07120102 - PUBa�51
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Permit IntofmatiOn
Permit Number
07120102
Status'
C - Closed v I
Master Number
Notes 0,
Project
Apply Date.
12/13/2007
Operator SylviaM_
Permit Issue Date
02/28/2008 ]
Operator patg
Certificate Issued
E
Operator
Certificate Type
Certificate Number
Permit " Property Zoning Applicant Contractor x Defined Fields
I
Permit Details - -- --
Permit Type' 1R3SFDW [Q�i
SINGLE FAMILY DWELLING
Usage Class' II-V N CYi
II, III, IV, V - N DDNT USE
19,
Applied Value "
SQUARE FT.
Calculated Value
OWN
US C-404 Type
101
NEW: SFD, DETACHED
Permit Form'
iAUTOPERM -PERMIT
Ownership
1 Private v
Project Size
Permit issued 02128/2008
Enter the purpose or any special conditions for this permit
Location Information
Address' 10651 MERRIMAN RD
City/State/Zip CUPERTINO CA 195014
APN
:34216031.00 {
U nit
0,;•!r-1er Entity Inforriiation
Owner Name']
JENNIE LEE -i
Use Default
Address
Home -18941 BARNHART AVE
City/State/—Zip CUPERTINO CA 95014
V
Purpose/Special Conditions
REV -TRUSS CALCS ORIGINAL PERMIT 07030227
FILMED- 2011
Add Default Text
7
OK
Back
lam, Contractors
l Fees
PlanReviewsl
Inspections
Print Permit
Adjustments J
IN Holds
1@0 Copy Permit
lc+ Close Permit
r�* Overrides
Mb Supplemental fields
) Notes
1- Attachments J
Permit Information
Permit Number 0M0102= Status Closed j ref OK
APN 34216031.00 - L�
—�
Address 10651 MERRIMAN AD 4v Back
Owner Name JENNIE LEE
Review Stop Revision Date In Due Date Date Out Status Time Reviewer Notes Contractor ID Sent To
BV 2 01/29/2008
BV 1 12/14/2007
Plan Res ielro Information -
-� - --- -
Review Stop
JBV -BUREAU VERITAS
Revision
3
Reviewer
RANDY
Status
_
Status Date
Date In
F62/19/08
Time In
Project Size
_
Default Days
Due Date
Date Out
102/27/08�
Time Out
Time Spent
0.00
Contractor ID
Sent To
Sent By
02/05/2008 N 0-00
12/18/2007 N R 00
11:43
Plar, Review Notes
14Vp.
CITY OF CUPERTINO
BUILDING DIVISION PERNIIT
i PERMIT NO.
BUIL'Tb?�TsMERRIMAN RD C&S CONSTRUCTION SERVICES, 07120102
OWNER'S NAME: PERMTf ISSUE DATE
ZHIHONG LIU 43575 MISSION BLVD STE'629 02/28/2008
PHONE: SANITARY NO. CONTROL NO.
(510) 402-8422
ARCHI EC (ENGINEER:
N Z LICENSED CONTRACTOR'S DECLARATION
V C I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
Z to
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
a
in full force and effect.
ZLicense Class Lie, p
t Dam Contractor
ARCHITECT'S DECLARATION
a 1 understand my plans shall be used as public records
aU
O y Licensed Professional
y g OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
00 following reason. (Section 7031.5, Business and Professions Code: Any city or county
m ii which requires a permit to construct, alter, improve, demolish, or repair any structure
Z y prior to its issuance, also requires the applicant for such permit to rile a signed statement
S that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
[— (commencing with Section 7000) of Division 3 of the Business and Professinns Code) or
F that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than rive hundred dollars (S500).
❑ 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. 70K Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employers, provided that such improvements are not intended or offered for sale If,
however, the building or improvement is sold within one year of completion, due owner.
builder will have the burden of proving that he did not build or improvefor purpose of
En, 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li-
cence Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a contractors) licensed pursuant to the Contractor's
License Law.
