11080079 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10337 COLD HARBOR AVE CONTRACTOR:SIGURA CONSTRUCTION PERMIT NO: 11080079
INC
OWNER'S NAME: LU,YING&GENG 614 NATIONAL AVE DATE ISSUED:08/10/2011
O R'S PHONE: 4085178832 MOUNTAIN VIEW,CA 94043 PHONE NO:(408)736-7952
❑ LICENSED CONTRACTOR'S DECLARATIONf—
�--- BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# p �< # r
MECH RESIDENTIAL COMMERCIAL
Contractor/�L!t`!�C CO;- s�--* Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:KITCHEN(150SQFT)&BATH(60SQFT)REMODEL;NON-
(commencing with Section 7000)of Division 3 of the Business&Professions STRUCTURA
L&INCLUDE NEW LIGHTING AT LIVING ROOM
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 Sq.Ft Floor Area: Valuation:$20046
permit is issued.
APPLICANT CERTIFICATION APN Number:36910007.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless 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,th plicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-p source reollations the Cupertino Municipal Code,Section
9.18. _
Issued by /,
�- Date• 't r'
Signatur Date '
G OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,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(Sec.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 BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I 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 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal 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(a)should I 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 Quality Management District I will
I certify that in the performance of the 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 Health&Safety Code,Sections 25505,25533,and 25534.
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 Ow or autho ' d age r
forthwith comply with such provisions or this permit shall be deemed revoked. 1' ate: V__1411141
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws 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
it nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
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. I understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36910007. 00
DATE ISSUED. . . . . . . : 08/10/2011
RECEIPT #. . . . . . . . . BS000014377
REFERENCE ID # . . . : 11080079
SITE ADDRESS 10337 COLD HARBOR AVE
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LU, YING & GENG
ADDRESS . . . . . . . . . . : 10337 COLD HARBOR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-3329
RECEIVED FROM . . . . : ILAN SIGURA
CONTRACTOR ILAN SIGURA LIC # 28892
COMPANY SIGURA CONSTRUCTION INC
ADDRESS 614 NATIONAL AVE
CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94043
TELEPHONE (408) 736-7952
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 20, 046 . 00 1. 00 0 . 00 1 . 00 0 . 00
1BREMFIXT NO. FIXTURES 4 .00 65. 00 0. 00 65 .00 0. 00
1BSEISMICR VALUATION 20, 046 . 00 2 . 00 0 . 00 2 . 00 0 . 00
1EPERMITFE FLAT RATE 1 .00 44 . 00 0 . 00 44 .00 0. 00
1REMRESBAT SQ FEET 60 . 00 588. 00 0 . 00 588 . 00 0 . 00
1REMRESKIT SQ FEET 150. 00 588 . 00 0 . 00 588 .00 0. 00
1TRAVDOC FLAT RATE 1 .00 44 . 00 0. 00 44 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 1332 . 00 0. 00 1332 . 00 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 1, 332 . 00 VISA
---------------
TOTAL RECEIPT 1, 332 . 00
II ('�5xDo1l
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
CUPERTIIVO (408)777-3228 • FAX(408)777-3333 • buildingQcupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROTECT ADDRESS 10-331 CU0® HA P-43 d,^ A\) APN#
OWNER NAME L_l l PHO -IU fJ I -U�J E-MAIL
I(JC1-L-U �'1i-�RIL.
STREET ADDRESS CITY, STATE,ZIP FAX
V)3%3_7 LOLD HRH 12 Cu PERTT►•Z) CA G
CONTACT NAME ��77 �[ r PHONM) E-MALT
STREET ADDRESS;^y �ATl ONtN� �� CITY,STATE. ZIP C� y �711D-2j�
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR "D&CONTRACi'OR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME i L_t\' \ 15\Gu LICINSE BE `_)n : LI SE TYPE ` BUS.LIC#
COMPANY NAME G16i n�J1 COK5��ry� E-MAILIilFAX �u >7�(O/� 1
V lJ � &S)IOU PA " C) 7U1J. v
STREET ADDRESS CITY,STATE,ZIP PH NE
1�i1�i-t OI.)A L AVE-- r.�Txt v Ew C O .7y
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
')ESCRIPTION OF WORK eATO R 0 O J
EL
I-ITLEIJ Rk_=KAL_ - 1�CLUbI Prt�l�lT�01Jl� 1. Ll C�i-QTS.
