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15100007-MAIN HOUSECITY OF CUPERTINO BUILDING PERMIT BUMDING,ADDRESS: CONTRACTOR: RERMITNO: 15100007 22343 MCCLELLAN RD CUPERTINO CA 95014 (357 05 004) DIANLI CHEN CONSTRUCTION CUPERTINO, CA 95014 OWNER'S NAME: HSUEK PO-JEN AND KONG PO DATE `ISSUED: 04/27/2016 OVVNER'S PHONE: (650) 303-9394 RHONE NO: (408) 888=2898 INCENSED CONTRA eTOR' DEC A R aTT ON* ]BUILDING PERMIT INFO: License Class B Lia. #$5B 51 4 Contractor DIANLI CHEN CONSTR ir'TIOTt Date 08/31/2017 _BLDG —ELECT _, PLUM I hereby affirm that I am licensed under the provisions of"Chapter 9 (commencing _ _ _ MECH RESIDENTIAL COMMERCLAL with Section 7000) .of Division 3 of the Business & Professions Code and that my license is. in full force and effect. JOB DESCRIPTION; 1 hereby affirm under penalty of perjury one of the followingtwo declarations CONSTRUCT (I� 2 STORY SFD (4,733 S.F.) WITH ATTACHED 3 CAR GARAGE (687 S.F.) i. I have and will maintain a certificate ofconsentto self -insure for Worker DEF # 1 (11/4/16) TRUSSES Compensation, as provided for by'Section 3700 of the Labor Code, for th gEV#1— REVISE MAIN HOUSE KITCHEN, BATH 6 AND PANTRY dieer�formance of the work for which this permit is issued`. LAYOUT - ISSUED 12/05/2016 2. have and will maintain Worker's. Compensation Insurance, as provided for by **A-6** CJS Section 3700 of the Labor Code, for the performance of the work for which this . permit is issued. Sq.FtFloorArea' ; Valuation: $400000:00 APPLICANT CERTIRI ATTON 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 • APN Number: Occupancy Type: and state laws relating to: building construction, and hereby authorize 357 05 004 representatives of this city to enter upon the above mentioned. property for inspection purposes. (Vile) agree to save indemnify and keep harmless .the . City of Cupertino against.liabilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non point WITHIN 180 DAYS OF PERMITISSUANCE OR source regulationsp r the Cupertino Municipal Code.; Section 9.18. 180 DAYS FROM L ► - PC ECTION. Signaturei fir' Date 12/05/2016 Issued by: I OWNER -B ffiDER D •CL ATiON Date:704f2 iLf-- ?- I S71 I G I hereby affirm that I am .exempt from the Contractor's License Law for one of the following two reasons: RF. ROOK : All roofs shall be inspected prior to any roofing material being installed. If a roof is s. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or.offered for inspection. sale (Sec.7044, Business a Professions Code) 2, I, as owner of the propgrty, am exelusively contracting with licensed Signature ofApplicant:. . contractors to construct the project (Sec.7044, Business & Professions Code). Date: 12/05/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER i 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 2. I have and will maintain Worker's: Compensation Insurance, as provided for by " tiA2 ARDOI�S MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health &'Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issuect s. