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12090062 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20609 Sl JELLY DR CON'I'RACI'OR:KUANG'SCONSTRUCfION PERMITNO: 12090062 CO OWN'ER'S NAME: CHFN HUNG AND CHYU JINGLING PO BOX 4802 DATE ISSUED:09/102012 OWNE.R'S[']IONE: 4082198061 F-I,D0RAD0111LLS,CA 95762 PDONENO:(916)941-2378 ❑ ! LICENSED CON,RACf(IR'S DECLARAT10N r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB i,iccnse Class �7 Lic.q 7 2 - MEGH r RESIDENTIAL r COMMERCIAL r Contractor f Dale PrYo—r '7- 1 he'eb)':dfirm than 1 am licensed ander the prurisiuns of Chopter9 .JOB DESCRIPTION:REPAIR LOWER 11'Ool'OFSIDINC AROUND I:N'I'IRI: (commencing with Section 7000)or Division 3 of the Bu.itm s l Professions HOUSE Code and that my license is in full force and effect. DRY ROT-LIKE FOR LIKE hereby 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 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,Ivor the performance of the ofk Inr which this Sq. PI Fluor Arrc \':du:nian:53000 permit is issued. �zt�� APPLICANT C1IRTIFICATION' AI;N Number:35911020.00 Occutomey'I'pPC: I certify that I have read this application and state than 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City ol'Cupenino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR Train of This omit. Additionally,thea licant understands and will complyz r > - r withal Ston-po'ml source rc"ulation5 per the Cupertino Municipal Code,Section 180 DAYSSFFROM ASTCALLED�+INSPECTION. 9.18. / ) r — /U— ) Z_ �r0 ry Issued by: b C Dane: $Ig118lUrl' DfltC / ❑ O\\'NE -IRALDER DECLARA 1100, RE-ROOFS: 1 hereby affirm than 1 am exempt from the Contractor's License Law for One of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection, I agree to remove all new materials lot 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the suuciurc is not intended or offered for sale(Sec.7044. Business&Professions Code) Signature of Applieam: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business C Professions Codc). ALL ROOF COs'ERINGS'1'O BE CLASS"A"OR Ill,'ITEIR hereby affirm under penalty of perjury one of the fallowing three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's DAZARDOUS BLA'I EIRI US DISCLOSURE Compensation,as provided(or by Section 3700 of the Labor Code,for the 1 have read thehazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued California Health,Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health Safe(,.Cade.Section 25532(a)should I more or handle hazardous material. Section 3700 of the labor Code,for the perlonn:mec of the work for which this Additionalh'.should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the/fay Area Air Qu:dity Management District I will I certify that in the performance of the work for which this permit is issued I shall maintain compliance with the Cut)enino Municipal Code.Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's I lcalth C Safely.Co, -eclions 2_5505,25533,and 25534: Compensation Ines of California. If,alter making this cenifieate of exemption,1 Worker's Omrncr or.m wiz on:� become subject m the N orker's Compens'mion provisions o(lhe labor Code,I must _ Z_ forihw'ith comply with such provisions or this permit shall be deemed revoked. Daie:. O APPLICANT CF RTI FI CATI ON CONS' RIK-I'ION LEINDING AGENCY I I entity that I have real This application and state that the above inl'ormalion is I hereby a(linn that there is a construction lending agency for the perlonnance of work's correct. I agree to comply with all city and county ordinances and Smte Imus relating for which this permit is issued(Sec.3097,Civ C) to building construction,and hereby authorize representatives of this city or enter Lender's N:une upon the above mentioned property for inspection purposes.