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10010066 CITY OF CUPERTINO BUILDING PERMIT 6 CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO:1001006 BUILDING ADDRESS: 19887 RODRIGUES AVE DATE ISSUED:01/14/2010 OWNER'S NAME: YUCHI TENG PHONE NO: ?ER'S PHONE: 4084896086 • BLDG ELECT PLUMB BUILDING PERMIT INFO. B 0 LICENSED CONTRACTOR'S DECLARATION --- COMMERCIAL Lic. � RESIDENTIAL License Class # MECH ESCRIPTION:REMODEL 103 SF KITCHEN,REPLACE DRYWALL,FLOOR Contractor JOB D under the provisions of Chapter 9 WATER DAMAGED TILE,CARPET, NOT STRUCTCABINETS, I hereby affirm that I am licensed and P SINK,AND RECESSED LIGHTS RAL commencing with Section 7000)of Division 3 of the Business&Professions ( Code and that my license is in full force and effect. I hey reb affirm under penalty of perjury one of the following two declarations: insure for Worker's I have and will maintain a certificate of consent to self-Labor Code,for the Compensation,as provided for by Section 3700 of the performance of the work for which this permit is issued. provided for by Valuation:$100000 I have and will maintain Worker's Compensation Insurance,as p Ft Floor Area: n 3700 of the Labor Code,for the performance of the work for which this Sq. e. Sectio occupancy T permit is issued. Occup Y YP APPLICANT CERTIFICATION APN Number:36904039.00 ation is I certify that I have read this application and state ordinan es and staat the above te laws relating correct.I agree to comply with all city and county to IS NOT STARTED to building construction,and hereby authorize representatives of(We) to aver PERMIT EXPIRES IF WO STAR E e for inspection purposes. (We)agreeIT ISSUANCE upon the above mentioned property judgments, WITHIN 180 DAYS OF PERM OR indemnify and keep harmless the City of Cupertino against liabilities, accrue against said City in consequence of the FROM LAST CALLED INSPECTION. costs,and expenses which may ac g ainsapplicant understands and will comply 180 DAYS FR granting of this permit. Additionally,the app wit h all non-point source regulations per the Cupertino Mu 'cipal Code,Section Date: 9.18. /` # ` 0/9 Issued by: :f ate �/ Signature RE-ROOFS: ed.if a roof l_. OWNER-BUILDER DECLARATION hall be inspected prior to any roofing material being all new materials installed without first obtaining an inspection,I agree to remove I hereby affirm that I am exempt from the Contractor's License Law for one o All roofs s the following two reapsons:or my caner of the property, employees with wages as their glee(Sec.7044, inspection. Date: I,ll o Applicant: will do the work,and the structure is not intended or offered for Signature of App Business&Professions Code) with licensed contractors to I as owner of the property,am exclusively contracting . ALL ROOF COVERINGS TO BE CLASS"A"OR BETTE construct the project(Sec.7044,Business&Professions Code) I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSUR declarations: e of Consent to self-insure for Worker's at have read the hazardous materials requirements 5533 and 25534.nder Chapter I will maintain 5 of the I have and will maintain a Certificate I ha Code,Sections 25505,25533, Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Chapter 9.12 and the Health& P compliance with the Cupertino Municipal Code, e as Provided for by Code,Section 25532(a)should I store or