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California.. If, after making this certificate of will maintain compliance with the Cupertino- Municipal Code, Chapter 9.12 and 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 the Health & Safety Co e, See' ns 25505, 25533, d255314. be deemed revoked. Owner or authorized agent: l s APPLICANT CERTIFICATION te: 12/05/2016 Daf AGENCX I certify that I have read this application. and state that the above information is I hereby affirm that there is a. cons uctioril lending agency for the performance correct. t agree to comply with all city and county ordinances and state laws of work's for Which this permit is issued {Sec. 309T, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands : ARC ffiTEGT's DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal I understand my plans shall be used as .public records. Code, Section 9.18. Licensed Signature Date 12105/2016 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARANT • BUILDING DIVISION 10300 TORR. E AVENUE CUPERTINO, CA 95.014-3255 CUP RTI NO (40$) 777-3228 -FAX (408) 777-3333 + buildincaft—cupertino.org I'S1 wi J( J� O NEW CONSTRIJGTION ADDITION 0 ALTF / TI I2 REVISION / DEFERRED ORIGINAL FERMrr # PROJECT ADDRESS >_ ol OWNERNAME - - PHONE /x-�C7 3 `3 � � g• ; ' C1 ��/� J �1 STREET ADDRESS CITY, STATE g Z3 3 c� l� 1 �' 6 y7 CONTACT NAME PRO(✓s(�CS �-V • C E it STREET ADDRESSy_Z_ � _ CITY, STATE ZIP Ia 1 FAX OWNER El OWNERBURDER ❑ OWNERAGENT CI CONTRACTOR EI CONTRACTORAGENT ARCHITECT ❑ ENGINEER Il DEVELOPER. Il TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LTC # COMPANY NAME E-MAIL _ FAX STREET ADDRESS CrM STATE, ZIP PHONE ARCHrrECT/ENGINEER NAME LICENSE NUMBER BUS. LIC ff COMPANY NAME . E-MATL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES- EXETO . NEW FLOOR DEMO TOTAL , ^; { AREA - AREA . AREA NET AREA BATHROOM KITCHEN .. - OTHER ':x,I REMODEL AREA REMODEL AREA REMODEL AREA �-''�'�` �' --'--- � . PORCHAREA DECKAREA TOTAL DECKNORCH AREA GARAGEAREA: DETACH F 0 ami Q ATTACH -W s WDWELLINGUMTS: ISASECONDUNIT YES SECOND STORY YES REINGADDIMI NO ADDMON? N0 10. b PRF -APPLICATION - Q YES IFYES,PROV16ROOPYOF PLANNER'SNAME: j'y "' � s PLANNING APPLE ❑ NO PLANNING -,„�, �, LaNNINCAPPRovALLeTrex 4 m .,� ? ;: _Iil By my signature below,. I certify to each of the following: I am the property owner or authorized agent to act on the property wner's behalf_ 1 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 tob . onsfruc$on. I authorize representatives of Cupertino to enter the a /t kntifie property for inspection purpose's: - SignatureofApplicant/Agent: Date:, SUPPLEMENTAL IWORMATION U RE MED ' Q a. ?T AL IEI4 _ New SFD or Multifamily dwellings: Apply for demolition permit for ov> R o� � EI ILi� G LAI I w s existing building(s). 1?emolitiori permit is required prior to issuance of building s permit for new building. pK . , A Commereiai Bldgs Provide a completed Hazardous Materials Disclosure ur ?IIBLIC�T:S, form if an Hazardous Materials are being used as art of this. project. � y g p p J 'Q bP.T Dopy of Planning Approval Tetter or Meeting with Planning prior to^ wI$70�ICTd{jC�1C Submittal of Building Permit application. ,�� `. _ BldgApp 20I1.doe revised 03116111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15100007 22343 MCCLELLAN RD CUPERTINO CA 95014 (357 05 004) DIANLI CHEN CONSTRUCTION CUPERTINO, CA 95014 I OWNER'S NAME: HSUEH PO-JEN AND KONG PO I I DATE ISSUED: 04/27/2016 I I OWNER'S PHONE: 408-326-9790 I I PHONE NO: (408) 888-2898 LICENSED CONTRACTOR'S DECLARATION Class 5 Lic. or DIANLI CHEN CONSTRUCTION Date 03/31/2017 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: i. 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. 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. Date 4/27/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 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 -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. 