12080214 CITY OF CU13EIlTINO 13UILDING PERMIT
BUILDINGADDRESS: 6092 WILI,OWGROVE LN - CONTRACTOR:JACK TANG&EDITH ONG PFRMITNO: 12080214
OWNER'S NAME: JACK TANG&EDITII ONG 19902 VIA ESCIJF,LA DR DATE ISSUED:08202012
OWNER'S PHONE': 4086465767 SARATOGA.CA 95070 PHONE NO:
❑ LICENSED COX l'RACI'OR'S DECLARATION BUILDINGPERMIT INFO: BLDG (- ELECT r PLUMB(-
License Class Lie.d
M ECII r RESIDENTIAL r COMMERCIAL
Contractor Date
-
I hercbv affirm that I out licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMODEL 2 BATHROOMS AND REPLACE 20VEN AND
(Commencing with Section 70011)of 1livision 3 of tlne Business& Professions COOK'1'01'
Code and that rnr license is in full force and effect. CIRCUI'T'S IN KITCIIrN.NOOTHER WORK IN KITCHEN TI'IA•1
R17QUIRES A PERMIT
here M'affirm under penally'of perjury one of the following two declarations:
1 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 which this 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
permit is issued. Sq.Ft Fluor Area: Valuation:$5000
,u'PLTCAXf cfdrru�Icrr10N
I cerify that I have read this application:and state that the above information is APN Number:37538018.00 OccupancyType:
correct. I agree to comply with all city and county ordinances mid state haws 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 Cupenino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands mid will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point sconce regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Date Isad 1 y: 012� Date:
� I
❑ OWNEWBUILI)Mt DECLARATION
1 hereby affirm Thal I am exempt from the Contractor's License Low for one of RF,-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees withwages as their sole compensation, installed wilhott first obtaining an inspection,I agree to remote all nc'rr materials for
will do the work,and the structure is not intended or offered for sale(Sce.7044, inspection.
Business&Professions Code) .
I,as owner of the property,am ecclusively contracting with licensed contractors to Signature of AppliuhnL' Date:
construct the project(Sce.7044;Business&Professions Code).
herebv affirm under penalty of perjury'one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR RITTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's Ih\%,\ItDOl1S�LVIICIt I,\LS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. 1 have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health S Safely Code.Sections 25505,25533,and'5534. 1 will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.1_and the Ilealth&
F Safely Coda Section 2.5532(x)should I.store or handle hazardous material.
permit is issued Additionally,should 1 use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants us defined by the tiny Arca Air QualityManagement District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
Compensation laws ofCalifomia. If,after making this certificate of eccmplion,I Ilealth, afety Code.Scctmns•25505.25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code.I must
forthwith comply with such provisions or this permit shall be deemed revoked Owner o usho iz 0 en .
Dale'
AI'I'LIC.\NI'CI?R'I'll'IG\'TTI IN CONSTRIJ _PION LI•:NDINC,\f liNC),
I certify that I have read this application mid state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating I hereby aRrm that there is a const ction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this pemnit is issued(Sec:3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep hamiless the City of Cupenino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non- int source regula'ms�er the Cupenino Municipal Code,Section ARCHITECT"S DECLARATION
9.18.
I understand my plansshall be used as public records.
Signamue Dmc -(1 Gni
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 6092 willowgrove Lane DATE: 08/20/2012 REVIEWED BY: jsg
APN: BP#: 'VALUATION: 1$5,000
*PERDIIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY 2nd Unit? l'cs No PENTAMATION
USE: SFD or Duplex OTC? O Yes 1 R3SFDREM
0No PERM i
WORK: Remodel 2 bathrooms and replace 2 oven and cookto circuits in kitchen. No other work in kitchen that
SCOPE requires a permit.
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. (s.t.
R-3 (Custom) I-B,III-B,IV,V-e 0 $0.00 $0.00
TOTALS: 0 $0.00 $0.00
MECFI, HOURLY O Yes 0 No PLUMB, HOURLY 0 Iles 0 No ELEC, HOURLY O Iles 0 No
Aleeh.[lion Check Phunb. Ilan Check Elec. Plan Check 0.0 1 hrs $0.00
blech. Permit Fee: Plumb.Permit Fee: Elec. Permit Fee: IFPF-RAHT
,Oder,Vech. lisp. Other Plumb lnsy. Other Elec. Insp. 0.0 hrs $45.00
.Rech.Insp. rev: Plumb. Insp. Fee: I files.Insp.Fee:
NOTE: This estimate does not includejees due to other Departments(i.e. Planning, Public IVorks, Fire,Sanitary Server District,School
District. etc.). These feev ore based on the prelinzinarl information available and are only tilt estimate. Contact the Dept for ar/dn'I info.