handle hazardous material. performance of the work for which this permit Insuranc , p Safety nt or devices which emit hazardous air I have and will maintain Worker's Comp Additionally,should I use equipment Air Quality Management District I will Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Municipal Code,Chapter 9.12 and the permit is issued. or which this permit is issued,I shall maintain compliance with the Cupertino that in the performance of the work f Worker's Health&Safety Code,Sections 25 5,25533,and 25534. I certify t become subject to the not employ any Person in any manner so as to b laws of California. If,after making this certificate I°Labor Codeol must Ow r or authorized nt: Date: ovisions of Compensation J� become subject to the Worker's Compenns this perrmit shall be deemed revoked. forthwith comply with such provisions CONSTRUCTION LENDIN;AGENCY performance of work's APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the p have read this application and state that the above informationteaws relating for which this permit is issued(Sec.3097,Civ C.) I certify that I h ordinances and s correct.I agree to comply with all city and county Lender's Name o building construction,and hereby authorize representatives of this ci to to enter t for inspection purposes.(We)agreeLender's Address upon the above mentioned property of Cupertino against liabilities,judgments, in�'P�►nify and keep harmless the City to consequence of the < .nd expenses which may accrue against said un ern co s and will comply ARCHITECT'S DECLARATION L_,ng of this permit.Additionally,the applic I understand my plans shall be used as public recordsall non-point source regulations per the Cuperti o Municipal Code,Section. r'L-�''( (�Date_r 4- Licensed Professional nature CITY OF CUPERTINO OPERATOR: TraciC 4 ITEMS OF 4 PERMIT RECEIPT COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36904039 . 00 DATE ISSUED. . . . . . . : 01/14/2010 RECEIPT #. . . . . . . . . BS000009564 REFERENCE ID # 10010066 SITE ADDRESS 19887 RODRIGUES AVE SUBDIVISION CITY • • . . , . . • CUPERTINO IMPACT AREA . • • • • • • OWNER YUCHI TENG ADDRESS . . . . . . . . . . : 19887 RODRIGUES AV95014-2901 CITY/STATE/ZIP CUPERTINO CA, RECEIVED FROM JIAN MIN CONSTRUCTI CONTRACTOR . . , , , , , : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP TELEPHONE PD-TO-DT THIS REC NEW BAL QUANTITY AMOUNT -- FEE ID _UNIT___-- -------------------- ---------- ---------- --------- --------- 0 . 00 ----- -- 4 .00 0 .00 0 . 00 1BCBSC VALUATION 100, 000 .00 0 .00 10 . 00 100, 000 . 00 10.00 114 .00 0 . 00 1BSEISMICR VALUATION 1 . 00 114 . 00 0 .00 0 . 00 1BUSLIC FLAT RATE _--- 570 . 00 0 . 00 570 .00 ------ 103 . 00 1REMRESKIT SQ FEET ____698_0_ ---------- ---6 698 . 00 0.00 698 . 00 0 . 00 TOTAL PERMIT AMOUNT REFERENCENUMBER METHOD OF PAYMENT --------------- __ _ ----------------- 698 . 00 1056 CHECK _______________ TOTAL RECEIPT 698 . 00 OVER L -PROJECT SHEET C RE SIDEN TIA ssessor's Parcel Number: Name of owner. - Project address. - � Phone. ,Contact person. Fax L) Net square footage of lot. - pro osed Existin First floor: Square footage. Second floor. i Garage: ,•- TOTAL: 20 foot clear spaces inside the garage? � ���¢�•--°�"� �`' � _.