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15080135�r CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20590 SHADY OAK LN CONTRACTOR: IMPERIAL PERMIT NO: 15080135 CONSTRUCTION OWNER'S NAME: CHONG FAY JR AND EDIE S 2412 HOMEWOOD DR DATE ISSUED: 08/18/2015 OWNER'S PHONE: 4084460509 SAN JOSE, CA 95128 PHONE NO: (408) 242 -6371 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ REMODEL (2) UPSTAIRS BATHROOMS (82 S.F.), REMODEL (/ License Class_ Lic. # 7.3 ?l KITCHEN (80 S.F.) AND INSTALL 12 RECESSED LIGHTS �����++ Contractor, /A, f e,(I A ( (-,) ' h &-c Date / � 44 C 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 Sq. Ft Floor Area: Valuation: $15000 performance of the work for which this permit is issued. 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: 32344037.00 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 D YS 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 c ��(,� ✓ 1� p( /� ✓. Issued by: Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section RE- ROOFS: 9.18. Signature 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) 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. 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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: 1 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 9.18. Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION 10090135 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building(a1cugertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS APN # � L o S O 0 K Di OWNERNAME /� PHONE o /, i `� E MrAIL r () 01()� I 'l ()1 STREET ADDRESS / CITY, STATE, ZIP a c FAX CONTACT NAME PHONE !!t E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER - BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBE LICENSE TYPE BUS. LIC #� {!�/ -57 1, (fi( COMPANY NAME P L R c v E -MAIL 01(W1 �l. C,M FAX _ - - STREET ADDRESS CrrY,STAT Z,IP�d C� r PHONE �1 pC"t(� I'// d /Z �,/ ✓ w� ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK � 1J J` (ZC /' (- )L,. o `t c s FT c� �`1���N i � c C 0 - — EXISTING USE PROPOSED USE CONSTR TYPE # STORIES I USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA I, Li `DECK`AREA REMODEL AREA K0 REMODEL AREA PORCH AREA TOTAL DECK/PORCH ARE GARAGE AREA: DETACH ❑ ATTACH I # DWELLING UNITS: 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 -. ED`B'= ` TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO ;" _.. a _ By my signature below, I certify to each of the following: I am the property owner or authorizell 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 buildin tion. I authorize representatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant/Agent: Date: b "-G /J SUPPLEMENTAL INF REQUIRED^ ROVTUVCSIP , x. ��a,FS "" OVER THE COUNTER ❑ UII DING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building i permit for new building. Expiss Y Zr ❑�rLArINIxc rLAN REVIEW TUBLIC _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. ❑ STAND € �� � L� WORKS ` i " _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. CIa BARGES' MAJOR a c +a � FTRbEPT �f © frrAIiXSEWERDISTRICT - ?� %R� NVH20 NIVIENTALHEALTA, BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO (5090135, FEE ESTIMATOR — BUILDING DIVISION Mech..Plun Check i'lec,h. Permit fee: Other tech. ,hasp. Phimb. Plan Cheek Plumb. Permit I ee_ Other Plurnb Insp. Ahl ch. Insp. Fee: I Plumb. Insp. Fee_ NOTE. This estimate does not include fees due to other Departments (Le. Elec. Plan Check 10. 0 1 hrs $0.00 Elec. Permit Fee: IEPERMIT Other Elec. Insp. 1 0.0 1 hrs 1 $48.00 IElec. [rash. Fee Public Works, Fire, Sanitary Sewer District, School Dictriet. etc). These fees are hated an the nrelindnary infarmadan availahle and are nnly an estimate_ Contact the Dent fnr addn'1 info_ FEE ITEMS (Fee Resolution 11 -053 E f 711113,) ADDRESS: 20590 Shady Oak Ln. DATE: 08118/2015 REVIEWED BY: Paul APN: 323 44 037 BP#: "VALUATION: 1$15,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY USE: SFD or Duplex Suppl. PC Fee: (E) Reg. 0 OT PENTAMATION PERMIT TYPE: 1 R3SFDRE WORK Remodel 2 Upstairs Bathrooms 82 S.F. Remodel Kitchen 80 S.F. and Install 12 Recessed Lights SCOPE Mech..Plun Check i'lec,h. Permit fee: Other tech. ,hasp. Phimb. Plan Cheek Plumb. Permit I ee_ Other Plurnb Insp. Ahl ch. Insp. Fee: I Plumb. Insp. Fee_ NOTE. This estimate does not include fees due to other Departments (Le. Elec. Plan Check 10. 0 1 hrs $0.00 Elec. Permit Fee: IEPERMIT Other Elec. Insp. 1 0.0 1 hrs 1 $48.00 IElec. [rash. Fee Public Works, Fire, Sanitary Sewer District, School Dictriet. etc). These fees are hated an the nrelindnary infarmadan availahle and are nnly an estimate_ Contact the Dent fnr addn'1 info_ FEE ITEMS (Fee Resolution 11 -053 E f 711113,) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F 82--1 s.f $645':.00 Remodel, Bath (< =300 sf) IREMRESBAT / Suppl. PC Fee: (E) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 F 80 s.f $645!;00 Remodel, Kitchen (< =300 sf) 1REMRESKIT Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT FOO his $0.00 12 Electrical $72,.00 1BREMFIXT Fixtures, Lighting PME Unit Fee: $0.00 PME Permit Fee: $48.00 Construcicon Tax., Administrative Fee: IADMIN $45.00 Work Without Permit? ® Yes e) No $0.00 Advanced Planning Fee. $0.00 Select a Non - Residential Building or Structure i Travel Documentation Fee: ITRAVDOC $48.00 Stronfz Motion Fee: IBSEISMICR $1.95 / Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 1n $143.95 $1, 362:00ar ... T TAL FEE: $1,505.95 Revised: 07/02/2015 FAr cNbNC s2 Z� 0 P1 A T Rt-J 0 f IL )JI, OFFICE C6 -PY Ib6 (��r�1N6 � o YT- J------- L ------------- -- CUPERTINO Building Departmen AUG 18 2015' REVIEWED FOR CODE COMP Reviewed 11y: COMMUNITY DEVELOPMEN DEPARTMENT BUILDING DIVISION - C JPERTINO LLv 0( APPROVE: This set of plans and specification s MUST be kept at the job site during construction. It is unlawful to make any changes or alterations ory sai ne, or to deviate therofrom, without approval fro rr the Building Official. The stamping of this plan and spe ificatio SHALL NOT of this plan and spe ificatio SHALL NOT be hold to per or to bean ap r t violation permit ov 10 Cl 0 s of L of a I f Cl Or nance or a Law. ryi�r? vis ons o an City BY — DATE uc� IVED - PERMIT NO: 1� .17 6 his zof %� = l Fl- n c�1Of< Z,oS�o ZN D ROO L 41D, 111 -vile i W dpow U� W -Am w G 1; CPO N6 SNAnY -�2 OAK -(lj j° t sr I�� o rc, t pp�5-8D PAN Sc P�p �N Pe -L f L rut- mss -I 8 014 �vf� . Ktt T cQp /,j ri I 3 c ooan . Y WLO04DV-J 3 S-L L, M6 Lug 3y s Zos�o S�IAav o �N ZN D FLoo2 P �J��t f�D�f*- J T I, 4D G� 11 1 v'l ►.paw u, w� w G ■9