15090030-FPCITE' 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
.NWS PHONE: 6508104473
OW
SANTA CLARA, CA 95050
PHONE NO: (408) 845 -9010
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
x
REMODEL KITCHEN (380 SQ FT); REMODEL (2) BATHROOMS
(106 SQ FT); OTHER REIGIM% ((523 SQ FT); PANEL
License Class t Lic. 4
UPGRADE (200 AMP); REPLACE WINDOW IN KITCHEN;
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Contractor d 1 � ��55, , r i "l I Dat f "' � ' M'
iw
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:
Sq. Ft Floor Area:
Valuation: $70000
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.
APN Number: 32618024.00
Occupancy Type:
1 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.
PERMIT EXPIRES IF WORK IS NOT STARTED
APPLICANT CERTIFICATION
WITHIN 180 DAB'S OF PERMIT ISSUANCE OR
1 certify that 1 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
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
c
/ n� n fC/ // LNG
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Issued by: 1 uLV _-_1 Date: V
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`'`` Date �V�
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
t. I, as owner of the property, or my employees with wages as their sole
HAZARDOUS MATERIALS DISCLOSURE
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
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.
i. I have and will maintain a Certificate of Consent to 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
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
performance of the work for which this permit is issued.
Health & Safety Code, Sections 25505, 25533, and 25534.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
t
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued..
Owner or aX_ the 6,,%
Datc:,! w
s. I certify that in the performance of the work for which this permit is issued, l 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. 1 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 1 ,ZgCO20 ,
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
CUP6Ri1P�i0 (408) 777 -3228 • FAX (408) 777 -3333 • building(d_)cupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION AL
u TERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS A ^ 0 / ���n ��
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APN #
OWNER NAME god
PHONE �o� 0 ^ f77 `J
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STREET ADDRESS 2294/ — ^ 'e 47
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CITY, STATE, ZIP Cv?67,e7r1,(,(�(��
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CONTACT NAME
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STREET ADDRESS CITY, STATE, ZIP FAX
❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
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LICENSE NUMBER n�
LICENSE TYPE
BUS. LIC #
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COMPANY NAME %
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STREET ADDRESS
CITY, STATE, ZIP
PHONE` �1.,c� �1j}- _gCJ0
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC ##
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK C� aAVAQ&m M `l / L
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EXISTING USE
ROPOSED USE
CONSTR. TYPE
# STORIES
AIu P(�
f
,4AI Pee,
D l TO
ITOTAL
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
AREA
AREA
AREA NET AREA
BATHROOM KITCHEN , I OTHER
REMODEL AREA / REMODEL AREA a J REMODEL AREA
1 0
PORCH AREA
DECK AREA
TOTAL DECKNORCH AREA
GARAGE AREA: El DETACH
[D kTrACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ Y5S
SECOND STORY ❑ YES
BEING ADDED? 2olqO
ADDITION? UN6
PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIVED BY =
.' TOT VALUATION:
PLANNING APPL # []NO PLANNING APPROVAL LETTER
EICHLER HOME? R .AO
000
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
Z PLAN 6H'ECKTYPE ' r
ROUTING SLIP
[ oVER�TIIE Couz�TER
❑ BUILDING FLAN REVIEW
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.
El EXPRESS.
PLANNING.PLANREVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
q STANDARD
❑ PUBLICwORKS
form if any Hazardous Materials are being used as part of this project.
LABGE
❑' EIRE -DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
JOR
❑ �SANITARY $EwERDISTRICT
submittal of Building Permit application.
,
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
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CITY OF CUPERTINO 1500 W3D
FEE ESTIMATOR - BUILDING DIVISION
r
ADDRESS: 22066 Clearcreek Ct.
DATE: 09/03/2015
REVIEWED BY: PAUL
Mech. Perini[ Fee:
APN: 326 18 024
BP #:
'VALUATION: 1$70,000
%PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Plumb. Insp. Pee:
PENTAMATION 1 R3SFDREM
PERMIT 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
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 Elf. 711113)
Nfech. Plan Check
Phunb. Plan Check
Elec. Plan Check 0.0 1 hrs $0.00
Mech. Perini[ Fee:
Plumb. Permit Fee:
Elec. Permit Fee: IEPERMIT
Other A /ech. 1T1,Sp,
Other Plumb Insp.
