13020018 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10302 TERRY WAY CONTRACTOR:CLAROS PERMIT NO: 13020018
V 7 CONSTRUCTION
OWNER'S NAME: LIAO CHUNG H AND BEI W 3843 WILLOWOOD DR DATE ISSUED:02/05/2013
OWNER'S PHONE: 4083931758 SAN JOSE,CA 95118 PHONE NO:(408)266-3384
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lic.# a '/(p /' ® REMODEL(E)KITCHEN&(E)HALL BATHROOM,NO
�U f D C ( $�V 1 R Sa e t-5 — 1
STRUCTURAL CHANGES.REPLACE 6(E)WINDOWS& I
Contractor "t
I hereby affirm that I am licensed under the provisions of Chapter 9 SLIDING GLASS DOOR(TEMP.&TO MEET EGRESS
(commencing with Section 7000)of Division 3 of the Business&Professions WHERE � )
Code and that my license is in full force and effect. V N / T y
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 which this permit is issued. Sq.Ft Floor Area: Valuation:$28900
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 Number:35917012.00 Occupancy Type:
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 and county ordinances and state laws relating VyITHIl�T 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS F 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 Z /
granting of this permit. Additionally,the applicant understands and will comply Y' Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
/y�/�
RE-ROOFS:
Signature (/�/.�i,n�X Date � -S 1; All roofs shall be inspected prior to any 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 DECLARATION
Signature of Applicant Date:
I hereby affirm that I am exempt from the:Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I 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&Safety Code,Section 25532(a)should I store or handle hazardous
1 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 Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor.Code,for the performance of the work for which this Owner or authorized agent: ' Date:)
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any mannerso as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING 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
APPLICANT CERTIFICATION Lender's Address
1 certify that I have read this application and state that theaboveinformation is
correct.I agree to comply with all city and county ordinances and state laws relating
to building concoction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
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
CONSTRUCTION PERMIT APPLICATION /gyp
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION /� V
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 to�/
CUPERTINO (408)777-3228• FAX(408)777-3333•buildinGt7G cuoertino.orG
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PRO]ECT ADDO >��� t M. /�f ,/^�� APN# 359 C 12
OWNERNAT¢4. eA , ��AWO,-S l� (�/V1• o' 393 _ l �- -MAIL
STREET ADDRESSZ ,STATE P" S0� FAX
CONTACT NAME PHONE &MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ owi E -B=Ea. ❑ owNERAGENT ❑ CONTRACrOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ ]EITANT
CONTRACTWK AM \O L� OS LICENSE�Mp�Ij O LI SE TYPE BUS.LIC# Z , 13
CO�e I_��bS Ce�NST UC.�) O /J 1-II IL E,GI-A"(Z�S O .C.D FAX
STREET ITY,STATE,ZIP P ONE
3 W 1 L-L_o W ooa D IZ. ose CFI 951 ! 8 08.386 - oq Y'1
ARCHITECT/ENGINEER NAME LICENSENUMBER BUS.LIC#
COMPANY NAME &MAIL FAX
STREETADDRESS CITY,STATE,ZIP PHONE / -
DESCRIPTION OF WORK K i -C�'le 01. n 6 al4- r O o an rP node r lac
(Q W� was anA o SUAInq door,
EXISTBJG USE PROPOSEDUSE CONSM TYPE #STO
5`A,M/ Ir USE TYPE OCC. SQ.FT. VALUATION(S)
AREA AR FLOOR AREA �T�
BATHROOM I =CHEM �-+,y OTHER
REMODELAREA Lf0 REMODELAREA XL�Gt REMODEL AREA A1 /J
PORCHARFA DECKAREA TOTALDECK/POV RCH AREA GARAGEAKEA: DETACH
[]ATTACH
#DWELLWGUNRS: ISASECONDUNIT []YES SECONDSTORY YES
BEMGADDED7 []NO ADDMONr []NO
PRE-APPLICATION ❑YES T YES,PROVIDE COPY OF ISTHEBLDG AN ❑YES E ,�,41111 z S a72 TOTAL VALUATION:
PLANNINGAPPL# []NO PLANMO APPROVAL LETTER EICHLER HOME? NO S 01173 MOM 0 :W. �o
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 is accurate. I agree 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 Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUII2EDu.--ei'wcitecxiye z."'- i."k«ry AouniwGSLte"N4a'!�,.
