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14060035CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7401 ROLLINGDELL DR CONTRACTOR:. L4 ✓ PERMIT NO: 14060035 OWNER'S NAME: HSU CHEN J DATE ISSUED: 06/06/2014 OWNER'S PHONE: 5102521631 PHONE NO: t� LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION! RFcmENTIAL nn COMMERCIAL Z_ //!/3�t.L 9 IAld-o STs Su inI y p, G License Class_ Lie. # "! 0 G L ql r! ' 77)0', �S L Ile C—_ IC--ZI2 4-11K Contractor 1Gv OXY Date 41 _C _ �� 440 5'I Z_e Clbq- WCC , 'C`L I hereby affirm that I am licensed under the provisions of Chapter 9 �E���� (commencing with Section 7000) of Division 3 of the Business & Professions 1 Code and that my license is in full force and effect. U 45;�vj y GOC 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 Sq. Ft Floor Area: Valuation: $7000 performance of the work for which this permit is issued. 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: 35932001 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�180AYSO P RiVI� -155 TANCE OR to building construction, and hereby authorize representatives of this city to enter the above mentioned property for inspection purposes. (We) agree to save 180 DAYAST CAL INSPECTI N. ,�jupon indemnify and keep harmless the City of Cupertino against liabilities, judgments, accrue against said City in consequence of the costs, and expenses which may ued by: Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9 18. �_ �� (� Signature Date OOFS: All roofs shall be inspecte or 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 2550 5533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: G —6 f 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 918. 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(51cupertino.org ri r1 1 I 11 T!_TTT A T Dr; V T AT -r R U NEW C:UNSIIZUUIIUN IJ AIJIJIIIUIN- PROJECT ADDRESS l APN #vJ r D -3 37 o 0, t' Ind Iq OWNERNAMEPHONE ` v�'1 c/ M n ^�� r L I E-MAIL STREET ADDRESSCITY, STATE, ZIP rp F7 .moi FAX + J I c vW (A M f�✓t CONTACT NAME PHONE !�G E-MAIL Ci L STREET DRQ S CITY, STATE, ZIP ��! 3 FAX !/ 1 �¢ d L ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENg TYPE BUS. LIC # COMPANY NAME - j E-MAIL G 1 �-' FAX c/ ( v/`I •. STREET ADDRESS CITY STATE, ZIP �!� [ P 0 / 6 CG,r✓ 1J. ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE / DESCRIPTION OF W K p A /� ACIf� J/! � /v4 �/ /! 1r� Go , EXISTING USE PROPOSED USE CONST& 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 DECKIPORCH AREA GARAGE AREA: DETACH ❑ ATTACH —i -DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ONO ADDITION? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES TOTAL VALUATION: LETTER HOME? ❑ NO •^ j '� ' 1 r 00 PLANNING APPL # ❑ NO PLANNING APPROVAL PLANNING c By my signature below, I certify to each of the following:. I am the property owner or aut o at on t property o er'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 a urate. I ee to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter th abo eentified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED ECKT2rrE iooluvcsLlr,' New SFD or Multifamily dwellings: Apply for demolition permit for E OVER�THI'tcr�iJNTER 'L} 0`J BUII.`DTNGPLANREVIEW, _ existing building(s). Demolition permit is required prior to issuance of building , permit for new building. p E R s ©� PLANNIIVGYLAKAEYIEw Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANpARD ' " -'P _ form if any Hazardous Materials are being used as part of this project. x� r _ Copy of Planning Approval Letter or Meeting with Planning prior to JOR �kSANI,TARYSERERDISTRICT submittal of Building Permit application. nk�;�w���t�`'i�,.�aS'ni,vlF;�.�k;�:�..x -m ,D,�tYEluVII20NMENTAL'HEALTH>, B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO TTT TC+TTAii A Tl1D 1DITII iITN(=' nl[V-FQ-FnN 1'LL •U".i ilii:i vi— ADDRESS: 7401 ROLLINGDELL DR ' — DATE: 06/06/2014 REVIEWED BY: MELISSA APN: 359 32 001 BP#: *VALUATION: $7,000 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY USE: SFD or Duplex J__R_�NTAMATION 1GENRES PEi WORK INSTALL 9 WINDOWS & 1 SLIDING GLASS DOOR LIKE FOR LIKE & SAME LOCATIONS WILL SCOPE MEET EGRESS AND BE TEMPERED WHERE REQUIRED BY CODE) E'Cf7, Plan ckiec:n NnTF.: This estimate does not T'Itttnbl pfal-r Check Plumb, Iyer mi> 1'ee' ofhe�, Plumb I'ltimh. litsp. fee: ,� Check 1�;le�r. f ;a.. �ccs fSiec Pz'''3m" Fee, due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School 1/ r__r_ F.1-1- rmation available ana are on[ e. an esamai%Iurtt LGL NLG LG L District, etc). /nese ees are oaseu un tae re imtna FEE ITEMS ((ee Resolution 11-053 E(f. 7/1/13) an o FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =# $557.00 Window / Sliding Glass Door I WINREP Replacement Suppl. PC Fee: s Reg. 0 OT 0.0 hr's $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:(E) Reg. 0 OT 0,0 . hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C on.Wj'.ac°llon Tax: E) Work Without Permit? ® Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 Travel Dr1C°ivnenialion Fees: Strong Motion Fee: IBSEISMICR $0.70 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 4 $1.70 $557.00 TONAL FEE; $558.70 Revised: 04/01/2014 V"'tV19 —3 ung OSL) -VI, �-o I cl f L40 k uta . I Ttt5 doiu57 ovia 5tW"(12 cloy' f t'0? 9 0 Nnr Q,qAIP, ui 14q CUPERTINO r7Building Department v U COM."U.1"JITY DEVELOPIMENT DEPARTMENT BUILDING DIViSION - CUP ERTINO APPROVED TW r!�-s and Specifications MUST be kept at the i -i construction. It is unlawful to make any or alterations on same, or to deviate A,„,hout approval from the Building Official. Tho in -1 of this plan and specifications SHALL NOT ?o 06"T'n BY PERMIT NO. State Law. REVIEWED FOR CODE COMPLIANCE Reviewed By: A��'