10060005 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10445 WESTACRES DR CONT RACTOR:DIANLI CHEN PERMIT NO: 10060005
CONS"RUCTION
OWNER'S NAME: ANIL LOHIYA 18824 .OREE AVE DATE ISSUED:06/02/2010
NER'S PHONE: 4087504738 CUPE;iTINO,CA 95014 PHONE NO:(408)888-2898
t ❑ LICENSED CONTRACTOR'S DECLARATION
� �--� ` BUIL SING PERMIT INFO: BLDG ELECT PLUMB
bb _
I License Class 7 Lic.# O d 1 1 `�
r— r—MECH RESIDENTIAL COMMERCIAL �
Contractor r,> LI 1,4A) G HTt✓ Date �91Z/``,01(]
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:WINDOW REPLACEMENT LIKE FOR LIKE;NON-
(commencing with Section 7000)of Division 3 of the Business&Professions STRUCTURAL
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. Jdt.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$3000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN P umber:35914030.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 1110 DAYS FROM LAST CALLED INSPECTION.
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• / Issue( by Date: �� w
Signature cam•— Date �rZ lolJ
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
All roc Is shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of install,d without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspect ion.
1,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, Signati ire of Applicant: Date:
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
constrict the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the Califo•nia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additi anally,should I use equipment or devices which emit hazardous air
contar rinants as defined by the Bay Area Air Quality Management District I will
permit is issued. mainti in compliance with the Cupertino Municipal Code,Chapter 9.12 and the
1 certify that in the performance of the work for which this permit is issued,I shall Healtb &Safety Code,Sections 25505,25533,and 25534.
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 Ownei or authorized agent:
become subject to the Worker's Compensation provisions of the Labor Code,I must — Date: 612_1Z-010
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for wh ch this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lende•'s Name
to building construction,and hereby authorize representatives of this city to enter
u^ten the above mentioned property for inspection purposes.(We)agree to save Lende•'s Address
inify and keep harmless the City of Cupertino against liabilities,judgments,
_.s,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I under stand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CLPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 35914 030 . 00
DATE ISSUED. . . . . . . : 06/0: /2010
RECEIPT #. . . . . . . . . BS000010530
REFERENCE ID # . . . : 10060005
SITE ADDRESS 10445 WESTACRES DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : ANIL LOHIYA
ADDRESS . . . . . . . . . . : 10445 WESTACRES DR
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2938
RECEIVED FROM . . . . : DIAN: I CHEN
CONTRACTOR DIAN: I CHEN LIC # 27577
COMPANY DIAN: I CHEN CONSTRUCTION
ADDRESS . . . . . . . . . . . : 18824 LOREE AVE
CITY/STATE/ZIP . . . : CUPEATINO, CA 95014
TELEPHONE . . . . . . . . : (408 , 888-2898
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- --- ------- ---------- ---------- -----
1BCBSC VALUATION 3, 000 . 00 1 . 00 0 . 00 1. 00 0 . 00
1BSEISMICR VALUATION 3, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1WINREP EACH 8 1 . 00 380 . 00 0 . 00 380 . 00 0 .00
--- ------- ---------- ---------- ----------
TOTAL PERMIT 381 . 50 0 . 00 381. 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 381 .50 VISA
---------------
TOTAL RECEIPT 381 .50
CITY OF CU PERTINO
CITY OF
CUPEt�TiNO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # Date:
c 2- /W to
Building Address:
wZSb a crams
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes 0 No
HOA: (Exterior work only) Yes ❑ No Er""If yes, )rovide letter from HOA
Owner's Name: N �[ Phone#40�
Contractor: .�
L Lo 0 � /4 Phone:
� I AA/2-1 c ti� F
hax:
Contractor License#: 1P f--6
Cupertino Business License#:
Contact: S i-A„{ Phone:
Fax: o
Residential KI Commercial El
Job Description:
W [ �'�-!Yl+A�S � �Ct,G Q1✓2�rt�t--- �;�.e- �-cr" l�� gun
Building Permit Info:
Bldg 0— Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B ❑-- V----
Valuation: Square Footage:
Project Size: Express ❑ 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.builditgreen.or-T
Revised 07/14/09
CITY OF CUPERTINO
CITY OF GENERAL BUILDITS[G APPLICATION
CUPEt�TiNO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applin;ations (up to 400 sf) B
additional stucco application
1 WINREP Replacement windows/sliding glass B
fdoor (ea 8 w.ndows)
1WINMEWSTR New Window-structural shear B
wall/mason) (includes plan ck fee)
IEPERMITFEE Electrical Pemit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Pe mit Fee P
IELCPLNCK Stand Alone Electric Pln Ck (hourly) E
1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M
1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P
1STPLNCK-(3 Hr Min Standard Plzn Check (when no E/M/P) B
when not over counter) hourly-stand alone
1BCBSC Cal Bldg St,.ndards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Residential B
1
1BSEISMICO Seismic Commercial B
1 TRAVDOC Travel &Documentation B
1BUSLIC Business Li tense B
5cf5
G CITY OF CUPERTINO BL ILDING PERMIT
BUILDING ADDRESS: 1059 WEST HILL CT CONTRACTOR: PERMIT NO: 10060131
OWNER'S NAME: DAVID K HASEGAWA �� J'fG (Lao'fw DATE ISSUED:06/21/2010
iER'S PHONE: 4083150288 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION BUILD ING PERMIT INFO: BLDG ELECT PLUMB
License Class Cl� Lie.#
MECH RESIDENTIAL COMMERCIAL
Contractor i �c
0S1 -- i Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB D ESCRIPTION: INSTALL A TANKLESS WATER HEATER(OUTDOOR)
(commencing with Section 7000)of Division 3 of the Business&Professions **SEE 1,OTES**
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 Sq.Ft I loor Area: Valuation:$3500
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. -3•Q.Q
APN Mimber:36227051.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of C pertmo against liabilities,judgments, Vk ITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which y accrue ag nst said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. A itionally,t applicant understands and will comply
with all non-point so
urc egulations r the Cupertino MuWCode, tion
9.18. Issued b Date�Z-/'
Signature Datel
❑ DOWNER-BUILDER DECLARATION RE-ROOFS:
All root's shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installer I without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspecti on.
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, Signature of Applicant: Date:
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
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 HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the Califon nia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contan dnants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Co ,Sectio 25505,25533,and 25534.
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 Owners or auth /O
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereb✓affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for wh ch this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lende•'s Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lende•'s Address
,unify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I under stand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CU PERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 1059 west hill ct. DATE: 06/21/2010 REVIEWED BY: building
APN: BP#: *VALUATION: $3,500
*PERMIT TYPE: Plumbing Permit PLAN C HECK TYPE: Alteration/Addition / Repair
PRIMARY 1� APPLICATION
USE: SFD or Duplex �, ,.� TYPE:
w . water hp-;;tpr
xa
OCOOD
3 �
APPLIANCE/EQUIP TYPE CAPACITY FEE IIi QTY BP FEES
Water Heater 1BPWHE4T 1 $25
TOTALS: $25.00
Plumb.Plan Check 0.0 hrs $0.00
Plumb. 'ermit Fee: IPPERMIT
Other Plumb Insp. 0.0hrs $42.00 ors,
NOTE: These fees are based on the preliminairTv in ormation available and are only an estimate. Contact the Dept for addn'l info.
_
FEE ITEMS (Fee Resolution 09-051 Eff.i 1/09) FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.0)
PME Unit Fee: $25.00
PME Permit Fee: $42.00
ro t
t
Travel Documentation Fee: ITRA VDOC $42.00
F=
Select an Administrative Item
(( 3
131d yStds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $110.00 $0.00 TOTAL FEE: $110.00
Revised: 5/27/2010
CITY OF CUPERTINO
4 ITEMS OF 5 PERMIT RE--EIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN 36227051 . 00
DATE ISSUED. . . . . . . : 06/21/2010
RECEIPT #. . . . . . . . . BS000010672
REFERENCE ID # 10060131
SITE ADDRESS 1059 VEST HILL CT
SUBDIVISION . . . . . . .