New SFD or Multifmil dwellings; Apply for demolition permit for n OV'ER`wIfi'& D
❑ sudDr�G PLn%xevlEw`y'
existing building(s). Demolition permit is required prior to issuance of buildingFM
i
permit for new building. '� ExeREss-��a t '� '❑,&PLA ING PLAN xsviEw t '
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
foam if any Hazardous Materials are being used as part of this project. ��§<� ��,rez ❑ i;meE nEPT 'aa
Copy of Planning Approval Letter or Meeting with Planning prior to ` �
submittal of Building Permit application. o-�<MaTo ❑ sANrrnRYseIYERnlsratcT ,XXiss„,,
��^.,.,,3si.(g-k"by °s'u'Ki'i�t..vC`x .❑.EI�R7RONAiENTAL HEAL E 't'�di".
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PERMIT NO. UZ 00l e ��, vyti,+
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Building Department
City Of Cupertino
I.ONTorre�Vmue
Telephone:408-777-3228
CU P E RTI NO Fax:408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: 10 '362. . I.,e-6+r Lu6t4 PERMIT#
NAME: eI W e,J - �-i 4z ` PHONE# 4198 -35C -
OWNER'S p I l
GENERAL CONTRACTOR: b BUSINESS LICENSE#
ADDRESS: 3 w ' 6 am' I ITY/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., �J ��, / - S_ /-?I am not using any subcontractors: k�/�- A Date
-:71-= Signature
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE#
Cabinets &Millwork
Cement Finishing'
Electrical g
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass/Glazing
Heating
hlsulation
Landscaping
Lathing
Masonry
Painting/Wallpaper dfAW
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock CSS
Tile
MAL, 13
Owner/Contractor Signature. Date
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10302 TERRY WAY UNIT 4 DATE: 0210512013 REVIEWED BY: MELISSA
APN: 359 17 012 BP#: 'VALUATION: $28,900
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD Or Duplex PENTAMATION 1 R3SFDREM
USE: PERMIT TYPE:
woRK REMODEL E KITCHEN & E HALL BATHROOM NO STRUCTURAL CHANGES. REPLACE 6 E
SCOPE WINDOWS & 1 (E) SLIDING GLASS DOOR (TEMP. &TO MEET EGRESS WHERE REQ'D
x
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Nfech. Plan CheckPhanb. Plan Check P•lec. Plan Check
,bfech. Permil Fee: Plumb.Permit Fee: Elec.Permit Fee:
Other,lfcch. Insp. Other Plumb ln.tp. Other Elcc', Insp. Ej
,Mesh.Insp. free.- Plumb. btsp. Fee: Elec.Insp.Fes.
NOTE:This estimate does not includejees due to other Departments(Le,Planning,Public Works,Fire,Sanitary Sewer District,School
District eta). These fees are based on the prefindna in ormation available and are only an estimate. Contact the Dept for addh7 info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/121 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 40 s.f. Remodel,Bath(<=300 sf)
Suppl.PC Fee: 0 Reg. 0 OT0.0 hrs $0.00 $600.00 1REMRESBAT
PME Plan Check: $0.00 86 s.f Remodel,Kitchen(<=300 sf)
Permit Fee: $0.00 $600.00 IWIORESKIT
Suppi. Insp. Fee-.0 Reg. 0 OT 0,0 Ins $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tns:
Administrative Fee: O
Work Without Permit? Yes 0 No $0.00 0
Advanced Plannine Fee: $0.00 Select a Non-Residential 0
Travel Documentation Fees: Building or Structure oA
Strong Motion Fee: IBSEISMICR $2.89 Select an Administrative Item
Blde Stds Commission Fee: 1BCBSC $2.00
4.89 $1,200.00 OTAL�EE $1,204.89
K m .t• 6. "t F •.._ $ .t f
Revised: 01/01/2013