14050103 (6) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21918 LOMITA AVE CONTRACTOR:JUNJIE ZHENG PERMIT NO: 14050103
OWNER'S NAME: JUNJIE ZHENG 161 MUIR AVE DATE ISSUED:08/29/2014
OWNER'S PHONE: 4089167988 SANTA CLARA,CA 95051 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
CONSTRUCT 2 STORY SFDWL LIVING SPACE 3426,
License Class Lic.4 ATTACHED GARAGE 448 AND PORCH 458 SQ FT
REV#1 -REVISE SIZE OF WINDOWS(5 TOTAL,NON-
Contractor Date STRUCTURAL)—ISSUED 1/2/15
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:$659000
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:35715002.00 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 WITII N 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 DAYS F T 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 � S
granting of this permit. Additionally,the applicant understands and will comply Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
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
vvv 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: ^Z�Z c7/'
permit is issued.
I certify that in the performance of the work for which this pennit 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
9 18. J I
Signature Date
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 1?
+CUPEtiTtNO
(408)777-3228• FAX(408)777-3333• build ing(a)cugertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TIREVISION DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS 1q
OWNER NAME / ,� PHONE E-MAIL• tj
r l
STREET ADDRESS CITY, STATE,ZIP FAX
AJ 110.3 A
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
OWNER OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
HI CT/ENGINEER NAME LICENSE NUMBER _ BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE ,r
Z Z- ) JC> `f�-i-1 yf�
DESCRIPTION OF WORK 1 I ti19
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
l� ?—j 2 USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG / NEW FLOOR D/EMOPOTM'HER
TOTAL / 7
AREA /��}' AREA ?C� �'- AREA d 7. NET AREA ? �/ i`I'.1,G� 3 12t �`7G� c/zlb
BATHROOM / KITCHEN' !i ) i !� v _ LLL��/
REMODEL AREA; REMODEL AREA ELAREA t:
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑DETACH -
�- _� p TTACH
#DWELLING UNITS: I IS A SECOND UNIT IJ YES SECOND STORY ❑YES
BEING ADDED? Ej..NO ADDITION? ❑NO
PRE-APPLICATIO I'�ES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES a RECENED BY ; � ,��' TOTAL VALUATION:
PLANNING APPL# FNO PLANNING APPROVAL LETTER EICHLERHOME? ❑NO
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 construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED "3
Q ROUTING
New SFD or Multifamily dwellings: Apply for demolition permit for ❑ ovER zxE COUNTER l � BUa D1I;G PLAN3REVIEw
existing building(s). Demolition permit is required prior to issuance of buildingv'
S
permit for new building. f E YPRE3
� �� Q PLANN NGPLA
IgREInEWr Y y,
M �� k�`2
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDATtDy` rusLlc��4RKs
form if any Hazardous Materials are being used as part of this project. fr � t
®a L�AGE ri w FIR£DEPTH P
_Copy of Planning Approval Letter or Meeting with Planning prior to ��s 4-
v
A *
submittal of Building Permit application. I,7A5oxk sAi\rrARX SEtSERDISTRIcT
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BldgApp 2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21918 LOMITA AVE DATE: 01/02/2015 REVIEWED BY: MELISSA
APN: 375 08 021 BP#: 14050103 "VALUATION: Iso
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: PERMIT TYPE:
WORK REV# 1 - REVISE SIZE OF WINDOWS 5 TOTAL NON - STRUCTURAL - ISSUED 1/2/15
SCOPE
'i�"vh 11!2'1-.Chi?%:L Pi`uinb.Alan
:F:. I.tr.'f'?i:.�/.E.<,. �=tif':3. }:'t'?Rii
Other 1=ItiTi?iD,I,r.v', (.�ii74f' ;tc'c' nm"
Lj
:< S
Fec : Eef:..rtr'S'P.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 fees are based on the prelinzina information available and are onLy an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053.E . 711113) FEE QTY/Ff MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 hours Plan Check,Hourly
Suppl.PC Fee: (j) Reg. Q OT 0.0 hrs $0.00 $143.00 ISTPLNCK
�:] A
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee:Q Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
. _7_1
(i7:sl)'7?f'tloi?t .a-i,-
r C7it 71t:S' r'tjt:if' `(,'e: 0
Work Without Permit? 0 Yes •, No $0.00 G)
Advanced Planning Fee. $0.00 Select a Non-Residential
t Building or Structure 0
Strom Motion Fee: $0.00 # Revisions
Bldg Stds Commission Fee_ $0.00 $0.00 1REVSFDYT'L SFDWL
f ST7BOTALS $0.00 $143.00 FTOTAL FEE 3 $143.00
Revised: 10/01/2014