13100216 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1166 SCOTLAND DR CONTRACTOR:BROTHERS HOME PERMIT NO: 13100216
IMPROVEMENT
OWNER'S NAME: FRANK C&MABE L CHENG TRUSTEE 2510 DOUGLAS BLVD DATE ISSUED: 10/31/2013
OWNER'S PHONE: 4082571582 ROSEVILLE,CA 95661 PHONE NO:(408)295-0680
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
REMOVE AND REPLACE 8 WINDOWS LIKE FOR LIKE TO
License Class Lie. bcoq0t,¢I
j MEET
Contractor Date (b 13, I 1 H EGRESS IN BEDROOMS
I hereby ff th t I icensed under the provisions of Chapter 9
(commencing w' Section 7000)of Division 3 of the Business&Professions
Code and t y 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. Sq.Ft Floor Area: Valuation:$4144
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:36228006.1166 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 WIT 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 D ROM 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
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.
q RE-ROOFS:
Signature _ Date 1�+ �3 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.
❑ O R-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
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. I 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(x)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 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: C� Date:
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 CONSTKUCTION 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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION J'v�
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 \�
CUPERTINO (408)777-3228• FAX(408)777-3333•building�i-)cuoertino.org \�
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS C�7 APN# l.V 2. , / -P.
OWNER NAMEM , 1 PHONE j 0O 1/ 1 E-MAIL
STREET ADDRESS V CITY, STATE,f ZIP o L J FAX
CONTACT NAME 5� A l PHONE E-MAIL
�S(TRREEET ADDRESS CITY,STATE,ZIP FAX
K� OR7.ER ❑ OwNER-BUH.DER ❑ OWN'ERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME y7v j� LICENSE NUMBERj /)� LICENSE TYPE -7BUS.LIC#
0
V 0
COMPANY NAME E-MAIL FAX
STREET ADDRESS (��/ CITY,STATE,ZIP (iptj /I _ ' PHONE"J
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# (,
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK j � 4 G O
EXISTING USE PROPOSED USE CONST R TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA I DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
[]ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? ❑NO ADDITION? ❑NO
PRE-APPLICATION [-]YES IF YES,PROVIDE COPY OF IS THE BLDG AN ElYES RECEIVE Y: TOTAL VALUATION:
PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO *. ?
`� i
By my signature below,I certify to each of the following: I am the property owner or authorized agent t6 act on the property owner's behalf. I have read this
application and the information I have rovided is 1coect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws rela ilding consi n. I authorize representatives ofCupertino to enter the above-i ntifiit
property for inspection purposes.
1
Signature of Applicant/Agent: Date: i 6 /
SUPPLEME TA_L, F7: Apply
A°TI REQ 'UIRED PL CK TYPE ROUTING SLIP
New SFD or Multifamily dm for demolition permit for ovER-TxE co[I>\rERBUILD PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building,-
permit for new building. ❑ EXPRESS , PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC 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 [] nlnloR ❑.SnxrrARY sE«ER IiIsrRlcr
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: DATE: 10/31/2013 REVIEWED BY: Mendez
APN: BP#: 'VALUATION: 1$4,145
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Du lex PENTAMATION
USE:
p PERMIT TYPE: 1 GENRES L
WORK remove and replace 8 windows like for like to meet egress in bedrooms
SCOPE
14c,h. Plan(ho 4 Phunb, Plan('/I, I,Wc. Phan Cilcck
Plmnt" Po nw Vcc, lil,r l'o-mil F_
Odwr Aluch. 11_1,r?, C?tt ct .Pham,h In.,P 0!h",.l;Fci.Iny,
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These ees are based on the prelinddna information available and are only an estimate. Contact the Dept-for addn 7 info,
FEE ITEMS (Fee Resolution 11-053 Ef' 7f 1113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 8 # Window/Sliding Glass Door
Suppl. PC Fee: Q Reg. Q OT0.0 hrs $0.00 $418.00 1 WINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-.0 Reg. Q OT 0,0 h r s $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Consirliction 1 tiX.
Work Without Permit? 0 Yes (E) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure 0
11-01 cel Coda icniotif In Fees:
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.50 $418.00 TOTAL FEE: $419.50
Revised: 10/01/2013
4-TINS./
Mil_ �,i k �'�/ '�•�•"' � �?��i u I I�P1t
H N
t f <E'ulEklfP .44
d
d
L.31 6
04
PLAAb M
CHECKED BY
PLANNIN EPT,DAIE
I�
Hi,ilt;, IIF.F�T
a I