A i--)pi i100-A1, LA Ca H-1 FI XTU ► J LA &t R-C)C)
EXISTING USE PROPOSED USE CONSTR.TYPE I #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL , //� /
AREA AREA AREA NET AREA {� >�_ V v 20r�
BATHROOM =CHEN OTHER
REMODEL AREA liJlJ REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECIUPORCH AREA GARAGE AREA: DETACH
ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? ONO ADDITION? []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY:. TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pr_rperty owner's behalf. I have read this ('
application and the information I have pro . d is correc ave read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bu' ' construc' I authorize representatives of Cupertino to enter the above-identi ed property for inspection purposes.
Signature of Applicant(Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE E2UTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit fora-66-THE-COUNTER BUILDING 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 1-1STANDARD ❑ 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 ❑ sANTTARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10337 cold harbor ave. DATE: 08/10/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: 1$20,046
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM
USE: PERMIT TYPE:
WORK kitchen and bath remodel non structural include new li htinq at living room.
SCOPE
Elec.Plan Check 0.0 hrs $0.00
Elec.Permit Fee: 1EPERMIT
Other Elec.Insp. 0.0 hrs77 7, $44.00
NOTE. These ees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info.
FEE ITEMS (Pee Resolution 11-05,f.: r-'11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.f. Remodel,Kitchen(<=300 sf)
Suppl.PC Fee: Reg. OT 0.0 hrs $0.00 $588.00 IREMRESKIT
PME Plan Check: $0.00 = s.£ Remodel,Bath(<=300 sf)
Permit Fee: $0.00 $588.00 IREMRESBAT
Suppl. Insp. Fee<D Reg. 0 OT 0.0 hrs $0.00 ® Electrical
PME Unit Fee: $0.00 $65.00 IBREMFIXT Fixtures,Lighting
PME Permit Fee: $44.00
Acoustical Fee: 0 Yes (D No $0.00 0
Work Without Permit? 0 Yes (j) No $0.00 G
Planning, Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fee: ITRA VDOC $44.00 Building or Structure 0
i
Stron: Motion Fee: IBSEISMICR $2.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $91.001$1,241.001 TOTAL FEE: $1,332.00
Revised: 07/04/2011
PROJECT DATA - RESIDENTIAL
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
t4
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
C U P E FtTI P+1E 0
(408)777-3228• FAX(408)777-3333•building(cr?.cupertino.org
PROJECT ADDRESS 16 2 7 Co �a -
APN#
c
OWNER NAME PHO E-MAIL
1AW
STREET ADDRESS CITY, STATE,ZIP FAX
C�•L Lam(/' h d
APPLICANT NAME PHIE-
p rf
STREET DRESSCITY,STATE, ZIP FAX COV
s2/ �l y 4A/
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENTCu ONTRALIOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINIER ❑ DEVELOPER ❑TENANT
r DESCRIPTION O *ORK
4-1
m ,70
EXISTINGUSE(S): PROPOSE USE(S):
OCCUPANCY(S): n TYPE OF PARCEL
u !� CONSTRUCTION: AREA:
FIRE Y N WUI AREA: Y N FLOOD AREA: Y N SIESMIC AREA: Y N
SPRINKLERS:
Existing Proposed
Floor Area: First Floor: s.f. s.f.
Second Floor: s.f.
Garage s.f. s.f
TOTAL: s.f. S. • .
rl
Y �
Are there at least two 10 feet by 20 feet clear spaces inside the garage? Y N ?
Is privacy protection planting required for the project? Y N
Governing Codes: 2010 California Building Code(based on the 2009 International Building Code)
2010 California Residential Code (based on the 2009 International Residential Code)
2010 California Plumbing Code(based on the 200" IIN INO
2010 California Mechanical Code based on the 2009 ni orm ec anica o;jARTMENT
2010 California Electrical Code(based on the 2009 Internatic "RQ% e)
2010 California Energy Code This set of plans and specifications MUST be kept at the
2010 California Green Building Standards q@dtite during construction. It is unlawful to make any
Cupertino Municipal Code changes or alterations on same,or to deviate
therefrom,without approval from the Building Official.
The stamping of this plan and specifications SHALL NOT
be held to permit or to be an approval of the violation
of any provisions of any City Ordinance or State Law.
BY [ Q-A
r-
- 9/11/0
DATE
PERMIT NO. G'
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Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
C U P E RT I N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: d -31PERMIT# 1 �0 U7
OWNER'S NAME: /h Z PHONE# C�Ca Z.
GENERAL CONT CTOR: S Z BUSINESS LICENSE #
ADDRESS: 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 SUB NTRACT S H OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
ignature 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