09100202 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10138 COLD HARBOR AVE CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO:09100202
OWNER'S NAME: KIN HING LEUNG DATE ISSUED: 10/29/2009
'ER'S PHONE: 4088732271 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
MECH f- RESIDENTIAL f- COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:CONNECT GUEST BEDROOM TO BATHROOM
(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 Sq.Ft Floor Area: Valuation:$12000
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 APN Number:36909043.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accnie against said City in consequence of the /
¢,
granting of this permit. Additionally,the applicant understands and will comply Issu y: Datel G �
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Signature Date
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
CEJ/ OWNER-BUILDER DECLARATION installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
I hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons: Signature of Applicant: Date:
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,
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE
I hereby affirm under penalty of perjury one of the following three I have read the hazardous materials requirements under Chapter 6.95 of the
declarations: California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain a Certificate of Consent to self-insure for Worker's compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Compensation,as provided for by Section 3700 of the Labor Code,for the Safety Code,Section 25532(x)should I store or handle hazardous material.
performance of the work for which this permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I have and will maintain Worker's Compensation Insurance,as provided for by 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
Section 3700 of the Labor Code,for the performance of the work for which this Health&Safety Code,Sections 25505,25533,and 25534.
permit is issued.
1 certify that in the performance of the work for which this permit is issued,I shall Owner or authorized Agent:
not employ any person in any manner so as to become subject to the Worker's / ^ Date: C7 Z VC)
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 CONSUCTION LENDING AGENCY
forthwith comply with such provisions or this permit shall be deemed revoked. I hereby affirm that there is a constriction lending agency for the performance of work's
for which this permit is issued(Sec.3097,Civ C.)
APPLICANT CERTIFICATION Lender's Name
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 Lender's Address
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
nify and keep harmless the City of Cupertino against liabilities,judgments,
c. ,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date Z (L
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36909043 .00
DATE ISSUED. . . . . . . : 10/29/2009
RECEIPT #. . . . . . . . . BS000009069
REFERENCE ID # . . . : 09100202
SITE ADDRESS . . . . . : 10138 COLD HARBOR AVE
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : KIN HING LEUNG
ADDRESS . . . . . . . . . . : 10138 COLD HARBOR AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-3327
RECEIVED FROM . . . . : EVA Y PANG
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 12, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 12, 000. 00 1 .20 0 . 00 1 .20 0 . 00
1REMRESBAT SQ FEET 43 . 00 570 . 00 0 . 00 570 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 572 .20 0 .00 572 .20 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 572 .20 AMEX
---------------
TOTAL RECEIPT : 572 .20
09
CITY OF CUPERTINO
ADDITION/REMODEL
CUPEkT1NO PERMIT APPLICATION FORM
APN # I. D q o o o Date: 1 j LI
Is a 2ndunit being added? Yes ❑ No F71 If yes, please fill out the permit a'pplic'atiod for 2" unit.
Building Address:
Mailing Address (if different from building address):
Owner's Name: Phone#�S , 8 -13
3 2 � T
KEN BIN -
Contractor: Phone#: 4ob
Fax #:
Contractor License#: 100-70
Cupertino Business License#:
Contact: Phone#:
Fax #:
Building Permit Info:
Bldg. [I- Elect. ER' Plumb. [Z/" Mech. E9-- Hillside ❑
Job Description:
Addition-What is being added?(Be Specific):
What is being remodeled (not including addition)?
CoN\)2 Ct ��kQSt b1?_QLr00rn +o bc•tk r00m
Remodel Includes Re-Roof: Yes ❑ No If yes list number of squares
Remodel Includes Structural: Yes ❑ No
Do you have the pre-application planning approval? Yes ❑ NA30
If yes, please provide a copy of your planning approval letter. Planners name:
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen Bathe c� Other
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B
Valuation: Z o oo Please check this box if the project is a
second-story addition ❑
Project Size: Express ❑ Standard ❑ Large ❑ Major❑
Please complete relevant portion of the Green Building
Checklist& attach it to the application or if applicable, Green Building Points Achieved:
include in plan set& the sheet index.
***For Office Use Only***
Over-the-Counter 7 Revised 07/06/09
CITY OF CUPERTINO
ADDITION/REMODEL
OF
CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
ADDITIONS 1R3SFDADD
1PLLONGRNGR Long Range PL
Planning/Residential
1R3INSP Dwellings Inspections B
1R3PLNCK Dwellings plan check B
1R3REPINSP Dwellings Repeat B
Ins ection
1R3REPPLNC Dwellings Repeat Plan B
Check
1 R3HINSP Dwellings Hillside B
inspection
1 R3HPLNCK Dwellings Hillside plan B
check
1R3HREINSP Dwellings Hillside B
Repeat Inspection
1R3HREPLNC Dwellings Hillside B
Repeat Plan Check
1R3ALTINSP Dwellings Alternate B
Materials Inspection
1R3ALTPLNC Dwellings Alternate B
Materials Plan Check
1PCESS Cesspool P
1PPRSEWG Ea. Private Sewage P
Disposal System
1 PRSEWER Sewers P
1BPSPRINK Lawn Sprinkler/Backflow P
1BPWSVCS Main Water Service P
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
C 113SEISMICRE SeismicResidential B
1RER00FRES Residential Re-roof Each B
100 SF
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
DECKS 1R3SFDADD OR
1R3SFDREM
1 DECKWOOD Deck (Wood)-Each B
(Each)
1 DECKRAIL Deck Railing-Each B
(Each)
GARAGES 1R3SFDADD OR
DETACHED 1R3SFDREM
1 GARDTW<=1 K Wood Frame up to B
1,000 SF (each)
1 GARDTM<=1 K Masonry up to 1,000 SF B
(each)
1BCONSTAXR Construction Tax Res
(new detachedgarage)
PATIO'S OPEN IR3SFDADD OR
IR3SFDREM
1 PATIOWOOD Wood Frame up to 300 B
SF
1PATIOMETAL Metal Frame up to 300 B
SF
1 PATIOOTHER Other Frame up to 300 SF B
PATIO'S CLOSED 1R3SFDADD OR
& SUN ROOMS 1R3SFDREM
1 PATIOENCLW Enclosed Wood up to 300 B
SF
1PATIOENCLM Enclosed Metal up to 300 B
SF
1PATIOENCLO Other Enclosed Patio up B
to 300 SF
1 COVPORCH Porch Covered-Each B
(Each)
REMODELS IR3SFDREM
1 REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan
300 SF check
1 REMRESBAT Bath Remodel up to 300 B "
y SF
1REMREOTH Other Remodel up to 300 B "
SF
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Community Development
w f 10300 Torre Avenue
Cupertino CA 95014
' Telephone(408)777-3228
CITY OF Fax(408)777-3333
�M TINO
Building Department
JOB ADDRESS: �o X39 COO, b4&-y6Y A4-o-, PERMIT#
CA, 9Sof L ' �l�C�2fJ�
OWNER'S NAME: K i N W N L G�KN PHONE # 4-Vg--TT-3Z2-7
GENERAL CONTRACTOR: FAX #
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
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
-*Owner/Contractor Sikp(nata4 Date