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13030173 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11458 GARDEN TERRACE DR CONTRACTOR:�tj( l G�7 jf_$ PERMIT NO: 13030173 Pf1-//V rIA) ";55 OWNER'S NAME: YING-CHIEH CHANG&SHU-MIN LIU DATE ISSUED:03/29/2013 OWNER'S PHONE: 4082210495 PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL0 License Class C11'. /3 3 �Lic/#' 3 �2 REPLACE 5(E)WINDOWS(NO STRUCTURAL,WILL /� P �sl Date l MEET Contractor `� P�3 EGRESS&BE TEMPERED WHERE REQUIRED) 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. Sq.Ft Floor Area: Valuation:$2800 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:36230086.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAY ERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 A M L CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the —$ Z`) i3 granting of this permit. Additionally,the applicant understands and will comply s by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 3- �1-3 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 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 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) I,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. 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 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. 2 Section 3700 of the Labor Code,for the performance of the work for which this 1 permit is issued. Owner or authorized agent: Date: 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 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 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 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 CONSTRUCTION PERMIT APPLICATION \ COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 O (408)777-3228•FAX(4 8)777-3333•building(cDcupertino.org N CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS / 'y C�y APN# �f �O O OWNER NAME/ /� ��yj�C H� P`HON$"f ^ EL-MAIL STREET ADDRESS ,J Q CITY,STATE,ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX OWNER ❑ OWNER-BuiLDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME //\ AME ` _ ) ��` LICENSE NUMBER LICENSE TYPE BUS.LIC# ?_ COMPANY NAME / o /� �S E-MAIL ` >n FAX`F�� 7-3 2 STREET ADDRESS Q / .� � CrrY,STATE,ZIP ARCHITECT/ENGINEER NAME [meq LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STA-TEE,,ZIP 1 PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: DETACH []ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? []NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES -B TOTAL�Li1ATION: PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO G%' WIN: By my signature below,I certify to each of the following: I am the property owner or authorized agent to a on operty 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 omply with all applicable local ordinances and state laws relating to building cons r 'on.l.�uthorize representatives of Cupertino to enter the above-id tified p perty for inspection purposes. Signature of Applicant/Agent:- 7M5 Date: �l SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit forOVER-THE-COUNTER UILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 Ldoc revised 06/21/11 PME Permit Fee: ---- -- - - wou Consowction Tc7x. Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C U P ERT 1 N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: l `�$ A,'- PERMIT# OWNER'S NAME: PHONE# GENERAL CONTRACTOR: G�-SS c'tc BUSINESS LICENSE# ADDRESS: la � 7o„v 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 SUBCONT CTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: _ `'/ l `Signature Date Please check applicable subcontra to s nd complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE# Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing j Z-- Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile � f3 Ow7`�tractor Signature ate CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 11458 GARDEN TERRACE DR DATE: 03/29/2013 REVIEWED BY: MELISSA APN: 359 17 012 BP#: "VALUATION: 1$2,800 %PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1GENRE woRK REPLACE 5 E WINDOWS NO STRUCTURAL WILL MEET EGRESS & BE TEMPERED WHERE SCOPE REQUIRED) -W,A Plan Check Plumb,Plan Check Elec.Plan Check iVtech_Permit Fire: Plumb.Permit Pee: Flee.Permit Tee: Other,Vech.Insp. Other Plumb Insp. ELI Other Elec.Insp. llech.Insp.Fee: Plumb. Insp.Fee. Elec.Insp.l ire: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District etc.). These ees are based on the prefiWdna information available and are only an estimate Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 5 # Window/Sliding Glass Door Suppl.PC Fee: (E) Reg. Q OT0.0 hrs $0.00 $400.00 IWINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-.0 Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction :Tax: ,4dininistrative Fee.: Work Without Permit? ® Yes (j) No $0.00 0 Advanced Planning Fee. $0.00 Select a Non-Residential E) Travel Documentation Fees: Building or Structure i Strong Motion Fee: 1BSEISILIICR $0.50 Select an Administrative Item Bldg;Stds Commission Fee: IBCBSC $1.00 $1.50 $400.00 = $401.50 Revised: 01/01/2013 De VR 00 cn 16 ::n (� m CSA 'p-t! 7i O cl. f �1 4 do J' e ,tiy� CHECKT,D MATE I' II�G DEPT ATE Rt.nr,. nFv,