15030144 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21886 HYANNISPORT DR CONTRACTOR:HSBC BROTHER CO PERMIT NO: 15030144
OWNER'S NAME: LIN JING C AND MICHELLE YANG TRUSTE 6512 ALMADEN RD DATE ISSUED:03/23/2015
OWNER'S PHONE: 6508611991 SAN JOSE,CA 95120 PHONE NO:(408)644-3112
do LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL El COMMERCIAL
��' �� � / REMODEL(E)250 S.F.KITCHEN,NO STRUCTURAL
License Class—11110 Lie.# 7 �� / CHANGES,LIKE FOR LIKE
REVISION#1: REMOVE SOFFIT AND INSTALL NEW
Contractor j3-C a 4a Date t ' S BEAM IN KITCHEN.-ISSUED 4/23/15
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:$15000
I have and will maintain Worker's Compensation Insurance,as provided for by
t
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:35614059 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 WITFIIN 180 D 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 180 DA O 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 Date: Z.3
granting of this permit. Additionally,the applicant understands and will comply °e
with all non-point source regulations per the Cupertino Municipal Code,Sect'
9 18.
� RE-ROOFS:
Signature Date i4 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
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(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,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which thisDate:
Owner or authorized agent: "
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.
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 APPLI� d5
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
r�
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255" -
CUPERTINO (408)777-3228• FAX(408)777-3333•building(a)cupertino.org
❑NEW CONST,R,U1CTION JJ❑ ADDITION ❑ ALTERATION/TI REVISION/DEFERRED ORIGINAL PERMIT# O Ul 7
PROJECT ADDRESS '//� /M /g n n O py AP.�N1 r# /�,q
OWNER NAME / '! VI PHONF( �O)I/VI (v E-MAIL
STREET ADDRESS �7.I V U a N ►Cf OY� D�F• CITY, STATE,ZIP ( t R 0, FAX
CONTACT NAME !�/l ® ! PHONE VE-MAIL
STREET ADDRESS (� CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER 77NSET;E BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITEC NGINEE E an I/_ LICENSE NUMBER BUS.LIC#
COMPANY NAME lF^ E-MAIL FAX
STREET ADDRESS j 9 p /� CITY,STATE,ZIP /_�n i'�p pn (A�I PHONE SVS d�n
DESCRIPTION OF WORK \ ce Pp C(O I,a/4 04
�V l q M rhdI
NT Z
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR, DEMO TOTAL
AREA AREA AREA NErAREA
BATHROOM. - KITCHEN.. OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREATOTAL DECK/PORCH AREA GARAGE AREA: DETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECONDSTORY ❑YES
BEING ADDED? []NO ADDITION? ❑NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF 1S THE BLDG AN ❑YES .�RECEIVED �r - y 't - TOT DATION:
PLANNING ADPL# ❑NO' PLANNING APPROVAL LETTER EICHLER HOME? ❑NO 91 b '� g 4i yid x
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided i 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 building cons ction. I a orize representatives of Cupertino to enter the above-ide tifiedp operty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INF
PLAN CHECK TYPE .:y U010 s W ROUTING_SI rP` " .
_New SFD or Multifamily dwellings: Apply for demolition permit for `s+
OVER THECOUhTER ( tBUILDINGPLANREVIEW
existing building(s). Demolition pen
is required prior to issuance of building ,�sr � ,t �� �x
gP 9 P g 1 ,
permit for new building. EXPRESS PLANNINCPLANREXIEw
�r "p, � +
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0�sTANDnRn GX z ` U1 PrJIlcwoRiGS a _ r' �' 0.
rLi 4 a.. '' '' 'S F '�
form if any Hazardous Materials are being used as part of this project. ��4 ,, ��� t �' ' P rV 1,_ �� �t 0 j
LARGE '� a { ,'t� ❑�wFZI2E pEPT �' k � + " yi��hr�;`
},g'
_Copy of Planning Approval Letter or Meeting with Planning prior to »
submittal of Building Permit application. ,� oRsANrrARY sEvuERDrsTRrcr
i ON ri .0ENYIRONMENTAI'AEALTHe
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 21886 Hyannisport Dr DATE: 04/17/2015 REVIEWED BY: Sean
APN: BP#: *VALUATION: Iso
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 GENRE
WORK REVISION#1: REMOVE SOFFIT AND INSTALL NEW BEAM IN KITCHEN.
