15010127CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7875 CREEKLINE DR
CONTRACTOR: ERIC TANG
PERMIT NO: 15010127
OWNER'S NAME:
CUPERTINO, CA 95014
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
REMODEL (3) BATHROOMS (243 SQ FT); INSTALL (55)
License Class Lic. #
NEW RECESSED LIGHTS.
Contractor Date
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: $25000
1 have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 36217050 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
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 DAYS FROM LAST 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 theId
b �i4N /aTG� Date: ' a� 'Z
ssue:
granting of this permit. Additionally, the applicant understands and will comply
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with all non -point source regulations per the Cupertino Municipal Code, Section
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.
9f 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 2 505, 2 25534.
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
Ulf
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-po egulations a Cupertino Municipal Code, Section
Licensed Professional
9 18.
-- (ZZ ?ols�
Signature Date
��rr,� CITY OF CUPERTINO
ff 1RIPIRi. F.QTTMATnR — RITILDING DIVISION
ka,ADDRESS: 7875 creek line dr
DATE: 01/22/2015
REVIEWED BY: Mendez
APN:
BP#:
*VALUATION: 1$25,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE: p
Remodel, Bath (<=300 sf)
1REMRESBAT
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
WORK
Remodel 3 bathrooms 243 sq ft); Install 55 new recessed lights.
SCOPE
$0.00
_ � q
f hunk. Plan Che( -%r Elec. Plan Check 0.0 hrs $0.00
Llec�(r Permit Fee: I'lr rtb. 1'errsza 1'c�e:: Elec. Permit Fee: ]EPERMIT
litlrcr Ptumlr 1�rsP. Other Elec. Insp. 0.0 hrs $48.00
1/2?Ilth. ]!iS/7. /`EL'"
NOTE: This estimate does not include fees due to other Departments (i e. rianning, ruouc vvorNs, r[re, aunitury Jewer ut3li mt, . Lftuut
_ mt_ __ _ r__- ,. _ c.. --,J __ sL,.---I ------- Cantart the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= s.f.
$645.00
Remodel, Bath (<=300 sf)
1REMRESBAT
Suppl. PC Fee: (j) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
55 1
$282.00
Electrical
1BREMF= Fixtures, Lighting
Permit Fee:
$0.00
Suppl. Insp. Fee: Reg. ® OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
%.'Cill. 17 `L `ft Fitt 70X.
Administrative Fee: ]ADMIN
$45.00
E)
Work Without Permit? ® Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
A
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$3.25
Select an Administrative Item
Bldg Stds Commission .Fee: IBCBSC
$1.00
`
• '
$145.25
$927.00
_ T 3itI, FEE:
$1,072.25
Revised: 01/06/2015