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. 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 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 4/27/2016 PERMIT INFO: —BLDG —ELECT —PLUME _ MECH _ RESIDENTIAL._ COMMERCIAL JOB DESCRIPTION: CONSTRUCT (N) 2 STORY SFD (4,733 S.F.) WITH ATTACHED 3 CAR GARAGE (687 S.F.) Sq. Ft Floor Area: Valuation: $400000.00 APN Number: Occupancy Type: 357 05 004 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by: Abby Aun-de 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: 4/27/2016 "A" 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, Sec' s 2550 2 33, and 25534. Owner or authorized agent: V Date: 4/27/2016 S_ EN Y I hereby affirm that there is a constr ction 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 CUPERTINO 1 1 NAW rnNRTRTlr CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 (40{8) 777-3228 • FAX ((408) 777-3333 • building Ca.cuperlino.crg / �'T� f, �y N I — T'TOI AT)1 T)TTTnV i I ATTT=RAT1 I T(1N/TT RFVnQTr1-J F /T�T_FT1TRlzn�I V 07PT(:TTQAT DT7D1,XTTy PROTECT ADDRESS (� ec'�} c} APN OWNER NAME , PHONE , ry E•M.AIL g /- STREET ADDRESSCITY, STATE, ZIP �p /' 102A FAX j2V) 0 r '* CONTACT NAME �^ PHONE E-MAIL �iV9 J c STREET ADDRESS CITY, STATE, ZIP FAX OA, ❑ OWNER ❑, OWNER -BUDDER ❑ 01TNEER^AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT �,ZARCIi1TECT 11"ENGINEER ❑ DEVELOPER ❑ TENANT- ENANT•CONTRACTOR CONTRACTORNAME•, , / s LICENSE NUMBER I LICENSE TYPE BUS. LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC n COMPANY NAME E-MAIL FAX STREET DRESS 511 CITY, STATE; ZIP PHONE , tt ` DESCRIPTION OF WORK /+C) �+ 2- L® r j 5;7- 1 ? b L -i Z G 6� EXISTINGUSE. PROPOSED USE CONSTR.TYPE 4STORIES I USE TYPE I. OCC.: ( SQ.FT:. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL - AREA AREA - AREA NET AREA BATHROOM - KITCHEN OTHER - - - REMODEL AREA REMODEL. AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA - GARAGE AREA: EDDETACH - ❑ ATTACH 4 DWELLING UNITS: IS A SECOND UNIT ❑ YES I SECOND STORY []YES- BEINGADDED? ❑NO ADDITION? []NO PRE -APPLICATION ❑ 1'BS IF YES, PROVIDE COPY OF 'TS THE BLDG -. _. `a+ NE-_ M TOTAL VALUATION_ PPLR NO PLANNING APPROVAL LETTER PLAN INGA❑ I EICHLERHOME? '❑N - -- — (Ij d D (J07 By my signature below, I certify to each of the following: I am the property ovmer or authorized agent to act on the property owner's behalf. I have read this application and the information I have rov d is corn ct, 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 ild' construe I . I author' representatives'of Cupertino to enter the above -id tified prope or inspection purposes. Signature of ApplicanVAgent: Date: ® � SUPPLEMENTALORMATION REQUIRED — z _ PT Ah CHECK iPE ._ w 3iOT3TII�GSL� New SFD or Multifamily dweri.g'S: Apply for demolition permit.for � o ER Tz�co>TI� ETR ��BTJIIDL�GPL4NREVIET r existing building(s). Demolition permit is required prior to issuance of buildma permit for new building.EXPAESS lid PLAn'h-IIiG.EI,A">4 RE4'IE4V Commercial Bldgs: Provide a completed Hazardous Materials Disclosure -Cl sTaLDAR� riTB coo _ form if any Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application._ Bldg-App_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 22343 MCCLELLAN RD DATE: 10/01/2015 REVIEWED BY: MELISSA APN: 357 05 004 BP#: (S to QOO- VALUATION: $400,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: 2nd Unit? 0 Yes •` No PENTAMATION 1 R3SFDW PERMIT