11020059 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10700 MERRIMAN RD B CONTRACTOR:AN KY CONSTRUCTION, PERMIT NO: 11020059
INC.
OWNER'S NAME: HSUAN-CHUNG LEE 7201 VIA LOMAS DATE ISSUED:02/15/2011
'NER'S PHONE: 4089167189 SAN JOSE,CA 95139 PHONE NO:(408)234-2673
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
EI
License Class Lic.# UNIT B--- REMODEL 57 SQ FTO TO BATH
Contractor Date
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. Sq.Ft Floor Area: Valuation:$5000
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:34216101.13 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 Issued by: � Date:
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.
L OWNER-BUILDER DECLARATION
I hereby affirm that 1 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
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,Secti s 25505,25533And 2$534.
Section 3700 of the Labor Code,for the performance of the work for which this _f
permit is issued. Owner or authorized agent: Dater
I certify that in the performance of the work for which this pen-nit 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
aemnify and keep harmless the City of Cupertino against liabilities,judgments,
is,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.
Signature
�^`� f Date `7 1 S ?•'
CITY OF CUPERTINO
3 ITEMS OF 7 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34216101 .B
DATE ISSUED. . . . . . . : 02/15/2011
RECEIPT #. . . . . . . . . BS000012720
REFERENCE ID # . . . : 11020059
SITE ADDRESS . . . . . : 10700 MERRIMAN RD B
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HSUAN-CHUNG LEE
ADDRESS 10700 MERRIMAN RD A
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : HSUAN-CHUNG LEE
CONTRACTOR . . . . . . . : HUNG TU LIC # 23642
COMPANY . . . . . . . . . . : AN KY CONSTRUCTION, INC.
ADDRESS . 7201 VIA LOMAS
CITY/STATE/ZIP . . . : SAN JOSE, CA 95139
TELEPHONE . . . . . . . . : (408) 234-2673
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 5, 000 . 00 1. 00 0 . 00 1 . 00 0. 00
1BSEISMICR VALUATION 5, 000 . 00 0. 50 0 . 00 0 .50 0 . 00
1REMRESBAT SQ FEET 57 .00 1140 . 00 0 . 00 1140 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 1141. 50 0 .00 1141. 50 0 . 00
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
CUADDRESS: 10700 merriman rd. unit b DATE: 02/15/2011 REVIEWED BY: bobs.
BP#: *VALUATION: 1$5,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex7_1
PENTAMATION 1 R3SFDREM
USE: PERMIT TYPE:
WORK bath remodel non structural
SCOPE
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NOTE. These ees are based on the preliminary information available and are only an estimate. Contact the De t or addn 7 info.
FEE ITEMS (Fee Resolution 09-051 Eff. 7;1/10) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.£ Remodel,Bath(<=300 sf)
Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 $570.00 IREMRESBAT
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee{') Reg. 0 OT 10—.01hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
G)11,';lt 1W!ion I-OX F71
Acoustical Fee: 0 Yes 0 No $0.00
Work Without Permit? 0 Yes 0 No $0.00 E)
Planni� $0.00 Select a Non-Residential 0
-fir ti r�I�t)�trtjt��zfu(i�>rt lcE',r_
Building or Structure 0
I
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg;Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.50 $570.00 TOTAL FEE: $571.501
Revised: 01/15/2011
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: j 0 oA riga, PERMIT# 2 6 QST'
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: 1, ' ons BUSINESS LICENSE# 5
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:
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
CITY OF CUPERTINO
ism ADDITION/REMODEL
CUPERTINO FEE SCHEDULE Ile W 41115-q
APN# Date: 1 1
Z7 - l 6- 1 Q T , (�j _ 2/jSr12-0
Is a 2" unit being added? Yes ❑ No [ , If yes, please fill out the permit application for 2" unit.
Is this a 2"d story Addition? Yes ❑ No [/
Is this house an Eichler? Yes ❑ No �f yes,needs Planning approval.
Building Address: � p
Q 4 4 JV'�e ,rr q!, c�g
Mailing Address (if different from building address): Q C
1-2 44 ra/hiv�pllll r� r
Owner's Name: Phone#
Contractor: Phone#:
Fax/e-mail:
Cupertino B iness License: State Contractor License #:
94-09, 4
Contact: Phone#:
Fax/e-mail:
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 complete Landscape Project Submittal is required.
Compliance Method: -F1 Plant Type ElWater Budget
Building Permit Info: Bldg. Elect. [j--Plumbing �chanical Hillside ❑
Project Size: Counter ❑ Express ❑ Standard ❑ Large ❑ Major ❑
Job Description:
Addition-What is being added?(Be Specific):
What is being remodeled (not including addition)?
Remodel Includes Re-Roof: Yes ❑ No �^ /If yes list number of squares
Remodel Includes Structural: Yes ❑ No L�
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 s A Other
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B Valuation:t 5 o0
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. ��