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12080110 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: 10141 HILLCREST RD CONTRACTOR:JIAN MIN PERMITNO: 12080110 CONSTRUCTION OWNER'S NAMEI: WING ROGER A AND SHARON S TRUS 322 AVIADOR AVE DATE ISSUED:08/092012 OWNER'S 1410NG: 4084461619 MILLBRAE,CA 94030 IIIIONENO:(415)716-8140 ❑ LICENSED CONI'RACI'OR'S DECLARATION •1013 DESCRIPI'ION: RESIDE-\I'IAI.LJ COMMERCLV-❑ License Class Lic.H_&O Oq( I REPAIR EXISTING STUCCO 120 SQ FT Contractor t %cirsx- R,o (/J v. Date hereby affir�nl 1:un liecti., under the provisions ul'Chapler 9 (commencing%villiSeclinn 70011)of I)i%isiou 3 of rhe Business S I'rnfesiuns Code and that nn'license is in full force and effect. 1 herehv affirm 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 Labor Code,for the performance of the work for which this permit is issued. Sq.1:1 Floor Arca: Valu lion:$35000 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of tire work for which this APN Number:32616054.00 Occupancy Type: permit is Issued. AI'PLICAN"I'CI?R'I'IFIC\'I'ION 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 state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of city to enter upon the above mentioned property for inspection purposes. (Nye)agree to save 180 DA ' OM LAST CALLED INSP TON. indemnify and keep harmless the City of Cupertino against liabilities•judgments, costs,and expenses which may accrue against said City in consequence of the 614-49', withgranting of this permit. Additionally,Elleapplicant understands and will comply Issued by: Dare: with all non-point source regulations per the Cupenino M1 niciryhl Code,Section 9.18. /� RE-ROOFS: Signature Datc -2-Y�L All roofs shall be inspected prior to my roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-Illlll-DER DECLARATION Signature of Applicant: Date: herehv affirm thin 1 am exempt from the Con lraclur's License Law for one of the following two reasons: ALL ROOF COVERINGS T'O BE CLASS"A"OR BE'ITER I,as owner of the property,or my employees with wages us 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 property,am exclusively contracting with licensed contractors to IIA%ARDOUS.MATERIALS DISCLOSURE construct the project(Scc.7044,Business k Professions Code). I have read the hazardous materials requiremcus under Chapter!95()title California I Icalth S Ssfety Code,Seclions 25505.25533,and 25534. ]will I hereby affirm under penalty mf perjury one of the fallowing three maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the declarations: Health S Safely 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. Addilionallr,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 1 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 tic.Health S Safety Code.=Cctlo, SAS5?5�ani 255347Section 3700 ofthe Labor Code,for die performance ofthe work for which this0wneroramthorized agentDate:�'`� 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 mamcr so as to become subject to the Worker's Compensation laws of California. If,after making this certificate ofesemption,I CONS'rRI1C1'ION LENDING AGENCY become subject to the Workers Compensation provisions of the Labor Code,I nwst I hereby affirm that there is a construction lending agency for the perfomtance of forthwith comply with such provisions or this permit shall be deemed revoked w'ork's for which this permit is issued(Sec.3097,Cis,C.) Lender's Name AI'I'LICANT CERTIFICATION Lender's Address I cenit•that I have read this application and state that the above information is correct.I agree to comply with all city and comity ordinances and state laws relating to building construction,laid hereby authorize representatives of this city to enter upon the above mentioned propeny I'or inspection purposes.