� there at least two 10 foot by _ Are N ired for the project? is privacy ion planting requ � p protect - Build it Green Total Points s is work being done? A p On what floor( ) Q Brief description of work. d N)2007 CMC -N) CBC N) 007 CFC - _N) Code editions:2007 _2007 CPC N)2007 NEC IN ACCOR[)A ;I 'Nm4 1 HE CITY OF g CUpERTINO CUUES AN[)ORDINANCES Effective 1 i 1/0 I _ _`�^II D DATE__ -- SIGNED- -- itications MUST of This set pis and spec be kept on the job at all times and itis es or alterations changes unlawful to make any rrrnssion from on same vmhout written Pe rtino. the guild"Department,City of C�fP ations of this plan and spec The stamprn9 or to be an SHALL NOT be held to permitprovisions approval of the violation of��nt i t.aw. of any City ordinance or Plan Review Process Work Book page-B-Revised 8/05108 ori 4i I`� At ICE lEA ----------- CA A lig VIC. ---------------------- AAZ 24 In EL A IE � M " s cin 7 i% cv, ------------ tv 0 ;o V V (Dull . CUPERTINOY OF CIT a � ONIREMODEL _ ADDITI PLICATI ORM ON F ITY OF RMIT AP PE CUPE TINO Date: -z.... z o C d t �-� n unit. APN # � � ill out the p ermit application for 2 j'1 No If yes,please f n added`' Yes❑ Is a 2 unit being �l Address*. g&lR,, 4 r i �s l�U�e Cw Building Addre ` t from building address) Mailing Address (if differen M Phone V'� I �P h Name: 5� Y(4 �Owner s N Q,it Phone#• 1 ' �J Fax#: ContractorVOV, i Aft cAao Pj1�1- Contractor License se � phone#: - - � - .—7 6 icenSe#: Cuertino Business t Fax#. Contact: � � �� Mech. ❑ I=lillside ❑ . _ Tlit Info. Plumb. Building P e Elect. Bldg. Job Description: $e Specific): Addition _what is being added? N including addition)? t What is being remodeled(n Q(A' ,t.,, , CG , .ten- c ,`h t0Vr AgPvW ! _ es numb of squar f es list num t No I y e_Roof: Yes ❑ Remodel Includes R rai. Yes ❑ No Remodel Includes Structu � s No ❑ Tanning approval. Ye . _a lication p royal letter planners name*. Do you haVe the pre re-application lannin a lease provide a co of our Attached If es, Garage: Detached Square Footage: Deck: porch:------------ Other _------ Bath Kitchen � Remodel: Occupancy Type: e Class): _ � = 'on U sag �Gt-Loti� � . Type o f construction( �. ro'ect is a � v-B [� III B,IV-I-IT, ase check this box if the p J II/III/V-A ❑ II/ lease -stor addition ❑ 1-A, l-B ❑ second y Valuation: � �' " ess❑ Standard Large Major❑ s Achieved: Project Size; Exprtion of the GTeenBuilding Green Building point Please complete relevant po lication or if applicable, ecklist & attach it,to the app dex. d 07/06/09 include in Tan set& Ch the sheet m Revise *** For Office Use Only*** over-the-Counter ❑ CITY OF CUpERTINO 10-0 ADDITIOT`4/RE MODEL (JLE OFFEE SCI-IED- UTY CVpEkT1N0 Fee Description Permit Type cri tion Fee Group Quantity Fee ID 1R3SFDADD S Ft ITIONS ADD PL Long Range 1pLLONGRNGR tannin esidential P B Dwellings Inspections 1 R3INSP B 1R3PLNCK Dwellings plan check SP Dwellings Repeat B 1 R3REPIN Ins ection B Dwellings Repeat Plan 1R3REPPLNC Check Dwellings hillside B 1R314INSI' ins ection B Dwellings Hillside plan 1 R3HPLNCK check B Dwellings Hillside 1 R3HREIN SP Repeat Inspection B C Dwellings Hillside 1 R3HREPLN Repeat Plan Check SP Dwellings Alternate. B 1R3ALTIN Materials Inspection B Dwellings Alternate 1R3ALTPLNC Materials Plan Check P SS Cesspool 1PCE P WG Ea.Private Sewage 1PPRSE Dis Osal S stem P Sewers 1 PRSEWERP Lawn Spri�ler/Backflow 1BPSPRINK P . IBP WSVCS Main Water Service B ALL PERMIT TYPES Cal