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09090003CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22346 MC CLELLAN RD CONTRACTOR: VT CONSTRUCTION PERMIT NO: 09090003 OWNER'S NAME: THUY LAM 3220 BROWNHILL CT. DATE ISSUED: 09/01/2009 ER'S PHONE: 4089216692 I SAN JOSE, CA 95135 I PHONE NO: (408)590-7268 I ❑ LICENSED CONTRACTOR'S DECLARATION 7 License Class . Lic. # � Contractor Date fJ 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. Signature /� I Date 9 — / -- C7 2 Li OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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, 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: 1 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 shall be deemed revoked. 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 mify and keep harmless the City of Cupertino against liabilities, judgments, 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. Signature_ Date BUILDING PERMIT INFO: BLDG f— ELECT I— PLUMB f— MECH F RESIDENTIAL f— COMMERCIAL f— JOB DESCRIPTION: DECK REPAIR(197SQ)TO STOP LEAKING; VT CONSTRUCTION RENEWD BUS LIC 9/1/9 Sq. Ft Floor Area: I Valuation: $5500 APN Number: 35705062.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by:��-�' Dater/, RE -ROOFS: All 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 inspection. Signature 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. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants 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. O ujjrorjzed agent: --- Date:! 5' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35705062.00 DATE ISSUED.......: 09/01/2009 RECEIPT #......... BS000008575 REFERENCE ID # ...: 09090003 SITE ADDRESS .....: 22346 MC CLELLAN RD SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: patg COPY # : 1 OWNER THUY LAM ADDRESS 22346 MCCLELLAN RD CITY/STATE/ZIP ...: CUPERTINO CA, 95014-2753 RECEIVED FROM ....: THUY T LAM CONTRACTOR VINH TRAN LIC # 25220 COMPANY VT CONSTRUCTION ADDRESS ..........: 3220 BROWNHILL CT. CITY/STATE/ZIP ...: SAN JOSE, CA 95135 TELEPHONE (408)590-7268 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ----------------------- 1BCBSC VALUATION ---------- 5,500.00 -------------------- 1.00 0.00 1.00 0.00 1BSEISMICR VALUATION 5,500.00 0.60 0.00 0.60 0.00 1SUPINSFEE HOURS 2.00 252.00 ---------- 0.00 252.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 253.60 0.00 253.60 0.00 METHOD OF PAYMENT AMOUNT REFERENCE -------------------- NUMBER ----------------- --------------- CREDIT CARD 253.60 MC --------------- TOTAL RECEIPT 253.60 CITY OF CUPEkTINO CITY OF CUPERTINO GENERAL BUILDING PERMIT APPLICATION FORM q ocl, 0 0 0 -3 APN #�t-7 3 l o oz Date: og l Building Address: 1-1-346 MC, C4 -E L LA RU A (� coPEP- -1CA % � 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, provide letter from HOA Owner's Name: 714v Y LAM Phone tL�o$3 Contractor:,____ P � ) I l� ice/ L)e----)-7a Phone: Fax: Contractor License #: 'S S % Cupertino Business License #: Contact: .V / nl/V d L= `T 'rt Phone/ � -a s;) Fax: Residential Commercial ❑ Job Description: D e Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ IFIII/V-A ❑ II/III B, IV -HT, V -B ER",- V Valuation: Square Footage: G/`7 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 Revised 07/14/09 aff,12-1 cm OF CUPERTINO CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) additional stucco application B 1 WINREP Replacement windows/sliding glass door (ea 8 windows) B 1 WINMEWSTR New Window -structural shear wall/masonry (includes plan ck fee) B 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE 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 1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min when not over counter) Standard Plan Check (when no E/M/P) hourly -stand alone B 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel & Documentation B 1BUSLIC Business License B / ScPti,sr 5 of 5 Assessor's Parcel Number: '3S-? "0 S' O G Z Name of owner. Project address. �, % 3 Le 6 �� cC��►r, Contact person. ill y', -Q, Net square footage of lot. Phone. !S� g'O --?,1 6/ 01 Fax. Existin Proposed Square footage: First floor: Second floor: Garage: TOTAL: Ore there at least two 10 foot by 20 foot clear spaces inside the garage? Is privacy protection planting required for the project? N On what floor(s) is work being done? 2 n k Brief description of work. �� k S c' {' Ss �v �l E�•�I 2V nA Code editions: 2008 CBC N)2008 CFQ,l,()VF' - N)2008 CMC (Y4 2008 CPC (Y -� ._ vITM�6 n'NI Y OF 5 AN R�Ij�ANCES DATE__r� ti Effective 1/1/08 sly D This set of plans and specifications MUST be kept on the job at all times and it is unlawful to make any changes or alterations on same without written permission from the Building Department, City of Cupertino. The stamping of this plan and specifications SHALL NOT be held to permit or to be an approval of the violation of any provisions of any City Ordinance or State law. Plan Review Process Work Book Page -8-Revised 1/1/08 e> y v. G 0-, CITY OF ,UPEf�TINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: �`� PERMIT A50 OWNER'S NAME: GENERAL CONTRACTOR: PHONE FAX # d ao�3 I am not using any subcontractors: ---i'�� 1 Signature Date P1pnop L`1, P!`l� a»»l;rahla q„1-k-n„tractnrs and complete the following information: /; �. Owner/ Contractor Signature Date y �y SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile /; �. Owner/ Contractor Signature Date