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15090030 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22066 CLEARCREEK CT CONTRACTOR:CSCI CONSTRUCTION PERMIT NO: 15090030 INC OWNER'S NAME: RONALD YU 2574 LAFAYETTE ST DATE ISSUED: 10/08/2015 OW S PHONE: 6508104473 SANTA CLARA,CA 95050 PHONE NO:(408)845-9010 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL + r (�q _ REMODEL KITCHEN(380 SQ FT);REMODEL(2)BATHROOMS License Class 8 Lic.# L�� ( l� (106 SQ FT);OTHER REMODEL(523 SQ FT);PANEL f� UPGRADE(200 AMP);REPLACE WINDOW IN KITCHEN; Contractor ( �(f�--_N.{�d-A Date 6"(/I (f� 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: t I have and will maintain a certificate of consent to self-insure for Worker's Sq.Ft Floor Area: Valuation:$70000 Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:32618024.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED 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 D FROM LAST CALLED INSPE TION. 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, Issued by: 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 C" =--- `N Date_4(offf- 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 compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE 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. I will 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. 9. I have and will maintain a Certificate of Consentto 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 performance of the work for which this n 370ermit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 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 Owner or a„gthor' edcnt: � permit is issued. - Date: i I, 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 I -, COMMUNITY DEVELOPMENT DEPARTMENT BUILDING•DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95094-3255 Ct PE€TIN (408)777-3228•FAX(408)777-3333•building(Dcupertino org NEW CONSTRUCTION El ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS /� - �� L (7rL APN# .r OWNER NAME K0/t VJ ,) PHONE E-MAIL V Ifo) o- 4f7j STREET ADDRESS �.a�y^ �E. /yam CITY, STATE,ZIP 61K 7't/_/J�' FAX CONTACT NAME PHONE 77� g` n E-MAI STREET ADDRESS - - CITY,.STATE,ZIP FAX OWNER ❑OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑.ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME fC T/V6 � /p.q LICENSE NUMBER go4r96 LICENSE TYPE BUS.LIC# COMPANY NAME 1 C7 CQ'��V4q,,/`�'1 I E-MAIL C �v SEIrE�✓ (se o�v5a� c7��r�/ FAX ADDRESS - CITY,STATE,ZIP _ PHONEt - - ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANYNAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK 60 1" t✓i eV 40 SF) fPao JP EXISTING USE PROPOSED USE I CONSTR.TYPE #STORIES A/Af �ly hAl ES USE TYPE OCC. SQ.FT. VALUATION(S) e t � D AREAEXISTNEW FLOOR DEMO TOTAL - AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA P O/ 4> REMODEL AREA (. 0 REMODEL AREA b PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LIDETACH - [EI,KrTACH #DWELLING UNITS: IS A SECOND UNITS SECOND STORY ❑YES BEING ADDED? � ADDITION? ZX6 PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN' YES .I�ECI.VI•ri�!'� >--. ST" ` TOT VALUATION: PLANNING ADPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME. VAO _ F � o I.� v�"a ,fin 3,.,' .... ..:1 .✓ :..:. .........?