Other Elea Insp. 0.0 hrs $48.00
,4lech. Insp. Pipe:
Plumb. Insp. Pee:
Elec. Insp. Pipe:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 Elf. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
150 s.f.
$645.00
Remodel, Kitchen (< =300 sf)
IREMRESKIT
Suppl. PC Fee: (j) Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
F106 s.f
$645.00
Remodel, Bath (< =300 sf)
IREMRESBAT
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0,0
hrs
$0.00
200 s.f. Remodel, Other
$431.00 IREMRESOTH
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
200 amps Electrical
$48.00 IBELEC200 Services
Construction Tax.
Administrative Fee: 1ADMIN
$45.00
0 #
$431.0011
Window / Sliding Glass Door
WINMP Replacement
Work Without Permit? ® Yes Q No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
G
0
i
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$9.10
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$3.00
SUBTOTALS:
$153.10
$2,200.00
TOTAL FEE::
$2,353.10
Immow
IMMOPP, ilAwas, A#
CUPERT.INO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Tone Avenue
Cupertino., CA 95014 -3255
Telephone: 408 - 777 -3228
Fax: 408- 777 -3333
JOB ADDRESS: 22066 Clearcreek Ct, Cupertino, CA
PERMIT # 15090030
OWNER'S NAME: Ronald Yu
PHONE # 650 - 810 -4473
GENERAL CONTRACTOR: CSCI CONSTRUCTION INC
BUSINESS LICENSE # 36474
ADDRESS: 2574 Lafayette St, Santa Clara, CA
CITY /ZIPCODE: Santa Clara /95050
*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
Please check applicable subcontractors and complete the following information:
Date
Owner / Contractor Signature Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
.Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
X
Heating
Air and Plumbing Systems Inc
31732
Insulation
Landscaping
Lathing
Masonry
X
Painting / Waltpaper
Green Brush
40246
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
X
Sheet Rock
Green Brush
40246
Tile
Owner / Contractor Signature Date
0
CITY OF CUPERTINO 15GqC030,
FEE ESTIMATOR — BUILDING DIVISION
19
ADDRESS: 22066 Clearcreek Ct.
Phunb. Plan Check
DATE: 09/03/2015
REVIEWED BY: PAUL
Plumb, Permit Fee:
APN: 32618 024
BP #:
Other Plumb Insp.
°VALUATION: Iso
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
hrs
$0.00
PENTAMATION I REAP1
PERMIT TYPE:
WORK 1,
Ml�IT�M. [Remodel Kitchen 380S•.f. 2 Bathrooms 106S.f. Other 200S.f. Panel Upgrade to 200
SCOPE
mp, eplace window in Kitchen, Remove 2 fireplaces, in Living Room, Install 23 (N) Recessed Lights
NOTE: This estimate does not include fees due to other Departments (i.a Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept/or addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 Fff 711113)
He& Plan Check
Phunb. Plan Check
Elec. Plan Check 0.0 hrs $0.00
hleclr. Permit Fee:
Plumb, Permit Fee:
Elec. Permit Fee: IEPERMIT
Other AIcch. Imp.
Other Plumb Insp.
Other Elea Insp. 0.0 hrs $48.00
Mech. Insp. lee:
Plumb. Insp. Fee:
Elec. Imp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.a Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept/or addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 Fff 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
23 #
$90.00
Electrical
IBREMFIXT Fixtures, Lighting
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:E) Reg. Q OT
1 0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
Conso- action Tax:
Administrative Fee: IADMIN
00
)
Work Without Permit? 0 Yes Q No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
Q
0
i
Travel Documentation Fee: ITRAVDOC
$ .00
Strong Motion Fee:
$0.00
Select an Administrative Item
q0
Bldg Stds Commission Fee:
$0.00
SUBTOTALS;
$141.00
$90.00
TOTAL FEE:
$2
.00
Revise-.