11040001 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10129 MELLO PL CONTRACTOR:WELKIN PERMIT NO: 11040001
INTERNATIONAL IND INC
OWNER'S NAME: YEUNG WEI WEI 19925 STEVENS CREEK BLVD DATE ISSUED:04/01/2011
NER'S PHONE: 5308480739 CUPERTINO,CA 95014 PHONE NO:(408)733-0188
'T LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL
License Class 13 Lic.# 12 �,->- O TO INSALL(9)RECESSED CAN LIGHTS IN BEDRM AND
FAMILY ROOM
Contractor ral I X_ Date 10
I hereby affirm that I am f1censed 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:$600
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
APN Number:36905029.00 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 DAY 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 t
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature 54, All roofs shall be inspected prior to any roofing material being installed.If a roof is
L installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
IJ 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
1,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
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.
Section 3700 of the Labor Code,for the performance of the work for which this . �� G�
Owner or authorized agelit: �`� ;/ Dater
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 ARCHITECT'S DECLARATION
unify and keep harmless the City of Cupertino against liabilities,judgments,
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.
Signatu '' Dat
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10129 Mello PI. DATE: 04/01/2011 REVIEWED BY: RDW
APN: BP#: 'VALUATION: $600
;'PERMIT I TYPE: Electrical Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Du lex PENTAMATION 1 REAP11
USE: p PERMIT TYPE:
WORK Install 9 recessed can lights in bedrooms and family room.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Fixtures, Lighting 1BREMFIxT 9 # $63
TOTALS: $63.00
Elec.Plan Check 0.0 hrs $0.00
Elec.Permit Fee: IEPERMIT
Other Elec.Insp. 0.0 hrs $42.00
NOTE: These ees are based on the prelindnary in ormation available and are only an estimate. Contact the Dept-for addn 7 info.
FEE ITEMS (Fee Resolution 09-051 I ff 7;'1.10) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $63.00
PME Permit Fee: $42.00
Work Without Permit? Q Yes E) No $0.00
Travel Documentation Fee: ITRA VDOC $42.00 A
Stroh: Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Blommission Fee: IBCBSC $1.00
SUBTOTALS: $148.50 $0.00 TOTAL FEE: $148.50
Revised: 03/01/2011
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: o . w r- PERMIT# 1 (0 `'f O 001
OWNER'S NAME: �, �/�' PHONE# � v - U2 3
GENERAL CONTRACTOR: X - BUSINESS LICENSE#
ADDRESS: �n - '� - j j�-o/#t 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.
1 am not using any subcontractors: �T
Signature Date
Please check applicable subcontractors and complete the following information:
V 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
CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36905029. 00
DATE ISSUED. . . . . . . : 04/01/2011
RECEIPT #. . . . . . . . . : BS000013068
REFERENCE ID # . . . : 11040001
SITE ADDRESS . . . . . : 10129 MELLO PL
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER YEUNG WEI WEI
ADDRESS . . . . . . . . . . : 10129 MELLO PL
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : SHIH LO
CONTRACTOR . . . . . . . : XIE, CAIXING LIC # 24081
COMPANY . . . . . . . . . . : WELKIN INTERNATIONAL IND INC
ADDRESS . . . . . . . . . . : 19925 STEVENS CREEK BLVD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (408) 733-0188
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 600 .00 1 . 00 0 . 00 1 . 00 0. 00
1BREMFIXT NO. FIXTURES 1 .00 63 . 00 0 . 00 63 . 00 0 . 00
1BSEISMICR VALUATION 600 . 00 0 .50 0 . 00 0 .50 0 . 00
1EPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0. 00
1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 148 . 50 0 .00 148 .50 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 148 . 50 AX
---------------
TOTAL RECEIPT 148 . 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL 512 FINAL HANDI-CAP
PROJECT DATA - RESIDENTIAL
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
CUPERTINQ (408)777-3228• FAX(408)777-3333•building
CcD-cupertino.org
PROJECT ADDRESS APN#
OWNER NAME PHONE t E-MAIL
STREET ADDRESS CITY, STATE,ZIP FAX
10 ! 141C2 C-414� i-t- �'� q9_04c.
APPLICANT NAME P ON (6 SbJ SG S b' E-MAIL
STREET ADDRESI CITY,STATE, ZIP FAX
y¢b ; v WfoL �4, 3r>
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR XCONTPLACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
DESCRIPTION OF WORK, A
t
L Mai
EXIST G USE(S): PROPOSED USE(S):
OCCUPANCY(S): TYPE OF PARCEL
CONSTRUCTION: AREA:
FIRE y N WUI AREA: Y N FLOOD AREA: Y N SIESMIC AREA: Y N
SPRINKLERS:
Existinjz Proposed
Floor Area: First Floor:
Second Floor: s.f. s.f.
Garage _ s.f. s.f.
r
TOTAL: - s.f. S.f.
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 2009 Uniform Plumbin e)
2010 California Mechanical Code(based on the 2009 Uniform e)
2010 California Electrical Code(based on the 2 io al ct 'VC dei
2010 California Energy Code ~ i',_ O i "
2010 California Green Building Standards� oile ��i
Cupertino Municipal Code �S r �3
T
ProjectData-Residential.doc revised 03/09/11
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GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT.• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
- (408)777-3228• FAX(408)777-3333•building cDcupertino.org MISC
CUPERTINO 00
❑PLUMBING ❑MECHANICAL ELECTRICAL ❑MISCELLANEOUS 110410L /
PROJECT ADDRESS 0 APN# �l n v► vJ Y O t l
OWNER NAME PHONE (J/ ` E-MAIL / \J
STREET ADDRESS CITY,STATE,ZIP FFAX
e �qcz r- Cq So/
CONTACTNAME P ONE� 96 9 8 E MAIL
STREET ADDRESSCITY,STATE, ZIP FAX
p C !4Z � 7
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAMEL'a O \ LICENSE NUMBER �1z6 LICENSE TYPE BUS.LIC#
COMPANY NAMEL E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE 1-o6.
Z o of c,ra( t)r. Ga ick C C 5�0 `S F 7 b
ARCHrIECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑ SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No
DESCRIPTION OF WORK
—rQ z . C C �t� rev
7 h i e3—&—f
TOTAL VALUATION: bT) p RECE11Bn BY
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 correct. 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 buildin sTMction. I authorizejepresentatives of Cupertino to enter the above-identified property for inspection purposes.
� X
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQU1�RED
s E&ERLSSm_2yt *
MEPMiscApp_1011.doc revised 03/16/11