(We)agree to save indenmify and keep harmless the City of Cupertino against liabilities,judgmenls. Lender's Address costs,and expenses which may accrue against said City in consequence of the granting o(this pemnit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITEM"S DECLARA'T'ION 9.18. d understand my plans shall be used as public records. Signature Date Licensed Prnfessionod CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 20609 Shelly Dr. DATE: 09/10/2012 TREVIENVED BV: RDW APN: BP#: U 'VALUATION: $3,000 *PERI111T TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK a air lower 1 foot of siding around entire house. A/ SCOPE ,Meth. Plan Check Phurth. plan Check Elec. plan Check Mech. Permit Fee: Plumb. permit Fee: Clec•.Permit Fee: Other,51ech.Insp. Ocher Plumb Insp. Other Elec.,Imp. ,Meeh. lisp. For: Plumb. In.cp. Fee: Cler.Insp.Fee: A'OTE: This estitnate does not include fees clue to other Departments(i.e. planning, Public II'arks, Fire,Sanitary Server District,Schaal District,etc. . Thesefees are based on the prelinfinan information available and are only an estimate. Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution 11-059 Elf 7/1/1 U FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 400 s.f. Siding Suppl. PC Fee: (D Reg. Q OT0.0 hrs $0.00 $400.00 ISIDEOTHER I All Other PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.S Reg. Q OT Fo.oThrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tar: Administrative Fee: Q Work Without Permit? O Yes (j) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) Building or Structure O 'Travel Documentation Fees: A Strong Motion Fee: IBSE1SMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $400.001 TOTAL FEE: $401.50 Revised: 07/01/2012 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 GUPERTINO (408) 777-3228 • FAX (408)777-3333 • buildino((Dcupertino.org / aD��(xppZ ❑.NEW CONSTRUCTION ❑ ADDITION ff ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMITN PROJECTADDRESS I r)(� / 1 '� APN# �J�C� 00 OWNER NAME': PHONE ^ (� _ Lj IF _`f —/-MAIL STREET ADDRESS CITY, STATE,ZIP S 1 I FAX CONTACT NAME j /ft l l/'s PHONE I C Ig7f_ ;.() } E 11v, Lk// CITY.STATE, ZIP FF\AXSTREET ADDRESS, -I ❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME e�l ,T I I •)}�� LICENSE NUMBER / L� 7 _L LICENSE TYPE J' BUS.LIC a O COMPANY NAME �j E-MAIL ( FAX STREET ADDRESS ,`, )J �Y ,. CITY,STATE,ZIP/,q A�j/ --` Lr P ONE ARCHITECT/ENGINEER NAME 'l rS LICENSENUMBER 7F1-(ir!- BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK T �\l / // / LowP— ONzfS„FJ OT 6�-/1tDU /V -v � 4A�LlS1£ !- / EXISTINGUSE PROPOSED USE CONSTR.TYPE I #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OMER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK ORCH AI1EA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: ISASECONDUNIT DYES SECONDSTORY E]YES BEINGADDED? []NO ADDITION.” ANO PRE-APPLICATION ❑YES IF YES,PROVIDE COPYOF ISTREBLOGAN E]YES `RECEIVED:BY:' - TOTAL VALUATION: PLANNINGAPPL# [JNO PLANNING APPROVAL LETTER EICHLERROME'. 0NO - - l 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. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it accurate. I agree to comply with all applicable local ordinances and state laws relating t�I ag cons ch aut ize representatives of Cupertino to enter the above-identifie property for inspection purposes. Signature of Applican—genC / Date: SUPPLEMENTAL INT 'IATI N REQUIRWhianthecl: ire ? NoUTI\csuP,. - New SPD or Multifamily dwellings: Apply for demolition permit for DVER-T He GOOSTER :❑' BUILDING PITA,\REVIEW- esistingbuilding(s). Demolition permit.is required prior to issuance of building : . permit for new building. ❑ eiseutss ❑,'-PI Vn;Ntsc e1.VNReI'tee�' J _Commercial Bldgs: Provide a completed h �a lardMaterials aterials Disclosure 101 "917ANDAND ❑�-1 mil icit'"o nHs .. form if am'Hazardous Materials are being used as part of this project. 4 . i ❑ LARGE ❑i FINED_EPT' _ _Copy of Planning Approval Letter or Meeting With Planning prior to ❑,MAJ0RF; -- - ❑ Ss\IT\RYSEt\FN DISTNICT submittal of Building Permit application. - -e— - I �: F.N'\'IHON,MFYT,i 1.11 F,A1.T11:__ BldgApp_2011.doc revised 06121/11