14120008-D)S,'
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20849 GREENLEAF DR
CONTRACTOR: SIMON ZHANG PERMIT NO: 14120008
OWNER'S NAME: HUANG XIANGDONG AND ZHANG XIAOYI
18488 PROSPECT RD DATE ISSUED: 05/28/2015
OWNER'S PHONE: 4083327690
SARATOGA, CA 95070 PHONE NO: (408) 887-0591
fu/LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
REMOVE (E) ACCESSORY SHED AND CONSTRUCT (N) 1
License Class_ Li #/1,.
STORY 2ND UNIT WITH 1,261 S.F (2 BEDROOMS/1 BATH)
Contractor.
I hereby affirm that I am licensed under to 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 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: $230000
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
b'ection 3700 of the Labor Code, for the performance of the work for which this
APN Number: 32609007.20849
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 DRMIT 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 AST C SPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
ate:
granting of this permit. Additionally, the applicant understands and will comply
s
with all non -point source regulations per the Cupertino Municipal Cod Sectio
RE -ROOFS:
9.18.
Signature e k/
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
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 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 25505, 25533, and 25534.
�u
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: C Date:------------
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
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
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
Ve
mak: a.a
•
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ` V
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 `
(408) 777-3228 •FAX (408) 777-3333 • building a(�cupertino.or q O
NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESSJtq _7+
APN k
OWNERNAME I PHONE 7- 6
X 'Cly U /V
E-MAIL J �L4(A
(� �- Maryl
,
STREET ADDRESS
'2
%� FAX
CITY, STATE, ZIP IA 7 /' CA
P7C
0
(�
CONTACT NAME
PH%o / _ (�➢i (Q
E-MAIL
STREET ADDRES CITY, STATE, ZIP r�FAX
2
- C �\ 1-G- H O U
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ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
❑ OWNER 1:3OWNER-BUILDER ❑ OWNER AGENT El CONTRACTOR 13 CONTRACTOR AGENT b<_
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC k
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
CHITECT NGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
- `e
Provo, 4- S Y h
EXISTING USE
PROPOSED USE CONSTR
TYPE
#STORIES
'n
r¢-
Y) �J
V I
USE TYPE OCC.
SQ.FT.
VALUATION (S)
EXISTG
AREA % j _
!(J
NEW FLOOR
AREA / I
DEMO
AREA �2 2 /�
/
TOTAL
NET AREA
�(p
�I C
B�
C V v1 0
BATHROOM
REMODEL AREA
KITCHEN
REMODEL AREA
OTHER
REMODEL AREA
ll..
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA
GARAGE AREA: DETACH
❑ ATIACH
9DWELLINGUNI 'I'S:
ISASECOND UNrrc� [j YES
SECOND TORY E] YES
BEING ADDED? ❑NO
ADDITION? ❑NO
PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑YES
TOTALVALUATION:
PLANNING APPLX NO PLANNING APPROVAL LETTER
EICHLER HOME? FIND
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the opA 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 accur I agree to comply with all applicable local
ordinances and state laws relating tog construction. I autho .ze representatives of Cupertino to enter the above -identified property for inspection purposes.
C 1
Signature of Applicant/Agent: Date: C 2^
SUPPLEMENTAL 0RMAT1CM_REQbfT1SD
PLAN cPrEciT��E ...u_..
Y . RouTuac silr
Q OVER THE COUNTER s'
❑ BUILDING PLAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition per is required prior to issuance of building
*
a
permit for new building.
❑ {EXPRESS 4 e
❑ PLANI\II\G PLAN REVIEW e
vp1Yu
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ sTAnnnRD
❑ PVBLIcwoRxs '
form if any Hazardous Materials are being used as part of this project.
a3
❑
LARGE w
FZRE DEPT
Copy of Planning Approval Letter or Meeting With Planning prior to
p
❑'
_
submittal of Building Permit application.
IVIArox
sAnITAIiY SEwER:I)ISTRICT:
.'
