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13100061 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10195 SCENIC BLVD CONTRACTOR:CHANG JON SHIAO- PERMIT NO: 13100061 CHUNG AND CHEN RUTH OWNER'S NAME: CHANG JON SHIAO-CHUNG AND CHEN RUTH 10195 SCENIC BLVD DATE ISSUED: 10/08/2013 OWNER'S PHONE: 4085644123 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ REMOVE CHIMNEY AND REPLACE WITH BAY WINDOW License Class Lic.# REV#1-KEEP FIREPLACE&CONVERT FROM WOOD BURNING TO(E) GAS LINE FOR(N)DIRECT VENT GAS INSERT.MODIFY THE(N) Contractor Date WINDOW SIZE.-ISSUED 5/9/14 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$15000 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:35709086 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 WITHIN 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 FROM LA 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 r`J granting of this permit. Additionally,the applicant understands and will comply ss Date: with all non-point source regulations per the Cupertino Municipal Code,Sectio 9 18. RE-ROOFS: Signature Date 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. 9 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 npt 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 CONSTRUCTION LENDING A NCY 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. 114 Signatureat�-J CONSTRUCTION PERMIT APPLICATION J COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION y 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building .cuNertino.om [—]NEW CONSTRUCTION ❑ ADDITION ® ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# U 0 0V r PROJECT ADDRESS 10195 Scenic Blvd. , Cupertino APN# OWNERNAME Ruth Chen PHONE 408-564-4123 E-MAIL twnrose@yahoo.com STREET ADDRESS ZIP FAX 10195 Scemic Blvd. CITY, STA�izpei't�no y,i.CA 95014 408-564-4088 CONTACT NAME Ruth Chen PHONE E-MAIL 408-564-4123 twnrose@yahoo. com STREETApD,�t$S�5 Scenic Blvd. CITY,ST�upertino, CA 95014 FA"4 �J� 08-564-4088 M OWNERl ❑ 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 PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK Remove the huge and useless 6himney from the family room and replace it with a •code complianced window. Convert the wood burniag fireplace to a gas fire lace. EXISTING USE PROPOSED USE CONSTR.TYPE I #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 DECK/PORCH AREA IDETACH ❑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 ❑YES RECEIVED BY: TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER 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 relatin building cons ti n. I authorize representative f Cupertino to entershe abwfe-id fied roperty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEME AL INFORMATION REQU rLAN cry rli�E ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING 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 Ca 'ST ANVARD ❑ 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 ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL:HEALTH Bldg4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 10195 SCENIC BLVD DATE: 05/09/2014 REVIEWED BY: MELISSA APN: 35709086 BP#: 13100061 *VALUATION: $0 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Du lex PENTAMATION 1 RMAP1 USE: p PERMIT TYPE: i WORK REV# 1 - KEEP FIREPLACE & CONVERT FROM WOOD BURNING TOE GAS LINE FOR N SCOPE DIRECT VENT GAS INSERT. MODIFY THE (N)WINDOW SIZE. - ISSUED 5/9/14 h s� aLhes - t Mech.Plan Check 0.0 hrs $0.00 Phulltb, Ph/n C hco f�'(e:. Pian Mech.Permit Fee: IMPERMT __LOther Mech.Insp. 0.0 hrs $47.00 t?11wr�Plumb 1r�=.p. Otlrer�' it:c.Insp, El 11:<:P. {,; r. 1 rE Plzrr,tb Ii,1t. l'c,z:; 1"70", hls F"'C' 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 on! 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 0 # Mechanical Suppl.PC Fee: Reg. 0 OT 0.0 hrs $0.00 $70.00 IBAPPLOT7 Other Appliance/Equip 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: $47.00 Administrative Fee: IADMIN $44.00 0 Work Without Permit? ® Yes 0 No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) Travel Documentation Fee: ITRA VDOC $47.00 Building or Structure i Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 V � ,.. N . >LSr $138.00 $70.00 e TOTAL FEE: $208.00 Revised: 04/01/2014 004,, rel h���-. I4.eV t p f�/ G �' �� ♦;1y1 V .�/l.; at Ke O c, t��✓t✓'t -! r s 1'� -✓Yc P li V -Tyr. i 6- ;y'STvpy %th /� °(fit SOf �yAr0L t0 'o wo l V,, /rN yr ''a$t�O��S c�� c,�_ _...... ___ Of • °rSt��pkat/pVA nflF Sr UPERTINO Buildin Ig Department i f FFICE REVIEWED a n OR CODE COMPLANCE reviewed 8y TRNK F-41c tev o 2 FF Y ST�n�ob� 6x.tr¢.N�c, lk Voe-(,�.lz•u;.., c �v s / 1 pus a-�T16/J P 1/►�t..t,132 MA f3. [_ 1 tUPERTINO rtment {2EVIEV -D FOR CODE COMPLii NC;E: N r evi wed By. 4 - G .. ,, I I pERTINO ui ina-oepartmen4 REVIEVVEG FOR CC. OE is C)MPLIANCE reviewed 6y. �.% .. hk 77" �q 4 KOOK 9000 �404 190 Ippne FAMILY _ROOM4 /� fL I Q-j �Vr�✓E I i/1.t/ jIF . rjr%.I I . . ' I r moi'". LA ...{� i ._l d ��� � ( GU f1-t�-�t�� .:j v: V;i;^ V I�I rI i E�. .. . .._� �•-f � •� --�' � ;,� IC•a / I hn . A I f 1' 1 !. Z' i + ID a 72 � 1 40 c>? I i } y t 4 f ' 30 .- 36' ' m m 1• CL `x 172 CID !