TYPE: A WORK CONSTRUCT N 2 STORY SFD (4,733 S.F. WITH ATTACHED 3 CAR GARAGE 687 S.F. SCOPE PME Plan Check: TYPE OF FLR AREA OCCUPANCY TYPE: PC FEES PC FEE ID BP FEES BP FEE ID CONSTR s.f. R-3 (Custom) II-8,111-B,IV,V-B 5,420 $3,388.95 IR3PLNCK $4,402.95 IR3INSP it ch. PkLn Check i1ech� Permit Fee: Other 11ec;h. Ii sly. ilech. Irp. lee: TOTALS: I 5,420 I $3,388.95 (-- $4,402.95 I ' Phimi:. Plein Check. Plutnb. Per last .Fee: Other.Plynih Jnsp,, Plarnxb. Imp. Fee: 17ec. Plan Clzec,k Elec. Per,}rat F* w: 09her Elea Insp. Elea Ins. Fee: AM E: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Pire, Sanitary Sewer Vistrict, School District, etc.). These_fees are based on the preliminary information available and are only an estimate. Contact the Dept for aadn'i FEE ITEMS (Fee Resolution 11-053 E, f .7/1/13} FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,388.95 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (D Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0:00 Permit Fee: $4,402.95 Suppl. Insp. Fee: Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 1BCONSTAU # new units $684.98 Admini.qratt,;e-- Work Without Permit? O Yes (F) No $0.00 Advanced Planning Fee: IPLLONGR $758.80 Select allon-Residential Building or Structu 0 grave/ l�f}cumeiiialion. Fees: Strong- Motion Feer 1BSEISMICR $52.00 Select an Administrative Item t'I- 2 . yBldg BldgStds Commission Fee: IBCBSCk $16.00 SITBTOTAI:S:- $9,303.68 $0,00L $9,303.68 Revised` 07/02/2015 0 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15100007 22343 MCCLELLAN RD CUPERTINO CA 95014 (357 05 004) DIANLI CHEN OWNER'S NAME: HSUEH PO-JEN AND KONG PO • OWNER'S PHONE: 408-326-9790 101 lei wm 04 lislou t t: 1 1► License Class a Lic. #858154 Contractor DIANLI CHEN CONSTRUCTION Date 03/31/2017 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 Compensation, as provided for by Section 3700 of the Labor Code, for the 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. 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. I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. 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). CONSTRUCTION CUPERTINO, CA 95014 DATE ISSUED: 04/27/2016 PHONE NO: (408) 888-2898 BUILDING PERNHT INFO: —BLDG —ELECT _ PLUNM MECH RESIDENTIAL CONUVIERCLAL JOB DESCRIPTION: CONSTRUCT (I) 2 STORY SFD (4,733 S.F.) WITH ATTACHED 3 CAR GARAGE (687 S.F.) Sq. Ft Floor Area: Valuation: $400000.00 APN Number: Occupancy Type: 357 05 004 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Ayende Date: 04/27/2016 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: 4/27/2016 hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER t. 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. 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. 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 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 4/27/2016 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, Sec ' s 25505, 2 33, and 25534. Owner or authorized agent: Jrl Date: 4/27/2016 ��hereby affirm that there is a constr ction 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 Professic CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15100007 22343 MCCLELLAN RD CUPERTINO CA 95014 (357 05 004) DIANLI CHEN CONSTRUCTION CUPERTINO, CA 95014 OWNER'S NAME: HSUEH PO-JEN AND KONG PO DATE ISSUED: 04/27/2016 OWNER'S PHONE: (650) 303-9394 PHONE NO: (408) 888-2898 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lic. #856154 