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11010159CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10429 BONNY DR CONTRACTOR: FRANK SHEN PERMIT NO: 11010159 OWNER'S CUPERTINO, CA 95014 PHONE NO: ❑ JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALS LICENSED CONTRACTOR'S DECLARATION License Class Lic. # REMODEL TWO BATHROOMS 200 SQ FT, REPLACE 6 WINDOWS Contractor Date AND INSTALL 6 CAN RECESSED LIGHTS I hereby affirm that I am licensed 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. 3-22-11 REVISION HI- RAISED CEILING IN LIVING, FAMILY ROOM ENTRANCE- ISSD 3-22 1 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 Sq. Ft Floor Area: Valuation: $12000 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 APN Number: 35913014.00 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 y Issued by: `; Date: granting of this permit. Additionally, the applicant understands and will comply _ with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date 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. 0, 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 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 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 p ", `'>r` '" '' ` r permit is issued. Owner or authorized agent: ., - __Date: �` --�- -- 1 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.) l 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 per the Cupertino Municipal Code, Section Licensed Professional 9.18. r' f Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10429 BONNY DR CONTRACTOR: FRANK SHEN PERMIT NO: 11010159 OWNER'S NAME: CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALS License Class Lic. # REMODEL TWO BATHROOMS 200 SQ FT, REPLACE 6 WINDOWS Contractor Date AND INSTALL 6 CAN RECESSED LIGHTS I hereby affirm that I am licensed 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. 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. APPLICANT CERTIFICATION 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, costs, 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 per the Cupertino Municipal Code, Section 9.18. Signature Date OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). Gq/_� 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 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. 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 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 reppvv�okke�ed. V � APPLICANT CERTIFICATION 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, costs, and expenses which may rue against said City in consequence of the granting of this permit. Addi9 n I he applicant understands and will comply with all non -point source rep& er e Cupertino Municipal Code, Section 9.18. / / / Sq. Ft Floor Area: I Valuation: $12000 APN Number: 35913014.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cup erti unicipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505 2 , an 4. > Owner or authorized agent: Date: y CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Profess Date 1/5//( CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 10429 bonny dr. DATE: 01/31/2011 REVIEWED BY: APN: BP#: *VALUATION: 1$12,000 -PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex PENTAMATION PERMIT TYPE: 1 R3SFDRE WORK To Clear Code Enforcement Case: remodel 2 bathrooms at existing sfd. Relocate furnace. Add six can SCOPE light at kitchen location Mech. Plan Check 0.0 hrs $0.00 Plumb. P&m Chock Elec. Plan Check 0.0 1 hrs $0.00 Mech. Permit Fee: IMPERMIT Flrr.nb. POWlir Elec. Permit Fee: IEPERMIT Other Mech. Insp. 0.0 hrs $42.00 Onc��, PIum7� hasp, Other Elec. Insp.��hrs$42.00 �llech. Insp. rc(. Phan), fuse. T ea: E/cc. Insp. Fee: NOTE: These fees are based on the nrelintinary information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS ("Fee Resolution 09-051 Eff. 7/1/10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 200 I s.f. $570.00 Remodel, Bath (<=300 sf) 1REMRESBAT Suppl. PC Fee: 0 Reg, 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 0 # $126.00 Mechanical IMFR=<100 Furnace, Forced -Air Permit Fee: $0.00 Suppl. Insp. Fee:0 Reg. 0 OT 0.0 hrs $0.00 © Electrical $63.00 IBREMFIXT Fixtures, Lighting PME Unit Fee: $0.00 PME Permit Fee: $84.00 Construction TQl" 171 Acoustical Fee: 0 Yes G No $0.00 G Work Without Permit? G Yes 0 No $843.00 Planning Fee: $0.00 Select a Non -Residential Building or Structure E) 0 i Travel Documentation Fee: 1TRAVDOC $42.00 Strom Motion Fee: IBSEISMICR $1.20 Select an Administrative Item Bldg- Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $971.201 $759.00 TOTAL FEE: 1 $1,730.20 Revised: 01/15/2011 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION I 9_Nj ADDRESS: 10429 bonny de. DATE: 03/22/2011 REVIEWED BY: bobs. APN: BP#: I � 1 VALUATION: $3,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: WORK revise ceiling in livinq and family room entrance. SCOPE (::Ic;,6ta'r`ti"„rr', ctaF f-, .. <.,i ET NOTE. These fees are based on the preliminary in ormation available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resohition 09-051 E f. 7/00) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (F) No $0.00 0 hours Plan Check, Hourly $252.00 ISTPLVCK Suppl. PC Fee: 0 Reg. 0 OT 10.0 firs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee: Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes 0 No $0.00 0 G Work Without Permit? 0 Yes G No $0.00 Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bld�,y Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $252.00 TOTAL FEE: $253.50 Revised: 01/15/2011