�: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property 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. Signature of Applicant/Agent: - ( ' Date: SUPPLEMENTAL INFORMATION REQUIRED :- >2Ir �Y _New SFD or Multifamily dwellings: Apply for demolition permit form �l F3 It THE Gf) t�IT ti33 MGM" AN REVI�w existing building(s). Demolition permit is required prior to issuance of building R permit for new building. r, p � n v _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure l STANDARp l� rtfzcauor �s form if any Hazardous Materials are being used as part of this project. r TI � _Copy of Planning Approval Letter or Meeting with Planning prior to - � F, submittal of Building Permit application. BldgApp_2011.doe revised 06/21/11 CITY OF CUPERTINO 15Mffi9b FEE ESTIMATOR-BUILDING DIVISION MA7DDRESS: 22066 Clearcreek Ct. DATE: 09/03/2015 REVIEWED BY: PAUL 618 024 BP#: *VALUATION: $70,000 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair URIMARY SFD or Duplex ��JPERMIT NTAMATION 1 R3SFDREM TYPE: WORK Remodel Kitchen 380S.f. 2 Bathrooms 106S.f. Other 200S.f. Panel Upgrade to 200 Amp, Replace SCOPE window in Kitchen, Remove 2 fireplaces, in Living Room, Install 23 (N) Recessed Lights it ch. Plarr Check I'I7w7b. Non('he l� Elec.Plan Check 0.0 hrs $0.00 lleclr. YerTrnit Fee! Zu y fl. I' rrni,Fee: Elec.Permit Fee: IEPERMIT €.J;7red ,ilccFr. Inse'. 01her PhYp"2h Irrsr'. Other Elec.Insp. 0.0 hrs $48.00 M&I'). Pei:: T>lz?r,rts frtslJ. Fee: ile[.1rt<Ir. Pei: NOTE:. This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the prelimina information available and are only an estimate Contact the De t or addn'l info. FEE ITEMS(Fee Resolution 11-053 E . 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel,Kitchen(<=300 sf) Suppl.PC Fee: (E) Reg. 0 OT 0.0 hrs $0.00 $645.00 1REMRESKIT PME Plan Check: $0.00 106 s.f Remodel,Bath(<=300 sf) Permit Fee: $0.00 $645.00 1REMRESBAT Suppl.Insp.Fee.-(E) Reg. t OT p 0 hrs $0.00 F 200 s.f. Remodel,Other PME Unit Fee: $0.00 $431.00 IREMRESOTM PME Permit Fee: $48.00 F-200-1 amps Electrical /. Construction Tax: $48.00 1BELEC200 I Service's Administrative Fee: 1ADMIN It $45.00 1 # Window Z Sliding Glass Door Work Without Permit? 0 Yes (j) No $0.00 $431.00 1WINREP Replacement E) Advanced Planning Fee: $0.00 Select a Non-Residential G Travel Documentation Fee: ITRA VDOC $48.00 Building or Structure A Strong Motion Fee: IBSEISMICR $9.10 Select an Administrative Item Bldg Stds Commission:Fee: IBCBSC $3.00 ASIIBTfiAI :.: $153.10 $2,200.00 '' 'T 07 $2,353.10 R d: CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 22066 Clearcreek Ct. DATE: 09/03/2015 REVIEWED BY: PAUL APN: 326 18 024 BP#: 'VALUATION: Iso -� *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition U IM` RY SFD or Duplex PENTAMATION PERMIT TYPE: 1 REAP1 i WORK CONT/D- Remodel Kitchen 380&.f. 2 Bathrooms 106S.f. Other 200S.f. Panel Upqradeto200 SCOPE Amp, Replace window in Kitchen, Remove 2 fireplaces, in Living Room, Install 23 (N) Recessed Lights Meeh, J'fsan Check f'lnrfh.Pleat£:hec-l< Elec.Plan Check 0.0 hrs $0.00 tfec/f. Pefwfif Fee: Plumb.Permit Fee: 2Elec. ec.Permit Fee: IEPERMIT L111"I" I'll"71 01_ 0(her Plurrih&,sp. Othe . 0.0 hrsFee: Ptmiib. Ins��. Fee,- Oec. NOTE.This estimate does not include fees due to other Departments(Le..Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l h?o. FEE ITEMS(Fee Resolution 11-053 E . 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Electrical Suppl.PC Fee: C) Reg. 0 OT 0.0 hrs $0.00 $90.00 IBREMF= Fixtures,Lighting i PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp.Fee:Q Reg. 0 OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 "onstn,ie ion Tax: Administrative Fee: IADMIN .00 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Travel Documentation Fee; ITRAVDOC $ Building or Structure.00 � Strong Motion Fee: $0.00 Select an Administrative Ite7t_10 Bldg Stds Commission Fee: $0.00 z [TBTOTALSr $141.00 $90.00 T©I`iL $2 .00 Revise