Bldg Standards 1BCBSC Commission Fee B 1SeismicResidential IBSEISMICRB Residential Re-roof Each B 1REROOFRES 100 SF CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE F7e_e1_D _____] Fee Description Fee Group Permit Type Quantity S Ft 1R3SFDADD OR DECKS 1R3SFDREM 1 DECKWOOD Deck (Wood)-Each B (Each) B 1 DECK:RAIL Deck Railing-Each (Each) 1R3SFDADD OR GARAGES 1R3SFDREM DETACHED B 1 GARDTW<=1 K Wood Frame up to 15000 SF (each) 1 GARD TM<=1 K Masonry up to 1,000 SF B (each) 1BCONSTAXR Construction Tax Res (new detached garage) JR3SFDADD OR PATIO'S OPEN 1R3 SFDREM 1PATIOW OOD Wood Frame up to 300 B SF B 1PATIOMETAL Metal Frame up to 300 SF 1 PATIOOTHER Other Frame up to 300 SF B 1R3SFDADD OR PATIO'S CLOSED 1R3SFDREM & SUN ROOMS to 300 B 1PATIOENCLW Enclosed Wood up SF 1 PATIOENCLM Enclosed Metal up to 300 B SF B 1PATIOENCLO Other Enclosed Patio up to 300 SF B 1 COVPORCH Porch Covered-Each (Each) 1R3SFDREM REMODELS B (Deduct "$"for ea plan 1 REMRESKIT Kitchen Remodel up to check 300 SF « u I REMRESBAT Bath Remodel p to 300 B SF to 300 B 1 REMREOTH Other Remodel up SF CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Fee Group Permit Type Quantity Fee ID Fee Description S Ft 1 MECP LN CK Stand Alone Mechanical M hourly Pln Ck( P 1PLMPLNCK Stand Alone Plumbing Pln Ck(hourly) 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee B 1BSEISMICRE Seismic Residential 1 TRAVDOC Travel &Documentation B 1BUSLIC Business License B D Mum.-IndDDr Qir Quality an ►nishes 1 IADJHealth pts Y::Y" 0 p 1.Use t owffilo-V()C Paint 2 IAOJ/ iealth pts y=yes 2.Use Low%10C,Water 1Nood Finishes 31ADJHealth Pts y--yes 0 3.Use LDWM,VoC Adhesives fishes 3 Resource pts yyres 0 4.Use Salvaged.hfjaterials for Interior Fin Urea = es 0 Use Engineered Sheet Goods with no added 6 IAWHealth pts y Y 5. 0 ----- Formaldehyde Uses 11AWBalth pts y=YL plywood for Interior 4 IApealth pts = es 0 6.Use Exterior Grade ply of M-DF 4 Resource pts y=yes 0 7..Saal . Is for Interior Finish y_yes 0 B.Use FSC Certified Materia Trim 1 Resource pts 9.Use Finger-Jointed or ReCycled-Content 3 IAQHealth pts y=yes 10.Install Whole House Vacuum System � 0 es N.Flooring = B Resource pts YY 0 1.Select FSC Gertif►ed\Nood Flooring 4 Resource pts Y=yes 0 ials es 0 2.USe Bapld►ReneV1 a Flooring Maje 4 Resource pts Y=Y ntent Ceramic Tiles - 5 IAQ/Heaith pts MeS 0 3.Use Recycled Co Place of Vin} Y=Yes 0 4.Install Natural Linoleum in 4 Resource pts 5.Use Exposed Concrete as Finished Floor = es 4 Resource pts Y Y 1 6.Install Recycled Content Carpet with Low VOCs 140 130 57 QO TOW�P6,�Available. 0f:0 0 [::Total Points Pro-ect Received: �4 rotecied.xls �progslgreenbuildingg uidefineslremod:lers(grzenpointsfinal212• P Community Development 10300 Torre Avenue Cupertino C A95014 -� Telephone(408)777-3228 y, tTF' Fax(408)777-333 CITY OF 11��0 ent ,U pEk artm -Build- De 11 , Bu PERMIT # v f I v OB ADDRESS: 1 0 R'S NAME= 'e n FAX# OVVNE CT - � v GENERAL CONTRA OR: f ate • an subcontractors: I am not using y Signature owin formation. rs and CO Tete the f oll ESS LICENSE # licable subcontracto NAME BUSINESS Please check a BUSINESS N S UB CONTRA,C'TOR Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring:Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry ornamental Sheet Meta Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Date owner/Contractor Signage