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09040095 77777777777 CITY OF CUPERTINO BUILDING DIVISION PERMIT +C�ll ► QR I ? MATIZ ' PERMIT NO. BUILDING ADDRESS: 10364 DEMP T TBD - TO BE DETERMINEII PERMIT ISSUE DATE NER'S NAME: A2'3 CONTROL NO. PHON : BUILDING PERMIT INFO ARCHITECf/ENGINEER: BLDG ELECT PLUMB MECH u0p LICENSED CONTRACTOR'S DECLARATION Job Description m I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is Z4,% in full fore and - � �_ ADD(2 4 5 S Q)&RMDL(3 6 0)K I TC HEN,DINING&NOOK,ADD A/C, jMZ License Class Lic•» A �F,n Date Contractor ELECTRIC PANEL UPGRADED 200AMP-ELECTRICAL THRU ARCHITECTS DECLARATION I understand my plans shall be used as public records KITCHEN & DINING RM. a Oy Licensed Professional H 5OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the Cp o following reason.(Section 7031.5,Business and Professions Code:Any city or county y which requires a permit to construct,alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area F- (commencing with Section 7060)of Division 3 of the Business and Professions Code)or $SQ000 y .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). 3264707E . 0 0 ❑1,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 Required Inspections and Professions Code:The Contractors License Law does trot apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors Li. cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under See. B&P C for this reason Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insure for WorkcesCompen- sation,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 Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance crier and Policy number arc: Cartier.SZ E Zt_ OF EXEMPTION FROM WORKERS' �O COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or Icss) 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 Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workces Compensation provisions of the Labor Code,you must ,J 0 forthwith comply with such provisions or this permit shall be deemed mvoked. Z 2CONSTRUCTION LENDING AGENCY (~-r rrA I hereby affirm that there is a construction lending agency for the performance of G�+5 the work for which this permit is issued(Sec.3097,Civ.C.) aa Lendces Namc :)z Lenders Address U 0 1 certify that 1 have read this application and state that the above information is LL►" correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction.and hereby authorim representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. t.1 t (We)agree to save,indemnify and keep harmless the City of Cupertino against Hliabilities,judgments,costs and expenses which may in any way accmc against said City U Z in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 7i� SOURCE REGULATIONS. -t-?-L-05 Re-roofs Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Loof Will the applicant or future building occupant store or handle hazardous material ,s defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety ,dc.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes 9) �/ If a roof s installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminarN. fined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes I have read the hazardous materials requirements under Chapter 6.95 of die Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must liq met prior to issuance of a Certificate of Occupancy. S ignaturE of Applicant Date All roof coverings to be Class' {`'or better Owner or authorized agent Datc CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec.- Twp: Rng: Lot : APN 32647076 . 00 DATE ISSUED. . . . . . . 05/21/2009 RECEIPT #. . . . . . . . 0 : BS000007771 REFERENCE ID # . . . 09040095 SITE ADDRESS 10364 DEMPSTER AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . ELANE PAO & JOE FENG ADDRESS . . . . . . . . . . 10364 DEMPSTER CITY/STATE/ZIP . . . CUPERTINO, CA 95014 RECEIVED FROM . . . . PETER FU 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 80, 000 . 00 4 . 00 0 . 00 4 . 00 0. 00 1BSEISMICR VALUATION 80, 000 .00 8 . 00 0 . 00 8 . 00 0 . 00 1PLLONGR SQUARE FEET 245 . 00 29 .40 0 . 00 29 .40 0 . 00 1R31NSP SQUARE FEET 245 . 00 1424 . 00 0 . 00 1424 . 00 0 . 00 lR3PLNCK SQUARE FEET 245 - 00 2270 . 00 2270 . 00 0 . 00 0 . 00 1REMRESOTH SQ FEET 360 . 00 306 . 00 0 . 00 306 . 00 0 . 00 1STPLNCK HOURS 1 .00 122 . 00 122 .00 0 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 4163 .40 2392 . 00 1771 -40 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 11771 .40 VISA --------------- TOTAL RECEIPT lf771 .40 0 0 C) ._ _ CITY OF CUPERTINO ADDITION/REMODEL CITY 0 CUPEKrINO PERMIT APPLICATION FORM APN # Date: 3 ?,,-L -w ze 7w-- o 7 0 4 .7,0 0 Building Address: /j9 36 � he op.. L Mailing Address (if different from building'address): Owner's Name: Phone# C�aN,2 �d v � �d e �� f+a�-2f 2 -d 7 8� Contractor: Phone 7 �''�E'V�' �l�S'Sae,-`� c�S .�-t.�� Fax #: Contractor License if: uupertino Business License;F: Contact: JL_ Phone Fax #: ��L-o .-c� � 3 6 Building Permit Info: Bldg. 'o Elect. Plumb. Mech. Hillside E] Job Description: h-Akt-l"i Addition-What is being added?(Be Specific),- A/� k,", What is being remodeled (not including addition) /` a--yoorr Remodel Includes Re-Roof: Yes No If yes list number of squares Remodel Includes Structural. Yes No Do you have the pre-application planning approval? Yes ❑ No If yes,please proviae a copy of your pianpIng a royal letter. Planners name. Square Footage: Addition-, Porch: Deck: Garage-, Detached Attached 4 0 :F Remodel: Kitchen Bath Other ------------------- - ------------------ Type of Construction (Usage Class): uccupancy ypeo. 1-A, 1-B ❑ II/III/V-A ❑ II/111 B, IV-HT, V-B Poe' Valuation: 010 Please check this box if the project is a second-story addition ❑ Project Size-., Express Standard Large 0 Major ❑ Please complete relevait portion of the Green Building Checklist& attach it to the application or if applicable, Green Building Points Achieved-, ( a include in plan set& the sheet index. ***For Office Use Only*** Over-the-Counter 1:1 Revised 01/07/09 CITY OF CUPERTINO ADDITION/REMODEL COPE T FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft ADDITIONS 1R3SFDADD PLLONGRNGR Long Range PL Planning/Residential .�f J S_ 1' _ h �-��,,, ', Dwellings Inspections B ------------- Z�S� 1R3PLNCK Dwellings plan check B IR3REPINSP Dwellings Repeat B 4i-spection IR3REPPLNC Dwellings Repeat Plan B Check IR3HINSP Dwellings Hillside B inspection IR3HPLNCK Dwellings Hillside plan B check IR3HREINSP Dwellings Hillside B 46A Rgeat Inspection IR3HREPLNC Dwellings Hillside B R eat Plan Check 1R3ALTINSP Dwellings Alternate B Materials Inspection IR3ALTPLNC Dwellings Alternate B Materials Plan Check IPCESS Cesspool P IPPRSEWG Ea. Private Sewage P Disposal System IPRSEWER Sewers P 1BPSPRINK Lawn Sprinkler/Backflow P 1BPWSVCS Main Water Service P IBCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee IBSEISMICRE SeismicResidential B IREROOFRIES Residential Re-roof Each B 100 SF