Contractor DIANLI CHEN CONSTRUCTION Date 03/31/2017 _ BLDG _ ELECT _ PLUMB MECH RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: CONSTRUCT (N) 2 STORY SFD (4,733 S.F.) WITH I hereby affirm under penalty of perjury one of the following two declarations: ATTACHED 3 CAR GARAGE (687 S.F.) 1. I have and will maintain a certificate of consent to self -insure for Worker's DEF # 1 (11/4/16) TRUSSES -.ISSUED 12.22.16 Compensation, as provided for by Section 3700 of the Labor Code, for the REV#1 — REVISE MAIN HOUSE KITCHEN, BATH 6 AND PANTRY performance of the work for which this permit is issued. LAYOUT - ISSUED 12/05/2016 r2. I have and will maintain Worker's Compensation Insurance, as provided for by **A-6** Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $400000.00 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 357 05 004 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non -point source regulationserer t�pertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 12.22.16 Issued by: SEAN HATCH OWNER -BUILDER D�CLARATION Date: 04/27/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) z. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 12.22.16 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the a. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous 'ty air contaminants as defined by the Bay Area Air Qua Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Munick4al Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, S7:�7 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 12,2215 1 certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 12.22.16 Licensed Professional �� CONSTRUCTION PERMIT APPLICATION �` CON41AUNITY DEVELOPMiENT DEPARTMENT • BUILDING DTVI N 10300 TORRE AVENUE • CUPERTINO, CA 950143255 CUPERT1htQ (408) 777-3228 • FAX(408) 777-3333 • buildino(c�cupertino.org ❑ KEW CONSTRUCTION ❑ ADDITION ❑ A-LTERATION / TI C@ REVISIO_ /DEFERRED ERRED / ORIGINAL PERh,TTT r PROIECTADDRESS m cclaor1 sr _ a - a o - OwNEP, XA> E pdUto\ 6, Xu e ffd� 316qllo E-> tslL sTR_r.ADDP£ss 1 7 CITY, sT.q?' lel) CPr I 9.0M- J CONTACT Xe -ME �O x ( P-0 ZE E-I,g.A L STPM ADD zip 9o1 I FACis43 o .cp OW -ER ❑ O"XWEER-BUILDER ❑ OWQERAGEI.T C0117RACTO? ❑ COKMkCTORAGEI7 ❑ !ACHTECT ❑ ENMBER ❑ DE\' LOpzR ❑ ; e .T CO \TRACTORN4hg DxAt L!.. LIr� I LICTSE?�LTI?ER g �4 LICENSE Tz r I BUS. LIC R CONP.k Y KTA.mF,Qji' ` A lj �JLO(1 J `R ju o I r,MAIL KI I ( I I c- Lot L@ ma l I (0(\- I FAX ST=P.DDP.£SS (Al /gaVF ICITY, STATE, Z3 1 �nb CIt) /�O' PHO\E i71 aUQ SQ U ARCi7IECVENOD E �G 4E n �n 1 LICMSE NUX-MER C'S -7 066 BUS. LIC r COA4PAI\yNAME E-MAIL ^C`1nC-I0012 ', FAX STREET ADDRES ICrTY,STAT 'n 3G — PHONESQ -r{ V s8683� DESCPIPTIO \' OF WORK �j�rs 5U\„ �t �,� / � ! T f„-,' 1 SE s l�.h) �ae�/� V� (,0 �,(6 CN) 1 u r' � C4�3� S. F )V w� 3 (a r EXISTING USE PROPOSED USE CONSTR T1?E R STORES I USE T)''PE OCC. SQ.FT. =� VALUATION (S) FLOOR D Ef0 TOTALS� SAG FZ I I BATP3.00hM KITCHEN OTr_ER Ra9DDELARE A, RB4ODELAFL A REMODELAREA PORCH AREA DECK AREA TOT.Z DBCK?ORCH .kREA GAR GE AP E4: DETACH - ❑ ATTACH DR'ELL^ G L'\7TE IS A SECOND L'<IT ❑ YES SECOND STORY ❑ TES BELN�G.4DDED? ❑NO ADDITION? ❑NO PRE-i.-LIC.4Ti0N [)YES IF YES, PROVIDE COPY OF I PL4\T'LNGAPiL.- ❑NO P - \ I.NGAPPROVALLE77ER is THE BLDG AN ❑ 5o EICHLER HOME?Fsx VALUATION: _. ��,� By my signature below, I ce;tiffy to each of the followine: I aun the grope. 