15060139 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10109 JUDY AVE CONTRACTOR:GEORGE A JULIAN PERMIT NO: 15060139
CONSTRUCTION
OWNER'S NAME: MILLIE WANG 1360 DONOHUE DR DATE ISSUED:06/22/2015
OWNER'S PHONE: 4084893558 SAN JOSE,CA 95131 PHONE NO:(408)464-8991
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E]
91- REMODEL(2)BATHROOMS-NO CHANGES TO
License Class Lic # S,-1/036 PLUMBING,
ZZ !S' ELECTRICAL&MECHANICAL.REMODEL KITCHEN-
Contractor�,pe,(} I - Date 6 REPLACE
I hereby affirm that I am licensed under the provisions of Chapter 9 CABINETS&COUNTERTOPS ONLY AND INSTALL 1
(commencing with Section 7000)of Division 3 of the Business&Professions OUTLET
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
pensation,as provided for by Section 3700 of the Labor Code,for the
�Il5erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$15600
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:37507051.00 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 YS FROM LAST CAL ED INSPE TIO
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:
with all non-point source regulations per the Cupertino Municipal Code,Section i
9.18.
RE-ROOFS:
Signature Date 4 Zti I� 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)
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. 1 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 25505 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. L
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
(50601311
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333 • building a-�cuoertino.org
CUPERTINO
❑NEW CONSTRUCTION ❑ ADDITION �ALTERATION/Ti A El REVISION
REVISION/^DEFERRED ORIGINAL PERMIT n
PROJECfADDRESS oto T (A I API`
V
OWNER NAME PHONE � 3 E-MAIL
LL` ) �-
STREET ADDRESS lold I CITY, STATE,ZIP `� ap FAX
CONTACT NAME Ti 7—Lp v PHONE �D �� E-MAIL
STREET ADDRESS3338 r CITY,STATE, ZIP / �� � FAX
13 OWNER 11 OWNER-BUILDER ❑ OWNERAGENr 13 CONTRACTOR 11 CONTRACTOR AGENT ❑ ARCHITECT ❑GEN•GINTEER ❑ DEVELOPER ❑ TENS
CONTRACTOR NAME n /• LIC SE NUMBER LICENSE TYPE r BUS.LIC N
COMPANY NAME P ,7 V I
E-MAIL �.dw O "'_" !� FAX 'j�Z 7 Lrer.
STREET ADDRESS (T(f CITY,STATE,ZIPS \ J/ J PHONrE �,5�
t ►J
ARCHITECT/ENGLNEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK d7 rr``'',,
M'V� I/"�"''PC-L' �.l J��� � ✓Iii-� L�.•'i•'- �%1 �- ' ��
•
EXISTING USE PROPOSED USE CONSTR.TYPE STORIES USE TYPE I OCC. SQ.FT. VALUATION(S)
E>,ZSTG NEW FLOOR, DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN. OTHER
REMODEL AREA Q 5�,. REMODEL AREA }C1 REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKIPORCH AREA I GARAGE AREA: DETACH
❑ATTACH
R DWELLING UNITS: 1S A SECOND UNIT E:)YES SECONDSTORY ❑YES
BEINGADDED? El NO ADDITION? ❑NO
PRE-APPLICATION ❑YES IF YES,PROVME COPY OF I IS THE BLDG.AN ❑YES - E D$� TOTAL VALUATION:
PLANNING APPL 9 ❑NO PLANNING APPROVAL LETTER EICHLER HO ME? ❑NO
By my signature below,I certify to each of the fcllm� ng: I am the property o xner or authorized agent to act on the property owner's behalf. I ave 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 build'no Fo traction. I authorize representatives of Cupertino to enter the aboe-identified property for inspection purposes.
Signature of Applicant/Agent: Date: �)"I't)s
SUPPLEMENTAL INFORMATION REQUIRED
�sal.Iccx� _ MmcsL_
New SFD or Multifamily dv�rellings: Apply for demolition permit for r �
VERIFTKEZ
existing building(s).
aDemolition ti
a }_ � ihTERi 'DL'VG P4�j,REIEWe �,. .
permit is required prior o issuance of buildtng
permit for new building.
t _
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
LAF�Ir � � k'II2ED
_Copy of Planning Approval Letter or Meeting With Planning prior to 'QoR p sn�xY$ R, rsTRrcr
submittal of Building Permit application.
EIa TROI�MENTAL:HEALTA r;
BIdg,App_2011.doc revised 06/21/11
CITY OF CUPERTINO eq
FEE ESTIMATOR - BUILDING DIVISION
7ADDRESS: 10109 Judy Ave DATE: 06/18/2015 REVIEWED BY: Paul
375 07 051 BP#: 150 CPd��3 *VALUATION: $8,000
YPERMIT : Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM
USE: PERMIT TYPE:
WORK Remodel 2 Bathrooms- no changes to plumbing, electrical & mechanical. Remodel Kitchen - replace
SCOPE cabinets & countertop and install 1 outlet on peninsula counter/ no other electrical or plumbing
Mech. Plzen Check Phunh. Plum Check E lec..Plan Check
lech. Permit Fee t" Po—mit T""' P rrnit hc,
Other Alech. Insp. Other Plumb lnsp. Li :)iher Llec.Insp.
Llech, Insp_ Fee: f'hunh. hrsp. l.'er lec•. Insp. Pipe:
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 prelitinina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 U 711113) FEE QTY/FEET_ MISC ITEMS
Plan Check Fee: $0.00 = s.f. Remodel, Bath(<=300 sf)
Suppl. PC Fee: E) Reg. Q OT 0.0 hrs $0.00 $645.001. REMRESBA T
PME Plan Check: $0.00 81 s.f. Remodel, Kitchen(<=300 sf)
1-1
Permit Fee: $0.00 $645.00 IREMRESKIT
Suppl. Insp. Fee-0 Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax.
Adininistl_WNa Fee: Q
Work Without Permit? Yes (j) No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential G
1rc vel Docutnetatation
Building or Structure
Strong Motion Fee: IBSEISMICR $1.04 Select an Administrative Item
Bld.P Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $2.041$1,290.00 TOTAL FEE: $1,292.04
Revised: 05/07/2015
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be held to permit or to be an aper val of t violation
of any 'isiors of any City Ordin nc r State Law. j�tiv¢� Fm _
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All dimensions_size designations20 �� This is an original design and must Designed: 6/16/2015
given are subject to verification on TECHNOLOGIES not be released or copied unless Printed: 6/16/20.15
job site and adjustment to fit job applicable fee has been paid or job
conditions. order placed.
408-585-8785 FOR JUDY PROJECT PLAN 2.kit All Drawing#: 1 N Scale.
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