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10080189 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10483 MIRA VISTA AVE CONTRACTOR:YIN CHAN PERMIT NO: 10080189 OWNER'S NAME: YIN CHAN 15159 MONTALVO RD DATE ISSUED: 11/05/2010 O. R'S PHONE: 4088366070 SARATOGA,CA 95070 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT I— PLUMB F License Class Lic.# MECH[— RESIDENTIAL I— COMMERCIAL Contractor Date JOB DESCRIPTION:NEW TWO-STORY(3760SQ),GARAGE(579SQ)& I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions LANDSCAPE AREA(4517SQ) 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 Sq.Ft Floor Area: Valuation:$800000 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:35704080.00 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. Datez Sig---ture Date Issued b)<' 12/ 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 structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) Date: I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: 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 � 1 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 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 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 Owner e nt• - S % ��/ forthwith comply with such provisions or this permit shall be deemed revoked. Date:—L O C'v 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 building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) V he above mentioned property for inspection purposes.(We)agree to save Lender's Name -- L _nify 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 regul 'ons per,, upertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. __..� l I understand my plans shall be used as public records. Signature / �` Date ( j / /� Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: ,�S DATE: REVIEWED BY: APN: BP#: , ��� `VALUATION: 1$800,000 —� OPERMITTYPE: Building Permit PLAN CHECK TYPE: AIS PRIMARY SFD or Duplex OVER THE PENTAMATION 1 R3SFDW USE: COUNTER? 0 Yes Q No PERMIT TYPE: WORK SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.L R-3 (Custom) II-B,III-B,MV-B 4,340 $2,924.36 1R3PLNCK $3,303.72 1R31NSP TOTALS: 4,340 $2,924.36 $3,303.72 MECH,'HOURLY 0:Y,'es '.No N PLUMB;HOURI:Y 0 Yes �.. HOURLY �. o ,. No � ET..EC Yes t r,,;;. l'i'ar, r)•..r{. h4u;rr Rr, � „_:_ii. Pcrr,!it f-C r�;iii;-.ii. iir, L�:;cv ,r';i;rr;i./n.:r" Oiur.•t_,,.v. lr: i- NOTE: These ees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 09-051 Eff 7/1;101 FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,924.36 Select a Misc Bldg/Structure Suppl. PC Fee: 0 Reg. OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $3,303.72 Suppl. Insp. Feer Reg. © OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes Q No $0.00 0 Work Without Permit? 0 Yes 0 No $0.00 0 Planning Fee: PLLONGRNGR $564.20 Select a Non-Residential Q 7ru�crl l)ncrtErrCra�wuuo F(e,): Building or Structure 0 I Strong Motion Fee: 1BSEISMICR $80.00 Select an Administrative Item Bldiz Stds Commission Fee: IBCBSC $32.00 (--(6-7,70 S>CTBTOTALS � $ $0.00 TO�L, gra i; Revised: 8/17/2010