15040050 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20888 FARGO DR CONTRACTOR:SIMON ZHANG PERMIT NO: 15040050
OWNER'S NAME: LIU YOUZHONG AND ZHAO WEIYING 18488 PROSPECT RD DATE ISSUED:06/05/2015
OWNER'S PHONE: 4084621188 SARATOGA,CA 95070 PHONE NO:(408)887-0591
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL
T� CONSTRUCT 2 STORY SFDWL TO INCLUDE LIVING(3942
License Class L'c.# SQ
FT)ATTACHED GARAGE(439 SQ FT)PORCH(439 SQ FT)
Contractor ate �s
1 hereby affirm that I am licene�Undee ovisions of apter
(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:$600000
CA have and will maintain Worker's Compensation Insurance,as provided for by
7 Section 3700 of the Labor Code,for the performance of the work for which this APN Number:32630116.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.1 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, , l
costs,and expenses which may accrue against said City in consequence of the Issued by ���N Date:
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
918. �
RE-ROOFS:
Signature Date—61# 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). 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(x)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.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agen • Date:
permit is issued.
1 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.1 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 1 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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIO ((\\[��
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 "4v
(408)777-3228• FAX(408)777-3333•building cDcupertino.orci
GUPERTINQ `
NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS �D (�n /7 ^ �j APN# 3�.r 3 O... 114
�C OWNER NAME O, J•�i /V rOJ�// /,C ) {// `!/ PHONE / ny_`rU L_���L%8 E-MAIL1 L I 7(_ t7l
X STREET ADDRESS /O(!//l(�� (� /�\�/L —/,/ CITY, STALE CZi/I (- "169 r /. /0 r G� ('Q/ FAx
CONTACT NAME l (yb/ !V�r [� PHONES ,�V� / y O Z E MA1 �y et r K . .
STREET ADDRES /Q b/ fritr9b CITY,STAT�E,�Z/iP �/O �O, r O `Z�Z� C
❑OWNER ❑ OWNER-BUILDER 11 OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSENUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME r E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECTIENGI EER NAME LICENSE NUMBER Z /Z BUS.LIC#/
U. o
COMPANYNAME t,, E-MAIL :�CJ� eg # �J � . FAX
STREET ADDRESS/ r �� CITY,STS Zi� t►' /Ir
PHONE
DESCRIPTION OF WORKpoSr
W y Z C OAY
EXISTING USE PROPOSED USE CONSTR.TYPE'lW #STORIES
L V,8 2 USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOG DEMO 1/ TOTAL r U'Y
AREA A 2� AREA NET AREA V"
BATHROOM KITCHEN0
THER f
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH A A DECK AREA TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH'
s/ sf /CJATTACH D
MNr
OKA
0 DWELLING UNITS: IS A SECOND UNIT ❑YES SECONDS ORY DYES
(�
' BEING ADDED? ;
Q NO ADDITION? ANO Pw rc,,-
PRE-APPLICATION YES IF YES,PR E C PY OF IS THE BLDG AN ^❑YES ',RECEIVED BY: ' - IOTA VALUATION:
PLANNING APPL# []NO PLANNING P O LEITER EICHLER HOME? AND u- I /)
1 /`�
By my signature below,I certify to each of the following: I am the property owner or authorized agent to, on 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 buil ng cP struction, authorize re resentatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: S
SUPPLEMENTAL INFORMATION REQ PLAN Cl[kCK-TYPE
'ROUTNGSLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for C1 OVER-THE-COUNTER `BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. O EXPRE S G 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. ❑ LARGETIRE DE
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑. ENVIRONMENTAL HEALTH
BldgApp_201 1.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 20888 fargo dr DATE: 04/08/2015 REVIEWED BY: Mendez
c "VALUATION: $600,000
APN: BP� 11"i
PLAN CHECK TYPE: New Construction
*PERMIT TYPE: Building Permit Yes •' No PENTAMATION
PRIMARY 2nd t. 1R3SFDW
SFD or Duplex PERMIT TYPE:
USE:
gRK construct 2 storysfdwl to include living3942 s ft attached arae 439 s ft porch 439 s
PE
TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
OCCUPANCY TYPE: CONSTR. s.f.
R-3 (Custom) II-B,III-B,IV,V-B 4,899 $3,342.57 1R3PLNCK $4,037.37 IR3INSP
$ ;
TOTALS: 4,899 $3,342 57 ',�; 4,037 37
eq. -.,.fir s(fa.f!i ai i ,' t'1xt t �Y L�rf v�•s"cl l:,,S arr ta '"zs�urNn r a.71�!'. h/ ,t sk ' ' 3ky.' .�{.....3¢
s j ,
K
-
..• Grit C?f
l tech. I'(crrt f'hc cI
l,f f!,nth. Tcrtrir 1•'�c:
:Unca;,
other•.Wec..h. In.+'pLi Ocher Piirn•rb lyre'/'.
UrL'c>r lace.Irtsli.
I'luntb. hrsp. 1-ee:
I;iec•.Irtsp. Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,Schoo
District,etc.,. These ees are based on the rel* ' in ormation available and are onl o.
an estimate. Contact the Dent or addn'1 info.
TY/FEE MISC ITEMS
FEE ITEMS(fResolution 11-053 Ef/' 7i1/l3) FEE Q
'ee
$3,342.57 Select a Misc Bldg/Structure
Plan Check Fee: or Element of a Building
Suppl.PC Fee: Q Reg. Q OT 0.0 hrs $0.00
PME Plan Check: $0.00
Permit Fee: $4,037.37
Suppl. Insp.Fee-.0 Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
--F=
#new
Construction Tax: IBCONSTAXR 1 units $677.77Q
I.dlninislrallt'c?1`c'(': O
Work Without Permit? Q Yes Q No $0.00
Select allon-Residential
Advanced Planning Fee: IPLLONGR $685.86 Building or Structure Q
Trc.n'cl Doc bane ntatinn Fees:
Strom Motion Fee:
IBSEISMICR $78.00 Select an Administrative Item
Bldg Stds Commission Fee IBCBSC $24.00 a
'` ' ' r `4 SiIBTOTALS $8,845.57 $0.00 x: f�4 1 TO ALFEE7$78,:845
57
l h ..5...,.... •_. t.... -.x,. M,t. .....h„j r..:v(. ......,i.t.',...tt. ff':hd r.»..nF
Revised: 04/01/2015