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11060169 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10478 S TANTAU AVE CONTRACTOR:GREEN ROCK PERMIT NO: 11060169 CONSTRUCTION OWNER'S NAME: PANG YONG AND SANDY 2064 CURTNER AVE DATE ISSUED:07/15/2011 OWNER'S PHONE: 4088879939 SAN JOSE,CA 95124 PHONE NO:(408)559-7625 ❑ LICENSED CONTRACTOR'S DECLARATIONr 7 BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class_ Lic.# !77--7 -:; -t— F MECH RESIDENTIAL COMMERCIAL Contractor(cee-a CDC,r, -Date I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMODEL MASTER BEDROOM (commencing with Section 7000)of Division 3 of the Business&Professions SUITE,BATH(183SQFT),WALK-fN Code and that my license is in full force and effect. CLOSET,BEDROOM(127SQFT),REPLACE FURNACE,WATER HEATER,ELECTRICAL UPGRADE&NEW SLIDING DOOR 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. 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 permit is issued. Sq.Ft Floor Area: Valuation:$30000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:37509047.00 Occupancy Type: 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Issued by: ❑ OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees-with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). 1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(x)should I store or handle hazardous material. permit is issued. Additionally,should 1 use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. 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. Owner or authorized ent: Dater APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 1 certify that 1 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional I CITY OF CUPERTINO BUILDING PERMIT . bot. BUILDINGADDRESS: 10478 S TANTAU AVE CONTRACTOR:GREEN ROCK PERMIT NO: 11060169 CONSTRUCTION OWNER'S NAME: PANG YONG AND SANDY 2064 CURTNER AVE DATE ISSUED:07/15/2011 OWNER'S PHONE: 4088879939 SAN JOSE,CA 95124 PHONE NO:(408)559-7625 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 17 COMMERCIAL[] License Class_ Lic.4 REMODEL MASTER BEDROOM SUITE,BATH(183SQFT),WALK-IN Contractor i�e Ole--12, 04k Date l CLOSET,BEDROOM(127SQFT),REPLACE FURNACE, I hereby affirm that I am licensed under the provisions of Chapter 9 WATER (commencing with Section 7000)of Division 3 of the Business&Professions HEATER,ELECTRICAL UPGRADE& NEW SLIDING DOOR Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: REVISION#1-REVISE EXISTING LAUNDRY/BATH AREA I have and will maintain a certificate of consent to self-insure for Worker's INCLUDES NEW STRUCTURAL CALCS.-ISSD 8/19/2011 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:$30000 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:37509047.00 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 FROM LAST 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 granting of this permit. Additionally,the applicant understands and will comply IssueM<- Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature D. 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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. 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 !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 25505,255oxi, 2 34. 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 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION 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 ner the Cupertino Municipal Code,Section Licensed Professional 9.18. r Signature _Datel -11f CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228- FAX(408)777-3333•building aQcupertino.org / NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI VISION/DEFERRED ORIGINAL PERMIT t# �( D PROSECT ADDRESS 1 oj�-7g SO<< -T611-vow APN X -3 -7-5- <390" OWNER NAME PHONE STREET ADDRESS CITY, STATE,ZIP 0 FAX 5. a i CONTACT NAME 1 PHONE A �2o c I:4) n D 408-*1 f o (eel) Co 4 <<l k. Cv�n STREET AD�RESCJ'w w '7e ," �,// CITY,STATE cA 2 FAX ❑OWNER OO❑l owNER•BuiLDER ❑ OWNER AGENT OC CONTRACTOR ❑CONTRACTOR AGENT ❑ APC=cT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME Khn5hdDud / LI E' -73 Z' LICENSE TYPE BUS.LIC N � COIviPANY_ IygME� /I L�C'1 (d rJ L KO ��//L ,• F SSC! � 1 �� STREET ADDDRERESS CITY,STATE.ZIP PHONE ARCHITECT/FNGINEER NAME LICENSE NUMBER BUS.LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORSC � 0A n5 L!