15050151-PUB10420 S DE ANZA BLVD
15050151
F/P
WU YE-MING TRUSTEE & ET AL
SCANNED BOX #598
I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10420 S DE ANZA BLVD
OWNER'S NAME: WU YE-MING TRUSTEE & ET AL
OWNER'S PHONE: 5109281808
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # 8/c S 3
Contractor Date S /4- & / / J�
I hereby a at I a icensed 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.
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
permit is issued.
APPLICANT CERTIFICATION
1 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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point s regulations per the Cupertino Municipal Code, Section
9.18.
Signature ._.----- Date_ �
❑ OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.I8.
CONTRACTOR: BELFOR PROPERTY PERMIT NO: 15050151
RESTORATION
2297 RINGWOOD AVE DATE ISSUED: 05/26/2015
SAN JOSE, CA 95133 PHONE NO: (408) 929-3473
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REPAIR 8 LF OF EXTERIOR WALL DAMAGED BY
AUTOMOBILE.
Sq. Ft Floor Area: I Valuation: $4200
APN Number: 36940038,10420 1 Occupancy Type: 1
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:,..�/�/ �}� L/-� Date: -,I'. l 5
RE -ROOFS:
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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Section 05, 25 3� 25534.
Owner or authorized agent Date:
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Signature
Date
CUPERTINO
15a501,� I
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(ftupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS
APN # 36O
✓ V _
l 4g
OWNER NAME
PHONE
E-MAIL
STREET ADDRESS
CITY STATE, ZIP
FAX
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i`i*1 -, 0 C3 S,46 / C
CONTACT NAME .
PHONE.
r-ro16. 7� 6 -361'
E-MAIL
C,
STREET ADDRESS
CITY, STATE, ZIP
FAX
ZL ,q-016
'Gw I
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ,161--CYTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAN
LICENSE NUMBER
LICENSE TYPE
BUS. LIC N
COMPANY NAME
E-MAIL
FAX
i.CtA
4,219
STREET ADDRESS
TATE, ZIP
CITY,..
PHONE
ZZ97
- C' / l
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS _..--- -"'"" '
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
'
L l
rt7-
Z 1►V1'
l T H c A r" 14 'Cr TLkiS C t VL e( t I
EXISTING USE
PROPOSED USE CONSTR. TYPE
# STORIES
USE
TYPE
OCC
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
AREA LJDETACH
rARAGE
[]ATTACH
# DWELLING UNITS.
[S A SECOND UNIT ❑ YES
SECOND STORY []YESBEING
ADDED? []NO
ADDITION? []NO
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEI Y:
TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
41 2 d 0 . ca
By my signature below, I certify to eac the fo owi g: 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 e proyid r ct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relati to bull g s ion. I authorize representatives of Cupertino to enter the above-i entitied property for inspection purposes.
Signature of Applicant/Agen . Date:
SUPPI17MI"ENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
OVER-THECOUNTER
BUILDING PLAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
INA
permit for new building.
❑ EXPRESS
PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
1] LARGE
❑ FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
❑
❑
submittal of Building Permit application.
MAJOR
SANITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
;dv
C or-*7
BldgApp 2011.doc revised 06121/11
CITY OF CUPERTINO
Fe M-7 FEE ESTIMATOR - BUILDING DIVISION
1AADDRESS:
10420 S DE ANZA BLVD
DATE: 05/26/2015
REVIEWED BY: SEAN
APN:
BP#: S �J
`VALUATION: 1$4,200
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
USE Commercial Building Tin
Civil / Religious activities
BQ zone? Yes Q No
PENTAMATION
PERMIT TYPE: 1 GENCOM
WORK
REPAIR 8 LF OF EXTERIOR WALL DAMAGED BY AUTOMOBILE.
SCOPE
Ill.
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the preliminary information available and are only an estimate Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E : 711/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? () Yes Q No
$0.00
1 hours Plan Check, Hourly
$143.00 ISTPLNCK
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? ® Yes Q No
$0.00
Suppl. Insp. Fee-0 Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXC
$0.00
E)
Work Without Permit? ® Yes E) No
$0.00
Advanced Planning Fee:
$0.00
hours Inspections
$286.00 ISTINSP Inspection, Hourly
0
o
"<
Strong Motion Fee: IBSEISMICO
$1.18
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.18
$429.00
TOTAL FEE:
$431.18
Revised: 05/07/2015