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 to comply with all applicable local ordinances and state laws rela=g to bu' ding c .sslction. I aun'IOrize representatives OfCupertino to enter the above -i 'enti?/- grope ey for inspection purposes. Signature of,t,pplicant/Agent: Date: 1 SUPPLEMENTAL O MATION REQUIRED Q SFD or.Multifamily dwellings: Apply for demolition pen7it for ;� OVER TIS COL'�TER G c ' c ii c 7'•' _` „ exist: bLild.J�(S). Demo.l�lon peiin]t i5 72C'.Lir'd Dilor i0:ss...a:ICe Ofbuildi^.Q } . BLILDI PLM'\ RE1T£\1 erlit -Tor ne\a+ building. 1D❑ �-w„�,,•�,,"��i�-c�?�;�-�,- ElPRESLT\GPLAN Fes REVIE',N _--, COi7772iCia1 B1 zs: Provide a ccnrleted :aZard L-.a.,,al. D;sclOst7e T3\.ARD: ,> L'BLIC\SORLS -• fora ir'any Hazardous NIFterials are being usz , as pa i Of tri:S piOjeCt. ❑ a Li'.RGE � "" : � FIR£ DEPT Copy of Planning Approval Letter or.Meeting with Planning prior to submittal of Building Pennit application. �k � � T*'�i i4I0_RT�"'�� Q�S4\TT4R1 SE1iERDI�i RICT�_ ~ RL�-tif �{��Si 9•[° { ��e�'i, M'�'�' �`e!o�� b, � p!�`eti'�ix b�u�iYY B1dg1pp_2011.doc revised 05/21111 CUPERTINO PURPOSE UTILITY RELEASE REQUEST FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - buildinga-cupertino.org For residential single family or duplex construction, there are cases where gas and electric utilities are requested to be released prior to the issuance of the certificate of occupancy. Upon approval from the building inspector, the City of Cupertino is allowing both utilities to be released prior to the final sign -off of the building. INSTRUCTIONS 1. Download this form at: http://www.cupertino.org/index.aspx?page=297. 2. Complete the form and obtain signatures from both the owner of the property and the primary contractor. 3. Fax, E -Mail, Mail or hand deliver the original signed form to: City of Cupertino Building Division Attn: Utility Release Request Form 408-777-3228 office 10300 Torre Ave. 408-777-3333 fax Cupertino, CA 95014 building(@cupertino.org 4. Schedule a Gas Meter Release inspection (#403) and/or Electric Meter Release inspection (#404). Please note, a Gas Test inspection (#506) is.required prior to or at the same time of the Gas Meter Release inspection. BUILDING INFORMATION (Please complete the following information): APNBLDG DD PERMIT #: L5Ia o06i DATE,,/ n SITE �Zl^, �d CQ ADDRESS: iroC cA 0NSL;. e APO —5C�I PHONE#: FAX #: 11 MAILING ADDRESS (if different from site address): CONTRACTOR: b l c- I 1 C�'}'�1 PHONE #: FAX #: t -t G �� k1 l� CONTACT. -PHONE Py (,K #: FAX #: � � � 74-z I request the City to release my utilities prior to obtaining a final inspection approval for the building. I fully understand the occupants of the building cannot move into the residence until they receive all of the required final sign -offs and the City has issued a certificate of occupancy for the building. .�•�xi•Y��Owner:............................................................................ Print:.......... .......... ��.. ....`...... .................................................. :o............. Contractor........0 .............................. Print:.......... !n� .................... Date%.