10040126 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21151 HAZELBROOK DR CONTRACTOR:ALMOST HEAVEN PERMIT NO: 10040126
OWNER'S NAME: CAROLINE CHEN 2809 HOSTETTER RD DATE ISSUED:04/20/2010
NER'S PHONE: 6509960622 SAN JOSE,CA 95132 PHONE NO:(408)858-7917
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG f— ELECT I— PLUMB
License Class / /'Lic.# g 2 L( MECH F_ RESIDENTIAL r— COMMERCIAL
Contractor 10&os-f b(z-_�� Date 2,6k(7
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:INSTALL WATER FOUNTAIN 2X2 BASE&3 1/2 FT HIGH;
ELECTRICAL LINE TO FOUNTAIN=36 LINEAR FT 15
(commencing with Section 7000)of Division 3 of the Business&Professions AMP**SEE NOTES**
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:$800
permit is issued.
APPLICANT CERTIFICATION APN Number:32628052.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED
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
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
?� Issued by: Date:
Sienatur��; �' i!�!/ Date
v
❑ OWNER-BUILDER DECLARATION RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
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
declarations: HAZARDOUS MATERIALS DISCLOSURE
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
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
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
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner o th rized age6t:
4� Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
ur^^the above mentioned property for inspection purposes.(We)agree to save
I fify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
cv:,...,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date 20�t/O Licensed Professional
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: .2115-1 ruor Df • PERMIT# 2
OWNER'S NAME: "kAx- PHONE# OF —
GENERAL CONTRACTOR: BUSINES LICENSE# 1� 6 "7C7
ADDRESS: "121S v A •�/3 CITY/ZIPCODE: Satoa b ,3L
*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:
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 CUPERTINO
5 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32628052 . 00
DATE ISSUED. . . . . . . : 04/20/2010
RECEIPT #. . . . . . . . . : BS000010226
REFERENCE ID # . . . : 10040126
SITE ADDRESS . . . . . : 21151 HAZELBROOK DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER CAROLINE CHEN
ADDRESS . . . . . . . . . . : 21151 HAZELBROOK DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : ALMOST HEAVEN
CONTRACTOR . . . . . . . : TIEN H. DINH LIC # 30070
COMPANY . . . . . . . . . . : ALMOST HEAVEN
ADDRESS . . . . . . . . . . : 2809 HOSTETTER RD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95132
TELEPHONE (408) 858-7917
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 800 . 00 1. 00 0 . 00 1 . 00 0 . 00
1BREMRECEP NO. OUTLETS 1 .00 42 . 00 0 . 00 42 . 00 0. 00
1BSEISMICR VALUATION 800 . 00 0 .50 0 . 00 0 . 50 0 . 00
1EPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00
1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 127.50 0 . 00 127 .50 0 . 00
-
1
,
REPLACE
I EXISTING
1 LAWN
1 � 1
t
1
1
I
o
PROMDE CONCRETE PAD AND ELEC.
f 20a sq It FOR OWNER SUPPLIED FOUNTAIN
(1)36'BOX
PISTACIA CHINENSIS
2X6
HEACERBOARD
p
185 s k
77771771 /omON
iL
j
O O O 43 sq It
(2)15 GALLON--6
ITALIAN CYPRESS
•-' 1. GOPHER WIRE.VINYL COATED HARDWARE CLOTH,112' �� O
SPACING GAW WIRE.19 GAUGE.(OSH HAS 3'%10'ROLL) /
` 2"SOIL OVER WIRE BEFORE SOO.
♦ /
— 2. RIVER ROCK.11i2"'NOIVO'AT MOUNTAIN VIEW GARDEN
f CENTER(S115.95TON.NEED ABOUT 2 TON).3'CEEP
OVER GREY WEED CLOTH
3. MULCH:3'GORILLA HAIR
(2)15 GALLON— : a- WIRE TRELLIS FOR VINES ALONG FENCE:
PYRUS COMMUNISo sq k 3)EYE HOOKS za"O C. j j�// o--(B)5 CALLON
COMICE' HIBBERTIA SCANDENS
V16'BRAIDED STEEL VINES ON WIRE TRELLIS,
so.zol F AT osH) 6 6 SEE DETAIL
{ 647 SF i LAWN Wl GOPHER WIRE
160 SF I RIVER ROCK,3'DEEP 1.116 sq k
I
185 SFS : CONCRETE
445 SF • 'I MIXED PLANTING,WITH MULCH
1,435 SF � MULCH,3'DEEP
i
�) O
110)5 GALLON
s sq It PHORMIUM TENAX
'RAINBOW SUNRISE �•
a R, •` - �� __�,
13)S GALLON
�..� `.:
�_��_I ECHIUM FASTUOSUM
ANICOZANTHOS FLAVIOUS ! . (6)5 GALLON
.%'.
(7)1 GALLON • • EUPHORBIA CHARACIAS
�\ EUPHORBIA RIGIDA
•
WITH(7)1 GALLON • (9)1 GALLON
lag sq k ' IRIS DOUGLASIANA • EUPHORBIA RIGIDA
• WTTH(7)I GALLON
472 sq It ✓�� IRIS DOUGLASIANA
(6)5 GALLON
PHORMIUM TENAX
ns sq rt 'BRONZE BABY' W)5 GALLON
— PHORMIUM TENAX
X6 TREX I 'BRONZE BABY'
— 80 s 4
q HEADERBOARD
27 sq 9 —(5)5 GALLON
PHORMIUM TENAX
HAZELBROOK DRIVE ��`,—a am10— �—
C�r4lkld , C� ,G)'SDl g
CITY OF CUPERTINO
CUPEf�TINO GENERAL BUILDING
PERMIT APPLICATION FORM
APN # � `� " Date: /1�Z� f0
Building Address: n s-� &YwbrooK, -Dr. �,o 64q - q&oI4
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 Eg, If yes, provide letter from HOA
Owner's Name: Phone#:
0 iMt 65O
Contractor: Phone:(401)
Alw-o,t& 46, Fax:
Contractor License#: g V6-74
Cupertino Business License#:
Contact: Phone:
' 1 �- ti . G In Y I Fax: J
Residential Commercial ❑
Job Description: 2x �
..a,(l (��
ecA-r cam- ��P-1 o ow-�� •w 3Co (..F�
Building Permit Info:
Bldg ❑ 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
Valuation: 4 CPo Square Footage:
Project Size: Express IR 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.buflditgreen.org
Revised 07/14/09
CITY OF CUPERTINO
CITY OF GENERAL BUILDING APPLICATION
CUPEI�TlNO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group IGENRES or
1GENCOM
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows)
1WINMEWSTR New Window-structural shear B
wall/masonry(includes plan ck fee)
l EPERMITFEE Electrical Permit Fee E
J
1MPERMITFEE Mechanical Permit Fee M
1 PPERMITFEE Plumbing Permit Fee P
1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E
1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M
1 PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P
I STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-stand alone
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
/ 1BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
1 TRAVDOC Travel &Documentation B
IBUSLIC Business License B
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