(We)agree to save indennit and keep harmless the City ol'Cupertino against liabilities,Judgments, ARCI I IT ECT"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 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDESS: 10141 hillcrest dr. DATE: 08/09/2012 REVIEWED BY: bobs. \ AANN..R13P#: VALUATION: $35,000 *PERiMITTYPE: Building Permit PLAN CIIECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTANIATION 1GENRE USE: PERMITTYPE: YORK re air existing stucco wall 120 s.f. SCOPE Alech. Man Check Plumb. Plan Check Elea Plan Check Alech. Permit Fee: Plumh.Permit Fee: F.lec.Permit Fee: Other A1cch. Insp. Other Plumb Insp. Oder Elect.Insp. L1 I ,b/ach. hc'P. Fec: Plumb. hcsp.F(v: Elea Lup.Fec: NOTE: This estintate does not include fees due to other Departments(i.e. Planning, Public 11'arkts, Fire,Sanitary Server District,School District.etc.). These feav are ha.sed on the prefinufnari•information available and are onh•an estimate. Contact the Dept for addn'I info. FEE ITEMS (Fee Resolution 11-053 EIl 711111) FEE QTY/FEE N11SC ITEMS Plan Check Fee: $0.00 120 s.f. Restucco Suppl. PC Feer Q Reg. O OT O.Q hrs $0.00 $467.00 ISTUCOIPP PME Plan Check: $0.00 Permit Fee: $0.00 SuppI. Insp. Fee0 Reg. Q OT 0_p hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tar: Administrative Fee: O Work Without Permit? O Yes Q No $0.00 G Advanced Planning Fee:. $0.00 Select Non-Residential E) Building or Structure 0 Travel Documentation Fees: A Strong Motion Pee: IBSEISMICR $3.50 Select an Administrative Item 131dg Stds Commission Fee: IBCBSC $2.00 SURTOTALS: 1 $5.50 $467.001 TOTAL FEE: $472.50 Revised: 07/01/2012 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 LOP C U PERTI NO (408) 777-3228• FAX (408)777-3333• building(ftupertino.oro c)r U ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION/'fl ❑ REVISION I DEFERRED ORIGINALPERMIT# V PROJECT ADDRESS /O I� LL� I1 , Cw G APNN OWNER NAME (}7,_V`. e6' IN {, PHO.' Og —�� —E-tel l(6 STREET ADDRESS CITY, STATE,ZIP I FAX CONTACT NAME ^^ C� PHONE E-MAIL STREET ADDRESS CITY,STATE ZIP FAX E3 OWNER ❑ OWNER-BURDER ❑ OWKEIi AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑04GMEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMETan K LICENSE NUNI�ER��I LICITSE TYPE BUS.LIC 0 COMPANY NAME 1 < OtiN OZl✓ E-MAIL FAX STREET ADDRESS •L L U /Y S�� •// CITY,STATE, r4 /., J5 d PHONE ARCHITECTIENGINEER NAME Y l LICENSE NUMBER I C. BUS.LICK O F COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP /� PHONE CRIPTION OF WORK ��J_._ J�, .D Pym at w.. !/. �" �• EXISTING USE PROPOSED USE CONSTR.TYTE 1 9 STORIES USE TYPE OCC. SQ.F7. VALUATION(S) GISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECKAREA TOTALDECKIPORCH AREA GARAGEAREA: UDETACH ❑ATTACH M DWELLING UNITS: ISASECON'DU61'T ❑YFS SECONDSTORY E]YES BEINGADIIDD? []NO ADIIITIOF? [3NO PRE-APPLICATION ❑YES WYEB,PROVIDECOPYOF IS-I'IIEBI.DGAN E]YES RECEIVED B,Y: ",r TOTAL VALUATION: PLANNINGAPPLe E]NO PLANNING APPROVAL LETTER EICHLE.RHOME? E]NO By my signature below,1 certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. 1 have read this application and the information I have provided is correct. I have read the Description afiVork and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating to building construction. I autho'zc representatives o upenino to enter the above-identified property for inspection purposes. Signature of Applicam/Agent Date: _ _ SUPPLEMENTAL INF012A'fA"I'IONREQUIRED •. rl„\s:cnecK•rri•e 'I;ovnN'csl;Dl. _ New SI?D or Multifamily dwellings: Apply for demolition pemlit for :Tln couN'i'eu' I ❑ nwl DTNd'PLAN HEvuiy existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS - ❑ pl..\NnIN'c ri.,�N HE\•it:w• _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ', ElPuul,IcwoRKs - To—nil if any hazardous Materials are being used as pan of this project. - - - I]\RCf: '❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑;MAJOR ' ❑. SANITARYSEWER DISI'RIC17 submittal of Building Permit application. - - ❑..f.NVI RON:MENTA L HEAI.T'H-___ BldgApp_201 Ldoe revised 06121/11