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12070056CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11103 CANYON VISTA DR CONTRACTOR: CII IA I1U PERMIT NO: 12070056 OWNER'S NADIE: CHIA HU 2409 LOMENT PL DATE ISSUED: 07/092012 OWNER'S PHONE: 4088077897 SAN JOSE, CA 95124 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL. COMNIERCI AL License Class Lic. q INSTALL 8 LIGHTS AND REMOVE AND REPLACE THE KITCHEN SINK Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of [he Business & Professions Code and that my license is in full force and effect. I hereby affirm under penally 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 Sq. FI Floor Area: Valuation: $1100 performance of the work for whichlhis 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 APN Number: 35628029.00 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 cored. I agree to comply with all city and county ordinances and stale laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to budding construction, and hereby authorize_ representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnily and keep harmless the City of Cupertino against Iiabilities,judgmems, costs, and expenses which may accrue against said City in consequence of the hF�� / /� Date: granting of this permit, Additionally, the hppl icant understands and will comply Issued by: / YYY---777 / /r with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Dale All 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---.;) Signature of Applic m Date: hereby affirm That I am exempt from the Contractor's License Lew for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California health & Safety Code, Sections 25505, 25533, and 25534. 1 will 1 hereby affirm under penally 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 1 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 Quality Management District I performance of the work for whichlhis permit is issued. will maintain compliance with the Cupertino funicipal Cade, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & SaCode, Section 59 33, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this t:fety Owner or authorized agenDale: 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 laws of California. If, after making this certificate of exemption, I CONS'T'RUCTION 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 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 ARCHITECT'S DECLARATION and keep harmless the City of Cupertino against Liabilities, judgments, 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. Additional) ytne applicant understands and will comply with all non -point sou u r the Cupertino Municipal Code, Section Licensed Professional 9.18. / 7 Signature Date �� CITY OF CUPERTINO I�D'r-�//_I FEE ESTIMATOR -BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'I info. FEE ITEMS (Fee Resolution I1-053 Q7. 7/1/1/) ADDRESS: 11103 Canyon Vista Dr DATE: 07/09/2012 REVIEWED BY: Sean imt APN: BP#: 'VALUATION: 1$1,100 *PERMIT TYPE: Building Permit =1 PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi -Family Dwelling USE: Buildina is >3 Stories O Yes O No PENTAMATION 1REAP11 PERMIT TYPE: WORK Installation of 8 lights and remove and replace the kitchen sink. SCOPE 1 0,0 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'I info. FEE ITEMS (Fee Resolution I1-053 Q7. 7/1/1/) I f- h i'/..., r ho A Plumb. Plan Check 0.0 1 hrs $0.00 Elec. Plan Check 1 0.0 1 hrs $0.00 ?h, h. Iwit f'cr: Plumb. Permit Fee: IPPERAfIT Elec. Permit Fee: /EPERAHT nr4;-r.tkah.1':'h Other Plumbinsp. 0.0 hrs Lwm Other Elec. Insp. 0.0 111, (h. hnp. lrr,: Phouh. Imp. I're leap. /hl" NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'I info. FEE ITEMS (Fee Resolution I1-053 Q7. 7/1/1/) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =# Electrical $67.00 1BREAIFIXT Fixtures, Lighting Suppl. PC Fee: Q Reg. O OT FO.0 I hrs $0.00 PME Plan Check: $0.00 1 # Plumbing $10.00 /BPFIXTURE I Fixture or Trap Permit Fee:$0.00 Suppl. Insp. Fee:Q Reg. O OT 1 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $90.00 ('n;w, it, twn 7a.t:' Administrative Fee: IADMIN $42.00 O 0 Work Without Permit? O Yes Q No $0.00 Advanced Planning $0.00 Select a Non -Residential O Building or Structure O Travel Documentation Fee: ITRAvooc $45.00 Stronti Motion Fce: IBSEISMICR $0.50 Select an Administrative Item 131da Sids Commission Fee: IBCBSC $1.00 SUBTOTALS: $178.50 $77.001TOTAL FEE: $255.50 Revised: 07/01/2012 CUPERTINO I 11 NFOT r nN.. T"Iir' nm CONSTRUCTION PERMIT APPLICATION B COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) T77-3333 • building(acuoeltino.orG ,may I—I AMMON I;`I ALTEFtATION/Tr�I I 1 R-ZVl5I0N/DEF=m nRlr;rNA7.PFR.VT3 FROIECT.ADDRFSS 1(# Q 3 VI !A -Dr AFNI 2/i 02-9 OWNER NAME PH / - ,4 _ L � E-MAIL ^�' S a C k A .XPi1T I 1 I oA I STREET ADDRESS 7� VTSlA Dr. �U A� 'na CAU 9S0Iq 1424-37 1 10 ['Ga pn -/is`/ CONTACT NAME C - I,A PHONE E -MAR. STREET ADDRESS lM a Su CITY. STATE. LIP FAX Il&QWNER ❑ OWNER -BUDDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTORAGEYT ❑ ARCHITECT ❑ FNGDIE,°R ❑ DEVELOPER ❑ TENANT CONTRACTORNAME C n O�{e i N VVV LICENSE NUMBER EXENSc TYPE BUS. LICP COMPANY NAME (7 a E-MAIL FAX . STREET ADDRESS CITY. STATE ZIP PHONE ARCHITECT/ENGINEER. NAME LICENSE NUMBER Bus. TIC A COMPANY NAME E -MAR FAX STREET ADDRESS CITY. STATE, ZD' PHONE DESCRIPMON OF WORK EGS�ING USE PROPO USE CONSM E V ISTORIES USE TYPE OCC. SQ VALUATION -FT. (s) ECSIG NEW FL00R DEMO TOTAL AREA AREA AREA NET.c,,A BATHROOM 14TCHEN OTHER REMOOELAREA REMODEL AREA REMODEL AREA 20RCHAREA DECCAREi TOTAL DECIOPORCH AREA GARAGE AREA DETACH LJ ATTACH 0 OWMI-24G UNITS: IS A SECOND UNIT YES SECON-D STORY ❑YES BEING ADDED? ONO ADDITIONr ONO PRE -APPLICATION OYES IF YES. PROVIDE COPY OF I IS THE BLDG AN ❑YES RECETV D Y. TOTAL VALUATION: PLANNINGAPPL4 ONO PLANNDIGAPPROVAI.LITTF]I EtC ROME' ONO � /IDQ By my sigoatme below, I cm-dfy to each of the following. a pro- owner or authorized agent m act on die prppety owner's oebalf. [ have r=d this applicarian and the information I have pruvided i CUTIC a read the DeseiprioD of Wadc and ver.fy it is arca rate. I agree m comply with all applicable local ordinances and state laws testing to building dtotize represca adves of Cuperdao to eater the above -identified pre(perty-vMspecdon purposes. Sign -am ofApplimnt(Agenc -Z Daze: -)k 7 SUPPLENIENPAL INFORMATION REQUIIiED PLAN CHBCKTYPE ROUTING SLS 'I't OVER-TEEE-COGNTZR lr( BUILDING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building r - permit for new building. Cl ExPnFss ❑ PTA.NN NG PLAN REvtEw Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS _ form if any Hazardous Materials arebeing used as part of this project ❑ LARGE _ ❑ FIRB DFPr _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ submittal of Building Permit application. "NITAHY SEWER DISTRICT ❑ ENVmON'EfENT.V, war TH BldgApp_ZOI I.doc revised 06/21/11