/! O EXISTING USE PROPOSED USE CONSTR-TYPE ASTORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXLSTG NEW FLOOR DEMO TOTAL �-1 AREA AREA AREA NET AREA ' P VO BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA 7 REMODEL ARFA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: h DETACH ATTACH N 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 RECEIVED BY_ q TOTAL VALUATION: PLANNING APPL A ❑NO PLANNING APPROVAL LEITER EICHLER HOME? C] UAQO NO (n� By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prpperty owner's behalf. I have read this application and the information I have provided is co t 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 Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECICTYPE -ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-,�COUNTZR Butr.DING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ MREss ❑ PLANPTING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 1-1ND STAARD C1PUBUCWORKS o_rm if any Hazardous Materials are being used as part of this project. ❑ LARGE Cl i+mE WEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ irrvmormrErrrAl.HEALTH BldgApp_2011.doc revised 06/21/11 I 1 v�n � ('0g CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX(408) 777-3333• building cDcupertino.org CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITIONRATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS O W 1 G f e1 & U APN L ✓ () 1 O OWNER NAME PHONE STREET ADDRESS CITY, STATE,ZIP FAX a► v) os, eti►/b - C 9Soi CONTACT NAME PHONE E-MAI ` I rCe R0CI� tic , n Moi o - Q9 -101 (7G-�een Kack �o�IS�'u ;Ur, STREET ADDRESS CITY,STATE, ZIP FAX uJ� 20614 Cr 4 ec s4 e 4S1z o$=S5 - b ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT u'CONTRACTOR ❑CQNTRAc-rORAGENT ❑ ARCHITECT' ❑ENGINEER ❑ DEVEIOPF,.R, ❑ TENANT CONTRACTOR NAME e LICENSE NUMBER LICENSE TYPE BUS.LIC k 25927 COMP 6 r�o R ce Cdn-s (U C I E.MAIL Q e n Co osiin FAX-+D - �., STREET ADDRESS CITY,STATE,ZIP PHONE 3 �j 5 C ARCHTTECT/ENGWEER NAME LICENSE NUMBER BUS.LIC k ( J COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK'C 1,` a,u of Loom 3 ��-A GVPGC�-rte a d� P- �e r nCGe rjbc %.54-41 �Ie w SI.ca1 ; c v�e) CV" H v A C EXISTING USE�(� PROPOSED USE CONSTR.TYPE N STORIES ( Y LSI wsrs r.__k EXISTGNEW FLO DEMO TOTAL AREA AREA ���✓ AREA NET AREA \— "-W•IJIJ.I Ir BATHROOM 't`c�x, IO.TCHEN OTHER I I ----•� REMODEL AREA REMODEL AREA REMODEL-- PORCH EMOD PORCH AREA DECK AREA T--.T nR(R/DnRM AREA :dARAGE AREA: ❑ DETACH s L f / D� ❑ATTACH L 0 DWELLINO UMTS D A SECOND DNU SECOND STORY ❑YES r l.�..�..._ DI.D'iG ADDEDT ❑NO ADDITION? ❑NO PRE-APPLICATION ❑ YES IF YES.PRO VIDE COPY OF PL.1 NAME:PLANNING AFFL 0 ❑ NO MANN NG APPROVAL LETTER - - 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 corpq 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 orize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: - Date: to SUPPLEMENTAL INFORMATION REQU= PLAN 1 New SFD or Multifamily dwellings: Apply for demolition permit for J �N:rr.ix existing building(s). Demolition permit is required prior to issuance of building permit for new building. -,N PL a-W _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure G a—LCN'7ARD form if any Hazardous Materials are being used as part of this project LARGE v _ RU Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. ��" MAJOR �-- $3.:d:E�ak1.j " 7R.DT.STRCt"I' ❑: LNVMONME.YTALHEA.LTH B1dgApp_2011.doc revised 03/16111 