14120033 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 834 MILLER AVE CONTRACTOR:LIM LUCIA TRUSTEE PERMIT NO: 14120033
OWNER'S NAME: LIM LUCIA TRUSTEE 1490 DARTSHIRE CT DATE ISSUED:05/22/2015
OWNER'S PHONE: 8087808386 SUNNYVALE,CA 94087-3634 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL
INFILL/COVER WITH SKYLIGHT 348 S.F.OF ATRIUM TO
License Class Lie.# CREATE(N)FAMILY ROOM.REMODEL(E)KITCHEN
(231S.F.),BATHROOMS(77 S.F.),RE-ROOF(E)22SQ'S
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:
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. Sq.Ft Floor Area: Valuation:$40000
1 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:37542002.00 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 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 the �I�
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
��/—r ���%C�t�f
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:
1 hereby affirm that 1 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)
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
1 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. 1
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
Compensation laws of Califomia. 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 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-poinsource r ulotions per the Cupertino Municipal Code,Section
Licensed Professional
9 18.
Signature Date S (ZZ I)S
CONSTRUCTION PERMIT APPLICATION O
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•building@cugertino.org
CUPERTINO
❑NEW CONSTRUCTION ❑ ADDITION ILJ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS8 3 4 M I L� NE APN t! 3�� — 2 — Q o 2
OWNERNAME LOGGIA �IM PHONE /6�p1'7Q�.a ` E-MAIL L.TPRa?M' yAJ1#47R 'IMM►►
1.vVD J w (AI
STREET ADDRESS J"v PART.SHIQ£ CC CITY, STATE,ZIP svN Ny vALE. e4 i 408 FAX (*0051*-D 0
CONTACT NAME L 154 1M PHONE Cs osc ®�� � E-MAIL 1_TpfWpS1M M iMJ!#*.r JL0
STREET ADDRESS1097-7 &CACIA WY CITY,STATE IA : AJO I FAX
OWNER ❑ OWNER-BUILDER 0 OWNER AGENT ❑ CONTRACTOR 13 CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME E-MAIL FAX
�t. A1� •
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
RTS
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORKor I)
MA& 414.0 Raof IN I L( '� . 3
l t G L=yam Y 0 5r /� FL 0�3 /YT � I��iGMS 77
EXISTING USE PROPOSED US CONSTR.TYPE #STORIES
I �Av01,�+� ^� ' USE TYPE OCC. SQ.FT. VALUATION(S)
)-Aloe SI h
EXISTG NEW FLOOR DEMO TOTAL
AREAI S.�® AREA b AREA NET AREA.LOG
BATHROOM O KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: LJ DETACH
ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY El YES
I BEING ADDED? IRNO ADDITION? VNO
PRE-APPLICATION YES IF YES,PROVIDE COPY OF IS THE BLDG AN YES tiRECE ' ,. �� TOTAL VALUATION:
PLANNING APPL# E]NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NOuM�
By my signature below,I certify to each of the following: I am the property owner or thorized agent to act on roperty 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' accurate. I agree to comply with all applicable local
ordinances and state laws relatin uilding co ction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
S i gnature of A ppl icant/Agent: �� Date: ���IIIf
SUPPLEMENTAL INFORMATION REQUIRED
New SFD or Multifamil} dwellings: Apply for demolition permit for Qv OVER THS COTJNTER D BUILbIAG
} yPLAREVIEW
existingbuildinb(s). Demolition permit is required prior to issuance ofbuilding p N ' k"r
y�"1a'+i; �kry` 3
permit for new building. a'��tt xPxE$s I PLnNNiIvG PI aN REVIEN
tF�t"�g��1��ePd
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure L? sTAi\DARD x;: ❑ PUNIC WQRKS ti r
T4w k
form if any Hazardous Materials are being used as part ofthis project. EAR'
;tfi
_Copy of Planning Approval Letter or Meeting with Planning prior to
1MI� 'N[AJOR tr;° x a s 3A"NITARY SEWER DISTRICT r
submittal of Building Permit application. a r y
i ,.,.}.. I•>.,.r 4'+:w±:fs`'�s � `SCr�;EIVYIRONMENTAY.,HEALTA�°..- t ..
B1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
F1
ADDRESS: 834 MILLER AVE DATE: 12/05/2014 REVIEWED BY: MELISSA
AlN: 375 42 002 BP#: �� `VALUATION: $40,000
j
,1PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY 2nd Unit? 0 Yes 0 No PENTAMATION 1 R3SFDADD
USE: SFD or Duplex OTC? 0 Yes )No PERMIT TYPE: i
WORK INFILL/COVER WITH SKYLIGHT 348 S.F. OF ATRIUM TO CREATE N FAMILY ROOM. REMODEL
SCOPE (E) KITCHEN (231 S.F.), BATHROOMS (77 S.F.), RE-ROOF (E) 22SQ'S & REPLACE 10 WINDOWS PC
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
R-3 (Custom) II-B,III-B,IV,V-B 348 $1,626.00 IADDPLCK $1,323.00 IADDINSP
TOTALS: $1,626.00 ` $1,323.00
E)N EL`EC,r IOURLY� Q Yes ,r 0 No
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prelinzinary information available and are only an estimate. Contact the Dept/or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Efl. 7,•'1!13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $1,626.00 308 s.f. Remodel, Other
Suppl.PC Fee: (F) Reg. Q OT 0.0 hrs $0.00 $503.00IREMRESOTH
PME Plan Check: $0.00 12 # Window/Sliding Glass Door
Permit Fee: $1,323.00 $574.00 F1 WINREP Replacement
Suppl. Insp.Fees. Reg. Q OT 0,0 hrs .$0.00 2,200 s.f. Re-roof
PME Unit Fee: $0.00 $374.00 1REROOFRES
PME Permit Fee: $0.00
0
Work Without Permit? 0 Yes 0 No $0.00 (D
Advanced Planning Fee: IPLLONGR $48.72 Select a Non-Residential 0
Building or Structure 0
Strong_Motion Fee: 113SEISMICR $5.20 Select an Administrative Item
Blde Stds Commission Fee: IBC3SC $2.00
SUBTOTALS $3,004.92 $1,451.00 TQTA`L FEE $4,455.92
Revised: 10/01/2014