14080045 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 8159 PARK VILLA CIR CONTRACTOR:JEMICO LLC DBA PERMIT NO: 14080045
RENEWAL BY ANDERSEN
OWNER'S NAME: XIAOCHUAN NN 30800 SANTANA ST DATE ISSUED:08/07/2014
OWNER'S PHONE: 4086017518 HAYWARD,CA 94544 PHONE NO:(510)263-3178
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E]
t.-„0 REPLACE 3(E)WINDOWS,LIKE FOR LIKE(WILL MEET
License Class Lie.# �- EGRESS&BE TEMPERED WHERE REQUIRED BY CODE)
Contractor Kee\ al ate �d
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:$5417
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:35610039 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 + LAS ALLED INSPE TIO .
indemnify and keep harmless the City of Cupertino against liabilities,judgments, /
costs,and expenses which may accrue against said City in consequence of the Date: F� /
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.
Q� RE-ROOFS:
Signature Date O — t 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 nd 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 �O
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228-FAX(408)777-3333•building aa)-cuoertinO.oM
NEW CONSTRUCTION 0 ADDITION ALTERATION/TI El REVISION/DEFERRED ORIGINAL PERMIT#
PROTECT ADDRESS .� 1 K p ` „ v,kk0.^` APN9 2 C v O
OWNERNAME `„t• c,., n l �j, PHONE fvr"COt+-Z/J`Ctr E•MAE,
STREETADDRESS P v\� CITY,STATE ZIP '}hooIK FAX
CONTACTNAMEL6-15m " C6' 1A sA G/lam momrl0 2.6.3 J 1 /C &C` J�/tn�•[�:R '(��1w':� 4 4.^Z ccrv�
STREET ADDRESS,2 a U'u w k ` CITY,STATE,ZIP G J 7 C y LJ FAX
❑OWNER ❑OWNER-BUILDBR ❑OWNERAGENT IiI CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NA:" -I�, x (CENSE NUMBER ('j •1.�1--T�777FTYPF t BUS.LIC 0
COMPANY NAME J '�J f-b(1e`k&T- Cr O tIoc�/ PAX b)u' y
SrRBET ADDRESS STATE,Z[F, .0 PHONE
• L
ARCFHTECTIENO[NEERNAME LICENSENUMBER EU9.LIC N '
COMPANY NAME E-MAIL FAX
STREET ADDRESS CRR,STATE,ZIP PHONE
DESCRIPTION OF WORK r ` �1 ` o�
E20TWO USE PROPOSED USE Comm TYPE STORIES
USE TYPE UCC. SQFT. VALUATION($)
EXISTG NEW FLOOR DING TOTAL
AREA AREA AREA NErAREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKMORCH AREA I C ARAGE AREA eDErACH
ATTACH
#DWELLING UNITS ISASECONDUMT ❑YRS SECONDSTORY ❑YES
BEINGADORDP ONO ADDITION? []NO
PRE-APPLICATION ❑YES IFVas,PROVIDECOPYOF IS THE BLDGAN TOTALVALUATION:
PLANNING APPLN ONO PLANNING APPROVAL LETTER EICHLERHOINE NO '{ 1-7 O�
By my signature below,I certify to each of the following: [am the property cwrrer or authorized agent to act afiAwfproperty owner's behalf. I have read phis
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 construedom authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent:�V"v T Date; V i[ I(`'I
SUPPLEMENTAL INFORMATION REQUIRED PLANCRECKTYM ROUTING"
_New SFD or Multifamily dwellings: Apply for demolition permit for r6&C:ourfm ❑ BUILDING PLAN RRVMW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building, ❑ ERPAE99 ❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11 STANDARD ❑ PUBLIC WOAIM
_
form if any Hazardous Materials are being used as part of this project, ❑ LARGE ❑..FMS
_Copy of Planning Approval Letter or Meeting with planning prior to
❑ M�oR 11 sANiTARYSEwEHDrsTrucT
submittal of Building Pemnit application.
❑ ENVHtOMWdVTALHEALTH
B1dgApp_2011.doe revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
W�;PERMIT
DDRESS: 8159 park villa cir DATE: 08/07/2014 REVIEWED BY: MELISSA
PN: 356 10 039 BP#: *VALUATION: $5,417
PE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: p PERMIT TYPE:
WORK REPLACE 3 E WINDOWS LIKE FOR LIKE WILL MEET EGRESS & BE TEMPERED WHERE
SCOPE REQUIRED BY CODE)
IM
Pi1j,ni) Tc tnr,Fee: f �. P,
Other Plu"11"lyes",
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 inormation available and are onlyan estimate. Contact the Det or addn7 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711/131 FEE QTY/FEE I. MISC ITEMS
Plan Check Fee: $0.00 0 # Window/Sliding Glass Door
Suppl. PC Fee: Reg. ® OT Fo.0 hrs $0.00 $431.00 IWINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee: Reg. C) OT p 0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
(,'c;,,,.v°w,fion Tax: F L
Fee: 0
Work Without Permit? ® Yes (E) No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure 0
7,r-rr��1 1.,'r�t_rftr<�rtfutir>rt I��ce.s`: �
Strom Motion.Fee: IBSEISMICR $0.70 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$1.70 $431.00 TOTAL FEE: $432.70
Revised: 07/10/2014
Project name: Xiaochuan Niu Renewal
S a r K V) l(o► C 1 it bmAndersen_
Backyard/Rear Setback
.�✓ S h J 0'-- ' r 2 P GLC, 102 GL 45X40
W.MOOW 4 LCEYEI.T
%rte ��✓ �_ _
KITCHEN
103 AW
32X20 ' BATH
LIVING ROOM
101 GL 58X56 Setback
Setback
Comment
ENTRY Street/Front Setback
COMMUNITYD DEVELOPMENT
ENT
BUILDINGp31CUERT
APPROVED
This set of plans and specifications MUST be kept at the
job site during construction. It is unlawful to make any
changes or alterations en same, or to deviate '
therefrom without approval from the Building Official. UCa pF
Rrwo
The Stamping of this plan an ecifications SMALL PJOT PQa"finent
be held to o be a pproval of the violation k�
rovisions of ity Ordinance or State Law.
p Rev,-ev' By-G��
6Y N cOPv1PLIAWCE
PERMIT NO. 0
PLOT PLANS
Scope of work: CHECKED BY
DATE2 4
*NNINGDE T
DATE
BLDG. DEPT.