10120057 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19091 TILSON AVE CONTRACTOR:WELKIN INTERNATIONAL PERMIT NO:10120057
IND INC
i 'R'S NAME: TAIPING WANG 20731 HANFORD DR DATE ISSUED:05/02/2011
OWNER'S PHONE: 4082047529 CUPERTINO,CA 95014 PHONE NO:(408)888-9096
❑ LICENSED CONTRACTOR'S DECLARATIONf—
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.# !0 1 2 6 Z b
I MECH r RESIDENTIAL� COMMERCIAL�
Contractor Q j �1n Date Z
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:CONSTRUCT ATTACHED 2ND UNIT 696 SQ FT-SANITARY
(commencing with Section 7000)of Division 3 of the Business&Professions IS
Code and that my license is in full force and effect. SUNNYVALE'S JURISDICTION.ADDRESS CHANGED FROM
19089 TO 19091 TILSON AVE. THE MAIN HOUSE REMAINS
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
permit is issued. Sq.Ft Floor Area: Valuation:$80000
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is APN Number:37508056.2ND 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.
Date '� _)-01/ Issued by• Dated 7=-G(
❑ OWNER-BUILDER DECLARATION
I 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
1,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 stricture is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
I 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(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
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 at rued agent:
Date:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of work's
to`-•;Iding construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
L ie above mentioned property for inspection purposes.(We)agree to save Lender's Name
in. ,,inify 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.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
SFDWL - 2ND UNITS
��PERT�No FEE SCHEDULE /00005
APN# Date:
3 `TS — 08 --p�{� to — co — tc
Building Address:
I Gt 0 a0mF T u--so ry -10\ cFz;
Mailing Address (if different from building address):
Owner's Name: Phone#:
t-JC tom. rv4 (moo E) a o-� --7 S-1 9
Contractor: Phone#:
Fax#:
Contractor License#:
Cupertino Business License #:
Contact: Phone#:
!�Y t (� .�►� Fax #: ?6 o
Building Permit Info:
Bldg. 'SZ Elect. Plumb. Mech. Hillside ❑
Job Description:
Addition-What is being added?(Be Specific):
ac;td,..&", E_) L:v, rouW * -_7-
Do
Do you have the pre-application planning approval? Yes ❑ N0
If yes, please provide planners name:
Landscape Ordinance Compliance:
Landscape area in sq. ft. ( includes all irrigated areas):
If 2,500 sq. ft., or less, compliance with the Landscape Water-Efficiency Checklist is required.
If more than 2,500 sq. ft., a Landscape Project Submittal is required.
Compliance Method: ❑ Plant Type ❑ Water Budget
Square Footage:
New Construction: Attached Detached
d
Addition-Attached to existing house:
Porch: Deck: Garage: Detached Attached__
Type of Construction (Usage Class): Occupancy Type:
— 3 d
1-A, 1-B ❑ H/III/V-A ❑ IM11 B, IV-HT, V-B
Valuation: o Please check this box if the project is a
second-story addition ❑
Project Size: Express a Standard ❑ Large ❑ Major ❑
Please complete relevAnt portion of the Green Building
Checklist & attach it to the application or if applicable, Green Building Points Achieved:
include in plan set & the sheet index. �---
Revised 05/18/10
CITY OF CUPERTINO
is SFDWL - 2N" UNITS
CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
NEW 1R3SFD2ND
CONSTRUCTION (ATTACHED OR DETACHED)
1R3INSP Dwellings Inspection B
1R3PLNCK Dwellings Plan Check B
-1R3HINSP Dwellings Hillside B 1R3H2NDDW
Inspection (ATTACHED OR DETACHED)
1R3HPLNCK Dwellings Hillside Plan B
Check
1BCONSTAXR Constax-Resi/Mobile B
1GARDTW<=1K Detached Garage Wood B
1 GARDTM<=1 K Detached Garage B
Masonry
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICR Seismic Residential B
1PLLONGRNGR Long Range PL
Planning/Residential
ADDITIONS 1R3SFAD2ND
(TO EXIST HOUSE) (ADD TO EXISTING HOUSE)
lR31NSP Dwellings Inspections B
1 R3PLNCK Dwellings plan check B
1R3HINSP Dwellings Hillside B 1-R3H2NDDW
inspection
1R3HPLNCK Dwellings Hillside plan B
check
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICR Seismic Residential B
1 PLLONGRNGR Long Range PL,
Planning/Residential
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
C O P E RT I N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: lAn PERMIT#
OW'4ER'S NAME: q ` 1 K q n PHONE# Fs* $,
GENERAL CONTRACTOR: 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.
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
ner/ Q-jr for Signatu Date