CITY CUP=INO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DAVID K HASEGAWA
ADDRESS . . . . . . . . . . : 1059 VI HILL CT
CITY/STATE/ZIP . . . : CUPER-INO, CA 95014
RECEIVED FROM . . . . : FANTASTIC ROOTER IN
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------------
---------- ---- ------ -----
1BCBSC VALUATION 3, 500 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0 . 00
1PRWHEATR UNITS 1. 00 25 . 00 0 . 00 25 . 00 0 . 00
1TRAVDOC FLAT RATE 1. 00 42 .00 0 . 00 42_ ------
00 0_00
-----
TOTAL PERMIT
110 . 00 0 . 00 110 . 00 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- --
518 WATER HEATER
CITY OF CUPERTINO
RECEIPT NUMBER: BS000010672
RECEIVED BY: PATRICIAG PAYOR: FANTASTIC ROOTER IN
TODAY' S DATE: 06/21/10 RECISTER DATE: 06/21/10
TIME: 14 :54
5
10060131 $1 .00
1BCBSC 10060131 $42 . 00
1PPERMITFE 10060131 $25 .00
1PRWHEATR $42 . 00
1TRAVDOC 10060131 $114 . 00
BUSINESS LICENSE TAX NEW-FANTASTIC :ZOOTER INC
TOTAL DUE: $224 . 00
CREDIT CARD: $224 . 00 REF NUM: VISA
TENDERED CHANGE
$224 . 00 $ .00
CITY OF CUPERTINO
REPIPE/SEWER04AIN SERVICE
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
---1 ( ,
I - (Qtf 64
Building Address:
C�-
Owner's Name, Phone#:
Contractor: Phone#:
-tFax #:
Contact: Phone#: q03-.6(?0-33C8
v Fax #:
Contractor License#:
Cupertino Business License#:
Job Description:
Y>\ --CekqSS W (()Ucbmlz�
Residential Commercial ❑
Valuation: 0 y
3
Project Size: Express Standard D Large Vlajor
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set& the sheet index.
Green Building Points:
Quantity Fee ID Fee Description Fee Permit Type
Group
1PCSEWER Commercial building P 1CPSS
sewer/sanitary sewer-
1BPREPIPE Commercial re-pipe per fixture P 1CPRP
1 PGASCOM Commercial Gas Piling System P
1-4 Outlets
1BCBSC Cal Bldg Standards Commission B ALL PERMIT
Fee TYPES
1BSEISMICOM Seismic Commercia. P
Revised 01/07/09
CITY OF
CITY OF CUPERTINO
REPIPE/SEWER/?4AIN SERVICE
FEE SCHEDULE
CUPERTINO
Quantity Fee ID Fee Description Fee Permit Type
Group
113CBSC Cal Bldg Standards Commission B ALL PERMIT
Fee TYPES
1BSEISMICR Seismic Residential P
1PRSEWER Residential building P 1RPSS
sewer/sanitary sewe:-
1 PRREPIPE Residential re-pipe per fixture P 1RPRP
1BPWSVCS Water Service P 1CPWS or
1RPWS
1 PPRSEWG Private Sewage Disposal System P
1PCESS Cesspool P
1 BPWATER Install/alter Water Pipe P
1 BPFIXTURE Plumbing Fixture P
1 PGASRES Residential Gas Piping System P
1-4 Outlets
1 BPGAS Gas Piping System 5+ Outlets P
1PPERMITFEE Plumbing Permit Fc a Issuance P
1PLMBLNCK Plumbing Plan Cheek P
1PLMBINSP Other Plumbing/g&,; Insp. P
� VV
1 TRAVDOC Travel &Documentation Fee B
1 BUSLIC Business License B
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: Vlvq't G2 ' PERMIT# O 3
OWNER'S NAME: PHONE#
GENERAL CONTRACTOR. �k 'tit RO BUSINESS LICENSE#
ADDRESS: \.�\� CITY/ZIPCODE: \l' c '
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPE TION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCO RAC C S HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. ` vL
I am not using any subcontractors: Date
Signal re
Please check applicable subcontractors and complete the following information:
j/ 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