15110043ve
so
qNsp
CITY OF CUPERTINO BUILDING PERMIT
DING-ADDRE §"I-'i4kRIC HWOODCT,
CONTRACTOR-
PERMIT NO: 15110043
Vukw coviSAYU CA,
i
OWNER:s„.I;IIvI,i'ONG AND ESTBER TRUSTEE & ET AL
DATE ISSUED: 11/06/2015
OWNER'S fH -.,,65057513
PHONE NO:
-LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL
License Cass
(N) footing at removed fireplace foundation. Infill at removed fireplace chimney.
Ity 15
Contract
I hef`ebyaffirm tJ of Chapter 9
-h am:Iicensed under,the provisions
(commen"c"in 'ith 8eictildw-70,66). of Division 3 of the Business & Professions
Codean( - , ie&nseiis -in full force -and effect
I it at '
I hereby ;affirm under penaltyb( perjury one of the following two declarations:
I have and will: a:oerfificate of consent to self -insure for Worker's
Compensation as provider Y,Stdtill of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $5000
erformance ofthe'�"work T&;, which this'peimit is issued.
ave atidw"Ill'i;` "ta-'*';.W r�k'erlls'Compeiisation Insurance, as provided for by
Cer
C_A��
- eli` labdit - .
c for the performance of the work for which
5,100 6f
:Fion, ch this
APN Number: 37501011.00
Occupancy Type:
p s issue
CERTIFICATION
cert that I hiielread -,this' aliplication and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
c orrc la gre . oiy,�ith all city and county ordinances and state laws relating
f "e4o";com
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
tobiillditik'.6ors"66n,'and h6jeby authorize representatives of this city to enter
upon;&Zov'e�' enii6hedp'r9P'erty1or inspection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION.
indemriif 'arid i�eplg
Y, lcss'�&.-City,of Cupertino against liabilities, judgments,
costs;' and expen'ses,�hichniiy. accrue against said City inconsequence of the
I '.
ILI
.L
granting'of this j��imie-;�kdditi6nally',the applicant understands and will comply
Issued by: ()W^ Date:
with all non-pb'int,sourceregulations per the Cupertino Municipal Code, Section
9. lgik:
Date D
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.
DECLARATION
I herebyifi,that? am,Aempt from the Contractor's License Law for one of
Signature of Applicant: Date:
the following two reasons."11
ALL ROOF COVERINGS TO BE CLASS "A” OR BETTER
I, as:6wner of th6 pfboortyi,?r,my:employees with wages as their sole compensation,
will do the. work l'and 1fie'§tru tur'e"isnot intended or offered for sale (Sec.7044,
Business .&'Pr'o�ie'�.'s'ions 'Code)„,,',
e! contracting with licensed contractors to
e . ;bfl property
HAZARDOUS MATERIALS DISCLOSURE
constrict1he"proj-6 (S "'7044 B'dsiness'&Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
lbeteby'penalt 'o fperjury one of the following three
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
Cupertino Municipal Code, Chapter 9.12 the
afriiiii",,under ,y ,
maintain compliance with the and
-'''1I ''I
decl aratbD9lIl1,I$'n'Consent to -insure for Worker's
I hav'atid,wiiiii�ait�in.i:C�'itific�te
Health & Safety Code, Section 25532(a) should I store or handle hazardous
hazardous
of self
material. Additionally, should I use equipment or devices which emit
Compensation,18 pf4i ed f6f,by Section 3700 of the Labor Code, for the
.
