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13010016CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19507 STEVENS CREEK BLVD UNIT 103 OWNER'S NAME: FOOK WENG CHEONG OWNER'S PHONE: 4082467866 ❑ LICENSED CONTRACTOR'S DECLARATION //7 License Classc_ - Lia H ContmctorA2&ez&:(4n Date (—Z -%P1 13 I 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 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT 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 countyordinances 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 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 with all non point s egulations per the Cupertino Municipal Code, Section 9.18. 77 Signature- Date t! �Z, ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 performanceof the work for which this permit is issued. 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 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 manner so as to become subject to the Worker's 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 forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accme against said City in consequence of the 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. CONTRACTOR: AMERICAN PERMIT NO: 13010016 TECHNOLOGIES, INC 30911 WIEGMAN RD DATE ISSUED: 01/02/2013 HAYWARD, CA 94544 PHONE NO: (510)129-5000 JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL UNIT 103, REMOVE/REPAIR (E) CEILING INSULATION (2 LAYERS, RATED) Sq. Ft Floor Area: Valuation: $4900 APN Number: 31649003.00 I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION.. Issued by: F /✓ !i Date: 1-(71-13 RE -ROOFS: All roofs shall be inspected prior to any rooting material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: I ip 1 41 - Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION nn` f0 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 20\ �v (408) 777-3228 • FAX (408) 777-3333 • buildinG ftuoertino.ora I— INEWCONSTRTIOTION R ADDITION IMALTERATION/TI F] REVISION/DEFERRED ORIGINAL PERMIT w PROTECT PDDS `07 N# !j / / 00 q5o"� JuAg „o J L.b i PHONE O . 2 b ❑ r6.% E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACTAME b�Cb PH NE MAIL Y. Robica z d Int' / - M€R—�e mac, STREETADDRESS A CITY STA ZIP _f Cli­lsw5 FAXto a ta' �I `cf-Ld -LtZA X❑J ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER TENANT COIJTRACTOErNAME c RMERA e,<WI �i�G oto vIC LICENSE ER 5-11 LICENSE TYPE - ? Zlff 5 6 BUS. LIC# oZly� COMPANY7_-NA I n�l� iR..'� F )W ' I � ^�`�Y Q —9VIZ STREET ADDRESS CITY, ST E, ZIP fJ _ f. C �J yl P�ONl ARCHITECT/ENGINEER NAME LICENSE NUMBER BUGS. LIC# COMPANYNAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF 'CORK t4c QH fLJ I!"Iq* EXISTING U E PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SOFT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTALDECK/PORCH AREA GARAGE AREA: DETACH ATTACH I #DWELLMG UNITS: IS A SECOND UNIT 11 YES SECONDSTORY ❑YES BEING ADDED? ONO ADDITION? ONO PR&APPLICATION ❑YES IF YES, PROVIDE COPY OF ISTHEBLDGAN ❑YES ;:RECEIVED BY: TOY7 VALUATION: PLANNING APPL# ONO PLANNING APPROVAL LETTER EICBLERHOME? ONO 'q 0o By my signature below, 1 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. 1 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 buildho constructio authorize representatives of Cupertino to enter the above -identified property for inspection purposes. ' Signature of Applicant/Agent: Date: SUPPLEMENT ORMATION REQUIRED ".,PDANCHECKTYPE - ROUTINGSLIP New SID or Multifamily Wellings: Apply for demolition permit foroWrt-THE.COUNTER existing building(s). Demolition permit is required prior to issuance of building - "' BUILDING PLAN REVEEW - permit for new building. ❑= SXPkESS ' ❑ PLANNING PLAN REVIEW. - _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ srANDARD . El . PUBLIC wog[cs = forth if any Hazardous Materials are being used as part of this project." ❑ '❑ _ Copy of Planning Approval Letter or Meeting with Planning prior to LgRGE • I= ❑ MAJOR❑` FIREDEPT�' ` �� �� SANITARY SEWER DISTRICT., submittal of Building Permit application. , - ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 ��� CITY OF CUPERTINO Imo% I FEE ESTIMATOR - BUILDING DIVISION i �s I -� G_.t � i li .