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13100212 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19884 PRICE AVE CONTRACTOR:ANDERSON PERMIT NO: 13100212 INSTALLATION OWNER'S NAME: DANIEL KAU&CHUANAN LIN 696 AUZERAIS AVE DATE ISSUED: 10/31/2013 OWNER'S PHONE: 4088582267 SAN JOSE,CA 95126 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 1:1COMMERCIAL License Class Lic.# <��C-��_ REMOVE AND REPLACE 2 DOOR AND 3 WINDOW ON 2ND // FLOOR TO MEET EGRESS IN BEDROOMS Contractor ��?Qe,j.. Lhs 1? Date w'"�/ "0 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 o ance of the work for which this permit is issued. Sq.Ft Floor Area:,cdValuation:$1850 havTaand will maintain Worker's Compensation Insurance,as provided for by ction 3700 of the Labor Code,for the performance of the work for which this APN Number:36904030.00 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 WITHINA80 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 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 Issued b f Date: granting of this permit. Additionally,the applicant understands and will comply y' with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date� r� 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 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(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 2 05,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age " Date/,- -11-ti 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 CONSTRUCTION LENDING AGENCY 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 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 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•building(a)-cupertino.org [:]NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS C- y pr.l v' APN# 1 C � OWNER NAME PHONE 707 E-MAIL STREET ADDRESS 6CITY, STATE ZIP FAX l r�cc �}�e � C,/" 1 5c)1 CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP _ FAX t. �vLei� 7 �LL6 �'-Z. S.- r ❑ OWNER ❑ OwNER-BUH,DER ❑ OWNERAGENT 0000NTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME / LICENSE NUMBER LICENSE TYPE BUS.LIC# w 6-C 610 COMPANY NAME ^ E-MAIL FAX C ! hit"=1U'� A wy e;�•y- �:s l - r-8f�b STREET ADDRESS C` CITY,STATE,ZIP PHONE i n �t•' rT! L �i !,&�� Z ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK / tip Ice , , hOl N/zC Lv NL'cC' J h J -I 'j c I EXISTING USE PROPOSED USE CONSTR 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 DECK AREA TOTAL DECKTORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? El NO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES 17VED-gy: TOTAL VALUATIO.N� PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? E]NO 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 construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLE TAL INFORMATION REQUIRED PL�CK TYPE ING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for `' existing building(s). Demolition permit is required prior to issuance of building VER-THE COUNTER BUIID AN REVIEW 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 I ❑ PH2E DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to 0 AlAJOR. ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO itsFEE ESTIMATOR- BUILDING DIVISION ADDRESS: 19884 prive ave DATE: 10/31/2013 REVIEWED BY: MENDEZ APN: BP#: `VALUATION: $1,850 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY PENTAMATION 1GENRES USE: SFD or Duplex PERMIT TYPE: WORK remove and replace 2 door and 3 window on 2nd floor to meet egress in bedrooms SCOPE I'le"31. 1"'an Uhc(, P/o/rb Nuo Choi, C'lnzck Lt�rt�. Y>sntrt Fc'r: 1'7rur�1:. Partn;�h �.: 7aac Ptrrnr!he°c'� h. Phonh Insp. Ph;ntb. hlsp. 1-c" ": NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,SanitarySewer District,School District,etc.). These fees are based on the relimfna information available and are onlyan estimate Contact the Dept or addn'1 info. FEE ITEMS(Fee Resolution 11-053 Eff 7.%1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 F-5 # Window/Sliding Glass Door Suppl. PC Fee: Q Reg. QOT 0.0 hr's $0.00 $418.00 1WINREP Replacement 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: $0.00 ('on.�tru tion Kix: : -1<llnini.st�rrtr�<>f'c>t': 0 Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential E) Building or Structure 0 1'ra el 0ociflacalation Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $1.50 $418.00E TOTAL FEE: $419.50 Revised: 10/01/2013 i F RL��V�e .� -C cc rt d Od r r� 7,v I Pv r a U Q p p�� t s 31 2013 ��-r - CO E C MPL ANC EVI e re-s �yr ss s .evil ed xp h� Q10g 30 9 4lkd 00( A�tT� o��• Y l� Il ° —o ll eL T LA: s pct CHECK D BY '• _)A-T L P A 'IN%,I T. OAT _ RT E35.. 6w.P 1 � Cr