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12090133 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20609 SI TELLY DR CONTRACTOR:KUANG'S PF.RMITNO: 12090133 CONSTRUCTION CO OWNER'S NAM F: Cl IEN HUNG AND CHYU LINGLING PO BOX 4802 DATE ISSUED:09/142012 OWNER'S PHONE: 4082198061 ELDORADO HILLS,CA 95762 PIIONE NO:(916)941-2378 ❑ LICENSED CONTRACT'OR'S DECLARA'T'ION .1013 DESCRIPTION: RFSIDEN T7AI.U COMMERCIAL '`7 2 REPAIR 3 FOOT SECTION OF FOUNDATION License Class Lic.t! —7--?U � Contractor (A) r atc- 17_ hereby affirm that I am license under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business K Professions Code and that my license is in full force and effect. I 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 whichthis Permit is issued. Sq.Ft Floor Area: Valuation:$1000 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\umber:35911020.00 Occupaney'1'ype: 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 correct.I agree to comply with all city ad county ordinances and suite laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentimed property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the graining of this permit. Additionally,the applicant understands and will comply Issued by: 249&-1V r �zl Date: -�a— with all non-point source re uI tions per the Cupertino Municipal Code,Sectio 9.18. _ RE-ROOFS: Signature r _ Dat�—I / 'j. 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-BUILDER DECLARA'T'ION Signature of Applicant: Date: I hereby affirm(hot 1 am temp from the Contractor's License Low for one of the following two reasons.. ALI,ROOF COVERINGS TO BE CLASS"A"OR 13F;ITER 1,as owner of the property,or my employees with wages as their sole comp:nsation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I.as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIAL-S DISCLOSURE construct the project(Sec.7044,Business d Professions Code). 1 bare read the hazardous materials requirements under Chapter 6.95 of the California Health S Safety Code,Sections 25505,25533,and 25534. I will hereby affirm under penalty of perjury one of the following 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. Additionally,should I 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[Say Area Air Quality Management District performance of the work for which this pemhit is issued will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&&Safety Code,Sections 25505.25533, J 25534. Section 3700 of the Labor Code,for the performance of the work for which this �-i Owner or authorized agent: Detc: permit is issued I certify that in the performance of the work for which this permit is issued,I shall _ r 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,) CONSTRUCTION'LFNDING 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 APPLICAM'CF.RTIFICATION 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 slate 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECI"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 ADDRESS: 20609 Shelly Drive DATE: 09/1412012 REVIEWED BY: Sean APN; Bpq: 'VALUATION: $1,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY PENTAMATION USE: SFD or Duplex pER�tITTYPE: 1GENRE WORK Re air three foot section of foundation. SCOPE ,arch. Plan Check Plumb. Plan Check Flee.Plan Check Me& Permh Fee: Plumb. Permit Fee: Elec.Permit Fee: Other¢loch. Insp. Ocher Plumb Insp. Other F•Iec.Insp. Li I Ale.ch. /nip. Fee: Plumb. losp.Fee., Elec.Insp.Fec: NOTE: Thisestimate 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 dee prelinainan information available and are only an estimate. Contact the Det fi7r addn't info, FEE ITEMS (Fee Resohuion 11-053 E(T 7/1/1/) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 1 hours Plan Check, Hourly Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $133.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes 0 No $0.00 SuppL Insp. Fee.0 Reg, 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C011Slrnctirm Tar: Administrative Fee: 0 Work Without Permit? 