14030121 (2) 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 ❑
r O CANNON MUSIC-GLASS REPLACEMENT FOR SINGLE 5„-
License Class `.� Lic. get
I I ` WIDE PANE AT FRONT FACADE..SEE PLANS ON PERMIT
Contractor Date l0:S1W42,1Ql/G #
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 WIT] N 80 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 DA OM LA 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 by: Dat
granting of this permit. Additionally,the applicant understands and will comply 1
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signature ”—' Date 101 yc7 01 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: Dater
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•buildingna cupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESSk" APN# /, � .
OWNER NAME/�. � / l `/�,I PHONE j� F W r b 379 21 E-MAIL
E-MAIL
STREET ADDRESS CITY, STATE,ZIP a FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP 17AX7
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME�,A Lt LICENSE NUMBER[J L�S 0 LICENSE TYPE 0(2 BUS.LIC#
COMPANY NAME `\ ' E-MAIL ((` V 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
!�C �c�-C � G4. � >�TS �D►-`, rte' I I�J ?-�z_
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
PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNrr ❑YES SECOND STORY []YES
BEING ADDED? []NO ADDITION? []NO
PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES `I2EC D BY` TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHL6R HOME? ❑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.
a ZO �O
Signature of Applicant/Agent: Date:
SUPPLEMENTAQ
NRE UIRED � �
�e „��LAN KTYPE. `, 4 ROIITINGSLTP ,`
77
New SFD or Multifamily dwellings: Apply for demolition permit forR
OVER THE COi7�V1ER BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to Issuance of building y
permit for new building. QXPRESs El PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C] sxArmAxfi ❑ uBLlcwoRizs
form if any Hazardous Materials are being used as part of this project. '� =
u 11RGE� T ❑ FARE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ S�INTTARYsEWER DISTRICT
MAJpR
submittal of Building Permit application. �� , a „
m. '
❑ ENYIRONNIENTALHEALTH
B1dgApp_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
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE:
WORK cannon music-glass replacement for single 5"-8"wide pane at front facade.. see plans on permit#
SCOPE 13060197
b9c'c%t. 1'7xrt€,_ircar`kA— I l'I�ur,t>.111art C'tre;cT f i8t..Pon C h."'ch
M>i Wi Fee: Peeli bt Pcri Oil Fee:
hisF> Li 01111"f I'rVnee;77ssp, Li C d7e'i�, r r-Inst?.
Fce'
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef.. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 Select a Misc Bldg/Structure
Suppl. PC Fee: Q Reg. 0 OT 0.0 1 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: Hourly Only? ®Yes (E) No $0.00
Suppl. Insp. Fee:Q Reg. ® OT Fo7o hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
("Onse'ruciion Tax:
r'1 f/i121#tf.4"}}"f,Ll L'E?./`t'(':
Work Without Permit? ® Yes (E) No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Building or Structure
u,t l.:,x zr,rt<r'tt atior"t fi'ees:
Strom Motion Fee: 1BSEISMIC0 $0.50 1.0 hrs Inspections
Bldg Stds Commission Fee: IBCBSC $1.00 $139.00 ISTINSP Inspection,Hourly
L $1.50 $139.00
TOTAL FEE: $140.50
Revised: 01/15/2014