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR.TYPE ISTORffS USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET A UEA BATHROOM KITCHEN OTHER V 4 J REMODEL AREA REMODELAREA REMODEL AREA PORCH AREA I DECKAREA TOTALDECK/PORCHAREA GARAGE MEA DETACH ATTACH u DWELLING UNITS: ISA SECOND UNTT YEs SECOND STORY' ❑YES BEN'GADDED? ❑NO ADDITTON: ❑NO PRE-APPLICATION ❑YES T YES,PROVIDE COPY OF .IS THE BLDG AN ❑YES 416 RECEIVED BY: / - TOTAL VALUATION (:]NO NO PWNNING APPROVAL LETTER EICHLER HOME? ❑NO J/ rV By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. ave read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. uth riu representatives of Cupertino to enter the above-identiifietd{property for inspection purposes. Signature of Applicant/Agent: Date: '�I / A� `2 SUPPLE, ORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for 5-W�--THELOUNTERB�DMG PLAN REVIEW existing building(s). Demolition permit_is required prior to issuance of building - permitfornewbuilding. - ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD 11PUBLIC wORrc Tom if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ NWOR ❑ SANTrARY SEWER Dlsmc-r submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06121/11