�A� .... UtilityReleaseForm_2011.doc revised 08109111 FREMONT UNION HIGH SCHOOL DISTRICT 589 WEST FREMONT AVENUE SUNNYVALE, CALIFORNIA 94087 408-522-2200 Developer Impact Fee Compliance Building permits will not be issued without a completed Certificate of Compliance Building Permit Application The City of C t) PL E7 I IJ IL has received a request for a Building Permit described as follows: _ New Residential Development p_ Residential Addition (501) sq. ft. or more _ Commercial Development Name of Owner / Developer: Project Address: 7� �. (F �"1 ( Ci Lot/Parcel # Square Footage: �„ Description: "LIC Permit / Plan Check # 1510000 -9 - AXI n Er Date: By: l City Building Inspector— 'HOME nspector— HOME (6 ) t3`ly 5•F, Square footage verified by the city prior to issuance of a building permit; fees may be adjusted accordingly. Feeder Elementary District SCHOOL DISTRICT DEVELOPER IMPACT FEE CERTIFICATE OF COMPLIANCE The authorized representative of the Fremont Union High School District has reviewed the City of Building Permit Request described above and hereby certifies that the developer or authorized representative has met the requirements of the District's Developer Impact Fee requirements. Dated: By: Fremont Union High School District Authorized Representative Certificate not valid without District Seal, Initial, and Date Fee $ 7 f Distribution: Facilities Planning —White City — Yellow Requestor — Pink Accounting — Gold Dev. Impact Fee Compliance (Rev. 11/22/05) [12/08 — 1000] Cupertino Union School Ditrict 10301 Vista Drive, Cupertino, CA 95014 Tel (408) 252-3000 • Fax (408) 865-0326 10958 Developer Impact Fee Compliance The Cupertino Union School District has adopted Resolution Nos. 1403, 1404, and 141501, imposing developer impact fee pursuant to Government Code 53080. Building Permit Request The City of :I P41 r� -7 Irl D has received a request for a Building Permit described as follows: Residential Development Project Commercial/Industrial Development Project Name of Developer/Owner: Project Address: . L4 Tom. Description: 0 (in X11' A ( Al .2 - S T P t,/ L) Square Footage: l Lot/Parcel #: �> U Permit Date: 0/ B �' y City Authorized Representative Square footage will be verified by the city prior to issuance of a building permit; fees may be adjusted accordingly. Important Notice: Bring this form and payment to 10301 Vista Drive, Property Office. Cupertino Union School District gives no credit for total demolition of existing square footage area, which makes way for new construction as mandated in the Government Code Sections 53080, 53080.6 and 65995. SCHOOL DISTRICT DEVELOPER IMPACT FEE CERTIFICATE OF COMPLIANCE The authorized representative of the Cupertino Union School District has reviewed the City of C0P)5R TINo Building Permit Request described above and hereby certifies that the developer or authorized representative has met the requirements of the District's Developer Impact Fee requirements. Dated: 1 _.M ,��• _ ,rye �'�{i l Certificate not valid with'4 t District seal, initial, and date. r� By: Authorized ve Cupertino Uniop School District Fee: $ /i �� C) Ifo Check No.: Facilities Planning - White City - Yellow Requestor - Pink Accounting - Gold CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue: Cupertino, CA 95014-3255 Telephone- 408-777-3228 Fax. 408-777-3333 JOB ADDRESS �2- M S -G k �9q) f k 0 -Pe op W PERMIT # 1S'10bb D7 1S1(}U OWNER'S NAME Pi) d;- pelt(G4 PHONE # 4DUM MN GENERAL CONTRACTOR. D10!) (i ckQo BUSINESS LICENSE # ?,5'6/5-4 ADDRESS QMi t "Av, cum ' V CITY/ZIPCODE Cu (-11 b , 7014 amu= 1-univipai wuc requires au nusmesses worKing In the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY .OF CUPERTINO BUSINESS LICENSE. " r � - " 1 ' � ,s-� ' �;,�lf,(a I am not using any subcontractors. 7�`� U "I Signature 4 Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date