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10040051CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21976 MC CLELLAN RD 'VNER'S NAME: ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. 4 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. 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. CONT); ACTOR: RICHARD MENG I PERMIT.NO: 10040051 219761 ACCLELLAN DATE ISSUED: 05/26/2010 CUPEF.TINO CA, CA 95014-4058 I PHONE NO: JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ADD 2 BEDROOMS, 2 BATHROOMS, FAMILY RM & STUDY (1781 SQ) -REMODEL 2 BEDROOMS, KITCHEN, LIVING RM, BAT -IRM & GARAGE;RE-ROOF 25 SQ & DOES HV STRUCTURAL Sq. F1 Floor Area: v` -nature 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). 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 shallbe deemed revoked. APN Vumber: 35608048.00 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 n the above mentioned property for inspection purposes. (We) agree to save ,::lify 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. 1 Valuation: $474000 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 insta led without first obtaining an inspection, I agree to remove all new materials for inspc ction. Sign iture 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 mai stain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Heo Ith & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air :ontaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Ow ner or authorized a est: Date: S D io CONSTRUCTION LENDING AGENCY I he reby affirm that there is a construction lending agency for the performance of wo Vs for which this permit is issued (Sec. 3097, Civ C.) Le rder's Name Le ider's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Li sensed Professional # REVISION �.� CITY OF CUPERTINO BUILDING PERMIT DATE BUILDING ADDRESS: 21976 MC CLELLAN RD CONTRACTOR: RICHARD MENG PERMIT NO: 10040051 OWNER'S NAME: CUPERTINO CA, CA 950144058 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. # MECH RESIDENTIAL r COMMERCIAL r Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: ADD 2 BEDROOMS, 2 BATHROOMS, FAMILY RM & (commencing with Section 7000) of Division 3 of the Business & Professions STUDY (1781 SQ) -REMODEL 2 BEDROOMS, KITCHEN, LIVING RM, Code.and that my license is in full force and effect. BATHRM & GARAGE;RE-ROOF 25 SQ & DOES HV I hereby affirm under penalty of perjury one of the following two declarations: 7/13/10 - REV#1- MOVE PATIO DOOR IN FAM RM APPX 5' TOWARD EAST I have and will maintain a certificate of consent to self -insure for Worker's WALL,ADD CROWN CEILING (INTERIOR)IN BEDROOMS UPSTAIRS,ADD A 2'X4' Compensation, as provided for by Section 3700 of the Labor Code, for the SKYLIGHT IN LIVING ROOM 4 ADD A 14" TUBULAR SKYLIGHT IN FAMILY ROOM 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: $474000 permit is issued. APPLICANT CERTIFICATION APN Number: 35608048.00 Occupancy Type: 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, 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. Signature Date Issued by: Date: 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 I, 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) I, as owner of the property, am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project (Sec.7044, Business & Professions Code).T�70- , I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 Section 3700 of the Labor Code, for the performance of the work for which this compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & 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 forthwith comply with such provisions or this permit shall be deemed revoked. 'TRK Owner or authorized agent: Date:_ -1 _ f�a 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.) upon the above mentioned property for inspection purposes. (We) agree to save Lender's Name indemnify 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 regulations per the Cupertino Municipal Code, Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Sign ��� Date / 3 Licensed Professional wo CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: FLR AREA s .ft. DATE: REVIEWED BY: BP FEES APN: BP#: *VALUATION: PERMIT TYPE: Building Permit $0.00 PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: hrs OVER THE COUNTER. 0 Yes 0 No APPLICATION 1 R3SFDADD/REM TYPE: MECHANICAL 0 Yes 0 No PLUMBING 0 Yes Q No ELECT IMCAL © Yes 0 No YW Permit Fee: tx a O Suppl. Insp. Feer Reg. 0 OT 0.0 3U $0.00 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s .ft. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 0 $0.00 Suppl. PC Fee: E) Reg. 0 OT $0.00 hrs $0.00 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 TOTALS: 10 $0.00 . 110il7l? Tay $0.00 '+'cr+r �'fr[•r.F, � rn,et'. t'lrrmh. i'ft++r C � l ldhe'r Plumb rr7..,r. Ii kc. f'ttr�, � ,,,e'.'i Fdc(. Per,.,,,, 1- ., . 002c"r 1Fh k . blxp. NOTE: These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 09-051 E . 711!09) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 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 . 110il7l? Tay Acoustical Fee: 0 Yes 0 No $0.00 0 0 Work Without Permit? 0 Yes (D No $0.00 Plannin Fee: $0.00 Select a Non -Residential Building or Structure 0 0 r r c{L 4l I - Strong, Motion Fee: $0.00 = hrs $252.00 Standard Hourly Rate Bldg. Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $252.00 TOTAL FEE: $252.00 Revised: 6/30/2010