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15040066 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 884 FERNGROVE DR CONTRACTOR:ABC REMODEL,INC PERMIT NO:15040066 OWNER'S NAME: LI DAVID AND CHANG TARA 544 HICKORY PL DATE ISSUED:04/08/2015 OWNER'S PHONE: 4156134867 SANTA CLARA,CA 95051 PHONE NO:(408)887-2514 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL License Class/Lic.# 6 REMODEL MASTER BATH 120 SQ FT TO INCLUDE M,E,P'S Contractorc� L Date 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:$9000 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:37538034 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 WITEIIN 180 DAY P RMIT 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 FR CALLED INSPE TION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued by: Date: granting of this permit. Additionally,the applicant understands and will comply with all non-point urce regulations per the Cupertino Municipal Code,Section ------- 918. /fJ RE-ROOFS: Signature Date GL (�/ �� 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 Date: Signature of Applicant: 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 Health&Safe H he eaSafety Code,Sectio 55 5,25 ,and 25534. I have and will maintain Worker's Compensation Insurance,as provided for by t �D Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent. Date: 10 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 CONSTRUCTION PERMIT APPLICATION �U [a COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building cD_cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS (J 1APN" �aeT�•✓o C,44�c7 i 75 3� OWNERNAME.,o PHONE ` STREET ADDRESS /7 p �T CITY, STATE,ZIP FAX .N� CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUDDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ✓ ❑ TENANT CONTRACTOR NAME 0/1 A l 9/�1,yier LICENSE NUMBER -74/ib^-7 LICENSE TYPE L5 BUS.L /Ej/(es COMPANY NAME/ /,6// // IOU(f��/ ,C E-MAIL m/ / Y��/ &b creN oc/� F o��-5 -4 /4-1 STREET ADDRESS y�9,CC�/� ,^ (/Y�I J `/ CITY,STATUE,ZIP GL� -j q ✓ 5 [�6 & G CA--,9� � P PHONE�O��U / �C.S ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK CZ x ,. ezl EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREAp, f n REMODEL AREA REMODEL AREA PORCH AREA I DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: LIDErACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY []YES BEING ADDED? ❑NO ADDITION? []NO PRE-APPLICATION El YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES ED;$+ � TOTAL VAL UATION: 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 t ct on Ae property owner's behalf. I have read this application and the information I have vided 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 relating t i in constructio . authorize representatives of Cupertino to enter the above-I e ofd^property for inspection purposes. Signature of Applicant/Agent: Date: Z SUPPLEMENTAL INFORMATION REQUIRED cicYp� .", .3�`..,. iso c s >P ,43, New SFD or Multifamily dwellings: Apply for demolition permit forI Oi71+TTER� UII.DINGPLANREVIER' -�,'� existing building(s). Demolition permit is required prior to issuance of building ZE permit for new building. [ LA��GpLaR _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. _Copy of Planning Approval Letter or Meeting with Planning prior to ai r�ttXSEkvERDISTRTC�' - submittal of Building Permit application. x BldgApp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION its I ADDRESS: 884 FERNGROVE DR DATE: 04/0812016 REVIEWED BY: MENDEZ APN: BP#: "VALUATION: $9,000 FPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY PENTAMATION 1 R3SFDREM USE: SFD or Duplex PERMIT TYPE: WORK REMODEL MASTER BATH 120 SQ FT TO INCLUDE M E P'S SCOPE 777n �r Roi ech. Plan Checkheck 1>lec.Plan(7heck _Meeh. Plumb. Permit F`ee: Glee. Perrazit 1��<<Ofherr.k/kwh. Insp. nsp. Cltller.flee.Insp. #>lecla. Insp. hie: ee: Elec-Insp. Fee: NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. [FEE ITEMS Lee Resolution 11-053 E . 711/13,)_ FEE QTY/FEE MISC ITEMS 1an Check Fee: $0.00 120 SX. Remodel,Bath(<=300 sfl uppl.PC Fee: Q Reg. ® OT 0.0 :hr:s $0.00 $645.00 IREMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp.Fee-0 Reg. ®OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: ,ldininistrative Fee: Work Without Permit? ® Yes ONO $0.00 Advanced Planning Fee. $0.00 Select a Non-Residential E) Building or Structure 7iruvel Doet,�menlaiion Fees: —F7=— 0 Strong Motion Fee: IBSEISMICR $1.17 0 # Revisions Bldy—tds Commission Fee:_ 1BCBSC $1.00 $0.00 1REVCOMTI Tenant Improvement } $2.17 $645.00 T TAL FEE: 647.17 Revised: 04/01/2015 �vi� i kepUfee. X457-eV- 53 r Li�{ht 2emodel IL-0,ano►J. Cao v Pr-t' V 4--a vec�. Ti Lc- �c4 GFl R GMSC t_1GI.�1 �►�x� — — ©ur c eT LE> QPe CdJ Mier _ ��������AM/� `V1'1a.J Marx) LC APPROVED 1V 'ls a:^,d spe.I ic-z.Io,;s 1,!,.U^- +:,�4 k(?i� 3t t�E -Tempe job site t!t ,ink construction. !t is u.-,,U to nuke uy OLp55 changes oratic-:,, c^ s^ ;a, cr to i jt f therefrom, Without a,�,r °. .! f-crn the <'.i � , -j `r :: al. ..-_. -..W...,. y T?'?Sty A Pg of �S'! », .'�.� NCT -TJ(_,p SFF0,, fy �� Awry Gr r a 1 ;it cr n G _ 4f t a PE}n1 a ENC gykayXt>� f al,y C;� CUPIERTINO �;ui►dina Department REVIEWED i J� ODE C;UhIF'i_iAhiGE Reviewed fav 9 S y t errj&"ve Cue!�e. ►-4 o eA cirot,4 Ch.►�r" av w I C f+ W tg— t (10& � PAbt Z O F Z 408 88 1 a' -1 3�acQ 'laD+- r Cao vev-r- TUE -4-a LC DI FLoove(..--* G t-I G I-A-j. ourceT M �sre� i f t i i 1 gykaNx�� v CUPERTINO tt�idinc Dzmartment i L�v°6e.r ���•///���•••••• REVIEWS,,-,� G0Iv PL.jAN( F ReviewedBy /kP-m`l: 0814 fiF#-NG cove 42VPe'e-'{"'4 O A C,--Pt ►. �• 421D I Ct+ w6- Cit : qAC t Z p3 - Qey oclel Nt_13 QOw 3, - qoS S$`1 testy wmE Yzff Per 4borl