air contaminants as defined by the Bay Area Air Quality Management District I
.., .'il ;-,!, .I I
performance of the,WdrkT6r1which this 'permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
1,
1 have''and will fiiaiqffin-�Woriker'sl C0m''Peiisation. Insurance, as provided for by
1 ' ' 71 !,;1,; Code Workers , , ,
the Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700,o Code, f6t the performance of the work for which this
Owner authorizedDate: 4115
permit is issuem,i- III rl 1
I that th the for this is issued, I
fill
or
u► pe o4rihriceof work which permit shall
.11 .,y
not employiany, person in anymanner, so as to become subject to the Worker's
rJi'[ .'., ” ,
Corhp'ensAtiorilAWs,of:C if00-ia;',-Iff, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
becomesuijecito theWorkers -Corrip6riskion 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, r' 4 i§' ' pJicatibn, and state that the above information is
correct: I a e 1: 1 all city and county ordinances and state laws relating
ei
to building cong 61 erlbby authorize representatives of this city to enter
2ii
'e 6ple4y.fior inspection purposes. (We) agree to save
upppi e. o mentioned
1-e'_"'-
i i I e.' l it ItheI"' I` f Cupertino against liabilities, judgments,
inde"mn" letsCyo Cup
ARCHITECT'S DECLARATION
'' 1, .. T '. 1 �
costs, and expen§� 4id�� ftiay�'&c accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting bf,��s;pbrmit.,' iti6nall the applicant understands and will comply
with all, rion-pointi u ations per the Cupertino Municipal Code, Section
Licensed Professional
Signature 4'l, I Date
L -
I
U"i
CUPERTINO
CONSTRUCT ION PERMIT APPLICATION
COWIWNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building a.cuuertino.org
❑ NEW CONSTRUCTION ❑ ADDITION . ❑ ALTERATION/T1 ❑ REVISION / DEFERRED ORIGIN?A - PERMIT
PROJECT ADDRESS i I
APNLl f1 1 Pn
OWNER NAIYM L 6 J" \ PQ `,` J a -1 I
P"'Iso
r 5 75 -
5-13W
t.l✓ All
STREET A.DDRESS1LSg5 PR� I Jgl a 1
//����
CrfY, STAT+ ZI
I
FAX
CONTACT NA IF
PHONE
EE�
E-MAIL
STREET ADDRESS
CITY, STATE, ZIY
FAX
OWNER ❑. OWNER -BUILDER ❑ OWNER AC-Wr VCONTRACTOR ❑ CONTRACTOR AGM,7 ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TEXAN -r
CONTRACTORNAM ,r. c LICnTSENU'SER
L�
V 1
I LICENSE TYPE
I BUS. LIC R
601�gA1v-YNA1,Ii, 0 k® vu 09I
E-MAIL
1 g
FAX
STREET ADDRESS ��Z I fL CT
CITY, STATE, ZIP
q a _
`
I PHONE,
ARCHITECT/ENGINEFR NAME
LICENSE NUNSER
BUS, LIC
COMPANY NAME
E-MAIL
FAX
STREET ADDP.ESS
CITY, STATE, ZIP
I PHONE
DESCRIPTION OF WORK
FISTING USE PROPOSED USE CONSTR TYPE I STORIES
USE
TYPE OCC.
SQ.FT.
VALUATION (S)
FXTcTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
F rfCHEN O ISR
REMODEL AREA
EMIODEL AREA REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AS, -A
GARAGE AREA: DETACH
❑ ATTACH
n DWELLINGU?.TrrS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑YES
BEING ADDED? ONO
ADDITION? [3 No
PRE -A -°PLICATION ❑ l ES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
LC I� ED =
TOTAL VALUATION:
PLANWMG APPL R ❑ NO PLANNING APPROVAL LETTER
EICHLER HONIE? ❑ NO
By my signature below, I certify to each of the following: I am the property o',Nmer or authorized agent to act on the pr pe owmer'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 accurzte. grey to comply v'ith all applicable local
ordinances and state lays relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
S i Mature of Appl icant/Agent:
Date:
SUPPLEMiENTAL INrFORMATION REQUIRED
❑ oR TicoL�rER
$ZIIIDLnGrr �la�v r
r?eW SFD or Multifamily d,,vellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
l _
permit for new building.I�
Ex�r�sS Y i
PI a'.3,L�GPL4,, t�M
��
1� �T-LT�ARD� 4
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
PLEIacoRxs 4 �-
form if any Hazardous h4aterials are being used as part of this project.