`• i, . yr 44F._ei ADDRESS: 19507 STEVENS CREEK BLVD # I DATE: 01102/2013 REVIEWED BY: NAMES Plumb. Plan Cheek APN: 31649003 BP#: *VALUATION: $4,900 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi -Family Dwelling USE: Buildina is >3Stories ©Yes ®No PENTAMATION 1GENRES I PERMIT TYPE: WORK UNIT #103 REMOVE/REPLACE E CEILING INSULATION & DRYWALL 2 LAYERS RATED SCOPE Permit Fee: Hourly Only? O Yes Q No i �s I -� G_.t � i li .`• i, . yr 44F._ei -ssgc:`� ' � . LfN, xr .. '!f'P ' - L a 3 Fs x's,�}"i'&,� t. e I 1' GI d Atech. Plan Check Plumb. Plan Cheek Plan Check Fee: Hourly Only? 0 Yes Q No Elec. Plat Check iLlech. Peril Fee: Plumb. Permit Fee: Suppl. PC Fee: Q Reg. Q OT 0.0 Elec, Permit Fee: Other Alec h. Insp. Other Plumb Insp.Li Other Elec. Insp. jlkwh. Insp. Fee' Plumb. Insp. Fee: Permit Fee: Hourly Only? O Yes Q No Elec. Insp. (ire: NOTE:- This estimate 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 the prellmina information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 EB 711/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00F__07 hours Plan Check, Hourly $0.00 Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? O Yes Q No $0.00 Suppl. Insp. Fee -.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tar: Administrative Fee: O 0 Work Without Permit? O Yes O No $0.00 Advanced Planning Fee: $0.00 3 hours Inspections $399.00 ISTINSP I Inspection, Hourly 0 0 Travel Documentation Fees: Strong Motion Fee: IBSEISM/CR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 �4ms�s- $1.50 $399.00 $400.50 Revised: 10/01/2012 �zAT� AMERICAN TECHNOLOGIES INC. SAN FRANCISCO OFFICE 25000 Industrial Boulevard Hayward, CA 94545 January 2, 2013 5101419-5000 offs. 8001400-9353 ronrm 5101419-5010 Fa, www.amer-teeh.com City of Cupertino CORPORATE Building Department ORANGE, (A 7)4/183-9990 To Whom It May Concern:, ALBUQUERQUE, NM 5051890-7300 I authorize Louis Robles, an ATI employee to purchase and obtain a building permit on CHICAGO, It my behalf (Kyle Pickett), Gary Moore and American Technologies, Inc. using the 6301548-8150 following MasterCard 5466-1602-7962-3001 Exp. 01115 DALLAS, TX Should you have any questions regarding this letter, please contact our office at (5 10) 971/389-1800 429-5000. LAS VEGAS, NV 701/568-0800 Sincerely, n LOS0 CA 818/700-50700-50 60 NEW ENGLAND J. Kyle Pickett 603/890-1085 General Manager PHOENIX, AZ 613/434-9445 RHODE ISLAND 4011818-0050 RIVERSIDE, CA 9511681-9100 SACRAMENTO, (A 9161388-1440 SAN DIEGO, CA 8581530-1400 SAN JOSE, CA 4081361-3030 TUCSON, AZ 5201807-9400 INTERNATIONAL 0011714-183-9990 u CUPERTINO CONTRACTOR/ SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: f0(,v0j PERMIT # �&'O OWNER'S NAME: �kg `o•l i.{- PHONE # GENERAL CONTRA TORAMOL�, WVu-61- c USINESS LICENSE # ADDRESS: 2 /�0 I h �' V WaY r _ CITY/ZIPCODE: *Our municipal code regaires;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. I am not using any subcontractorsOpLa -s/ T Signature Date Please check applicable stificontra'ctors and complete the following information: Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating M Insulation - CA- kx-[U,01,Jota j' S ?�P Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock (AAICIA'h 'CQbhJc� a %G6 07 Tile Date