15050033CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: CONTRACTOR: PERMIT NO: 15050033
10685 CULBERTSON DR CUPERTINO CA 95014 (375 36 033) NICE & RIGHT
OWNER'S NAME: LIAO CHIEN C AND MA CHUN
OWNER'S PHONE: (408) 861-0928
7.ICFNSED CONTRACTOR'S DECLARATION
License Class CONTRACTOR GENERAL Lic.,#821458
Contractor NICE & RIGHT CONSTRUCTION INC Date 09/30/2016
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:
r. 1 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.
z. 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
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 9.18.
Signature (� �Y Date 10/19/2016
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 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)
2. I, 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. 1 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.
z. 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.
3. 1 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 9.18:
Signature Date 10/19/2016
CONSTRUCTION INC
2285 POBOX
CUPERTINO, CA 95015
ISSUED: 09/11/2015 .
NO: None
PERMIT INFO:
BLDG —ELECT _ PLUMB
MECH _ RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
CONSTRUCT A 2 STORY SFD (1989 SQ FT); ATTACHED
GARAGE (416 SQ FT); COVERED PORCHES (504 SQ FT).
*SUNNYVALE SANITARY**
REV # 1 - CHANGE FRONT EXTERIOR - ISSUED 10/19/2016
Ft Floor Area: I Valuation: $400000.00
"N Number: Occupancy Type:
375 36 033
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: ABBY AYENDE
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: 10/19/2016
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, Sections 255005, 25533, and 25534.
Owner or authorized agent: (�
Date: 10/19/2016
CONSTRUCTION T LENDING AGENCY
I 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
CONSTRUCTICN PERMIT APPLICATION
C0I\/,MUN1 IY DEVELOPMENT DEPARTIJiENT •BUILDING DIVISIOol g 1B
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
r (408) 777-3228 • FAX (408) 777-3333 buildina(EcuDerflno.or4
CUPERTINO
❑ NE -IN CONSTRUCTION
❑ ADDITION ❑ ALTERATION i TI VISION / DEFERRED ORIGIN A- PERMIT
Eldgfpp_2011.doc revised 06/21!11
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Il ow.\ -ER ❑ owNI R.BL'LDER ❑ OW'NER AGENT ❑ CONTRACTOR ❑ CDI\7RACTORAGD\T ❑ ?ARCHITECT ❑ ENGn:"EER. ❑ DFv`HLOPEEP ❑ TD ANT
CONTRACTOR NAhS `f yq LICENSE? LIJ.BER I LICENSE TYPE
BL'S. LIC r
COA'2AI Y NAME {° (C& (CAV J (ICI.�.�I�/ I E-hWL
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I CITY, STATE, ZIP
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E-hi4IL
I FAX
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STREET ADDRESS
I CITY, STATE, ZIP
( PHONE
DESCRIPTION OF WORT: � ,r o �y
EXISTM USE PROPOSED USE CONSTR. TYPE - _ STORIES
USE TI'PE OCC. SQ.FT. (
-
VALUATION (S)
EXISTG
",FEW FLOOR
DE7\40
TOTAL
- -
AREA
AREA
AREA
I
NET AREA
-
I
BATEROOM -
KITCHEN
OTHER
-
RETQGDELAREA
REMODELAREA I
RE1,40DELAREA
PORCH?_RZA
DECICAREA
TOTALDECKTORCHAREA
GARhGEAREA: ❑DETACH
- -
❑ .ATTACH
I
MNELLIN-G UNITS:I ISA SECOND UNIT E] YES
SECOND STORY [I YES
BEIING ADDED? ❑ NO
.:ADDITION? ❑ NO
PRESPPLICATION ❑YES IF YES. PROVIDE COPY OF
IS THEBLDG:43 ❑1 S
£NE-OTALVALL:4TI0\•
PLA.\:�°1G.APPL' �]NO PLA.'\NI GAPPROVALLETTER I
EICHLERHOME? ❑'\O
--
By my signature. below, I certify to each of the following: I zrn the property owner or authorized agent t on the pro mer's behalf. I have read 's
application and the information I have provided is correct. I have read the Description of orlc and verify it is arc .` agree to comply with all applicable local
ordinances and state laws relating to a construction I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature ofSpplicantiAgentt mss- Date:(/�-�ij�
SUPPLEMENTAL INFORIl2ATION REQUIRED Q
PL4.'iCII
TIPE;>.New
S -D or 14ultifainily dvvellinggs: Apply for demolition permit forcoL�.TER
� BLn DING PL4 � RE«E1i
eXleungbuilding(s). Demolition pennit is required prior to issuance ofbuilding
permit for new building.
