13110095-public18650 CYNTHIA AVE
13110095
I
LI KUO TSAI AND LIU PEISHAN
SCANNED BOX #598
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18650 CYNTHIA AVE CONTRACTOR: HOMESTEAD PERMIT NO: 13110095
CONSTRUCTION INC
OWNER'S NAME: LI KUO TSAI AND LIU PEISHAN 10080 STERN AVE DATE ISSUED: 07/16/2014
OWNER'S PHONE: 4088871382 CUPERTINO, CA 95014 PHONE NO: (408) 255-8999
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
CONSTRUCT 2 STORY SFDWL TO INCLUDE IST FLOOR
License Class_Lic. 4 J 1231
SQ FT, 2ND FLOOR 912 SQFT AND ATTACHED GARAGE
Contractor > > �`� 420
I hereby affirm that I am licensed under the provisions of Chapter 9 SQ FT
(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
Y4 performance of the work for which this permit is issued. Sq, Ft Floor Area: Valuation: $285000
` 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: 37522028.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPI IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 18 DAYSERMIT 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 FR M 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
granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: l
with all non -point source regulations per.# Cupertino Municipal Code, Section
9.18. �/
RE -ROOFS:
Signature Date b� 'T 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
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
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
1 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 255595, 2.553 _- Z2553
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Z_
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
1 certify that 1 have read this application and state that the above information is
correct. l 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
XNEW CONSTRUCTION
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org
❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED
311
ORIGINAL PERMIT #
PROJECT ADDRESS t
APN #
�
OWNER NAME, 1
PHONE�-�,
STREET ADDRESS
N H t H A V&
CITY, STATE, ZIP
Rlt,� (4_
L v rz(:Z (Wo C'/,)
FAX
.
CONTACT NAME �AV1�
PHONE
1_4Le ) �9�- �a f�
E-MAIL
de�
STREET ADDRESS
i o_ G8 8AN DLE�DR. jl(OZ
CITY, STATE, ZIP
C.c I k/C A'i - E4
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME h
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME
J—�
LICENSE NUMBER C 2 (� �i
K}
BUS. LIC #
COMPANY NAME
A V (tom �R�-14-
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
S F. D.
S I Ir-8
2
USE
TYPE
OCC.
SQ.FT.
VALUATIONS)
EXISTG
AREA
NEW FLOOR EMO
AREA AREA
TOTAL
NET AREA
- �I4;t
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
w
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
��S
-4d ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
BEINGADDED? NO
SECOND STORY [] YES
ADDITION? NkO
7YES
PRE -APPLICATION YES IF YES, 4WIDOPY OF IS THE BLDG AN -
RECEIVED - TOTAL VALUATION:
PLANTIING APPL # ❑ NO P P 0 R� EICHLER HOME? ❑ NO
2 0 Uv
By my signature below, I certi to each of& f 1 wing: I am the property owner or authorized nt act on the property owner's behalf I have read this
application and the information I have provided is correct. I have read the Description of Work and v it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building co ction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION UIRED
PLAN CHECK TYPE
a ROUTING SLIP <r ' , r
_ New SFD or Multifamily dwellings: Apply for demolition permit for
t" OVER THE -COUNTER s
BUH.DINGPLAN REt3EW
existing building(s). Demolition permit is required prior to issuance of building
ah •
x k z
for new building.