SCOPE
l9ech. Plan Check 1'1z110.Plcua Check ]loc.Plan Cheelc'
dlech.Perinil Fee' Plumb. Permit Fee: laec. Permit Fee:
Oilier illech. lnsp. Otter Plumb Insp. Li Other E,lec.Insp. Li
:ldech.Insp. Pee: Phunh. hasp. Fee: Elec.Imp. Fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public[Forks,Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelimina inormation available and are only an estimate Contact the De t or addn'[info,
FEE ITEMS (Fee Resolution 11-053 L'ff.' 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 0 hours Plan Check,Hourly
Suppl.PC Fee: (2) Reg. Q OT 0.0 lits $0.00 $143.00 1STPLNCx
PME Plan Check: $0.00
Permit Fee: Hourly Only? Q Yes 0 No $0.00
Suppl. Insp. Fee-.(E) Reg. Q OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction 1 oY:
fldministrative Fee: 0
Work Without Permit? 0 Yes ) No $0.00 E)
Advanced Planning Fee. $0.00 717 hours Inspections E)
7icwel Docurnentatiori Fees: $143.00 ISTINSP Inspection,Hourly 0
Strong Motion Fee: $0.00 Select an Administrative Item
Bldg Stds Commission Fee: $0.00
_ SUBTOTALS:.; $0.00 $286.00 TOTAL FEE: $286.00
Revised: 04/01/2015
j
a
1 R:8._.A CIVED
E APR 17 215 o
y
ZIJNITY DEVELOP E„UILDf(V MINT
a DI�i;:�i7N_
—IS -.,� � S �A
T,1 as.ee�1811S and S��CIfICw 0 1;
J. ST be kept at the
r S �C ' f?Y COnc�rU:�lCjfl. rj� f, A
j .!�I to Mr!Ie any
c 1 i:•,J:.of af:0i 7tIC[7S 47l Sc C
t i2'a i •...to d Mia?e
., �. i ro�•✓i�houi apprc�al iro!,
T,,,-•-,� , a� gra plan and s!T
t GI`Flit nr f 7i!t AJC u0 an pc; lOi tih'V
CIt� Ord.l�E4 ce cr Stat,1
k cJ !.
GTL
%tip
�rjj4et prof C-Ab4 OAJ
All
rU
r
S i
X83: ' 1583 4 ii O_'
I� QRgFEss/
_.
�.. .. :,
W
0 38
EXP.
r 4
�Iy r Y
f
Yui U
d
No Ld
U272442 '� � X93 Ste^`
P � _
93 T
O .. m
f i it ED
4 - _
OA
"...,}
.. . h
E- 1
' �•�k � K3 svJ3:lierfrsr�n�pl ',HI B76R � a
� F Y9'f'okb
,u,1�-\ Yui.�� .
op
, 316:iJGH
o
F
y
IN!
Z4_
l ff G
CLIP BM. TO MATCH
.ROOF SLOPE
c VP
Ocrtn-rent
INalls PIR 2 3
'�G SOLID� •
1 1 I INET ,R O"DE CoiAPLIN
�! I evieWed E3y:
jr
E.N.
SUPPORTING BEAM
A35 CLIP TOP &
BOTTOM EA. SIDE k,}.�
rw
SDTL303..
TYPICAL CLIP ENI. DETAIL
-G►v Go;�=�, -,b
V4
� l �
6
T� 1 Y, I� 1p �
-Amvc
A CA
- - ,K` - - - - Q�pFESSI�
°;. :...I
383
EXP. I y.
eciv
n
relo
Fill
Dk 77J,
k�
_.. _ Eli _. �
pla S a"lr�t spep is,i>c�rr.i .Fri 7T! � y I:Y�
.. ..—_ job site ftn L
isual
i{{I, l;�Y�3±cS C� i�i2rat 3 5 �'3 �u, f( c u
ny
t i E� t 1�Fi:?iflu'J.�.a4�.i Ca am
f
A��t3Th
'7?'S,'!rlg,JT u'{ss:pisn a"i'iI�
`
C�� LID �rbteIl vC Vii! �a 9 �. r,..,f ,y� # y.•�
CJ :i" r-v4i' clif
co co
- FO. J 5703 o y
CUPERTINO
�., x t •t
t C77
f
P sul Ong QepaMent
A
MAR 2 2015
S �
i
a. REVIEWED FOR CODE GQMPLI�,t�uE
} Reviewed BT
Ma
j! is i �'� -(�•�' Y_
THIS PLAN SHALL REMAIN Cli��',[
HE AT ALL T1
�a
..---_.._.___..__.. �. ...._ _._. .... . ...>�._.....� -.... ..... -.gym.....