� E1PRE�s
� PLA�\L\GPL�` REQ IES
Commercial BIdQs: Provide a completed Hazardous ?Materials Disclosure
❑ sT1 DARD
� PLBLIC \\ ORT.S
form if any Hazardous Tv aterials are being used as pari of this project.
❑ LAPGE
FIRE DEPT
_Copy of Planning Approval Letter or Rieeting t3'iill Planning prior to
F71 Z. ALAJOR 4
S4 �40SE\� ERDI�TRTCT� k
submittal of Building Permit application.
y
EN IRO'<NIENTAL HEALTH .
Eldgfpp_2011.doc revised 06/21!11
I
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10685 CULBERTSON DR
CONTRACTOR: NICE & RIGHT PERMIT NO: 15050033
CONSTRUCTION INC
OWNER'S NAME: LIAO CHIEN C AND MA'CHUN
P O BOX 2285 DATE ISSUED: 09/11/2015
OWNER'S PHONE: 4088889638
CUPERTINO, CA 95015 PHONE NO: (408)861-0928
,.J LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
f��
License Class Lic.,# of `� �'R
CONSTRUCT A 2 STORY SFD (1989 SQ FT); ATTACHED
GARAGE (416 SQ FT); COVERED PORCHES (504 SQ FT).
**SUNNYVALE
`
Contractor A1/�7 Date ;
SANITARY**
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:
1. 1 have and will maintain a certificate of consent to self -insure for Worker's
Sq. Ft Floor Area:
Valuation: $400000
Compensation, as provided for by Section 3700 of the Labor Code, for the
APN Number: 37536033.00
Occupancy Type:
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.
PERMIT EXPIRES IF WORK IS NOT STARTED
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
correct. I agree to comply with all city and county ordinances and state laws relating
180 DAYS FRO INSPECTION.
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,
I y: Date:
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 9.18.
RE -ROOFS:
_
Signature Date _ i'
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
1. I, as owner of the property, or my employees with wages as their sole
HAZARDOUS MATERIALS DISCLOSURE
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed contractors to
I have read the hazardous materials requirements under Chapter 6.95 of the
construct the project (Sec.7044, Business& Professions Code).
California Health & Safety Code, Sections 25505, 25533, and 25534. twill maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
I hereby affirm under penalty of perjury one of the following three declarations:
Safety Code, Section 25532(a) should I store or handle hazardous material.
1. 1 have and will maintain a Certificate of Consent to self -insure for Worker's
Additionally, should I use equipment or devices which emit hazardous air
Compensation, as provided for by Section 3700 of the Labor Code, for the
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
performance of the work for which this permit is issued.
Health & Safety Code, Sections 25505, 25533, and 25534.
2. 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.
Own r or autl orized agent:
f f so!�_'. Date:
3. 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
I hereby affirm that there is a construction lending agency for the performance of work's
;become subject to the Worker's Compensation provisions of the Labor Code, I
for which this permit is issued (Sec. 3097, Civ C.)
must forthwith comply with such provisions or this permit shall be deemed
Lender's Name
revoked.
Lender's Address
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
ARCHITECT'S DECLARATION
correct. I agree to comply with all city and county ordinances and state laws relating
I understand my plans shall be used as public records.
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Licensed Professional
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 9.18.
Signature Date
CONSTRUCTION PERMIT APPLICATION NO
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 V
GUPERT[hIQ (408) 777-3228• FAX (408) 777-3333 • building(cDcupertino.ora
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PROJECT ADDRESS /' �J
APN * S /
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OWNER NAME %` % rC f ,
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PHONE
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STREET ADDRESS. P �
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CONTACT NAME r�
AJ
PHONE EMAIL _
� i O931 174 -� /6 ^J d
STREET ADDRESS /}
CITY, STATE, ZIP
FAX
OWNER OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT- ❑ ENGINEER --- M—DEVELOPER-"'13'-TENANT
CONTRACTOR NAME
LICENTSE NUMBER
LICENSE TYPE I
BUS. LIC
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEFRNAME J
log �L
LICENSE NUMBER /a ®�
BUS. LIC#
COMPANY NAME
%
E-MAILE ML
FAX
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l./C
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
oil"
EXISTING USE
`/,
PROPOSED USE CONSTRTYPE
#STORIES -
USE TYPE OCC. SQ.FT.
5",f,
5(/t
VALUATION (S)
IFnXMEXIS G
AREA /
NtW FLOOR,
AREA .F 7,1
AREA %g ��
(
-
NET AREA
BATHROOM.
KITCHEW .
OTHER.
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
. DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: El DETACH -
,v�
;;J-ATTACIi
9 DWELL GUNII ��` f{r� I-A,SECOND YES
SECOND STORY ❑YES
B NO
ADDITION? []NO,
PRE .4PPLI ATTON 'ES ff YES, PROF,'DE COPY OF -
IS THE BLDG AN -AEC - "`` ;
_ TOTAL VALUATION:
PLANNINGAPPL.� NO PLANIITINGAPPROVAL LETTER
EICHLERHOME?
