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14120099 - REV1 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10416 PRUNE TREE LN CONTRACTOR:AC LIU CONSTRUCTION, PERMIT NO: 14120099 INC OWNER'S NAME: LIU ALEXANDER C AND DOROTHY 10416 PRUNE TREE LN DATE ISSUED:04/16/2015 OWNER'S PHONE: 6509682832 CUPERTINO,CA 95014 PHONE NO:(650)492-0857 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL ❑ CONSTRUCT 2,913 S.F.(N)2 STORY SFD WITH 595 S.F. License Class_ Lic.# �(6*7 PORCH/BALCONY&462 S.F. ATTACHED GARAGE Contractor e- L,'k l`rn�S�"cr`'+�Date S' // / S REV# 1 -REVISE THE APPROVED FOUNDATION PLANS TO INCLUDE(N)SUPPORT DETAIL CHANGES-ISSUED I hereby affirm that I am licensed under the provisions of Chapter 9 5/11/15 (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 ave 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. APN Number:31633119.00 Occupancy Type: 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, d costs,and expenses which may accrue against said City in consequence of the �./! Iii✓✓ �/ r granting of this permit. Additionally,the applicant understands and will complyIssued by: / C Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ,- 0 Signature "moi DamI l 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. ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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) 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 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 25595,25533,and 25534. 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 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 CONSTRUCTION PERMIT APPLICATION ' 12 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 13 CUPERTINO (408)777-3228• FAX(408)777-3333•building(cDcupertino.p ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI REVISION/DEFERRED ORIGINAL PERMIT# PROJECf ADDRESS �rl� A v� APN# / ( I OWNER NAME . i _ / Q J e / ' PHONE /1OZ^ 00�7 E-MAILaCl C STREET ADDRESS 'o(0/ r D CITY, STATE,ZIP /e , c) CA ( FAx b !�-e [—at I— CJS\ l� �t �v CONTACT NAME \ r PHONE Q� IL 1 SSC/ Z OO >� E-MAIL STREET ADDRESS ' ,A(�r '��R f, N� CITY,STATE,ZIP �� r� FqJ{ ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ^ j U /CM M LICENSE NUBER LICENSE TYPE n BUS.LIC# COMPANY NAME � /��S L_ C�� EMAIL (e Y� � I\ ^ I .G` FAX STREET ADDRESS r(�4-I C-5 ?Yu, CITY,STATE,ZI 1 ( J CkA r`UI PHONE ARCHITECT/ENGINEER N ( l LICENSE NUMBER BUS.LIC# [AS 4 1 �oJ COMPANY NAME c E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK - D a WD V-f-4 i K," , a of S ki- _l_,Z 3 /�— i R�er �S FE)aSTING PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) NEW FLOOR DEMO TOTAL AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: ISA SECOND UNrr ❑YES SECOND STORY YES BE GADDED? ONO ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF is THE BLDG AN ❑YES K- PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO u 'r - TOTAL VALUATION: 4 By my signature below,I certify to each of the following: I am the property owneror authorize o act 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 i is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: � Date: S' SUPPLEMENTAL INFORMA ON REQUIRED _ +a PLAN CHECK TYPE a;_, ,r r Y,. ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for O ITItGO1J « C7 BUII DING PLAN REViWw existing building(s). Demolition permit is required prior to issuance of buildings permit for new building. � � �� , -1,1000"W'14" , PLANNII!TGT' �AIVRE ti _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �lSTA foTDAI �* JPT �� rm if any Hazardous Materials are bein used as art of this project. Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. _: .ENC'IIto '� .AEAL'TH+F -; BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 10416 PRUNE TREE LN DATE: 05/11/2015 REVIEWED BY: MELISSA APN: 316 33 119 BP#: 14120099 *VALUATION: $0 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: PRIMARY Alteration / Repair USE: SFD or Duplex PENTAMATION PERMIT TYPE: 1 GENRE WORK REV# 1 - REVISE THE APPROVED FOUNDATION PLANS TO INCLUDE N SUPPORT DETAIL SCOPE CHANGES - IISUED 5/11/15 i kc/). Plilr•"c'heck 1'hr„rh. >! ! (.lic'C,'k Meclr. Permit Fec' Numb. t'ennil I'ci 011cr•Alec'ft. Irrs'rz 011rc; I'ium,Ir Insp, !./e['.1i25�"">. �'!c'<.l i. Ji:St. !<'c': lJ7!i7f l. llitll, /'('•. l:lec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These ees are based on the prelimina information available and are only an estimate Contact the Dept for addn'1 info, FEE ITEMS (Fee Resolution.]1-053 Ef 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 1 hours Plan Check, Hourly Suppl. PC Fee: E) Reg. C) OT0.0 hrs $0.00 $143.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. ():0::T170_,0hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C"r nstrac•tion Tarr: Administrative Work Without Permit? 0 Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Q lilavei 1: ocumcnIation Fc,cs. L�� Building or Structure I Strong Motion Fee $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $143.00 TOTAL FEE: F $143.00 Revised: 04/01/2015