15080003t +7
I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10292 S TANTAU AVE
OWNER'S NAME: WANG CHENG -YI AND CHEN WAN JUNG
OWNER'S PHONE: 4088029369
P' LICENSED CONTRACTOR'S DECLARATION
License Claasss Lic. # c1_4-0 4-3
Contractors jlq �, Al Date
I hereby affirm that 1 am licensed under the provisions of Japter 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:
1 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.
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
permit is issued.
APPLICANT CERTIFICATION
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will com�
with all non -point rce regulations per the Cupertino Municipal Code, Section
9.18. �7
Signature Date 6 a hs
❑ OWNER - BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
1, 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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
permit is issued.
I certify that in the performance of the work for which this permit is issued, 1 shall
not employ any person in any manner so as to become subject to the Worker's
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
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
1 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
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
CONTRACTOR: MANA GENERAL PERMIT NO: 15080003
CONTRACTOR
1839 TAMPA WAY DATE ISSUED: 08/03/2015
SAN JOSE, CA 95122 PHONE NO: (408)3754288
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
INSTALL (N) WOOD COVERED PORCH OVER (E)
CONCRETE
PATIO (356 S.F.)
Sq. Ft Floor Area: I Valuation: $6000
APN Number: 37508038.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 T ISSUANCE OR
180 DAYS F CALLED INSPECTION.
Date:
RE- ROOFS:
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.
Signature of Appli
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should 1 use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District 1
will maintain compliance wit t Cupertin i nicipal Code, Chapter 9.12 and
the Health & Safety Code, ect n 25505, and 25534.
Owner or authorized agen Date: 3
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Lai
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMIVIUNITY DEVELOPI \JiENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building aQcuuertino.org
❑ NEW CONSTRUCTION ❑ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT n
PROJECT ADDRESS I (9 Z S • T PyA t( f\V .
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01VNtR ❑. OWNER -B=FR ❑ 0\1W. —R AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGL\TER ❑ DEVELOPER ❑ TENAN -r
COt{I'R T�"I' M)�AME (� _ _
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ARCHITECT/ENGINEER NPJ ✓E LICENSE NUMEER
BUS. LIC
COMPANY NA-NE
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FAX -
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
e-
EXISTING USE
PROPOSED USE CONSTR TYPE
?STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXLSTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
'-
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKIPORCH p.REA
GARAGE AREA: DETACH
❑ ATTACH
m DWELLING UNITS:
IS A SECOND UNrr ❑ YES
SECOND STORY [] YES
BEING ADDED? NO
ADDITION? ❑NO
PRE-APPLICATION ❑ YES IF YES, PROVIDE COPY of
PLANWINGAPPL# ❑NO PLANNfNGAPPROVALLETTER
IS THE BLDG AN
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TOT VAL�U).4'F�ON:
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By my signature below, I certify to each of the following: I am the property owner or authorized agent to e proper y o�mer's behalf. I have read this
application and the information I h vided i I have read the Description of «cork ' tt is
ordinances and state laws relating o it ing c ction. I authorize presentatives of Cupertino
to enter the above- identified property for inspection purposes.
Sir, ature of Appl icant/Agent:
Date:
SUPPLEMENTA MFORMATION REQUIRED
New SFD or Multifamily wellings: Apply for demolition permit for
Y PY P
existing building(s). Demolition permit is required prior to issuance of building'rr,
o a o
permit for new building,
Commercial Bld,gs: Provide a competed Hazardous Materials Disclosure
corm if any Hazardous Materials are being used as part of this project.
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_ Copy of Planing Approval Letter or Meeting with Planing prior to
submittal of Building Permit application.
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BIdg'App_2011,doc revised 06/21/11
FM__ff CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
imADDRESS:
10292 S TANTAU AVE
DATE: 08/03/2015
REVIEWED BY: MELISSA
APN: 375 08 038
BP #: ,50 r060 6
*VALUATION: 1$6,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Suppl. PC Fee: (E) Reg. () OT
PENTAMATION 1 R3SFDADD
PERMIT TYPE:
WORK
INSTALL N COVERED PORCH OVER E CONCRETE PATIO 356 S.F.
SCOPE
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 Dreliminary information available and are only an estimate. Contact the DeDt for addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 Elf. 711113)
WM
QTY /FEE
MISC ITEMS
Plan Check Fee:
.Nor
356 s. f.
$1,290.00
Patio Cover / Sun Room
1PATIOW000 Wood
Suppl. PC Fee: (E) Reg. () OT
0.0
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 Dreliminary information available and are only an estimate. Contact the DeDt for addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 Elf. 711113)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
$0.00
356 s. f.
$1,290.00
Patio Cover / Sun Room
1PATIOW000 Wood
Suppl. PC Fee: (E) Reg. () OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
I-0—.01
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
,tJY2b7
E)
Work Without Permit? Yes (j) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
i
Strong Motion Fee: IBSEISMICR
$0.78
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$1.781$1,290.001
TOTAL FEt',T
$1,291.78
Revised: 07/02/2015
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