15070081-DCITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7429 STANFORD PL
CONTRACTOR: MICTME17S-BUILDER
PERMIT NO: 15070081
OWNER'S NAME: XU TETE AND RUI SHI
39120 ARGONAUT WAY STE 165
DATE ISSUED: 08/07/2015
OWNER'S PHONE: 4087866574
FREMONT, CA 94538
PHONE NO: (510) 791-1588
um LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIALE]
Q
CONSTRUCT 1 STORY ADDITION (380 S.F), REMODEL 2
License Classes Lic. # �
(E) BATHROOMS (90 S.F), INSTALL (N) FURNACE IN
Contractors F✓ ate �/�/ [
ATTIC.
I hereby affirm that I am licensed under the provisions of C apter 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 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
Sq. Ft Floor Area:
Valuation: $70000
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
APN Number: 35932034.00
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 D S FROM LAST CALLED NW
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
e
'S,
granting of this permit. Additionally, the applicant understands and will comply
Issued by: (� Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
rte_
r5..¢- `1 _ ':
° '
ROOFS:
Signature ,���"'�'""_'�'" Date
r
All roofs shall be inspected prior to any roofing material being installed. If a roof is
any
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
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 (See.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 Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 9505,25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Owner or authorized agentLa�l. Date '
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
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
0
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(a)-cupertino.org
❑ NEW CONSTRUCTION 9 ADDITION ❑ ALTERATION 1 TI ❑ REVISION 1 DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS "" ,"rykrl rz J ICU
F �h"��� ` e
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APN # .3G41 — •� � .• 0 3
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OWNER NAME , • ►�
PHONE �L../ 574
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E -MAI.
STREET ADDRESS S ahn e /� L �a
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CITY, STATE, ZIP
7FAX
CONTACT NAME JM
PHONE / �,Q� 331, 64
STREET ADDRESS U 3d /�, �.`
9 C*
OWNER
e'
CITY, STATE, ZIP 'C>4* 11I "Ile'
.01
1Y,ARCHITECT
FAX
❑ OWNER ❑ O -BUILDER XOWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR A`GGENNT, ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE BUS. LIC #
COMPANY NAME
E-MAIL FAX
STREET ADDRESS
CITY, STATE, ZIP PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER BUS. LIC #
J
COMPANY NAME DE-MAILIP
STREET ADDRESS O,1 •N_'K/_Jy J� p�JV,
`i' ✓J�:/'
CITY, STATE, ZIP /�ry�n, Ui llW t / �►� G PHONE
DESCRIPTION OF WORK /� ,rue
w5� GV -3&"D qO
4m eeW C7) eoW*t"l bA4 "VW15-
EXISTINGUSE
jy .. 2 u
PRQPOOSED
rJ
USE CONSTRTYPE
y' 1 /
VN
Vf- }Z,
#STORIES
'
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTGU- yJ'
AREA (/` U
NEW FL006B
AREA
EMO✓TOTAL
AREA
NET AREA
BATHROOM�(
REMODEL AREA 9A (!J
KITCHEN
REMODEL AREA
OTHER
REMODEL AREA
PORCH AREA
_7
DECK AREA
T'/ ¢
(J
TOTAL DECK/PORCH AREA
2 35-
GARAGE AREA: DETACH
�g J ATTACH
# DWELLING UNITS:
/
ISA SECOND UUNITIT ❑ YES
BEING ADDED? I o
SECbO(ND STORY ,,.,❑......rrr000Y'''ES
ADDITION? KO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPL # A%iN0 PLANNING APPROVAL LEITER
IS THE BLDG AN ❑ YES
EICHLER HOME? j<NO
LVED BY - -
('
TOTAL VALUATION:
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 co uction. I authorize representati o to enter the above -identified property for inspection purposes.
Applicant/Agent:
Signature of Date:
SUPPLEMENTAL INFO TION REQUIREDPurr
cB Ecx TYPE
ROUTING SLIP
❑ OVER-THE-COUNTERBUH
DlvcrLnNI2EV1Ew
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPREss
PLANNINGPLANREVIEw
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
L7 sTAlvuaRn„
r'uBlrcvvORKS
_
form if any Hazardous Materials are being used as part of this project.
�] LARCE`
❑ FIRE DErr
_Copy of Planning Approval Letter or Meeting with Planning prior to
❑
DISTRICT'
submittal of Building Permit application.
MAaoltsANTTARY
SEWER
��•.
❑ ENVIRONMENTAL.HLALTH ."
B1dgApp 201 Ldoe revised 06/21/11
CITY OF CUPERTINORM-7,
FEE ESTIMATOR — BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 7429 Stanford Place
DATE: 07/13/2015
REVIEWED BY: Paul
PC FEE ID
APN: 359 32 034
BP#:
*VALUATION: 1$70,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE: p
2nd Unit? Yes •' No
OTC? 0 Yes E) No
PENTAMATION
PERMIT TYPE: 1 R3SFDADD
WORK
Construct 1 Story addition 380 S. Remodel 2 E Bathrooms 90 S.
SCOPE
Suppl. Insp. Fee -.(D Reg. Q OT
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.,
P& a #
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,III-B,IV,V-B
380
$1,626.00
1ADDPLCK
1,323.00
IADDINSP
Elec. Insp. Fee:
$1,323.00
Suppl. Insp. Fee -.(D Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Adtninistrative Fee:
Work Without Permit? Yes (F) No
$0.00
TOTALS:
380
$1,626.00
7ravel Documentation 14'ees:
$1,323.00
Strong Motion Fee: IBSEISMICR
ME.CH, HOURLY' . 0 Yes E) No
PLLTMB, HOURLY Yes .No
ELEC, HOURLY e Q Yes Q No
,bfech. Plan (.'heck
Plumb. Plan (:'heck
Elec...Plan Check
Flech. Permit Fee:
Plumb. Permit Fee:
Elec. Permit Fee:
Other AIech. Insp.
Other Plumb Insp. Li
Other Elec. Insp. Li
Wech. Insp. Fee:
Plumb. Insp. Fee:
Elec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711113,)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,626.00
90 s.f. Remodel, Bath (<=300 sf)
$645.00 1REMRESBAT
Suppl. PC Fee: Q Reg. 0 OT0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,323.00
Suppl. Insp. Fee -.(D Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Adtninistrative Fee:
Work Without Permit? Yes (F) No
$0.00
Advanced Planning Fee: 1PLLONGR
$53.20
Select a Non -Residential
Building or Structure 0
i
7ravel Documentation 14'ees:
Strong Motion Fee: IBSEISMICR
$9.10
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$3.00
SUBTOTAi
$3,014.30
$645.00 TOTAL T,
i
Revised: 07/02/2015