08100121CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 21871 DOLORES AVE (LOT2) I CONTRACTOR: TBD - TO BE DETERMINED I PERMIT NO: 08100121
OWNER'S NAME:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #1
Contractor
Date
DATE ISSUED:07/29/2009
PHONE NO:
BUILDING PERMIT INFO: BLDG r ELECT F PLUMB r
MECH F RESIDENTIAL F COMMERCIAL r
I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:NEW 2 STORY SFDWL W/ATTCH
(commencing with Section 7000) of Division 3 of the Business & Professions GARAGE(514.5SQ)& PORCH
Code and that my license is in full force and effect. 77'
LOT 2
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
Date
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 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)
1, 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.
1 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, 1
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. 1 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 -
. -7—Z +
Licensed Professional
I CITY OF CUPERTINO BUILDING PERMIT I
IBUILDING ADDRESS: 21871 DOLORES AVE I CONSTRUCTION E & RIGHT I PERMIT NO: 08100121
OWNER'S NAME:
CUPERTINO, CA 95015 PHONE NO: (408)861-0928
❑ LICENSED CONTRACTOR'S DECLARATION I" F
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. 4 j- r r
MEC11 RESIDENTIAL COMMERCIAL
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. 1 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.
Date
OWNER -BUILDER DECLARATION
I hereby affirm that 1 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)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
1 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, 1
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
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
91R
JOB DESCRIPTION: NEW 2 STORY SFDWL W/ATTCH
GARAGE(514.5SQ)& PORCH
77'
LOT 2.V I S. 1 Q tU
Sq. Ft Floor Area: I Valuation: $700000
APN Number: 35714081.00 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:
Date:
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
1 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 1
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code,
/
CONSTRUCTION LENDING AGENCY
1 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 Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Signature,
Z
a • •
CUPERTINO
April 8, 2009
Suejane Han
770 Allen Court
Palo alto, CA 94303
Building Department
CITY OF CUPERTINO
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
TELEPHONE: (408) 777-3228 • FAX: (408) 777-3333
SUBJECT: Permit application extension
Dear Suejane:
Your permit application #08100121 for 21871 Delores Ave (lotp has been extended the maximum 6 months till
10/20/2009. This is a one-time only extension. Your permit for the new house will need to be approved, paid for and
issued no later than 10/20/2009. If the permit is not issued by 10/20/2009 then you will need to pay all new fees.
You need to continue with the plan checking process for both permits for 21871 & 21881 Delores Avenue. Even
though you still have Public Works issues, you need to keep the plan check process going so the other departments will
be approved. Do not let these sit without any activity on them.
Your permit application #09010037 for 21881 Delores Avenue will expire 7/09/2009. Mike Chewgot the comments
on 2/11/2009. We still have not received a resubmittal. I talked to Mike 4/08/2009 and he indicated that you were
concerned about the P submittal supplemental fees. This fee is $122.00 compared to $2800.00 if you let the permit
application expire.. There will be no extension for 21881 Delores if the plan check process has not been ongoing.
If you have any questions or concerns, please contact me at 408-777-3246.
Sincerely,
Susan Winslow
City of Cupertino, Building Department
Cc: Mike Chen
H.M.C. Associates, LLP
12280 Saratoga/Sunnyvale Rd
Saratoga, CA 95070
Susan Winslow
To: hmikechen@aol.com
Subject: 21871 & 21881 Delores Ave
Attachments: 21871 & 21881 DELORES AVE2.doc
Hi Mike,
I am attaching a letter regarding the extension for 21871 Delores and the resubmittals for 21881 Delores Ave. I have
sent this letter to the owner and also mailed you a copy.
Sincerely,
Susan Winslow
0
•
Dear Sir or :Madam:
April 3, 2009
� APR o 3 Zoos
This letter is to request the extension of plan review for property at 21871 Dolores Ave., Cupertino. The
plan was submitted on Oct. 20, 2008. The comments were received on Nov 11, 2008. One of comments is to
submit the plan of adjacent neighbor 21881 Dolores Ave., Cupertino. It normally takes 2 to 3 months for
architect and structure engineer to complete a new building design. We managed to submit the plan of 21881
Dolores rive on Jan. 9, 2009. The comments are received on Feb. 13, 2009. We consolidated the feedback on
21871 and 21881, and submitted the revised public works plan on :March 3, 2009. The comments were received
on March 19, 2009. One of comments is to obtain arborist report to design sidewalk. We paid the fee to City
on :March 26, 2008. I was told it takes about 2 weeks to complete the report.
In the past few months, we work hard on the projects. One biggest challenge was to submit the adjacent
neighbor's plan that takes many months to make a good design. Also we still cannot resolve the public works
issues. According to the first comments on 21871 Dolores, we ought to submit public works and other plans at
the same time at resubmittal. These issues caused unexpected delay on 21871 Dolores Ave. plan resubmittal.
Please approve the extension of plan review on 21871 Dolores Ave. If you have any questions, please contact
me at 408-4645030. Your assistance is highly appreciated.
Sincerely,
Tracy Hsu
a 1871 pt4��
21871 DOLORES AVE • CCPERTiNO/CA • 95014
PHONE: 408-4645030 • FAX: 408-6245425
^• J CRy of Cuper0no
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