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13010004 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20280 PACIFICA DR CONTRACTOR:BROTHERS HOME PERMIT NO: 13010004 IMPROVEMENT OWNER'S NAME: YUFEN WANG 2510 DOUGLAS BLVD DATE ISSUED:01/022013 OWNER'S PHONE: 4082575446 ROSEVILLE,CA 95661 PHONE NO:(408)295-0680 LICENSEDCONTItALTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL L1 OMMERCIAL License Clasrrs�� C I Lie.# REPLACE(E)5 WINDOWS,LIKE FOR LIKE - Contractor�l7Vo'l4P.LS' Date 2 r 1 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&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:certifrcate 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:$3165 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:36944015.00 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 WITHIN 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 Flr! Y ALLED 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 ]slued by: Date: 1a' 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. RE-ROOFS: Signature Date- 2 r 3 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 T� inspection. ❑ �� OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that 1 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 isnot 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 concoct 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. 1 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 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 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 9.1 2and I have and will maintain Worker's Compensation Insurance, provided for by the Health&Safety Code,Sec ' 25505, 33,and 25534. as Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: /Z 3 pernit 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 manner so as to become subject to the Worker's CONSTR CTION LENDING AGENCY Compensation laws of California. if,after making this certificate of exemption,I 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 - I certify that have read this application and 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 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 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 20280 pacifica dr DATE: 0110 2/2 01 3 REVIEWED BY: mendez APN:. BP#: `VALUATION: $3,165 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex PERMIT TYPE: 1GENRES USE: P PERMIT TYPE: WORK Remove and replace 5 windows like for like SCOPE i e1F;'i�l� �� 14 He �Pk�tl,s�? ilatr[t' yt�x. i*d t ia, ��vF...s •. { ,� yy .'�N��any.s":...:. Mech. Mon Check Plumb. Plan CheeA Elec.Plan Check ibfiv:h. Permit Fee: Plumb.Permit Fee: I Elec. Permit Fee: Other Mech.Insp, Other Plumb Insp. Other Elec.Insp. Li - A-lech.Insp.Fke: Plumb. hup.Fee: Elec.Insp,Fee.- NOTE:This estimate does'not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary SewerDistrict,School District etc.). These fees are based on the prellmin information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS(Fee Resolution 11-053 Eft 7////21 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Window/Sliding Glass Door Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $400.00 IWINREP I Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee:Q Reg. 00 Q,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ConsDuction Tax: Administrative Fel: 0 Work Without Permit? 0 Yes 0 No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential O Travel Documentation Fees: 177� Building or Structure 0, Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bide Stds Commission Fee: IBCBSC $1.00 1 $401.50 $1.50 $400.00 ,, ;; TOTALFEE Revised: 10/01/2012 t k yl J ,m.. � S s O N o w o: G wf CD o s s s acc 49* - A A CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE'•CUPERTINO,CA 95014-3255 CUPERTINO (408) 777-3228•FAX(408)777-3333•building4cuoertino.orit l 3 U I Q p0 ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION./TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECTADDRFSS /f � ^ APN# OWNER NAME �L(J. '1 PHONE zf�j ��y �./��/_l E-MAIL STREET ADDRESS w CITY,STATE,ZIP I ` K� FAX 9So1 CONTACT NAME PHONE EMAIL STREET ADDRESS CITY,STATE, ZIP FAX O OWNER O OWNER-BUDDER O OWNERAGENT O CONTRACTOR O CONTRACTOR AGENT ❑ ARCHITECT O ENGINEER O DEVELOPER O TENANT CONTRACTOR NAME S LICENSENUMBER w ^., LICENSE TYPE BUS.LIC# COMPANYNAME �/Iv� E-MAIL (� ('( FAX STREET ADDRESS tge ,w„�-� Az)gCITY,STATE,ZIP G,�I, ^M � PHONE LD _It 27 77 CA ARCHITECT/ENGINEER NAME �/ LICENSE NUMBER X C►J VZ BUS.LIC# L 1 COMPANY NAME EMAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK LW EXISTING USE PROPOSED USE CONSTRTYPE I #STOAEES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODELAREA POACH AREA DECK AREA 70TALDEIX/POACXAREI GARAGE AREA: DETACH ATTACH #DWELLING UNITS: IS A SECOND UNIT OYES SECONDSTORY OYES BEING ADDED? ONO ADDITION? ONO PR&APPLICATION OYES IF YES,PROVIDE COPY OF IS THE BLDG AN OYESTOTAL VALUATION: PLANNNGAPPL# O 'B':NO PLANNING APPROVAL LETIEK EICHLER HOMET ONO (a";- 0e) 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 relatingilding cons ' n.I authorize representatives of Cupertino to enter the above Iden if it property for inspection purposes. Signature ofApplicam/Agent: Date: l l2f �3 SUPPLEMENTAIPFORMAnON REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. v1 _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materialsare being used as part of this project. a _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. .. ENVIRON" BldgApp_2011.doc revised 06/21/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U PERTI N O Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADD V701PERMIT# OWNER'S NAME: ;; PHONE# -Z57- YY GENERAL CONTRACTOR:. K6 - BUSINESS LICENSE# 66 ADDRESS: CITY/ZIPCODE: S/Z� *Our municipal code requires;alI businesses working in the city to have a City of Cupertino business license. NO BUILDING FINALOR 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:: 3 Si64dure Date Please check applicable subcontracto nd,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 dt/13 (Ywn—er/6"diactor Signature Date