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15060171ID CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20590 SHADY OAK IN CONTRACTOR: IMPERIAL PERMIT NO: 15060171 CONSTRUCTION OWNER'S NAME: CHONG FAY JR AND EDIE S 2412 HOMEWOOD DR DATE ISSUED: 06/25/2015 OWNER'S PHONE: 4083139026 SAN JOSE, CA 95128 PHONE NO: (408) 242-6371 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL REMOVE AND REPLACE (4) WINDOWS. License Class_ Lic. # �Z -3 ? REV # 1 - ADD 2 SLIDING GLASS DOORS TO SCOPE OF ��t ��✓'�`%�Z Cdr' 7I 4 ` z o IS WORK, LIKE FOR LIKE - ISSUED 8/5/15 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 Sq. Ft Floor Area: Valuation: $3000 erformance of the work for which this permit is issued. 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: 32344037.00 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 WITIIIN 180 DA IT 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 DA INSPEC ION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the S granting of this permit. Additionally, the applicant understands and will comply ue Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. NRE-ROOFS: Signature Date ,( GT { �p� 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 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) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 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 2550 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: - Date:. < Cd 5 - 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 Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 +CUPERTINO ❑ NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIONJ 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building.5cupertino.org ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS O L 7APN # —� 1 ", V 1 0 � Ol 0 \ (v 04 N V OWNER NAME 04 vy 6 4 y T ^ o� /1T I J /V �(� PONE /3 L Z� ! E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME i1 l ciV PHONE U - 6j--711 E-MAIL _ STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME (/C ti LICENSE NUM BEI LICENSE TYPE BUS. LIC # 4- COMPANY NAME < C E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP HO dl ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ,/// A/ / ^ ! 5� DESCRIPTION OF WORK ez,e � Z /v �U %�//V % �L �� 1'/dO/ �/ff //(/�/�/r� (l 5 ' Al 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 REMODELAREA REMODEL AREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: 0 DETACH 0 ATTACH # DWELLING UNITS: IS A SECOND UNrr 0 YES SECOND STORY ❑ YES BEING ADDED? ONO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES R BY, TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? By my signature below, I certify to each of the following: I am the property owner or authorized agent to act n the ty owner's behalf. I have read this 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 relating to building�qptruction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: Z Q J( 1 70 /J - !1 SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ ❑ LARGE FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR 11 submittal of Building Permit application. SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH BldgApp_201 1. doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION 19' ADDRESS: 20590 SHADY OAK LN DATE: 08/05/2015 REVIEWED BY: MELISSA tee(°h. p: APN: 323 44 037 BP#: 15060171 1 *VALUATION: iso 7771 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: 1 1ec- Iusp. Fee: PENTAMATION 1GENRES PERMIT TYPE: WORK REV # 1 -ADD 2 SLIDING GLASS DOORS TO SCOPE OF WORK LIKE FOR LIKE -ISSUED 8/5/15 SCOPE 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 Dreliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) Hech. Plan Check 1'171ntb . flan Ole(./ 1 lec. Plan Check tee(°h. p: 1'111rnl,, '' llec. Permit Fee: Other:ilech ;:; ; ,E]__L_ Other Pluntb hap. Other Elec. Iusp Meeh. Imp. Fee Pltumh. Insp. f i .: 1 1ec- Iusp. Fee: 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 Dreliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? © Yes Q No $0.00 hours Plan Check, Hourly $143.00 1STPLNCK Suppl. PC Fee: (E) Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -.0 Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (7onstruclion Tttk: Administrative Fee: O E) Work Without Permit? © Yes (j) No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure E) O i / nivel Documentation Fees: Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $143.00 TOTAL FEE: $143.00 Revised: 07/02/2015 LN t F oo2 V, # I App (Z) '�;4-W&V �S Oovxs -�-� GO' P?fJaNC COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION - CUPERTINO APPROVED This set of plans and specifications MUST be kept at the job sits during construction. It is unlawful to make any changes or alterations on same, or to devote thQrefrom, without approval from the Building Official. ,.i stamping of this ^' -*;ons SH.A1 I_ N0T :.Q Lid, of any i �- OFF`G� Lo-�[CaP PER g pQpartMent 'q `I 2315 REVIEWEV OR CODE COMPLIANCE Reviewed By DATE 8 / s / -�6& PLANNING DEPT CUPERTINO BY