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14040176CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7874 ROBINDELL WAY CONTRACTOR: PETER WANG PERMIT NO: 14040176 OWNER'S NAME: PO KAM CHEUNG 100 CONCORD CIR DATE ISSUED: 04/24/2014 OWNER'S PHONE: 4086917697 MOUNTAIN VIEW, CA 94040 PHONE NO: (650) 906-8788 JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ LICENSED CONTRACTOR'S DECLARATION REMODEL BATHROOMS (MASTER & HALL) 80 S.F. License Class 19 Lic. # r -TV' � TOTAL 7 Date /1 r Contractor I hereby of arm 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 erformance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $4000 have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 36219028.00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this 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 WITHIIN 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 DAYS FROM LLED 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 Is Date: Z i granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 918. E -ROOFS: Signature_Dat �/ 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 the Health & Safety Code, Sections 25505, 25533, and 25534. 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 Owner or authorized agent: 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building a(-cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 4 1 a70 feo� "N' OWNERNAME ONEn J� G7 Q e,14.0 E-MAIL` O _ STREET ADDRESS / CITY, STATE, ,y yh� I FAX CONTACT NAME . ' NE 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 j//�y _ / n A 1 PHONT l / ` G --Ci / ('T J b ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK d �L ' EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: EIDETACH ❑ ATTACH I # DWELLING UNITS: IS A SECOND UNrr ❑ YES SECOND STORY []YES BEIN'GADDED? [:]NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # NO PLANNING APPROVAL LETTER IS THE BLDG AN [3 YES EICHLER HOWIE? iV `•B - -' TOTAL ALUATION: ❑ E]IN property owner's behalf. I hav�-read this By my signature below, I certify to each of the following: I am the property owner or autho n gen�thjeaLbpve-identified application and the information I have provided is correct. I have read the Description of ork d veate. I agree to comply with all applicable local ordinances and state laws relating to building construction a thorize representatives of Cupertl property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTA iNIFORMATION. R TIRED P r�>�cr rrE xolIil c s �. , New SFD or Multifamily dwellings: Apply for demolition permit for DYER TE CO. ER . BUILDING AN-REVIEW— N REVIEW existing existing building(s). Demolition permit is required prior to issuance of building_. _ f4� �3a�NtrtE permit for new building.1] ar s LnN Commercial Bldgs: Provide a completed Hazardous Materials Disclosure s D ="a s UBLIeoRlzs=� _ form if any Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or Meeting with Planning prior to _ submittal of Building Permit application. ' n o 3 sA.ITARY�E InIST1 BldgApp_201 1. doc revised 06/21/11 CITY OF CUPERTINO UT`i V 10 CTTM A'rnD _ RTTTT ,nIN[f T)TVTRTON ak<c1r. �'?rxri t._72erc'k r1�Peci1. t�'errrtK E'ee: f? Itr-r ,W,; h. /Psp, llhit; . Plow C"Fo-eeA Phtmh� Permit lee: Othvr Plumb Insp. Phinth, he,,: P/an C hcc t Uther laec. Insr�. L� Islcr.lns,� �ae°� NOTE: This estimate does not include fees aue to other uepartments (i.e. rlanning, uonc rr ulna, i „o, .,a11 -1y —1-1 .�• •• . ___a _ ._,.. _ ..f..... .- /'..... fnnf fl— rlonf fnr nili/r, �t iHFn_ Ulstrict, el"j. Ineae feva ure uuaeu us c . P,�o...w...... FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) 7874 ROBINDELL WAY DATE: 04/24/2014 REVIEWED BY: MELISSA IQADDRESS: APN: 36219 028 BP#: *VALUATION: $4,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Du lex P 0.0 PENTAMATION 1 R3SFDREM PERMIT TYPE: USE: PME Plan Check: WORK REMODEL BATHROOMS MASTER & HALL 80 S.F. TOTAL SCOPE $0.00 ak<c1r. �'?rxri t._72erc'k r1�Peci1. t�'errrtK E'ee: f? Itr-r ,W,; h. /Psp, llhit; . Plow C"Fo-eeA Phtmh� Permit lee: Othvr Plumb Insp. Phinth, he,,: P/an C hcc t Uther laec. Insr�. L� Islcr.lns,� �ae°� NOTE: This estimate does not include fees aue to other uepartments (i.e. rlanning, uonc rr ulna, i „o, .,a11 -1y —1-1 .�• •• . ___a _ ._,.. _ ..f..... .- /'..... fnnf fl— rlonf fnr nili/r, �t iHFn_ Ulstrict, el"j. Ineae feva ure uuaeu us c . P,�o...w...... FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) •• ..•••.w•.�•. ».--------- FEE ---__ _. _ QTY/FEE ___ ____ ___.. MISC ITEMS Plan Check Fee: $0.00 =s.£ $626.00 Remodel, Bath (<=300 sf) IREMRESBAT Suppl. PC Fee: (9 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:(j) Reg. ® OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ('012StMt'tt0n TctX: Ir.bnir lisfrc:rrrve> Pee: L E) Work Without Permit? ® Yes (j) No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure 0 C) � "II'!t 'ul Dof':7ti170'71011 OKI FtXs: Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission .Fee: 1BCBSC $1.00 WAR, ..: $1.50 $626.00 FEE: $627.50 Kevisea: U4/Ul/ZU14 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: i 4&11 W PERMIT # IY01Y40 OWNER'S NAME: A0 (? V/V PHONE # 0-B — GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: 0'y C3 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE ,SCHEDULED UNTIL THE GENERAL CONTRACTOR AND �LL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating z z Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date IF ,tear c, c 0 w.,,- PP�� O10\41 at re P G yel� k�.\5urea� a _� 5P°_k.or• _., sa'� �e�r GNB\ :.��°r O?" - �� NV. P�G�� &C76 Qz�l .410 COO 1 5J> ,ECFIVT APR % 4 2014 191�611119-0 � 01- -J/ ::) ( - 0 T�A! jv &A"i I%