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12100093
CITY OF CUPERTINO BUILDING PERMIT BIIILDINGADDRF,SS: 104751MPERIAL AVE CONI'RACI'OR: / 'EItMITNO: 12100093 OWNER'S NAME: TSUN STEPHEN N AND GINGER C —r� t O c)nl DATE ISSUED: 10111/2012 OWNER'S PlIONE: 4086218220 ,� rDONENO: -t:c, LICENSED CONTRACIOOR'S DECLARATION BUILDINC PERNIIT INFO: BLDG r ELECT r1 PLUNIB Ci License Class Lie.4 O S Z?/A Lr rr q p D1ECF1 RESIDENTIAL COMMERCIAL Contractor P.x.�--,°,x-...�.,��- o!'t L2ate herebyaffirm that 1 am licensedunder the pro'was of Chapter) JOB DESCRIPTION: REPLACE SIDING AT EXISTING SINGLE FAMILY (commencing with Section 7000)of Division 3 of the Business&Professions DWELLING Code and that my license is in fn11 force and effect. 1 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. 1 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 Sq.Ft Floor Area: Valuation:$100 permit is issued. APPI,IGyNI'CER'1'I1-'ICAI'ION AI,NNumber.35719106.00 Occupancy Type: I certily 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 to building construction,and herebyauthorize representatives of this city to enter upon the abort mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep hmmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. /�— Z Issu Dal,�<jlf2 Signature ``� Dam /o— ❑ OWNIiR-BUILDER DECLARA'T'ION RE-ROOFS: herehv affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material beiig installed.If a roof is the following two reasons: installed withmx first obtaining an inspection,1 agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sce.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR ISP,17ER hereby affirm under penalty ofperjury one of the following three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's IIA--/.ARDOUS MATERIA S DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 255115,25533,and 25534. 1 will maintain 1 have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino\lunicipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code.Section 25532(x)should 1 store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Qualify Management District I will I certify that in the performance of die work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Ilealth&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,alter making this certificate ofexemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or author" agent �© f forthwith comply with such provisions or this permit shall be deemed revoked Date2— CONSTRUCTION LENDING AGENCY AI'I'LICAN'I'CFR'I'IFIG\T1f)N I certify that I have read this application and state that the above information is 1 hereby affirm that there is a construction lending agency for the perforrnmmce of work's correct.I agree to comply with all city and comely ordinances and state Imvs relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities.judgments. Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT"S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Dale Licensed Professional CITY OF CUPERTINO -I nf.n n cm�nn_Amnn_ oiil� ntAiC_Ill\llfilllN ___ I Z ' ` o09 � CONSTRUCTION PERMIT APPLICATION C COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408) 777.3228 • FAX (408)777-3333• building8cupertino.orD ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PER�jMIIT# PROJECT ADDRESS APN 1 /C)4(�s��i � � v = ON'NIERNAME I PHONE < C/ 6 STREETADDRESS CITY, STATE,ZIP FAX CONTACT NAME n ^� PHONEO D E-Ai41L V Y r STREET ADDRESS t CITY,STATE, ZIP N FAX q J 0 OWNER D OWNER-BUILDER 0 OWNER AGENT kCONMRACTOR D CONTRACTOR AGENT D ARCHITECT 0 ENGINEER 0 DEVELOPER TENANT CONTRACTOR NAME / LICENSE NUMBER , LICENSE TYRE BUS.LIC e COMPANYNAME (� p✓/I� \ 1\ 1 E-MAIL FAX STREET ADDRESS CITY.STATE,ZIP PHONE 4 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC M COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORE: EXISTING USE PROPOSED USE CONSTR TYPE a STORIES USE 'TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMOTOTAL AREA AREA AREA NETAREA BATII[ROO KITCHEN OTFRA RENIODELAREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA 7DECK7ORCH AREA GARAGEAREA: LJDETACH 0 ATTACH Y DWELLING UNITS: IS A SECOND UNIT DYES SECOND STORY DYES BEING ADDED! []NO ADDITIOS! (:)NO PRE-APPLICATION DYES IF YTS,PROVIDE COPY OF IS THE BLDG AS []YES �..RECEIVED BY: :' N-34 "� +6;' TOTAL VALUATION: PLANNa:G APPLd mN0 PLANNING APPROVAL LETTER EICBLER HO?IE! r-1 NO k ];icI2Sf' ' j By my signature below,1 certify to each of the fallowing: I am the property oW Der or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided incorrect. 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 t wilding construe' . I autho 'ze repr entatives of Cupertino to enter the above-identiifed property for inspection purposes. Signature Of AppliwndAg . Date: eo SUPPLEMENTAL INFORMATION REQUIRED 't ..,,'Y i?C_IECK-^=vim` !� r.,oq �+m�� i'LAN CIIECH;T\'1'E ROUTINC;SCII' New SFD or Multifamily dwellings: Apply for demolition permit for �'a--'�''• '' �&ms's`.fir-ti'i ' Y O,\4R 7HL COUp]ER Aa ItU1LU1\GILAN RE\IEW existing buiw buil Demolition permit is required prior to issuance of building permit for new building �❑3�LTs " � O 1 LA\�I\c i u\Re\TeW _Commercial Bidgs: Provide a completed Hazardous Materials Disclosure ��'O"y�s n�a�D`i,� z:'- "❑O 1 uRLI,~c�\\oahs ti•` :o Colin if anv Hazardous Materials are being used as pan of this project. d0 � " - • � � '. LARGE A Zu ` } FIRE ❑ y _Copy of Planning Approval Letter or Meeting With Planning prior to - '�""' a• 'cd• _ subminal of Building Permit application. 0± \IAaoR F y,ttw�r,,{a{ ® SA`IT4R1 SFS\iFis�picr '�- .1:i9�Usb A:.§ EN VIRONMIIENN.'•TA' LTN CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10475 imperial ave. DATE: 10/11/2012 REVIEIVED Bl': bobs. APN: RPN: 'VALUATION: $100 *PERMIT TYPE: Building Permit PLAN CHECK Tl'PE: Alteration / Repair PRIMARY SFD or Duplex PENTAMA"PION 1GENRES USF,: PERIIIIT TYPE: WORK [replace siding at ex. sfd. SCOPE Alech. Plan Check Plumb. Plan Check Elec. Plan Chock F1ech.Penult Fee: Ph,mb. Permit Fre: Flee.Permit Pec: Odter Much.Imp. Other Plumb Insp. Other Flce. Insp. Adech.Insp. Fee: Plumb. bop. Fee: Elec.leap.Fee: NOTE: This esrintate does not include fees elite to other Departments(i.e. Planning, Public H'orks, Fire,Sanitary Sewer District,School District, etc.). These ees are based on the prelitininan information available and are only an estimate. Contact the De t or tttldn'I in n. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/12) FEE QTY/FEF MISC ITEMS Plan Check Fee: $0.00 0 s.,f., Siding Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $0.00 All Other PME Plan Check: $0.00 Permit Fee: Hourly Only? (F)Yes O No $0.00 Suppl. Insp. Fee-.0 Reg. Q OT 0.0 [its $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tar: Administrative Fee: Q Work Without Permit? Yes Q No $0.00 E) Advanced Planning, Fee: $0.00 0 hours Inspections E) Travel Documentation Fees: $266.00 1 ISTINSP Inspection, Hourly Stron¢Motion Fee: 1eSF"1SMICR $0.50 Select an Administrative Item Bldg, Stds Commission Fee: ~IeCeSC $1.00 SUBTOTALS: $1.50 $266.00 TOTAL FEE: $267.50 Revised: 10101/2012 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: Q ^ / l-- PERMIT# OWNER'S NAME: _ PHONE # GENERAL CONTRACTOR: Co USINESS LICENSE # ADDRESS: " c3 4. CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 am not using any subcontractors: Signature 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 Heating Insulation Landscaping Lathing Masonry Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date