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1506009911 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7429 STANFORD PL CONTRACTOR: XU TETE AND RUI SHI PERMIT NO: 15060099 OWNER'S NAME: XU TETE AND RUI SHI 7429 STANFORD PL DATE ISSUED: 07/09/2015 OWNER'S PHONE: 4087866574 CUPERTINO, CA 95014-5814 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL TO CLEAR CODE ENFORCEMENT CASE: DEMO License Class Lie. # UNPERMITTED 243 S.F. ADDITION & REMODEL (E) 93 S.F. KITCHEN Contractor Date (WORK DONE WITHOUT PERMITS) 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 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 APN Number: 35932034.00 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 FR LED 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 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. 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) 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. rte./ n `, �/S 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 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 U CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building -cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION K ALTERATION / TI F] REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS -747,1 /t7,9 -,54a ,5� et APN # --3547 OWNERNAME /�L/��_ —� T/IJ� f 67 � E-MAIL PHONE ,p 7&4-924 STREET ADDRESS' q � ��V hhW �' CITY, STATE, ZIP / f ® FAX CONTACT NAME HONE ®�� 2 e O E-MAIL STREET ADDRESS 7 `„� d -W RM e, 4 -, 4cTy.STATE, ZIP e -`i ®Ow � FAX ��❑ �/ARCHrTECT ❑ OWNER ❑ OWNER -BUILDER XOWNERAGENT ❑ CONTRACTOR ❑ CONTRACTORAGENTYN�/ ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER 77SET;E BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEERNRME A p� LICENSE NUMBER BUS. LIC # COMPANY NAME Pgl/�n�� E-MAIL FAX GJV STREET ADDRESS k30 CITY,STA ,Za A ///�/ PHONE Z91 _ O� ✓ (J DESCRIPTION OF WORK 4W40 411 Add,(% EXISTING US I PROPOSED USE CONSTIL — 3 TYPE I / ,moi P2/ # STORIES ® USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG / �J AREA , ,ice D NEW FLOG AREA fi�QD DEMO AREA `2�3 TOTAL NET AREA/, 24 BATHROOM REMODEL AREA Xf KITCHEN REMODEL AREA '30 OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGDETACH _y .77 ATTACH 14�&4W #DWELLINGUNITS: IS A SECOND UNIT ❑ YES SECONDD ST0 Y , ] YES ® BEING ADDED? NO ADDITION? Ti�110 PRE -APPLICATION [I YES IF YES, PROVIDE COPY OFF IS THE BLDG AN ❑ YES ,ItE $Y :" TOTAL ALUATION: PLANNING APPL # []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO - s OO it By my signature below, I certify to each of the following: I am the property owner or auth ed agent th rty owner's behalf. I have re Is application and the information I have provided is correct. I have ead the Description of Work and curate. I agree to comply with all applicable local ordinances and state laws relating to building cons on. I I orize r fives of Cupertino to enter the above identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFO TION REQUIRED PLANCHECK,)1TE RQUTINCsSLiP ' ° I] , O'VEE<; TII>'rCOUNTER y, C� Btn2.Dnvc PiANREV�w _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building t. permit for new building. L7. ExPxEss 1] . rLANivjN�x axxEviEw Commercial Bldgs: Provide a completed Hazardous Materials Disclosure12 -9,4, rIDAgu Li' rr1>3Lxcvvo�rlcs form if any Hazardous Materials are being used as part of this project LARGE � - ❑mtEnr;Px _Copy of Planning Approval Letter or Meeting with Planning prior to sANi rAxYSEwERnisrHlcr submittal of Building Permit application. mAaoR ; C3 -ENVIRoxvls tv�AL'�ALTx • - BldgApp_201 Ldoc revised 06/21/11 Fm—N CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION 1AADDRESS: 7429 STANFORD PL DATE: 06/15/2015 REVIEWED BY: MELISSA [LIBCl1. Pe /•11171 Fe: APN: 359 32 034 BP#: "VALUATION: 1$7,000 XPERMIT TYPE: Building PermitPLAN CHECK Till Alteration /Repair PRIMARY USE: SFD or Duplex Plumb. Trish. lee: PENTAMATION PERMIT TYPE: 1 R3SFDREM WORK To Clear Code Enforcement Case: DEMO UNPERMITTED 243 S.F. ADDITION & REMODEL E 93 SCOPE S.F. KITCHEN (WORK DONE WITHOUT PERMITS) 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 Prelimlina in ormation available and are only an estimate Contact the Dept for addn'l into. FEE ITEMS (Fee Resolution 11-053 Eff.' 7/1/132 "Wech. Plan Check Phwib. P1un (:'/leek 1"Iec. Plan Check [LIBCl1. Pe /•11171 Fe: phlmb. Pe:!'112rr Fee: I IdC. Pernnr Fee: Other ;llech. Ins'l1. E Other Plumb Insp. Oilier Ek. -c. Imp. Ll 1 "',Ie •h. hup. Fe.. Plumb. Trish. lee: Efee. h p. 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 Prelimlina in ormation available and are only an estimate Contact the Dept for addn'l into. FEE ITEMS (Fee Resolution 11-053 Eff.' 7/1/132 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. $645.00 Remodel, Kitchen (<=300 sf) IREMRESKIT Suppl. PC Fee: (E) Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 243 s.f. $431.00 Remodel, Other 1REMRESOTH Permit Fee: $0.00 Suppl. Insp. Fee:(F) Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C.onsirurtion Tax: Achninistrative Fee: 0 G Work Without Permit? Yes No $1,076.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 1 G 0 i Travel Doc•urnentalion Fees: Strong Motion Fee: IBSEISMICR $0.91 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS;- $1,077.91 $1,076.00 � TOTALFEE : $2,153.91 Revised: 05/07/2015