FEE ITEMS (Fee Resolmion 11-053 Eff ZgL/11 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.f. Remodel, Bath (<=300 so
Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 $600.00 1REAIRESBAT
PME Plan Check: $0.00 2 Electrical
Permit Fee: $0.00 $45.00 1 IBREAIRFCEP Recep/Switch/Outlets
Suppl. Insp. Fee0 Reg. 0 OT p,p hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $45.00
Construction Tax
Administrative Fee: O
Work Without Permit? O Yes 0 No $0.00 0
Advanced Plannine Fee: $0.00 Select a Non-Residential 0
Travel Documentation Fee: ITRA VDOC $45.00 T-7771Building or Structure
Strong Motion Fee: IBSF-ISMICR $0.50 Select an Administrative Item
Blde Stds Commission Feel IBCBSC $1.00
SUBTOTALS: 1 $91.501 $645.001 TOTAL FEE: F$736.50
Revised: 07/01/2012
GENERAL PERMIT APPLICATION E
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 @� �, I
CUPERTINO (408)�-328 - FAX(A08)�-3333 - buiillddiingr5guoerino.ora �\®��
SC
❑?LU1.L31NG ❑bCC'?:4.MCAL>> L�[1=T�CiILiCAL ❑NESCELL>_NEOUS
PR01EC T ADDRESS 01-2- w ��-L �� �C: � �sPN a (, O I
OWNER NAME -6iDl 1- O I" I PY.ON'E'",{��(i]'-' J_u� / E.MAtL d t
S�) ()rl /V Lt'(J6 U O
STREET ADDRESS / V /A .. ' Crr. STATZ.ZIP syr/ FAX I
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CONTACT NAME /!— IT� Q PHONE oO _
ST=ADDRESS l � 0'� "I"1^_. ��`� i QTY.5-A � FAX
VIA �-.
❑ OWNFA ❑ OWNER.BUBJEt ❑ OW.4fR AGi=Yi ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCK ECT, ❑ENGINE- ❑ DEVEIDP'_"i ❑ T'=`tANi
CON'RAC;OR NAME 'Z- r GN��S^` 1 CNU C..
UME TYPE I BuS.JC4
f, (w,jl�'izvSE _ �
COMPANY NAME t./ E-MAB. I FAX
ST R.SIT ADDRESS7T .STATS ONE
P � t�
ARCh7["ECT17.1GA'ZR NAME I UCEN5-.NUNMER I BUS.LIC q
COMPANY NAME' I E-MAB. I FAX
STR=ADDRESS CIN,STATE,ZIP I PHONE
USE OF O SFD a DUPLEX ❑ M '
UL -FAN.GLY I PROTECT INwBpiAND 0 YES I PROIECr IN ❑YES I S THE BLDG AN ❑ YES
=D:
BG: COMMERCIAL URBANINTERFACEAREA NO FLOODZONE ❑NO EVER HoM ❑NO
DESCRIPTION OF WORK
-
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�Q Rr-1 ovin 70 E ca .
Z-N.0P 5'o9-6h av18 z L G — M, CJ t xZwR
TOTAL VALUATION: i�r�t I RECEIVED BY:
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By my signanre below,I certify to each of the following: Ian:the prope:y owner Or authorized agent:o act on the property Owner's behalf I have read this
application and the information I have provided is Corr, --Ihavcread th escipcon of Work and verify it is acemztc. I agree ro comply with all applicable local
ordinances and sate laws relating uil�rg COD= I auu rite r p ' ..awes of Cuper,.rc._^.._:the=verfdeafi5 l3=PC.—;.or inspection pui�oscs.
Signature of Applicant/Agcac Date:
'SUPPLEMEt N7AL 1'NFORMAT' N REQLITZED OFFICE USE ONLY
m ❑ OVER-THE-COUNTER
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❑ EXPRESS
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