.❑+•ENVIROIvfiIENTALIHEALTFi. ,
BldgApp_2011.doc revised 06/21/11
"'I,
CITY OF CUPERTINO
10 oiAVIO FFF. FRTIMATOR —BUILDING DIVISION
igADDRESS:
208441GREENLEAF DR
DATE: 12/02/2014
REVIEWED BY: MELISSA
PC FEE ID
APN: 326 09 007
BP#:
VALUATION: $230,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: New Construction
PRIMARY
USE: SFD or Duplex
2nd Unit? '' Yes 0 No
PENTAMATION 1 R3SFD2ND
PERMIT TYPE:
WORK I
REMOVE E ACCESSORY SHED 336 S.F. CONSTRUCT N 1 STORY 2ND UNIT WITH 1,261 S.F
SCOPE
(2 BEDROOMS/1 BATH)
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
S.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,III-B,IV,V-B
1,261
$2,715.89
IR3PLNCK
$1,887.73
IR3INSP
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,887.73
Suppl. Insp. Fee:O Reg. 0 OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
1,261
$2,715.89
Construction Tax: 1BCONSTAXR
1 $1,887.73
# new
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, Schoot
nictrirt erc ) The.ce fees are hated nn the nreliminary information available and are onlv an estimate. Contact the Dept for adda'l info.
FEE ITEMS (Fee Resolution 11-053 Ef ' 711113)
t fech, Man "heck
1'1111rrh. Plum C. he('%
Check
mech. P2rutit F e
I'lerxzh. Fevinit ";,ee:
h7vc. Per)Wf Fce.
Ofhcr ,t loch. Irrsp
!other Pi11;nb /VuPsLi
Usher Ins"',
i?e.
P/21n1b. hisp. /.ev.
Elec. InS17. 1`;?O:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, Schoot
nictrirt erc ) The.ce fees are hated nn the nreliminary information available and are onlv an estimate. Contact the Dept for adda'l info.
FEE ITEMS (Fee Resolution 11-053 Ef ' 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,715.89
Select a Misc Bldg/Structure
or Element of a Building
A
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,887.73
Suppl. Insp. Fee:O Reg. 0 OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: 1BCONSTAXR
Filunits
# new
$667.73
_ 2. irninistr ati t a Fee:
0
0
Work Without Permit? 0 Yes C• No
$0.00
Advanced Planning Fee.
IPLLONGR
$176.54
Select a Non -Residential
Building or Structure
0
0
TrowelC7r>r, urrr.arat�,'iu,t IE7�>.>:
Strong Motion Fee:
IBSEISMICR
$29.90
Select an Administrative Item
BIL --Std Commission Fee: IBCBSC
$10.00
SUBTOTALS:
$5,487.791
$0.00 ° TOTAL FEE -T
$5,487.79
Revised: 10/01/2014
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: zo 8 ,r�.�
PERMIT # X6)00
OWNER'S NAME:414 &44`IT14
PHONE # 'C
GENERAL CONTRACTOR:
BUSINESS LICENSE #
ADDRESS:
CITY/ZIPCODE: f
*Our municipal code requires all businesses 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.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
o/
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
ELEC-J ICAL
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
L' I -i J� � 0,'A'i CC;,( h C_
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Ay' A2L /xic .
-?0oo �?
Tile
Owner / Contractor Signature
Dat
Sep. 2, 2015
To: Building Inspector
City of Cupertino
10300 Torre Ave.
Cupertino, CA 95014
Re: Final framing inspection
20849 Greenleaf Dr.
Cupertino, CA 95014
Dear Mr. Building Inspector,
IqQ vd'
I have a final review the framing work at the job site of 20849 Greenleaf Dr. at Aug. 29,
2015. I found the final framing works comply with approved plans.
Should you have question, please contact me at 408-446-8418.
Sincerely p>
Mike Clfa`e�f"
H.M.C.
12280 Sar
atogas�' Rd. #209
Saratoga, CA 95070