15120177CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 874 SEPTEMBER DR CONTRACTOR - 'PERMIT PERMIT NO: 15120177
Iii
OWNER'S NAME: WUSUE YUNTRUSTEEf1a7 DATE ISSUED: 12/21/2015
OWNER'S PHONE: 4083968443 • _ PHONE NO
❑ LICENS D CONTRACTOR'S DEC ION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
REMODEL MASTER AND HALL BATHROOMS (80 S.F.);
License Class Lic. # REMODEL KITCHEN (299 S.F.); REMOVE LOAD BEARING
Contractor j% �� Q10-%� / WALL IN BETWEEN KITCHEN AND LIVING ROOM
I hereby affirm that I am licensed under the provisions of Chapter 9
(commenc' with Section 7000) of Division 3 of the Business & Professions
Code that my license is in full force and effect.
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: $50000
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: 36214015.00 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 WITHIN 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 FROM LAST CALLED IN49-
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indemnify and keep harmless the City of Cupertino against liabilities, judgments, i j
costs, and expenses which may accrue against said City in consequence of the Date:
granting of this permit. Additionally, the applicant understands and will comply Issued by:
with all non -point source regu ;ons per the Cupertino Municipal Cod/SSetion9.18.RE-ROOFS:
Signature / �J Date a� 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.
ri 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
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 Are Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the e f mcipal Code, Chapg9?.1122dthe Health &SafetyCode, Sectio ; 25 and 25534.
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 Owner or authorized'agent: Da e:
permit is issued.
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 i a construction lending agency for the performance of
become subject to the Worker's Compensation provisions of the Labor Code, I must
work's for which. this permit is issued (Sec. 3097, Civ C J
forthwith comply with such provisions or this permit shall be deemed revoked. 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.
Signature Date
CONSTRUCTION PERMIT APPLICATION
COMIJiUNI IY DEVELOPMtENT DEPARTMENT BUILDING DIVISION
10300 T ORRE AVENUE • CUPERTINO, CA 95014-3255
(4 08) 777-322$ - FAX (408) 777-3333 - buildino(c-1cuDarbno.oru
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DESCR?P T ION OF WORK t ��
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PLANNTNGA?PLR ❑NO PLANTIINGAPOYPTLit-- t..
By my signature below, I certify to each of the foilo« ing: the pr oi�m r author! d agent to act on the prop ov Ter's behalf ha mad this
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it is accurate. I a to comply a
application and the inferr ation I have provided is COT-,-, e re- ` .e Des. Ion of � rk and erI } ,
ordinances and state lass relating to bu . 'in- construe riz re re f t upertino to enter the above-inena3ed p o er y ',r im z io rposes.
Signature of Applicant/Agentt Da e
SL'PPLEVE' IIS OR�iATION REQUIRED T.3 csEcx E Dov Gs1
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New SFD DIMLI ifamily d-wellingS Apply for demolition pernit 'OT O �R TH CO kTE IIILDL�GPL i2n�3i
existing building(s). pemolitlon pe nit Is required peer o issuance of build lIg E w
-
PLAT�NGYLdEtEiZEV
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pe Init for new buildingNO
_ Conarnercial Bldgs: Provide a completed H`ardous,TGiaterials Disclosure �
of tniS
lor l if any Hazardous h6a',erla!S 21e being used as r?rt project. -
f nv �7 Plamnin ' prior t0
Planning Approval Letter or ?�ieetL.� With � p
_Copy of
submittal of Buildir-g Permit application.
Bldgl-pp_2011. do revised 06/21/11
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CITY OF CUPERTINO I
1WW IPPIP VqT11%/tATnR - IRIT11,I)ING DIVISION
.9ADDRESS: 874 Septmeber Dr DATE: 1212112016
1 APN: 362 14 015 1 BP#:
REVIEWED BY: PAUL
*VALUATION: $50,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
USE: SFD or Duplex
I V
PENTAMATION I R3SFDREM
PERMIT TYPE: 'A
WORK
Remodel Master and Hall Bathrooms (80 S.f.); Remodel Kitchen (299 S.f.); Remove load bearing wall
SCOPE
in between Kitchen and Living Room a
____ .— J_ ---
District, etc.). _ These -fees are based on the prelinzinau
FEE ITEMS (Fee 3 Eff. "''1/132
information available and are onl_
r y
FEE QTY/FEE
an estimate.- Contact the Dept.for addn't Info.
MISC ITEMS
J-1
$0.0080
I V
Ei
Suppl. PC Fee: Reg. C) CIT 0.0
hrs
ib"T L.
" T-a2i
PME Plan Check:
71
299 s.f. –_Remodel, Kitchen (<--300 sf)
$645.OaOIREIM;ES�KIT
y - r- 4—
f_ –4— T) nt"10"tQfi_P_ Planning. Public Works,
Fire, Sanitary Sewer District, School
____ .— J_ ---
District, etc.). _ These -fees are based on the prelinzinau
FEE ITEMS (Fee 3 Eff. "''1/132
information available and are onl_
r y
FEE QTY/FEE
an estimate.- Contact the Dept.for addn't Info.
MISC ITEMS
..Resoluflon11-0
Plan Check Fee:
$0.0080
s.f. Remodel, Bath (<--300 sf)
P$645.00 IREMRESBATj
Suppl. PC Fee: Reg. C) CIT 0.0
hrs
PME Plan Check:
_$0..00
$0.00 :
299 s.f. –_Remodel, Kitchen (<--300 sf)
$645.OaOIREIM;ES�KIT
Permit Fee: Hourly Only? 0 Yes (E) No
$0.00
$0.00
Suppl.Insp. Fee.(j) Reg. OOT
0.0
hrs
PME Unit Fee:
$0.00
$0.00
PME Permit Fee:
01
Select a Non -Res .. idential E)
Building or Structure 0
3.0 hrs Inspections
$429.00 ISTJA'SP inspection, Hourly
$1,719.00TOTA1Cf$1727.50
Work Without Permit? Yes (j) No
$0.00
$0.00
$6.50
Advanced. Planning, Fee:
o'
Strong Motion Fee: IBSEISMJCR
Bldg�, Stds.. mmission Fee: IBCBSC
$2.
$8.50
S"T'omws.. -
Rpvisbd: 10101/20151