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15060097 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10953 LINDA VISTA DR CONTRACTOTi.' PERMIT NO: 15060097 I-- - �v OWNER'S NAME: CHANG AMY W TRUSTEE DATE ISSUED:06/15/2015 OWNER'S PHONE: 4082454808 PHONE NO: 119 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL ❑ License Class go. Lie. ,, ? REMODEL(E)MASTER&HALL BATHS(105 S.F.),NO # /O,S _ I STURCTURAL CHANGES ContractorW I hereby affirm that I am 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:$21490 have and will maintain Worker's Compensation Insurance,as provided for by ection 3700 of the Labor Code,for the performance of the work for which this APN Number:35606036.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRE IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WIT AY T 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 ED 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 "/S- granting of this permit. Additionally,the applicant understands and will c p y Issued b Date: with all non-point source re ions per the Cupertino Municipal Code,Section 918. ..� / RE-ROOFS: Signature a°`" Dated/ 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) 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. 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 25505,2 ,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 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. 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 918. Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 CUPERTIPIO (408)777-3228• FAX(408)777-3333•building(a)cupertino.org /�Q�Go ❑NEW CONSTRUCTION El ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT PROJECT ADDRESS�� ` i 52 co_P�� APN R �J 5 - G 6 - U 3 OWNERNAMI� !J Y PHO1 7 E-MAIL rod Z L �' T5EDREgfi 4L V IifY S,ATE,)Z `C. FAX CONTACT NAA;E �A�® � � PHONEj C T fi% ip�s, 11 'OWNER ElOWNER-BUILDER ❑ WhNERAGENT ❑ CONTRACTOR 1:1COONf IRACTORAGENT ❑ ARCHITECT r1:1 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME' ),, ��l�'C LICENSE NUMBER �`� t� LICENSE TYPE BUS.LIC R COMPANY NAME C.-O S f K� c' l E di t3 �tl { �X'.v�'i/D, 1 F '7o•� ST% CITY. P1 _ /� PHONE I �r� ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC C7 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK o �U EXISTING USE PROPOSED USE CONSTR.TYPE .".STORDiS USE TYPE OCC. SQ.FT. VALUATION(S) EXaSTG NEW FLOOR- DEMO TOTAL AREA AREA AREA NET AREA BATHROOM. KITCHEN, OTHER. REMODEL AREVO ` REMODEL AREA REMODEL AREA PORCH AREA . DECCK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LIDETACH ❑ATTACH 4 DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? NO ADDITION? E]NO . PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES TOTAL,V DATION: PLANNING APPL ❑NO' PLANNING APPROVAL LETTER EICHLERHOME? ❑N _ _ _ _ '. 9 G, By my signature below,I certify to each of the following: I am the property o,,Nmer or authoriz agent to n the property owner's behalf. I have read this application and the information I have r4�Ided is correct. I have read the Description of Work erify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to �I a onstruct . I authoriz sentatives of Cupertino to enter the above-identifiedrooperty for inspection purposes. Signature of Applicant/Agenl: Date: /?/ fes/ G© ,�r SUPPLEME AL INFOR-MATION REQUIRED — I A�CiCKTYPEtOI3TLM1_GSLIP z New SFD or Multifamily dvvellings: Apply for demolition permit for WK I] o�ERTr courTEa y 7 BuunuzGPLgxREVLEe� existing building(s). Demolition permit is required prior to issuance of building t - permit for new buildinn � P c•g ��TXP.AESS .� e� PLANN�G"PLANREVTEw� s _Commercial Bldas: Provide a completed Hazardous Materials Disclosure © sTAi;DAxD � PUBLewoRxs form if any Hazardous Materials are being used as part of this project. ;f 3 _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. © hJa7oR3�sATIrtY so xDTs�Iuc PP _ � �._ r� EA'VSRbIdMEIyT:AL-AEALTH � BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10953 LINDA VISTA DR DATE: 06/15/2015 REVIEWED BY: MELISSA APN: 356 06 036 BP#: *VALUATION: 1$21,490 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 R3SFDREM WORK REMODEL E MASTER & HALL BATHS 105 S.F.), NO STURCTURAL CHANGES SCOPE Xhch.Ilan Check Piumb. Pkin Check IJec.flan Check �b1ec11.Permit Fee: Plumb.Permit Fee: Elea Permit Fee: otlrer MecFr. Irtsp. EIF-1- Other Plumb Instr. C)ther L''lec.Inch. llech. hap,Fee: Phirnh. trtrtz Tee: lilec.Imp.Fee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Theseees are based on the relimina information available and are onlyan estimate. Contact the Det or addn'l in o. FEE ITEMS (Fee Resolution 11-053 Ef. 7/t 1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel,Bath(<=300 sf) Suppl.PC Fee: (F) Reg. Q OT 0.0 hrs $0.00 $645.00 1REMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Feer Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cens1ru tion Tar.: Administrative Fee: 0 Work Without Permit? 0 Yes (j) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) Building or Structure 0 Travel.Documentalum Fees: I A Strong_Motion Fee: IBSEISMICR $2.79 Select an Administrative Item Bldg Stds Commission.Fee: 1BCBSC $1.00 a SUBTOTALS: $3.79 $645.00 TOTAL FEE: $648.79 Revised: 05/07/2015 &wtA.5Fe9Q PAI' -�OeZ 3e7#_5 10) COMMUNITY DEVELOPMENT DEP�,F2Ttit�FM� ' BUILDING DIVISION - CUPERTINO � I }(� APPROVIED This et of plans and specifications MUST be kept at the 1 G Ijob ite during construction. It is unlawful to make any changes or alterations on-s-sae;-er--to-deviate- 9 ! P then;:from,without approval from the Building Official. The tamping of this o e ns SHALL NOT { be "eld or an • pproval of the violation 1y Pr ns of nce or State Law. PEIT# S �5 - f 3� r ! i grn co W Sam F d i CD- O i { UM .. ._.... .._.. ! O sus r= 0 Q C I O e rn �13 R ® r r Z I 4 ! C) EIVE t JN t5 2015..�__� av � BY