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13080140 REV1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21095 WHITE FIR CT CONTRACTOR:HO YU HUA TRUSTEE PERMIT NO: 13080140 OWNER'S NAME: HO YU HUA TRUSTEE 21095 WHITE FIR CT DATE ISSUED:08/20/2013 OWNER'S PHONE: 4088651219 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL License Class Lic.# INTERIOR REMODEL TO CONVERT M.CLOSET TO BATHROOM, Contractor Date RELOCATE WATER HEATER AND FURNACE 78 SQ FT I hereby affirm that I am licensed under the provisions of Chapter 9 �is (commencing with Section 7000)of Division 3 of the Business&Professions ` / 1'►n Code and that my license is in full force and effect. ` p�'�ol. fCi 1 t✓1 I hereby affirm under penalty of perjury one of the followW!O I have and will maintain a certificate of consent to self-insure Compensation,as provided for by Section 3700 of the Labor performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$10000 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:35905077.00 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 DAY FROM LAST 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 � 23-t'3 granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: 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. ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 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. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 255055, ,,23533,and 534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: permit is issued. Date: 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 CO STRUCTION 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 ceitify 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. 9 Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 l (408)777-3228• FAX(408)777-3333•building0)eugertino.ora �UP�R."["tNt� X36 0 ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI REVISION/DEFERRED ORIGINAL PERMIT# 7 IT PROJECT ADDRESS I 01 +t t fj r _,],. r11n O ( APN# OWNERNAME Ho YiA: l 'L& E-MAIL STREET ADDRESS 1 1 { 1 CITY, STATE,ZIP / �l h� 0�, r� 014/ FAX CONTACT NAME W k PHONE ('l^ E`-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK 1 eS 0. >A EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM CHEN OTHER REMODELAREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY [:]YES BEING ADDED? ONO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECE TOTAL VALUATION: PLANNING APPL# [:]NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO .� -, "'2 V AL M By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building cons ' n. I autho' presentarives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: qtli3 SUPPLEMEN INFORMATION REQUIRED � pLAI�TH ciczyr,E RouriricSLIP, _New SFD or Multifamily dwellings: Apply for demolition permit for BZILDING PLAN REVIEWoETtNTE� existing building(s). Demolition permit is required prior to issuance of buil 9 ` ' © PI ANIVING permit for new building. PI AlV REVIEW'`' >; ❑• EXPRESS _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �> STANDARD ` ❑ 3'UBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑' LARGE ❑„FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ IvrAaOR ❑ 5ANITA6"Y�RDISTRICT submittal of Building Permit application. R, . Q,'ENVIRON1lIENTALHEALTH z BIdgApp 2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 21095 white fir ct DATE: 09/23/2013 REVIEWED BY: Mendez APN: BP#: 13080140 "VALUATION: 1$2,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION PRWHEATR USE: PERMIT TYPE: WORK [revision#1 relocate water heater with tankless water heater in attic SCOPE Mech.Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec:.Plan(.,heck L7 Permit Fee: Plumb.Permit Fee: IPPERMIT [aec. Permit Fee: Oiherr•.,Vec h. Imp. Other Plumb Insp. 0.0 hrs $47.00 Chher Elec.Imp. EIF-L-- 1.11ech.Insp.Fee: Plurnb. h+sp.Fee: Elec.Insp.1'ce: NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Thesefees are based on the preflinina information available and are only an estimate Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F-T-1 # Plumbing Suppl.PC Fee: 0 Reg. ® OT 0.0 1 hrs $0.00 $28.00 IPRWHEATR Water Heater PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 (7onsir uction Tax: Administrative Fee: IADAIIN $44.00 0 Work Without Permit?. ®Yes (j) No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential E) Travel Documentation Fee: ITRAVDOC $47.00 Building or Structure 0 i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Com mission Fee: IBCBSC $1.00 $139.50 $28.00 ��° $167.50 Revised: 08/01/2013 ,"d ►c�SJit(1 T�i�►Kins5 t E A- 77 7.._. z$fsf�o �.s die U1 er 4ove !tke cei i ` 4 f � F• J i i `• F- •-__y �!-.F.___w. VISION 0 Lo O ; n >> ' W i i in `" CUPERTINO Building Department 0 0 •� � E �� z . t— m 3 SEP 232013 vs s REVIEWEC FOR CODE COMPLIANCE Reviewed By: ', '