ppp- Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 D U P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: �� � PERMIT# 61 OWNER'S NAME: o PHONE# 4-a —4 R GENERAL CONTRACTOR: G-ed&A FIG 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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. �� �—�T 11 I am not using any subcontractors: Signature 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 71 0 ne Contractor Signature Date CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10478 south tantau DATE: 08/08/2011 REVIEWED BY: bobs. APN: I BP#: 'VALUATION: 1$7,000 :J *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: 'WORK revise exisiting laundry/bath area includes new structural talcs. SCOPE E lec Piaii F7, 77 Of�Io 1!c-., ET Iqsv Fee, NOTE. These ees are based on the preliminary!!!r—ornwtion available and are only an estimate. Contact the Deptfor addn'l info. FEE ITEMS (Fee Resolution 11-0531s 7/1111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp. Fee.-E) Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Pen-nit Fee: $0.00 Colt+trui--Iwpl Tok Acoustical Fee: 0 Yes (E) No , $0.00 0 Work Without Pen-nit? 0 Yes (3) No $0.00 7_ E) Planning Fee: $0.00 Select a Non-Residential E) T Building or Structure 0—A Strong Motion Fee: IBSEISAflCR $0.70 = # Revision Bldg Stds Commission-Fee: IBCBSC Remodel $1.001 $652.00 IREVRESREM SUBTOTALS: $1.70P$652 040 TOTAL FEE: $653.70 Revise 4: 07/04/2011 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10478 s.tantau ave. DATE: 06/20/2011 REVIEWED BY: bobs. FllAPN: BP#: "VALUATION: 1$30,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: PERMIT TYPE: WORK sfd remodel master suite bath walk in closet bedroom rel lace furnace water heater, electrical SCOPE upgrade, new sliding door. Mech.Plan Check 0.0 1 hrs $0.00 Elec.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: IA PERMIT Elec.Permit Fee: IEPERMIT Other Mech.Insp. 0.0 hrs Other Elec.Insp. 0.0 hrs $42.00 NOTE: Thesefees are based on the prelindnaq information available and are only an estimate. Contact the De t or addn7 info. FEE ITEMS (Fee Resolution 09-051 E . 7/1'10 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 183 s.f. Remodel,Bath(<=300 so Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 $570.00 1REMRESBAT PME Plan Check: $0.00 = s.f. Remodel,Other Permit Fee: $0.00 $380.00 /REMRESOTIi Suppl. Insp.Fee:O Reg. © OT 0.0 hrs $0.00 0 # Window/Sliding Glass Door PME Unit Fee: $0.00 $380.00 1WINREP Replacement PME Permit Fee: $84.00 A00 amps Electrical C'r�rr4tr trd T=rr;r 7r.i $42.00 IERT<200 Services Acoustical Fee: 0 Yes (F) No $0.00 0 # Mechanical 0 Work Without Permit? 0 Yes 0 No $0.00 $126.00 IWR=<100 Furnace,Forced-Air Planning Fee: $0.00 Select a Non-Residential Q Travel Documentation Fee: 1TRAVDOC $42.00 Building or Structure 0 i Strong Motion Fee: 1BSEISMICR $3.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $131.00i$1,498.00TOTAL FEE: $1,629.00 Revised: 04/29/2011 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: "VALUATION: $0 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/Repair PRIMARY SFD or Duplex PENTAMATION PRWHEATR USE: PERMIT TYPE: WORK SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Water Heater 1PRWHEATR 1 # $25 TOTALS: $25.00 Plumb.Plan Check 0.0 hrs $0.00 Istrrc.J'LI7; Plumb.Permit Fee: IPPERMIT Other Plumb Insp. 0.0 hrs $42.00 NOTE: Thesefees are based on the prelintinary Information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (I ee Resolution 09-051 [ff. 711/10,) FEE QTY/FEE MISC ITEMS PC:Vz:c PME Plan Check: $0.00 82.,Ppi, PME Unit Fee: $25.00 CA PME Permit Fee: $42.00 Work Without Permit? 0 Yes (F) No $0.00plamlin 4 V Travel Documentation Fee: ITRA VDOC $42.00 A Strong Motion Fee: $0.00 Select an Administrative Item Bldg Commission Fee:Fee: $0.00 SUBTOTALS: $109.001 $0.00 TOTAL FEE:7 $109.00 Revised: 04/29/2011