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09070169I CITY OF CUPERTIN D BUILDING PERMIT I BUILDING ADDRESS: 908 BROOKGROVE LN OWNER'S NAME: HONG YANG MAO ER'S PHONE: 4082551908 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor Date 1 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 1 certify that 1 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 11 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, 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: 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. 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 1 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 i, �ify and keep harmless the City of Cupertino against liabilities, judgments, CL I fluid 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. Signat `'. Date 67/�7/2Q0q CONTRACTOR: HONG YANG MAO PERMIT NO: 09070169 ()08 BROOKGROVE LN DATE ISSUED: 07/27/2009 CUPERTINO, CA 95014 PHONE NO: 13UILDING PERMIT INFO: BLDG r ELECT r PLUMB r— r r r MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: KITCHEN REMODEL,APPRX IOOSQ Sq, Ft Floor Area: Valuation: $10000 ,CPN Number: 37539037.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. ssued by: Zlooflq'�IVPICCIOOV, Date: 7.Z7•Of RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ;signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain i ompliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. ,Additionally, should I use equipment or devices which emit hazardous air 4 ontaminants as defined by the Bay Area Air Quality Management District I will inaintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the I lealth & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Dater CONSTRUCTION LENDING AGENCY hereby affirm that there is a construction lending agency for the performance of work's :or which this permit is issued (Sec. 3097, Civ C.) .ender's Name ,ender's Address ARCHITECT'S DECLARATION understand my plans shall be used as public records. .icensed Professional ��' CITY OF CUPEk�TINO CITY OF CUPERTINO ADDITION/REMODEL PERMIT APPLICATION FORM 0707 0 L�-p I APN # ,� � 4 D Date: „l z� f -70o Is a 2 "d unit being added? Yes ❑ No If yes, please fill out the permit application for 2" unit. Building Address: 0$ Brvokarove [ane Mailing Address (if different from building address): Owner's Name: �1 av Phone # o� 251 Q 08 4-09j o Contractor: Phone #: Fax #: Contractor License #: Cupertino Business License #: Contact: Phone #: Fax #: Building Permit Info: Bldg. ❑ Elect. ❑ Plumb. [ Mech. ❑ Hillside ❑ Job Description: Addition -What is being added?(Be Specific): kitchen r'gmodfe� What is being remodeled (not including addition)? Remodel Includes Re -Roof. Yes ❑ No [!] If yes list number of squares Remodel Includes Structural: Yes ❑ NoEl Do you have the pre -application planning apF roval? Yes ❑ No ❑ If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen ( 00 Bath Other Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV -HT, V -B ® R 3 Valuation: Please check this box if the project is a second -story addition ❑ Project Size: Express ❑ Standard ❑ Large ❑ Ma'or ❑ Please complete relevant portion of the Green Building Checklist & attach it to the application or if appli,:able, Green Building Points Achieved: include in plan set & the sheet index. ***For Office Use Only*** Over -the -Counter ❑ Revised 07/06/09 CITY OF CUPERTINO ADDITOP 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) 1GARDTM<=1K Masonry up to 1,000 SF B (each) 1BCONSTAXR Construction Tax Res (new detachedgarage) PATIO'S OPEN 1R3SFDADD OR 1R3SFDREM 1PATIOWOOD Wood Frame up to 300 B SF 1PATIOMETAL Metal Frame ul) to 300 B SF 1PATIOOTHER Other Frame ul► to 300 SF B PATIO'S CLOSED 1R3SFDADD OR & SUN ROOMS 1R3SFDREM 1PATIOENCLW Enclosed Wood up to 300 B SF 1PATIOENCLM Enclosed Meta. up to 300 B SF 1 PATIOENCLO Other Encloses Patio up B to 300 SF 1 COVPORCH Porch Covered Each B (Each) REMODELS 1R3SFDREM 0 O 1 REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan 1 300 SF check 1 REMRESBAT Bath Remodel ip to 300 B 66 SF 1 REMREOTH Other Remodel up to 300 B SF CITY OF I�UPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type 1 MECPLNCK Stand Alone M ,-chanical Pln Ck (hourly M 1PLMPLNCK Stand Alone Ptunbing Pln Ck (hourly) P 1BCBSC Cal Bldg Standards Commission N e B ALL PERMIT TYPES 1BSEISMICRE Seismic Residerrtial B 1TRAVDOC Travel & Documentation B 1BUSLIC Business Licen,;e B 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37539037.00 DATE ISSUED.......: 07/27/2009 RECEIPT #...•...••: BS000008272 REFERENCE ID # ...: 09070169 SITE ADDRESS .....: 908 BROOKGROVE IN SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............. HON -9 YANG MAO ADDRESS ..........: 908 BROOKGROVE LN CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: HON3YANG MAO CONTRACTOR .......: LIC # *OWNER* COMPANY ..........: HONG YANG MAO ADDRESS ..........: 908 BROOKGROVE LN CITY/STATE/ZIP ...: CUPERTINO, CA 95014 TELEPHONE ........ OPERATOR: patg COPY # : 1 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- ----------------------- 1BCBSC VALUATION ---------- 10,000.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 0.00 1BSEISMICR VALUATION 10,000.00 1.00 0.00 1.00 0.00 1REMRESKIT SQ FEET 1.00 1140.00 ---------- 0.00 ---------- 1140.00 ---------- 0.00 ---------- TOTAL PERMIT 1142.00 0.00 1142.00 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- CREDIT CARD 1,142.00 -------------------- VISA --------------- TOTAL RECEIPT 1,142.00