The URL can be used to link to this page

12090004 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21115 LAURFTTA DR CONTRACTOR:WONG'S GENERAL PERM IT NO: 12090004 CONSTRUCTION ON;NER'SNAINIE: VOON SET CHIN TRUSTEE 21150 SARATOGA BILL RD DA'Z'E ISSUED:09f04R012 OWNER'S PIIONF.: 4084312625 SARATOGA,CA 95070 PRONE NO:(408)334-1893 ❑ LICENSED CONT'RACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT rt PLUMB (- License Class f�L Lie.q <_ 6- 2 C 1-1 ", r7MECIi RESIDENTIAL COA1h1ERCL , Contractor 6ICL J Date O d3 2 hereby affirm II at I am licensed under a prorisions of Ch pier 9 JOB DESCRIPTION:CONSTRUCT SOFFIT AND ADD(8)LIGHTS TO MASTER (commencing with Section 7000)of Division 3 of the Business S ProfessionsBEDROOM Code and that my license is in full force and effect. 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 Sq.Ft Floor Area: Valuation:52800 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. .0.N Number:32655012.00 Occupancy"Type: APPLICAN`V CERTIFICATION 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 Imus relating to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by: .��A/� T/��Gf7G Date: Signator "1� Date � 6� �2 ❑ OWNER-RUILIIER DECLARATION RF.-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is hereby affirm that I am exempt from the Contractor's License Law far one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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(Sce.7044, Signature of Applicant: Date: Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contmetors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER hereby affirm under penalty of perjury one of the following three declarations: IL\"/.ARDOUS MATERIALS DISCLOSURE 1 have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Ilealth&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino hl unicipal Code,Chapter 9.12 and the Ilealth& I have and will maintain Worker's Compensation Insurance,as provided I'or by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,forthe performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. conm mi nants as defined by the Bay Area Air Quality Management District 1 will in ainla in compliance H ith the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued.I shall Health&Safety Code,Sections 25505.25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of Cali fomia. If,alter making this certificate ofexemption,I Owner or authorized agenC become subject to the Worker's Compensation provisions of the Labor Code,1 must Date: Z forthwith comply with such provisions or this permit shall be deemed revoked. CONSfRUC`FION LENDING AGF-NCV ,\PPLICANI'CISRT'IF ICA'1'ION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.1 agree to comply with all city and comity ordinates and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCIII"fF:Cr'S DF.CL.\R.\'TION with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plats shalt be used as public records. 9.18. Licensed Professional Signature Date 12-09 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING,DIVISION 10300 TORRE AVENUE •-CUPERTINO, CA 95014-3255 GUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildinoCG)cuoertitio.oro , ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION;DEFERRED ORIGINAL PERMIT rI PROJECT ADDRESS \.1111/ I r Ztj�I111CA APNq OWNERNAME l� �I_I � Voor% PH 27, —L� 31- : 6 E-MAIL STREET ADDRESS>�111\/ VII _ r,rt�� n^ ' CITY, STATE,ZIP ./� •(•f� /�'\,rt 111, FAX CONTACT NAME 7 �,(�� (/tet;` 11/Y PHONE W fff��T l�j•� -1 IL V 1 IWA7 O /,Qc e � / �� - ZE-MAIL STREET ADDRESS CITY,STATE, 2IP FAX J ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT *CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT .❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME n �"i.j I L 1_/ c9 �� LICENSE NUMBER a p g4 LICENSETYPE BUS.LIC.0 COMPANY NAME ✓_ E-MAIL FAX 6 ,9 ; C� ST' C- ✓D l STRE TADDRESSJ CITY.STATE,ZIP PH E ai v -7 RILL et:- ray Tvs > C a7 7a�'- 3i ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC p COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK A / EXIST GUSE PROPOSED USE CONSIL E I OSTORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXLSro NEW FLOOR DEMO TOTAL AREA AREA TXT AREA NEr AREA. BATHROOM KITCHEN OTHER REMODELAREA REMODEL ARE\ REMODEL AREA PORCH AREA DECK AREA TOTALDECKNPORCHAIUA I GARAGE AREA: 0 DETACH El ATTACH A DWELLNG UNITS. ISASECONDUNIT LJYES SECOh'DSfORY / BEINGADDEDT ONO ADDITION? PRE-APPLICATION IFYES,PROVmECOPYOFF ISTHEBLDGAS � RECEIVED - - TOTAL VALUATION: PLANNINGAPPLA NO PLANNING APPROVAL LEITER EICHLERHOMF.? � - _ /. � �4D 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. 1 have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I'ngree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of ApplicandAgent: Date: d C SUPPLEMENTAL INFOR,NATION REQUIRED - PL\NcuecKrvPe - ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for �Ly`OVER-TINE-COULTER. �'�ATj"��UIbDL\G•PL\S REVIEW building(s). Demolition perrnit is required prior to issuance of building �(/-�` //�V permit for new building. - L� EXPRESS "L-I PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11STA,'DARD - ElPUrn.164ORKS form if any Hazardous Materials are being used as part of this project. ❑, LARGE _ - - C3 FIRE oerT _ Copy of Planning Approval Letter or Meeting with Planning prior to ,❑ •\I\JOR.. _ ❑ $A\IT\Rl'SEN'Eft DISTRICT' ' f submittal of Building Permit application. . . - -❑ ENVIRONMENTAL HE\LTII. B19g7pp_2011.doc revised 06121111 .J_ -- - - - - -- -- = - CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION :Q:hA%DDRF!SS: 21115 Lauretta Dr DATE: 09/04/2012 REVIEWED BY: Sean BP#: 'VALUATION: $2,800 *PERMIT TYPE: Building Permit PLAN CIIECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1REAP11 USE: PERMIT TYPE: WORK Construct soffit and add 8 lights to master bedroom. SCOPE Slech. flan Check Plumb.Plop Check Elec. Plan Check 1 0.0 hrs $0.00 "ech. Permit Fee: Plumb.Permit Fee: Elec. Permit Fee: IEPERMIT Other,tfech.Insp. Other Plumb lacp. Other Elec.Insp. 0.0 hrs $45.00 A1ech. Insp. Fee: Plumb. host.Fee: Elec.Insp. Fec: NOTE: This estimate sloes not include fees due to other Departments(i.e. Planning, Public Btorks, Fire,Sanitary Sewer District,School District,etc.). Thesefeu are baser/on the prelinzinan information available and are only an euimate. Contact the De t or addn'I info. FEE ITEMS(Fee Resohtpon II-053 EfI MLI/I FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 8 # Electrical Suppl. PC Fee: Q Reg. O OT 0.0 hrs $0.00 $67.00 IBREMFUT Fixtures, Lighting PME Plan Check: $0.00 Permit Fee: Hourly Only? 0Yes 1'Q No $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 Consimetion Tar: Administrative Fee: 1sDMIN $42,00 O Work Without Permit? O Yes 0 No $0.00 0 Advanced Planning Fes. $0.00 0 hours Inspections E) Travel Documentation Fee: ITRA VDOC $45.00 $266.00 ISTINSP Inspection, Hourly Strong Motion Fee: IBSEISAHCR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $133.50 $333.001 TOTAL FEE: 1 $466.50 Revised: 07101/2012 RECEIVED AUG 0 4 2012 _ LfX/ 4 i 2,V, 0 I I � L I O 4-X4 ' \ COMMUNfTN DEVELOPMENT D RTMENT (u\ BUILDING DIVISION-CUPERTI 7 APPROVED This set of plans and specifications MUST be kept al the changes or alterations on same,or to deviate therefrom,without apm the Building Official. The stampingof this plan and specifications SHALL NO TOFFICE be held to permit or to be an approval of the violation C L L /v O �1 e prpvic�of any City Ordinance or State Law. ------------- yN /7gTG/� DATE 9' A/. per PERMITNO. x/061 96O6Y