B-2016-1429 PERMIT, APP, FEE ESTCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10576 MERRIMAN RD CUPERTINO, CA 95014-3922 (342 16 124)
OWNER'S NAME: LIN TZYY-SHENG AND KATTY TRUSTEE
OWNER'S PHONE: 4083983765
LICENSED CONTRACTOR'S DECLARATION
License Class B Lic. #1123L
Contractor ( TALENT DECIDE INC 1 Date 2/25 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 fill[ 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
Compensation, as provided For by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
f 2. 1 have and will maintain Worker's Compensation Insurance, as provided for
A by Section 3700 of the Labor Code, for the performance of the win k for which
this permit is issued.
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.
Signatures !jf/ri��% Date 2/25/2016
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. 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)
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:
1. I have and will maintain a Certificate of Consent to self-insuav for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of tine work for which this permit is issued,
2. 1 have and will maintain Worker's Compensation Insuance, as provided for
by Section 3700 of the Labor Code, for the performance of the work for which
this permit is issued.
s. 1 certify that in the performance of the work for which this permit is issued, t
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 properly 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.
CONTRACTOR: PERMIT NO: B-2016-1429
( TALENT DECIDE INC)
LOS GATOS, CA 95030
DATE ISSUED: 02/25/2016
PHONE NO: 4083063968
BUILDING PERMIT INFO:
X BLDG —ELECT —PLUMB
_ MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
REMODEL 2ND FLOOR MASTER BATHROOM (100 S.F.)
Sq. Ft Floor Area: Valuation;$15000.00
APN Number: Occupancy Type:
342 16 124
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST �AJ�L�L�E�D� INSPECTION.
Issued by: PAUL O'SULLIVAN
Date: 2/25/2016
RE -ROOFS:
All roofs shall be inspected prior to any rooting 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: 2/25/2016
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 tine
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 25505, 25533, and 25534.
)wner or authorized agent: GOON
)ate: 2/25/2016 /
CONSTRUCTION LENDING AGENCY
hereby affirm that there is a construction lending agency for the performance
rf work's for which this permit is issued (Sec. 3097, Civ C.)
.ender's Name
ARCIIITECT'S DECLARATION
understand my plans shall be used as public records.
Date 2/25/2016
CUPERTINO
CONSTRUCTION PERMIT APPLICATION 59%, —[. 96q .
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 El
(408) 777-3228 • FAX (408) 777-3333 • building gC.cupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT 9
PROJECT ADDRESS ZD ,7/ [/,4 ff,W • p�'
6 f�Yy /�
APNp
OWNERNAME PHO14E
STREET ADDRESS
CITY, STATE, ZIP
FAX
CONTACT NAME
yC!„yp.
PHONE
•
.;e �" O
i�
STREET ADDRE:j,,,P wI''t
CITY, STATE, ZIP 44 o
FAX
❑ OWNER ❑ OWNERnUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME yy��
LICEN�B�M1M
LICENSE TYPE
BUS. LICp�
l/H
mod'
COMPANYNAME
,�CtPC� /NG
E-MAIL
FAX
STREET ADDRESS
.�8 !L,4wew ,q�&
CITY, STATE ZIP
Zo rr C4 lb
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC S
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
EXISTING USE
PROPOSEDUS9
CONS1'R TYPE
R STORIES
USE
TYPE
OCC,
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM KITCHEN OTHER
REMODE AREA 'i- REMODELAREA REMODELAREA
O
PORCA AREA DECK AREA
TOTAL DECK/PORCH AAEA
GARAGE AREA: DETACH
❑ ATTACH
NDWELLMGUNITS:
IS .ASECONDUNIT ❑YES
SECONDSTORY ❑YES
BEING ADDED? ENO
ADDITION? ENO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
1S THE BLDG AN ❑YES
IVED. BY. -
TOTALVALUATION:
PLANNMOAPPLN ENO PLANNING APPROVAL LETTER
EICHLER Domino ENO
- Lo
/�aOOIO
By my signature below, I certify to each of the following; I am the property owner or authoried agent to act on the properly 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.
ov
Signature of Applicant/Agenh 'vI" % Date:
SUPPLEMENTAL INP RMATION REQUIRED
PLAN exECR'rY¢E _ '.
- _ RonTINc stih-- =-
.
_ New SED Or Multifamily dwellings: Apply f01' delllOhd031 pe11111t fOr
OVER -THE CODNTER
BUILDING PLAN REV IEW ,
existing building(s). Demolition permit is required prior to issuance-
permitforneWbuilding.
❑ ENPRESs
PLaVNiNG PLANREVIEW'=
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
. ❑ STANDARD -
~❑ PUBLIC)VORKS
_
folln if any Hazardous Materials are being used as part o£this project.
❑ LARGE _ '_
❑ FINE DEPT _-
_ Copy OfPlanning Approval Letter Or Meeting with Planning prior t0
,.
❑
❑
submittal of Building Permit application.
nO4SOR
� BA\IT4RY SEP EA DISTRICT,
ICTIRONMENTAL HEALTH'
B1doApp_2011.doc revised 06121111
CITY OF CUPERTINO fan" �f �
M ,,� , FEE ESTIMATOR - BUILDING DIVISION
JAEADDRESS:
10576 MERRIMAN RD
DATE: 02/2512016
REVIEWED BY: PAUL
APN: 342 16 124
BP#:
*VALUATIONr
1$15,000
*PERMITTYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
WORK
REMODEL 2ND FLOOR MASTER BATHROOM 100 S.F.
SCOPE
r hw f : ck
P .. 1'10re !1,-Ck
t;t i , : Lecf
i'trh."'%'I've_
t mn. Pel7rrte F'ae:
G gels .`ee
c1t5�r, rPkth. fmq/3
tii%k-r r"(una/; la;,vn.
i?o""' f ief. /ftap.ET
'l-:ch.. Imp pee_"
1 fa, d' hl'pl tt'x'-
isk t Inv", 1"eP:
NOTE: This estimate floes not include fees tlite to other Departments (i.e. Planning, Public Works, Fire, Sanitary Seaver District, School
District, etc.. These fees are based on the ;relinvinar in orination available and are onjV an estimate. Contact the Dept for addu'1 info.
FEE ITEMS (Fee Resolution 11-053I f 711/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Fl-00-1 s.f.
$645.00
Remodel, Bath (<=300 so
IRFMRESBAT
i
Suppl. PC Fee: 0 Reg. C) OT
O.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:(D Reg. Q OT
O.Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
t trlirL'XtC'=°; f3+"i tta:Y:
,1U'rPZiFrliPcifGtY �'..e.'zt:
0
G
Work Without Permit? C) Yes (D No
$0.00
Advanced Plannine Fee:
$0.00
Select a Non -Residential 8
Building or Structure Q
i
/'rat I.},z rrra<rt1 ".3 t .I
Strong MotionLee. IBSEISMICR
$1.95
Select an Administrative
Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SIIBTOTALS: ',
$2.95
$645.001
i
TOTAL Fr
E: $647.95
Revis 01/01/2016