❑ i am exempt under Sec , B & P C for this on
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will mai nudn a Certificate of Consent to self -insure for Worker's Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Carver. Policy No.:
CERTIFICATE OF D EMP ION FROM WORKERS'
COMPENSATION INSURANCE
or less.)
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 agoV the Workers' Compensation
Laws of Califomia. Date A�
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Cody; you must
,Z forthwith comply with such provisions or this permit shall be deemed revoked,
z O CONSTRUCTION LENDING AGENCY
r_ ram-, I hereby affirm that there is a construction lending agency for the performance of
Z 7 the work for which this permit is issued (Sec. 3097, Civ. C.)
WCd. Q Lender's Name
Z Lender's Address
U O 1 certify that I have read this application and state that the above information is
t—+ correct. 1 agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction, and hereby autborim representatives of this city to enter upon the
W above -mentioned property for inspection purposes-
p. (We) agree to save, indemnify and keep harmless the City of Cupenmo against
H to liabilities, judgments, costs and expenses which may in any way accrue against said City
(� Z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH,ALL NON -POINT
SOURCE RELATIONS.'I///� ((JX(y
Signature of Applicant/Conuactor I Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety
Cod.,
Section 25532(a)?
El Yes 0No
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
❑Yes KN.
1 have mad the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safcty Codc. Secdons 25505.25533 and 25534. I understand that if the building
does not currently have a tenant, that It is my responsibility to notify the occupant of
the
requirements ich must be met prior to issuance of a Cenificatf Occ:
Owner or authorizedaeacn`t� 1/ Datc
BUILDING PERMIT INFO
BLDG ELECT PLUMB
Job Description
REV.TRUSS CALCS ORIGINAL PERMIT # 07030227
Sq. Ft. Floor Area I
$ 0 Valuation
34216031?MN
Required Inspections
Issued by:
Re -roofs
Type of Roof
Occupancy Type
Date 2
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
All roof coverings to be Class "B" or better
MECH
.9
CITY OF
CUPEKrINO
CITY OF CUPERTINO
REVISION/DEFERRED
PERMIT APPLICATION FORM
APN # 3 r2 - `6 -- t) 3/
Date:
Original Permit #: 07 P 3 b >-7
Building Address:
rig
Mailing Address (if dent from builds address):
p4
Owner's Name: / j
Phone #:
Contractor: 0 j CCS
Phone:
Fax:
Contractor License #: 13
I
Cupertino Business License #:
Contact: ��
Phone: 4o - ,Z ( _ 3 2-
Fax: Z — -1&3 — 23 S-j
Building Permit Info:
Bldg ❑ Elect ❑ Plumb ❑ Mech ❑
Residential Commercial ❑
C- 01 C-f
Job Description:
Type of Construction (Usage Class):
* Occupancy Type:
1 FR, IIFR ❑ 11, 111, V-1HR ❑ 11, 111, 1V V-N
-�
Valuation (cost of project):
Project Size: Standard arge ❑ Major ❑ Valuation:
aCITYF
CUPERTINO
CITY OF CUPERTINO
REVISION/DEFERRED
PERMIT APPLICATION FORM
FEE SCHEDULE
Quantity
Sq Ft
Fee ID
Fee Description
Fee Group
Permit Type
1REVCOMNEW
Revision Commercial New
B
1*
1REVCOMTI
Revision Tenant Improvement
B
1* TI
1REVSFDWL
Revision SFDWL
B
1R3SFDW
1REVRESADD
Revision Addition
B
1R3SFDADD
1REVRESREM
Revision Remodel
B
1R3SFDREM
1DEFINSP
Deferred Submittal not R-3
B
1*
1DEFPLNCK
Deferred Submittal not R-3
B
1* OR
1* TI
G/2 6'�J--
IDEFR31NSP
Deferred Submittal R-3
Inspection
B
1R3SFDW
1R3SFDADD
1R3SFDREM
c�2 6 S-
1DEFR3PLNCK
Deferred submittal R-3 Plan Chk
B
1R3SFDW
1R3SFDADD
1R3SFDREM
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