S
_ Copy of Planning Approval Letter or lvieetir-g with Planning prior to
r
f f t
submittal of Building Permit application.
A24JOR 1
SARTTARYSEFi�R�ISTRICTs a .
B1a'gflpp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
0rh"T
i'1:a,
Fee:
1'.'.1'ec. Plan (..71eck I I
E'lec, per"nit I'c'e:
O'd-ler Elec. ins' D.
NOTE. Th&estimaie 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 preliMinarV information available and are only an estimate. Contact the Dept for addh 7 info.
FEE: ITEMS. (Fee Resolution 11-053 Eff. 7///U3
ADDRESS: 19460 Richwood Ct
DATE: 11/06/2015
REVIEWED BY: Phuong
APN:. 375-01-011
BP#:
*VALUATION: 1$5,000
*PERMIT7YPE:. Building Permit
PLAN CHECK TYPE: Alteration Repair
PRIMARY
. , SFD. or Duplex
USE.:
PENTAMATION
PERMIT TYPE:
wokK
(N) footing at removed fireplace foundation. Infill at removed fireplace chimney.
SCOPE
0rh"T
i'1:a,
Fee:
1'.'.1'ec. Plan (..71eck I I
E'lec, per"nit I'c'e:
O'd-ler Elec. ins' D.
NOTE. Th&estimaie 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 preliMinarV information available and are only an estimate. Contact the Dept for addh 7 info.
FEE: ITEMS. (Fee Resolution 11-053 Eff. 7///U3
FEE
QTY/FEE
MISC ITEMS
.7,
Plan Check Fee:
$0.00
Select a Misc Bldg/Structure
or Element of a Building
Supp P' ''
,Fee: (D Reg. 0 OT
hrs
$0.00
PME!Plah Check:
$0.00
Permit Fee:,: Hourly Only? 0 Yes (D No
$0.00
Suppl. Insp. Fee:Reg. 0 OT
Q p
hrs
$0.00
PM[E:1UnitTe6!'.
$0.00
PME ;P 6r'mii Fee:
$0.00
T
(D
Work Without Permit? 0 Yes (D No
$0.00
Advanced I Piannjri Fee:
$0.00
Select a Non -Residential
Building or Structure
G
0
lqm . q= , w . on /',6f 5:
Stronj'Z N,46tiol'n Fee'-,'. IBSEISMICR
$0.65
= hrs
$286.00
Inspections
ismsp Inspection, Hourly
8ldg;!St.dsCommission Fee: IBCBSC
$1.00
LSi..
$1.651
$28 6.00
TOTALFEE'l
$287.65
rxtzvlJuu. 1U/Uj14L)1ZJ
•
CCootA d*%
COMMUNITDIELOPMENT DE M i1fMa
B "LDING Divi6iuiv CuPERTINO AM
G.specifications MUST be kept at th
job silo during construction. It is unlawful to make any
chapg,js or alterations on same, or to deviate
therefrom, without approval from the Building Official.
The stamping of this plan and specifications SHALL NOT
IDS held to permit or to be an approval of the violation
of any provisions of any City Ordinance or State Law.
BY
DATE 6 .
PERMIT NO. A Li
0,
NOV 06 2015
BY
CUPERTINO
FI Building Department
OFCE
Cop
NOV 0 6 2015
REVIEWED FOR CODE COMPLIANCE
Reviewed By: w4a-,-
I'ZSUTTY
Joseph Zsutty, PE
408.313.5363
jzsutty@aol.com
C2).. r,)Cvs
Job Name: Q I C Usti � �- _ Date: J J#S :2Gt
Client Name: Drawn by: L
Job address: Page
Phone: Email:
CUPERTINO t
tit s.e
Bui6ng Departmen
V 0 6 2015
REVIEWED FOR CODE COMPLIANC
sw P7
J
CQ t jC, IR i DGS
pC§�r�(D r-4 dDousvr2---L- Vii --f .
p`�,: cow, pre'a--i DA91 i 0j,6