STRI T
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10760 S STELLING RD CONTRACTOR:ALLSTAR PLUMBING PERMIT NO: 15040169
OWNER'S NAME: JAUCH PATRICIA L TRUSTEE 326 PHELAN AVE DATE ISSUED:04/23/2015
OWNER'S PHONE: 4082040843 SAN JOSE,CA 95122 PHONE NO:(408)230-5569
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL
REPLACE EXISTING WATER LINE FROM WATER METER
License Class \t�� Lic.#_1 � TO
HOUSE
Contractor Date
I hereby affirm that I am licensed under t e 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:$8568
VWand 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:35922078.00 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 AYS FROM LAST CALLED INSP CT ON.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 1 ,VN
costs,and expenses which may accrue against said City in consequence of the /� C l(./�I
granting of this permit. Additionally,the applicant understands and will comply Issued by: fit/ Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
918. /
/� t' RE-ROOFS:
Signature ; ,, Q,4 Date' ✓ 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. 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 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.
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(See.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
9 18.
Signature Date
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
EMCUPERTINO (408) 777-3228• FAX(408)777-3333•buildin cupertino.orp
MISC
14PLUMBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS APN#35q
0
OWNER NAMEA L .� PHONE /1 O �® MAIL
�, �.� e e '4_
STREET ADD SI CIT J STATE,ZIP ! A�j FAX
d J U
CONTACT NAME 1 P E-MAIL
&A .
STREET ADDRESS C Y,STAT IP FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME1�s LICENSENUMB R LICENSETYPF{ BUS.LIC#.'X
COMPANY NAME �j E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHO
rr
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD or DUPLEX ❑ MULTI-FAMU,Y PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES
BUILDING ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO
DESCRIPTION OF WORK
TOTAL VALUATION: n��. �' RCEPJED BY yOO
� u y`
By my signature below,I certify to each of the following: I am the property owner or authorized agent to 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 verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building onsstt°ruction. I a t orize re entatives of Cupertino to enter the above-identified prope or inspection purposes.
Signature of Applicant/Agent: "+ ` Date:4/fir Z//
SUPPLEMENTAL INFORMATION REQUIREDti
t�" � OVER THE•COUNTER '
Ap`�E� i ❑ EXPRESS,";'� a.�: � , � �.-.
� a
r
SZOE-
MEPMiscApp_2011.doc
revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10760 S Stelling Rd DATE: 04/23/2015 REVIEWED BY: Paul
APN: 359 22 078 BP#: *VALUATION: 1$8,568
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Duplex PENTAMATION 1 RPWS
USE: p PERMIT TYPE: A
WORK �Re lace existing water line from water meter to house
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Service 1 BPWSVCS 1 # $25
TOTALS: $25.00
Afech. Plan Check Plumb.Plan Check 0.0 hrs $0.00 L'Iec..Plan Check
Flech. fermi[Fee: Plumb.Permit Fee: IPPERMIT Elec. Permit Fee:
F
0.0 Alech. Insp. Other Plumb Insp. hrs $48.00 Other Elec.Insp.
Insp. hie: Phmtb. Insp. lie; I Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These fims are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl—ff'Pee
PME Plan Check: $0.00
Permit Fee:
Supp/. Insp Fee
PME Unit Fee: $25.00
PME Permit Fee: $48.00
COIZSt]'2MOP7 Tax-:
Administrative Fee: IADMIN $45.00
Work Without Permit? 0 Yes (j) No $0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRAVDOC $48.00 A
Strong Motion Fee: 1BSEISMICR $1.11 Select.an Administrative Item
Bldg Stds Commission.Fee: IBCBSC $1.00
SUBTOTALS $168.11 $0.00 TOTAL FEE. $168.11
Revised: 04101/2015