15050151 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10420 S DE ANZA BLVD CONTRACTOR:BELFOR PROPERTY PERMIT NO: 15050151
RESTORATION
OWNER'S NAME: WU YE-MING TRUSTEE&ET AL 2297 RINGWOOD AVE DATE ISSUED:05/26/2015
OWNER'S PHONE: 5109281808 SAN JOSE,CA 95133 PHONE NO:(408)929-3473
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
_ REPAIR 8 LF OF EXTERIOR WALL DAMAGED BY
License Class Lic.A ��(� AUTOMOBILE.
Contractor Date
i hereby a at I a 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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$4200
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 APN Number:36940038.10420 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.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 Issued by: �l� � �}> [%/� Date:
granting of this permit. Additionally,the applicant understands and will comply
with all non-points regulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signature Date L /S� 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
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)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(See.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,Section 05,25 33, 25534.
Section 3700 ofthe 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
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.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.
grantingoldtis 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
I 1__J`—,,/L )I C_/ J
CONSTRUCTION PERMIT APPLICATION
its COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 • FAX (408) 777-3333• buildina(Wcupertino.org / 0�5 /
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED OORIGIN'AL PERMIT#
PROJECT ADDRESS APN# '�6 l O%_'U_
ac
OWNER NAME PHONE E-MAIL _
STREET ADDRESS CITY STATE,ZIP FAX
10q 26 5. r 7`irl G3 f C
CONTACT NAME. PHONE, E-MA L
7 121
-Datr Cizqizx 1-1616 4X.1- 61-
STREET ADDRESS CITY,STATE, ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT /TRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICE NSENU BER LICENSE TYPE BUS.LIC H
Z 19 Zs—
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,_§TATE,ZIP PHONE
2-2-9-2 tit y 4'_ / !
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC H
_7777777.777-1....
COMPANY NAME E-MAIL FAX
_...__... ..... 7777
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK I
2 t v, C
rte _ 00G L� e' `T H L r�-t a 'C. TI�clS td I
EXISTING USE PROPOSED USE CONSTR.TYPE 1 k STORIES
1 1 L
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA_.- 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
H DWELLING UNIT& IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? ❑NO ADDITION? []NO
PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES jCEj �Y TOTAL.VALUATION:
PLANNING APPL H []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO
B m signature below,I cert) to eac the fo owi I am the property owner or authorized y •g fy g: p p y agent to act on the property owner's behalf. I have read this
application and the information I e pro Id ct. 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relati to buil g s ion. I authorize representatives of Cupertino to enter the above-i entified property for inspection purposes.
Signature of Applicant/Agen. Date:
SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING-SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for ;oy tt T> -coUNTER `T BUILbII!1GjPLANREVIEW:
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. CO EXPRESS PLAN!`TIIYGPLAN`REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure O STANDAY;D. PUBIsTG WORKS
form+f 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 ❑ SA*, :t RY SEWER DISTRICT
submittal of Building Permit application.
ENYIRONM_XNTAL.HEALT$.
BldgApp_2011.doe revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10420 S DE ANZA BLVD DATE: 05/26/2015 REVIEWED BY: SEAN
APN: BP#: f� -VALUATION: $4,200
xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY Civil/Religious activities PENTAMATION 1 GENCOM
USE: Commercial Building in BQ zone? 0 Yes E)No PERMIT TYPE: i
WORK REPAIR 8 LF OF EXTERIOR WALL DAMAGED BY AUTOMOBILE.
SCOPE
� I 4�4 ��'1'�{I'Y 7 -:a s2 _t, .o+ ,�",�s�N'� f..,wr'� �r�y �-'3:.i � c ��-"``r '��x�' IyJ�:jy`�, 7m{a. i�', T j y �''s #�'„➢ ^I` r' 4�9 {: �!r'�9 nt,-•- is�S+xt�r r,xr
1
:1 fec h. 111arr(-heck I'lrux?. 1'101-1('hcor klec.Plein Check
P�10 Fac; Til FCC. 1"Yec. Perwir
llil 1EI-L-
)!(er !!t '. /rsp.
)lh<a ! +rh Ltr 01icr1lch. Irsrc1'2r
ID
W ch. lres/r. h'ec': Phcruh. lrrsp l•eF! 1:i c.Itzsf. !'tr
NOTE:This estimate does not include fees due to other Departments(l.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These fees are based on the Mlimina information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS(Fee Resolution 11-053 Ef>. 7./1,13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 L 1 hours Plan Check, Hourly
Suppl.PC Fee: Q Reg. Q OT 0.0 1 hrs $0.00 $143.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? ()Yes Q No $0.00
-.Suppl.Insp.Fee-0 Reg. Q OT p,p hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax: IBCONSTAXC $0.00
11dinillisIrctive'. Feu: o
Work Without Permit? 0 Yes Q No $0.00
Advanced Planning Fee: $0.00 L _J hours Inspections
7'rra+el Docuirlelalration Fees. $286.00 1STINSP Inspection,Hourly 0
Strong Motion Fee: IBSEISMICO $1.18 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
5 y 4 ST7B'F�TAit; t $2.18 $429.00 s. , $431.18
x $'
a.,
Revised: 05/07/2015