0 Yes No $0.00 0 Advanced Planning Fee: $0.00 0 hours Inspections Q Travel Documentation Fees: $133.00 /STINSP Inspection, Hourly 0 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 i i SUBTOTALS: $1.50 $266.001 TOTAL FEE: $267.50 Revised: 07/01/2012 B@IgApp_201 Ldoc reviser/06121//l CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 01!� C U P ERTI N O (408)777-3228• FAX (408) 777-3333• buildino(GDcupertino.oro ,r'tp�1 ❑NEW CONSTRUCf10N ❑ ADDITION D6 ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS / /o" 'r '"�,• .\PNM ✓ ✓ I I W JJ /✓ I V OWNER NAME PHONE •OS �I pD� E-NAIL STREET ADDRESS CITY,STATE,ZIP FAX CD coal —9. CONTACT NAME /(10 PITON / E-MAIL STREETADD v g,,, CT1-.STATE- FAX O OWNER O OWNER-BUILDER O OWNER AGENT Ln'CON, ACTOR El CONTRACTOR AGENT O ARCHITECT ❑ENGINEER ❑ DEVELOPER O TENANT CONTRACTOR NAME r LICENSE NUMBER LICENSE TYPE BUS.LIC M COMPANY NAME E-MAIL / FAX u xr-C S' Cc�.�15' r,.cY u-•- k u . tr ' i ,�� cp- Co-.—, STREET ADDRESS CITY.STATE,ZIP PHONE ARCHITECTfENGINEER NAME AJ/ A LICENSE NUMBER BUS.LIC M COMPANY NAME E-MIAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK -Y—\ [1CIST1 G USE PROP❑ ED USE CONST. 'PIS I #Sm IFS USE TYPG OCC. SQ.FT. VALUATIONS) ESISTG NEW FLOOR DE%IO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODELAREA PORCHAREA DECK AREA TOTAL DECKIPORCII AREA GARAGE AREA: UDETACH OATTACII Y DWELLING UNH-S: IS A SECOND USIT []YES SECONDSTORY ElYES BEING ADDED7 ONO ADDITION' ONO PRG-APPLICATION OYES IF ITS,PROVIDE COPYOF I IS THE BLDGAA' OYES RECEIVED BV TOTAL VALUATION: PLANNING APPL0 ONO PLANNING APPROVAL LETTER FICIII.f:11I10ME7 ONO A/ `• - (D(/� 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 infomhation I have provided is correct. I have read the Description of Work and Verify it is accurate. I agree to comply With all applicable local ordinances and state laws relating to building constm ion I authorize representatives of Cupertino to enter the ahove-identified property for inspection purposes. Signature of ApplicwhUAgenC ' (l Date: Ir — _ SUPPLEMENTAL H ORN-IATION RG IRED viaNCiiCCR -YPE ��,,,rrr ROUTINGSi;lr New SFD or Multifamily dwellings: Apply for demolition permit for DYER.- -CounTER L7e,�BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building / permit for new building. ❑ "EXPRESS ❑! PLANNING PIAN.REVIEW _Commercial 13ldgs: Provide a completed Hazardous Materials DiSCIOSUre Ell STANDARD ❑ PIJIIIACwORRS foml if any Hazardous Materials are being used as pan of this project. ❑ LARGE ❑ FIRE DEFT _Copy of Planning Approval Letter or Meeting\vith Planning prior to submittal of Building Permit application. EJMAJUR' ❑ S,\NI'r.\Rl'SE\1'F,R DISI'RICI'/ ❑ F;N\'IROR,\IF-NTALUKALTH' I 131dgApp_20l Ldoc revised 06/21/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 L U P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOBADDRESS: PERMIT# OWNER'S NAME: PHONE # GENERAL CONTRACTOR: ' — BUSINESS LICENSE# ADDRESS: 0 1 CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino busines license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE. SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTR CTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Z S gnature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &•Millwork Cement Finishing Electrical Excavation Fencing Flooring./Carpeting Linoleum / Wood Glass/Glazing Pleating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date z a) n el Ibl • �N jo r I i Y (�✓ --V( \ � ti. � n. rr - z `o 3 Grj ._ C dom0 ¢ o m E> o, x > � mom c � m (n � yoa cfo a¢ � 3« m 00 m w W N o m m m c I� �a Lo OF c' c m � m wv 13J o « N E •0 d- �-- n aQ � _ a,' O O q N r '\ a pC) (L �r l y2m a� :� TZ c vb Q z� m 0 , La a rn - o o• U o 'o m a.o a O N y V E m C C O « IED O - m o a ll 0 d W U co a Q W o am i Vm' o o W u- N w � m u d r I- / Pliirfvs � 7