14030121 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10885 S BLANEY AVE CONTRACTOR:LIU'S CONSTRUCTION PERMIT NO: 14030121
OWNER'S NAME: PACIFIC RIM PARK,LLC 1582 QUEBEC CT APT 2 DATE ISSUED:03/20/2014
OWNER'S PHONE: 4089663787 SUNNYVALE,CA 94087 PHONE NO:(510)585-5907
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL E]
CANNON MUSIC-GLASS REPLACEMENT FOR SINGLE 5"-
License Class `.� Lic.# Zl 81t
I ! WIDE PANE AT FRONT FACADE..SEE PLANS ON PERMIT
Contractor Z- Date 1W42=,0
ll� #
I hereby affirm that licensed under the provisions of Chapter 9 13060197
(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. Sq.Ft Floor Area: Valuation:$800
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:36934052.10885 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 80 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
180 DA OM LA CALLED INSPECTION.
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 Issued by: G Dat 0.—
granting of this permit. Additionally,the applicant understands and will comply 7
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signature Date�� 7'� p 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)
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. 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 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 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 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 2�
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION d\�
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTBNO (408)777-3228•FAX(408)777-3333•build ing(abcupertino.orq `(
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED` ORIGINAL PERMIT#
PROJECT ADDRESS ///�hV e APN
�wm
OWNERNAMEt •1 eo�/ E,
PHONE og /y!/' 7F-Z E-MAIL
STREET ADDRESS VVCY��// CITY, STATE,,ZIP
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME�,w �I LICENSE NUMBER� L`DS O� LICENSE TYPE � ,, BUS.LIC#
COMPANY NAME r t t E-MAIL t(j 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 ju f([ Vevement
l`I('-j/T f i� z.Ji�rt � s L'90,--i ,4 1 JX 0 7�1✓
i 30 c�19-7 . l
EXISTING USE PROPOSED USE CONSTR.TYPE 1 #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 _
PORCHA7 DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: EIDETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNff []YES SECOND STORY OYES
BEING ADDED? ONO ADDITION? [:]NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES `, TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO yp �, 30
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: 2� �01
SUPPLEMENTA N REQUIRED a PiN c'ai TYPE iio>rruvc siP
-3u
New SFD or Multifamily dwellings: Apply for demolition permit for _ OYER r'i E iJV1ER BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑,. iZAiwrtlNG riLaN7 77
AE w
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STAPtp RD ❑. EUBLICw0RKS
form if any Hazardous Materials are being used as part of this project.
IF=W7
_Copy of Planning Approval Letter or Meeting with Planning prior to '`
Submittal Of Building Permit application. MAJOIiz ❑ SANITARYSEWERDISTRICT
❑` ENVIRONMENTALHEALTH
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 18885 s blaney ave DATE: 03/20/2014 REVIEWED BY: Mendez
APN: BP#: "VALUATION: $800
xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
USE: Commercial Building i I PERMIT TYPE:
WORK cannon music-glass replacement for single 5"-8"wide pane at front facade.. see plans on permit#
SCOPE 13060197
Wllifll 51 WC
,�,�n�"'(�r�� ' cud�' ,..ate—�"�" _yx
Lt :,r (IE; E_Pitc� P7tzltt�. Plan C`fceete t '�':.I
} -n C hfcC_,";
J'>;—mit Fee: Plumb, I'rrm l Fee, FFI
(:1r7ra Ifcr. I i�f 01her F'hrmh Insp, C)!Ir>r I Irac. InsI�.
Li
st.>c.t tr yp. ? rI'tz�utTizs�i. T�>�, rfec.!frs> t-ac
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the relimina in ormation available and are only an estimate Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E f.' 71143) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 Select a Mise Bldg/Structure
Suppl. PC Fee: Q Reg. 0 OTOA hr's $0.00 or Element of a Building ,
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes (E)No $0.00
Suppl. Insp.Fee: Reg. 0 OT 0,0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
('onsinuction T'1V: F-71
r C112t1?l. if'CXtI L't'
Fee: 0
Work Without Permit? 0 Yes C) No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure 0
ray 'Cl / , zrr,te',tttrt%E,>rt l yes:
Strong Motion Fee: IBSEISMICO $0.50 1.07 hrs Inspections
BldV,Stds Commission.Fee: IBCBSC $1.00 $139.00 ISTINSP Inspection,Hourly
"` TOTAL FEE:
IM
$1.50 $139.00 $140.50
Revised: 01/15/2014