p g
❑ xP ss`
ING Permit
PLAN REVIEW
�`
,
g
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
:STAN'DARDM
PUBLIC�VtORKS
❑ ;.,,"k
Copy of Planning Approval Letter or Meeting with Planning prior to,:
�a
❑
_
submittal of Building Permit application.,
MAJOR ::AIVTTARYSEWERDIST�IC
I . ENVIRONME \TAL HEALTH ,
BldgApp_2011.doc remised 06121111
CITY OF CUPERTINO
FEW FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 108650 Cynthia ave
DATE: 11/14/2013
REVIEWED BY: mendez
APN:
BP#:
VALUATION: 1$285,000
%PERMIT TYPE: Building Permit
PLAN CHECK TYPE: New Construction
PRIMARY SFD or Duplex
USE:
2nd Unit? Yes • No
PENTAMATION 1 R3SFDW
PERMIT TYPE:
WORK
construct 2 story sfdwl to include 1st floor 1231 sq ft 2nd floor 912 s ft and attached garage 420 sq ft
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,III-B,IV,V-B
2,563
$2,897.01
IR3PLNCK
$2,739.24
IR3INSP
TOTALS:
2,563
$2,897.01
$2,739.24
1lajr l 6irc {r 1'l+uilb. ly(;,il (Jle �� Af 0�'r�.'- £'filar f "l4A 4,
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Dietrirt- etr_! Theve foev ara ha.ced an the nreliminary information avoilahle and are only an estimate Contact the Dent far addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E ..� 7i1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,897.01
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Q Reg. OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$2,739.24
Suppl. Insp. Fee-0 Reg. Q OT
T0.0Thrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXR
1
# new
units
$650.84
I ;tatrist;mro,
0
Work Without Permit? ® Yes 0 No
$0.00
Advanced Planning Fee: IPLLONGR
$358.82
Select allon-Residential O
Building or Structure
/
1'�cli('_ 1)t)t'flli7i'Miladlf>il 3`c'�J_
Strong Motion Fee: IBSEISMICR
$28.50
Select an Administrative Item
Bldu Stds Commission Fee: IBCBSC
$12.00
SUBTOTALS:
$6,686.41
$0.00 TQTAL FEE:
$15,686.41
Revised: 10/01 /2013
Building Department
City Of Cupertino
10300 Terre Avenue
Cupertino, ("A 9501.4-3255
CUP �TI�I� Telephone:408-777-3228
Fax:408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: 18650 Cynthia Ave, Cupertino PER_MI T # 13110095
OWNER'S NAME: Li Kuo Tsai And Liu Peishan PHONE #� 408.887.1382
.................... .............................................._....................._......._....._.................
GENERALomestead Construction, Inc. .C'("iNTRACTOR:HBUSINESS .LK ENSF # .� ..._..........-__......._.......___"_
ADDRESS: 10080 Stern Ave, Cupertino-........—...._............_.......____ a CITY/ZIPCODE: 95014
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL. CAR FINAL OCCUPANCY INSPECTION(S) WILL. BE SCHEDULED UNTI.I., THE
GENERAL, CONTRACTOR AND ALL SUBCONTRACTORS HALVE OBTAINED A CITY OF CUPI+WFINO
BUSINESS LICENSE.
I am not using aw subcontractors:.... .................... .......... _....
_.
S ig n atu�"c� Date
Please check applicable subcontractors and complete the following, information:
V
._._...._
SUBCONTRACTOR
.....,...
.......... - ...... -- ----...._...........................
BUSINESS NAME
._. ..........
_.._........
BUSINESS L.IC.ENSE#
Cabinets & Millwork.
.. .. ............_._._......._ _ .._........
..�......... ....................__�_........................�.__..,...._...
x
Cement Finishing
M S Construction
_._.._..
31031'
__._........ _....... —___. -..__._ 2-7
Electrical
1 ,,,,
Excavation
Fencing
Flooring I Carpeting
Linoleu n 1 Wood
Glass / Glazing
-
--._................. .... _.......... _...... _........-........ .... _.
Heating
Insulation
_....
mS� p
3U
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
.............. _..-
Plastering
--._................... ............. ........ ..... .
Plumbing
�F`.___
_
Z77
Roofing
14 Svt a.,_. 7eA\ 0-
-..._....._............._...........
Septic `Tank.
__._.___........._.........._...._............_....._..
Sheet. Metal
Sheet R.ock
Tile
u j n .ractor Sign- Wure Date