- -
0 0
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on property owner's behalf. I ha e read this
application and the information I have provided is ccpTect. 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 co tion. I authorize representatives of Cupertino to enter the above-iden ' led pr perty for inspection purposes.
Signature Applicant/Agent:
of Date:��
SUPPLEMENTAL INFORMATION REQUIRED
-
=
� .��PL�oCHECK�SPEw:'�
- =3i0UTIIaGSLIP-�
New SFD or Multifamily dwellings: Apply for demolition permit for
❑
existing building(s). Demolition permit is required prior to issuance of building2-1
04ERTH1iCOI7hTER
25
BUIIDGPLANREVIEW
permit f6r new buildina.
x ss Y
X Pi A L�tv v w
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
IT SRD�
CETJBLTwo7zuc T
form if any Hazardous Materials are being used as part of this project.
yti -
COt
Planning Approval Letter Meeting Planning
opy of or with prior to
submittal of Building Permit application.
?Ux`�T
slT RD?s�RrCr�
B1d9App_2011.doc revised 06/21/11
iii
CITY OF CUPERTINO
590 FEE ESTIMATOR — WILDING DIVISION
101 ADDRESS: 10685 CULBERTSON DR
DATE: 05/06/2015
REVIEWED BY: MELISSA
APN: 375 36 033
BP#:
*VALUATION: 1$400,000
�PERN HT TYPE: Building Permit
PLAN CHECK TYPE: New Construction
PRIMARY SFD or Duplex
USE:
2nd Unit? - Yes ' No
PENTAMATION 1 R3SFDW
PERMIT TYPE:
WORK
NEW 2 STORY SFD WITH 1,164 S.F 1ST FLR 825 S.F. 504 S.F. DECK/PORCH & 416 S.F.
SCOPE
ATTACHED GARAGE (4 BEDS/3BATHS)**SUNNYVALE SANITARY**
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
11-8,111-B,IV,V-B
2,909
$3,067.05
IR3PLNCK
$3,012.15
IR3INSP
Permit Fee:
$3,012.15
Suppl. Insp. Feer Reg. 0 OT0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXR
1
# new units
$677.77
Work Without Permit? 0 Yes (E) No
$0.00
TOTALS:
2,909
$3,067.05:
`
$3,012.15
Strong Motion Fee: 1BSEISMICR
".:-Wec t Ph;,j Cl-eck P!$t1t & P.rav? ('gec'i£" r.:h<- Plan Z.. rFc4
f
Ys.ZN?rre£f.I?SFE3-1— ?tacss"is£???„Z;. Ea
le"'Ai t sj,:, 'e! a. Edi, r'1 .TP13 tas'i?:
NOTE. This estimate does not include fees due to other Departments (i.e. Planning. Public Works. Fire. Sanitary Sewer District.
District, etc.). These_ fees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'l info.
FEE ITEMS (Fee Resolution .1:1-053 .I;.7i1/1:L
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$3,067.05
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: @ Reg. 0 OT
Mhrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$3,012.15
Suppl. Insp. Feer Reg. 0 OT0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXR
1
# new units
$677.77
Work Without Permit? 0 Yes (E) No
$0.00
Advanced Planning Fee: 1PLLONGR
$407.26
Select a Non -Residential
Building or Structure
Strong Motion Fee: 1BSEISMICR
$52.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$16.00
SY7BT()TALS :
�.
$7,232.23
$0.00 TUTAL
7,232.23
Revised: 04/01/2015
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: /0 -AR's-,'
PERMIT # � _ .�
OWNER'S NAME: 6,j
PHONE # (? -�>-
GENERAL CONTRACTOR:
BUSINESS LICENSE # kZ
ADDRESS: -p, g
CITY/ZIPCODE: /
*Our municipal code requires all businesses working in the city to have -a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE. SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information:
V SUBCONTRACTOR BUSINESS NAME
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering,
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Date
LICENSE #
lfg;gg/ Contractor Sign re Date
Project Nees:
Project A.,
SIGNATURE DECLARATIONS �-.w
CHEN QLIAO
10685 CULBERT,$ON DRIVE, CUPERTINO, CA
SINGLE STORY 1,263 S.F. NEW TWO STORY 2,406.37 S.F.
CDmOlet.91 ancompleted checidist (columns I and 2) with thrz
plans and building permit application to the Building Department.
The ovitner and desi n prafesslonalres nei
owner's Signature
Owners N (Please Print)
oesign Pmtessionare Signature
TRI HONG
Signature of License ProiWalonal responsible compliance
Email, Addross for License 0'rofassional 9
� y k
MIA
10/13/2016
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