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10060156 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22633 QUEENS OAK CT CO vTRACTOR:BROTHERS HOME PERMIT NO: 10060156 IMI ROVEMENT OWNER'S NAME: YUMING GU 251)DOUGLAS BLVD DATE ISSUED:06/24/2010 iWNER'S PHONE: 4083145927 RO iEVILLE,CA 95661 PHONE NO:(408)295-0680 LICENSED CONTRACTOR'S DECLARATION JO 3 DESCRIPTION: RESIDENTIAL❑ COMMERCIALEI License Class a Lie.#(2C �W7 Ir STALL(5)WINDOWS& 1 PATIO DOOR LIKE FOR LIKE Contractor Date Z 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:$5412 I have and will maintain Worker's Compensation Insurance,as provided or by Section 3700 of the Labor Code,for the performance of the wz1aws APN Number:34232058.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the aboPERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinancesng 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 Is.,ued by: Date: W granting of this permit. Addition ,the appli t understands and will comply with all non-point source reg ons pe upertino Municipal Code,Section 9.18. / RE-ROOFS: Signature L Al 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 ins pection. ❑ 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 I iave read the hazardous materials requirements under Chapter 6.95 of the Cnlifornia Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three in tintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: H salth&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 in iterial. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the ai•contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. w II maintain compliance with the Cuperti unicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2550 , 5533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this O vner or authorized agent: Date: 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 CONSTRUCTION LENDING AGENCY 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 I I tereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. w)rk's for which this permit is issued(Sec.3097,Civ C.) L!nder's Name APPLICANT CERTIFICATION L!nder's Address 1 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 -non the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION emnify and keep harmless the City of Cupertino against liabilities,judgments, _osts,and expenses which may accrue against said City in consequence of the I rnderstand 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 L censed Professional 9.18. Signature Date RECEIVED JUN 24 2010 BY: A 1 A•*j TDINANCES HE CITY OF G f-LATINO CODjOR F:1 DATE c' 'l V 5IG.NEI( This set of plans and'specifications MUST LL be kept on the fob at all times and it is -� unlawful to make any changes or alterations on same without written permission from Q the BuildDepartment,City of Cupertino. �� f ing stamping of this plan and specifications, HALL NOT b�heil to permit or to be an approval of the vrolatrnn,,f,�n.y provisions 12-e 41 V �•l -�'�j i of ar,y COY()r,irnance ur `.Mate Law V-633 Q ue Q4�CA-.� CAAPer-16,w CA qSC J 4 . Ail �►�do.�u5 .v►e�} trr�5 U3C L (Fe c,%-t- 0 r i-I-6;,e-\ CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 34232058 . 00 DATE ISSUED. . . . . . . : 06/24/2010 RECEIPT # . . . . . . . . . BSOOOC10704 REFERENCE ID # . . . : 10060156 SITE ADDRESS 22633 QUEENS OAK CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA OWNER YUMING GU ADDRESS . . . . . . . . . . : 22633 QUENN OAK CT CITY/STATE/ZIP . . . : CUPER-INO, CA 95014-5616 RECEIVED FROM BROTHERS HOME IMP CONTRACTOR GENE 11. CAVANNA LIC # 27964 COMPANY BROTHERS HOME IMPROVEMENT ADDRESS 2510 DOUGLAS BLVD CITY/STATE/ZIP . . . : ROSEV::LLE, CA 95661 TELEPHONE (408) :!95-0680 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---- ------ ---------- --- 1BCBSC VALUATION 5, 412 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 5,412 . 00 0 . 60 0 . 00 0 . 60 0 . 00 1WINREP EACH 8 1 . 00 380 . 00 0 . 00 380 . 00 0 . 00 ---- ------ ---------- ---------- ---------- TOTAL PERMIT 381 . 60 0 . 00 381 . 60 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- - ------------------- CREDIT CARD 381 . 60 M, --------------- TOTAL RECEIPT 381. 60 CITY OF CUPERTINO CUPEf�TINO GENERAL BUILDING PERMIT APPLICATION FORM b OCP b f S-(-t� APN # Date: b ,C)U Gzz�y 10 Building Address: 22�� J Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes No HOA: (Exterior work only) Yes ❑ No If es. rovide letter from HOA Owner's Name: Phone p:..)� 2 (2( U Contractor: Phone: (�; bf�M� Fax: �� '6 7;�-- - 37 7 7 Contractor License#: G 71001 Cupertino Business License#: Contact: Phone: Fax: J ! ! 2 ✓ Residential ommercial ❑ Job Description: 12 e1,n I Building Permit Info: Bldg 0— Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B [}� 1�" Valuation: Square Footage: Project Size: Express g—Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Points Achieved: .— For help, contact Build it Green at www.buildityreen.org Revised 07/14/09 att", CITY OF CUPERTINO CU P TY OF O GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B additional shicco application 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) I WINMEWSTR New Window-structural shear B wall/mason, (includes plan ck fee) 1 EPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E I MECPLNCK Stand Alone 'Mechanical Pln Ck (hrly) M 1 PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check(when no E/M/P) B when not over counter) hourly-stand alone / IBCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES IBSEISMICR Seismic Resi iential B 1BSEISMICO Seismic Commercial B / 1 TRAVDOC Travel & Documentation B 1 BUSLIC Business Liconse B 5of5 CITY OF CU'ERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 22633 queens oak ct. DATE: 06/21/2010 REVIEWED BY: building APN: BP#: *VALUATION: $5,142 OPERMITTYPE: Building Permit PLAN CI[ECK TYPE: Alteration /Addition / Repair PRIMARY APPLICATION USE: SFD or Duplex TYPE: MECHANICAL Q Yes Q No PLUMBING 0 Yes E) No I ELECTRICAL Q Yes (F)No �4 w cc CBC 3 � OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s .ft. R-3 (Custom) II-B,111-B,IV,V-B 0 $0.00 $0.00 TOTALS: 0 $0.00 $0.00 T7 F-1 ------- NOTE. Theseees are based on the preliminary in ormation avails Me and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (hee Resohition 09-051 Ftf: Til%09) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Window/ Sliding Glass Door Suppl. PC Fee: (F) Reg. () OT 0.0 hrs $0.00 $380.00 1 WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: Yes Q No $0.00 0 Work Without Permit? Q Yes (E) No $0.00 E) Planning,Fee: $0.00 Select a Non-Residential 0 Building or Structure 0 Strom Motion Fee: IBSEISMICR $0.51 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.51 $380.00 TOTAL FEE: $381.51 Revised: 5/27/2010 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST I JOB ADDRESS: ?j7i(o,3 PERMIT# �Ul OWNER'S NAME: PHONE# S' ?Z" 7 GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: 25' J� J,,,� . CITY/ZIPCODE: R *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 SUBCONTRAC'%HAV BTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Date Signa'Ore Please check applicable subcontractors and complete I he following information: SUBCONTRACTOR BUSINESS 74AME 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 Z Date Owner/C actor Signature