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09100086 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10380 MILLER AVE APT 1 CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO:09100086 OWNER'S NAME: JENNIFER LIECHUAN AND DEMING CHA DATE ISSUED: 10/13/2009 ( 'sR'S PHONE: 4086425658 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT f— PLUMB License Class Lic.# MECH f- RESIDENTIAL f- COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMODEL KITCHEN CABINETS/COUNTERROP (commencing with Section 7000)of Division 3 of the Business&Professions REPLACEMENT, Code and that my license is in full force and effect. ADD CEILING LIGHT,2BATHROOMS SINK/CABINET& TOILET REPLACEMENT,CHANGE SHOWER FAUCET,BEDROM I hereby affirm under penalty of perjury one of the following two declarations: 0 Lt p W S ✓�� C�4�. 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:$10000 permit is issued. APPLICANT CERTIFICATION APN Number:37504017.01 Occupancy Type: 1 certify that 1 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 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,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued b Date: ��1 Signature Dateb�� OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that 1 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,1 agree to remove all new materials for I,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: 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 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. permit is issued. Additionally,should I 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 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 Owner auth ent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 i nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address cam, 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 source regulations p. Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature .l/ ' Date� Licensed Professional CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 37504017 . 01 DATE ISSUED. . . . . . . : 10/13/2009 RECEIPT #. . . . . . . . . BS000008908 REFERENCE ID # 09100086 SITE ADDRESS . . . . . : 10380 MILLER AVE APT 1 SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : JENNIFER LIECHUAN AND DEMING C ADDRESS . . . . . . . . . . : 10380 MILLER AVE APT 1 CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JENNIFER L CHA CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 10, 000. 00 2 . 00 0 . 00 2 . 00 0 . 00 1BREMFIXT NO. FIXTURES 1. 00 126 .00 0 . 00 126 . 00 0 . 00 1BSEISMICR VALUATION 10, 000. 00 2 .00 0 . 00 2 . 00 0 .00 1EPERMITFE FLAT RATE 1. 00 84 . 00 0 . 00 84 . 00 0 . 00 1PPERMITFE FLAT RATE 1 . 00 84 . 00 0 . 00 84 . 00 0 . 00 1PREPPIPE FLAT RATE 3 . 00 252 . 00 0 . 00 252. 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 84 . 00 0 . 00 84 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 634 . 00 0 . 00 634 . 00 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 634 . 00 AMEX --------------- TOTAL RECEIPT 634 . 00 0710 0 8� CITY OF CUPERTINO -t- ADDITION/REMODEL CUPEI�TINO PERMIT APPLICATION FORM APN # Date: n 2 00 Is a 2" unit being added? Yes 1:1No 0If yes, please fill out the permit application for 2" unit. Building Address: 0 D Mailing Address (if different from biAlding address): Owner's Name: Phone# ", r C, a. C i t v S SL - -� Contractor: Phone#: (4. 0 22-- ► ' 01 r► Fax#: Contracto icense#: �?"q bb o _ Cupertino Business License#: Contact: ` Phone#: CCe I I ) 6•9b ¢0 0 U Ip C41 Q Fax#: Building Permit Info: Bldg. Elect. Plumb. Mech. ® Hillside ❑ Job Description: Addition-What is being added?(Be Specific): ,n//A What is being remodeled (not including addition)? h Cab+ ��tsrCIOVAf r, op , a ba rK +h �ar�5 sin /Cnb= nefiI fico Iefa�m� � ` Remodel Includes Re-Roof. Yes ❑ No ® If yes list number of squares Remodel Includes Structural: Yes ❑ No ® 1&Ar4_Nw, dA Do you have the pre-application planning approval? Yes ❑ No If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen Bath_ Other Type of Construction (Usage Class): Occupancy Type: 1-A 1-B II/III/V-A ❑ IUIII B, IV-HT, V-B J�;J� Valuation: toV Please check this box if the project is a t� second-story addition ❑ Project Size: Expressandard ❑ Large ❑ Major❑ Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, Green Building Points Achieve include in plan set& the sheet index. ***For Office Use Only*** Over-the-Counter ❑ Revised 07/06/09 CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft 1 REMRES2 Remodel Residential B Greater than 1000 sq ft 1REMRES3 Remodel Residential B Greater than 2500 sq ft. 1REROOFRES Residential Re-roof Each B 100 SF REMODEL PLNCK 1 STPLNCK(1-3 for Standard Plan Check B NOT FOR OVER THE remodel) COUNTER PLAN CKS. WINDOW/SLIDING 1R3SFDREM GLASS DOOR .� 1 WINREP Replacement windows B (ea 8 windows) 1 WINNEWNSTR New Window (non- B structural IWINMEWSTR New Window (Structural B Shear Wall/Masonry) 1 WINBAYSTR Bay Window (Structural) B SKYLIGHTS 1R3SFDREM 1 SKYL<l0 SF Skylight less than 10 sf B 1 SKYL>10SF Skylight greater than 10 B sf or structural 1STAIRS Stairs-first flight/ea addt'l B IEPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M IPPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln E Ck (hourly) CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft 1 MECPLNCK Stand Alone Mechanical M Pln Ck (hourly 1PLMPLNCK Stand Alone Plumbing P Pln Ck (hourly) 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1 BSEISMICRE Seismic Residential B 1TRAVDOC Travel &Documentation B 1BUSLIC Business License B f1r, 0-pipa M.In oar Air Quality and Finishes 1.Use LOw%Io-VbC Paint 1 IAQJHealth pts y--yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IA(JHealth pts y=yes 0 3.Use Low/No VOC Adhesives 3 IAOJHealth pts y=yes D 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes D 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes D 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.Seal aloleboard or WF _ 4 lAQ/Healthyt�= es D B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts Ayes 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes D 1 1 D N.Fiooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes D 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes D 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/HPan pts Ayes 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 1 1 i Total Points Available: 1 1401 1301 57 Total Points Project Received: 01 0 D G:datalprogslgreenbuiiciingguidelines/ramodslers/greenpointsfina1212D4proteoied.xis