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15050124 CITE'OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20298 CLAY ST CONTRACTOR:NT GENERAL PERMIT NO: 15050124 CONSTRUCTION CO OWNER'S NAME: QIAN JUN AND ZHOU HAN ET AL 1351 NORMAN DR DATE ISSUED:05/20/2015 OWNER'S PHONE: 9176792773 SUNYVALE,CA 94087 PHONE NO:(408)623-2297 W JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL LICENSED CONTRACTOR'S DECLARATION REMODEL(E)90 S.F.KITCHEN,REMODEL(E)MASTER& License Class xa Lie,# 41,V5�1�� HALL BATHS(132 S.F.)&INSTALL 13(N)LIGHT FIXTURES Contractor�i3 » �.Trr. ! Dates 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:$18000 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 APN Number:36939019 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 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 AYS FROM LAS INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments costs,and expenses which may accrue against said City in consequence ofi�,Iv Issue:7y. Date: granting of this permit. Additionally,the applicant understands and w' with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. _?�/r RE-ROOFS: Signature ! Date d=-M-7All 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. 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, 5533 and 225534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: x53 Date: aC � 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(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 918. Signature Date CONSTRUCTION PERMIT APPLICATION 10 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building CcDcupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PE/Rmrr# PROJECT ADDRESS / �� APN# -36 11— 3 9 - - OWNERNAME 1 yL'� f n� ,^ PHONY/ „ -71-i77 E-MAIL STREET ADDRESS "—+ / CITY, STATE,ZIP (,j / FAX CONTACT NAME All PHONE /,y � _. r] E-MAILAIIWI 2(f(I�P!92_14A,101401 STREETADDRESS /->C/ g r��` � �� CITY,STATE,ZIPv ��/ FAX 11OWNER 11OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER 7�/q LICENSE TYPE BUS.LIC# LA I COMPANY NAME 7 E-MAIL C� FAX STREET ADDRESS CITY,STATE,ZIP PHONE /� z/L71 ARCHITECTIENGINEER NAME ^ / LICENSE NUMBER BUS.LIC# f� COMPANY NAME 1 v E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK EXISTINGUSE PROPOM USE CONSTR TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHENOTHER REMODEL AREA °= `, REMODEL AREAi, = REMODEL AREA " . PORFIC LREWNW I"DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH Q ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECONDSTORY []YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION OYES W YES,PROVIDE COPY OF IS THE BLDG AN O IES RECEIVE TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LEITER EICHLER HOME? ❑NO / Q Oc) By my signature below,I certify to each of the following: I am the property owner or authorized agen to ac 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 traction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: J SUPPLEMENTAI' ORMATION REQUIRED 'PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for VER-TH)iCOUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW. _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 1-1STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑,LARGE El FIRE DEPT _Copy of Plarming Approval Letter Or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp :261Ldoc revisedQ612flll CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION W-PERMIT DDRESS: 20298 CLAY ST DATE: 05/20/2015 REVIEWED BY: MELISSA PN: 369 39 019 BP#: *VALUATION: $18,000 PE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: PERMIT TYPE: WORK REMODEL E 90 S.F. KITCHEN REMODEL Q MASTER & HALL BATHS 132 S.F. & INSTALL 13 SCOPE (N) LIGHT FIXTURES Mech. Plan Check Plumb. Plan Check Elec.Plan Check 0.0 hrs $0.00 ;Llech. Permit Fee: Plumb.Permit Fee: Elec.Permit Fee: IEPERMIT Other 111ech.Insp. Other Plumb Insp_ Li Other Elec.Insp. Eflhrs $48.00 .11ech.Insp.Fee: Phuub. Insp. lee: 1s'tec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(La Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Theseees 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 ff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel,Kitchen(<=300 sf) Suppl.PC Fee: E) Reg. 0 OT T 0.0 hrs $0.00 $645.00 IREMRESUT PME Plan Check: $0.00 1 132 1 s.f. Remodel,Bath(<=300 sf) Permit Fee: $0.00 $645.00 1/REMRESBAT Suppl. Insp.Fee:Q Reg. Q OT 1 0.0 1 hrs $0.00 L13 J Electrical PME Unit Fee: $0.00 $72.00 IBREMFIXT Fixtures,Lighting PME Permit Fee: $48.00 Construction Tax: F_ I Administrative Fee: IADMIN $45.00 0 Work Without Permit? 0 Yes (2) No $0.00 E) Advanced Plannin&Fee: . $0.00 Select a Non-Residential G Travel Documentation Fee: 1TR4VDOC $48.00 Building or Structure A Strong Motion Fee: IBSEISMICR $2.34 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS:') $144.34 $1,362.00 TOTALFE :° $1,506.34 Revised: 05/07/2015 COMMUNITY DEVELOPMENT DEPARTMENT ^� BUILDING i-�!VtSl;�nl _ CUPERTINO APPROVED This set offans a"c! P Declfications MUST be kept at the Dobsite during cort,.,ct;on Itis unlawful to make any `� S changes or a:;--rations on same, or to deviate ch o therefrom, wIthoLt approval from the Building Official, The Stamping of ih.s pla _? ,, cif,„a.,ons SHALL NOT be held to pe or to be a pproval of the violation of an visions of a ance or Stale Law. —\-k4 � � DATF P MIT# P�' 1 1 ` N W ,s =- Ci- UJ U 4 cr� Cv V o � Ia w I f & V\ al Of - an � l O LL LL