13060194CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10408 JUDY AVE
CONTRACTOR: ISUM 9D0^&_S
PERMIT NO: 13060194
OWNER'S NAME: CHEW STEPHEN R AND WENDY NG
DATE ISSUED: 06115/2013
OWNER'S PHONE: 4082034950
PHONE NO:
El
JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALE]
LICENSED CONTRACTOR'S DECLARATION
_75—
<—k-)
License Class Lic. # 9'r L2 10
POUR (N) CONC"TE PAD & INSTALL Q�) SUNROOM (320
6L)Qk_0ntk_g aT
S.F.)
Contractor
Ch.pte
I hereby affirm that I am licensed under the pr,visimi"f
(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: $14000
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
APN Number: 37510002.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that tile 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
WITIIIN 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 ST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Z, 13
granting of this e it. Add'
V rul . ition , the applicant understands and will comply
te:
with all non -p in o rc re lati ns Municipal Cod, S
�ertino
9.18.
Signature Date
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.
0 OV^ER-BUILDER DECLARATION
-
Signature of Applicant: Date:
I hereby affirm that I am exempt from the C ontractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505,25533, and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
9
will maintain compliance w�ithc Cupertino u ici ode, Chapte7r,. 2 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, i Is 255 25 an 5 34, (0
2�
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent. '�Flate:
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
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, 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
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
Nlech. Plan Check
lfec-h. PennitlFee:
Othef-Alech. Insl).
Phanb, Plan Check
Plumb. Permit Fee:
Other Plumb Insl).
Elec. Plan. Check
F'Icc. Permit Fee:
Other Dec- Insp.
Ifech. Imp. Fee., I Plurnb. hisj). Fee: I Ele(. Insp. Fee: I
NOTE. This estimate does not includefees due to other Departments (Le Planning, Public Works, Fire, Sanitary Sewer District, School
Thpv& f&&.v arp hav&d an th& nr&fiminary information available and are nn1v an estimate- Contact the DeDt for addn 7 info.
FEE ITEMS (Fee Res dution 11-053 gff 711112
10408 JUDY "E DATE: 06/25/2013
REVIEWED BY: MELISSA
IlaADDRESS:
APN: 37510 002 BP#:
VALUATION: 1$14,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
I
PENTAMATION IR3SFDADD
USE:
-01
PERMIT TYPE:
woRK
POUR (N) CONCRETE PAD & INSTALL (N) SUNROOM (320 S.F.)
SCOPEI
$0.00
Nlech. Plan Check
lfec-h. PennitlFee:
Othef-Alech. Insl).
Phanb, Plan Check
Plumb. Permit Fee:
Other Plumb Insl).
Elec. Plan. Check
F'Icc. Permit Fee:
Other Dec- Insp.
Ifech. Imp. Fee., I Plurnb. hisj). Fee: I Ele(. Insp. Fee: I
NOTE. This estimate does not includefees due to other Departments (Le Planning, Public Works, Fire, Sanitary Sewer District, School
Thpv& f&&.v arp hav&d an th& nr&fiminary information available and are nn1v an estimate- Contact the DeDt for addn 7 info.
FEE ITEMS (Fee Res dution 11-053 gff 711112
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$O.00F-32--O
] s.f.
$1,465.001
Patio Cover / Sun Room
IPATIOENCM Metal, Enclosed
T
Suppl. PC Fee: (F) Reg. 0 OTO
-01
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -.(F) Reg. 0 OT
FO.0 I
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
I I MR` P� M
Sig A
Nlech. Plan Check
lfec-h. PennitlFee:
Othef-Alech. Insl).
Phanb, Plan Check
Plumb. Permit Fee:
Other Plumb Insl).
Elec. Plan. Check
F'Icc. Permit Fee:
Other Dec- Insp.
Ifech. Imp. Fee., I Plurnb. hisj). Fee: I Ele(. Insp. Fee: I
NOTE. This estimate does not includefees due to other Departments (Le Planning, Public Works, Fire, Sanitary Sewer District, School
Thpv& f&&.v arp hav&d an th& nr&fiminary information available and are nn1v an estimate- Contact the DeDt for addn 7 info.
FEE ITEMS (Fee Res dution 11-053 gff 711112
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$O.00F-32--O
] s.f.
$1,465.001
Patio Cover / Sun Room
IPATIOENCM Metal, Enclosed
T
Suppl. PC Fee: (F) Reg. 0 OTO
-01
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -.(F) Reg. 0 OT
FO.0 I
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
(7onsiruction Tax:
Administrative Fee:
0
E)
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Fe
$0.00
Select a Non -Residential
Building or Structure
E)
0
Travel Docuinentation Fees:
Strong Motion Fee: 1BSEISAffCR
$1.40
Select an Administrative Item
Bldp- Stds Commission �ee: IBCBSC
$1.00
$2.401
$1,465.00
WH
X,
$1,467.401
1�k Revised: 04/29/2013