15110052CITY OF CUPERTINO BUILDING .PERMIT
BUILDING ADDRESS: CONTRACTOR:, PERMIT NO: 15110052
10106 BYRNE AVE CUPERTINO, CA 95014-2807 (357 16 044) OWNER-BUILDVjR
OWNER'S NAME:
DATE ISSUED: 05/05/2016
OWNER'S PHONE: ( I PHONE NO -
101 Lei
O 1 1 \Y I t.;.. 11 lkvj 11 V-81 W41 k1r.1 I Well
License Class Lic. #
Contractor OWNER -BUILDER Date
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:
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.
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 1/18/2017
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
following two reasons:
1. I, as owner of the properly 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)
zlli, 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:
'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
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
Is- 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 X18.
Date 1/18/2017
BUILDING PEIMUT INFO:
_ BLDG_ ELFCT -PLUMB
_ MECH _ RESIDENTIAL _ COMMERCIAL
JOB DESCRIP'T'ION:
CONSTRUCT (1V) 2ND UNIT (488 S.F.)
Sq. Ft Floor Area: Valuation: $75000.00
i
APN Number: Occupancy Type:
357 16 044
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS ;FROM LAST CALLED INSPECTION.
Issued by: KIM 12UNBAR
Date: 05/05/2016
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: 1/18/2017
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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(x) 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 Sections 25505, 25533, and 25534.
i
Date: 1/18/2017
j
CONSTRUCTION LENDING AGENCY
I hereby affirm thajt there is a construction 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
CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS:
CONTRACTOR:
PERMIT NO: 15110052
10106 BYRNE AVE CUPERTINO, CA 95014-2807 (357 16 044)
D B LIN
CONSTRUCTION
MENLO PARK, CA
94026
OWNER'S NAME.
DATE ISSUED: 05/05/2016
OWNER'S PHONE:
PHONE NO: (650) 492-1236
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class a Lia #978548
Contractor D B LIN CONSTRUCTION Date 11/30/2016
—BLDG _ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
MECH RESIDENTIAL _ COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
JOB DESCRIPTION:
CONSTRUCT (1) 2ND UNIT (488 S.F.)
I hereby affirm under penalty of perjury one of the following two 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.
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
Sq. Ft Floor Area:
Valuation: $75000.00
permit is issued.
APPLICANT CERTIFICATION
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 16 044
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 regulations p rthe Cpoino Municipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
f
Issued
Signature DateU
by: Phuong Devries
Date: 05/05/2016
OWNER -BUILDER DECLARATION
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:
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
z. 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. 1 will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
3. 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
the Health & Safety Code, Sectio 25505, 25533 and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or utYYYNNNorized agent:
APPLICANT CERTIFICATION
Datesl
/ �
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
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.
I understand my plans shall be used as public records.
Licensed
Signature Date
Professional
CITY OF CUPERTINO 1r 1I
/ FEE ESTIMATOR - BUILDING DIVISION
ialADDRESS: 1010 Byrne Ave DATE: 11/09/2015
APN: 357 16 044 BP#:
REVIEWED BY: PAUL
VALUATION: 1$75,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: New Construction
PRIMARY SFD or Duplex
USE:
2nd Unit? G Yes 0 No
PENTAMATIUN 1 R3SFD2ND
PERMIT TYPE:
WORK
Construct N 2nd Unit 488 S.f.
SCOPE
$0.00
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. (s.E
R-3 (Custom) II-B,111-B,IV,V-B 488r ` $2,654.00 ' IR3PLNCK $1,666.00 IR3INSP
I TOTALS: 1 488 1 $2,654.00 I ) $1,666.00
tech Plan C'hcec% llhpF,,b. i"lwi2 Check f iec, Pion Check
i:le ch- Permii / e8: Futtaf'=, l'= # r .1 ?zf : Eke, pennit P�e:
0i,hes° ;fit<e:'h- .trt ° 3. Oilier Phar b kqj.-3. 0"her ble-•, t,r.p.
i<:r.l, zns.3. /:f1t,. lrtaf�, .1;t:=(;. sf;>t: 1. c;, 1,s, Fee:
Mn,rv. TZ.;...,os:,,.....s., .1— --# ir-.nlniln firm d— m nih— T►onnrfmor6fc /i o P]annina. Pnhlir Wnrkv 0rP_ .t'anitnry ,CPWPr nktrirt
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Tee Resolution 11-053 E{f 7/11132
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,654.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: •; Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,666.00
Suppl. Insp. Feer Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXR
1
# new
units
$687.10
ilea ninisfra ive I ee.
0
E)
Work Without Permit? OYes G No
$0.00
Advanced Planning. Fee: IPLLONGR
$68.32
Select a Non -Residential
Building or Structure 0
a
Trm-el.Docutnentafion Fees:
Strom Motion Fee: IBSEISMICR
$9.75
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$3.00
TSB-TOTALS
$5,088.17
$0.00 T4TALFEE
$5,088.17
Revised: 10/01/2015