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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; � -��'�� � rty t�r4 }T�,. ) 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 �� „ APN # OWNER NAME god PHONE �o� 0 ^ f77 `J E -MAIL STREET ADDRESS 2294/ — ^ 'e 47 l G (,t/ CITY, STATE, ZIP Cv?67,e7r1,(,(�(�� 7F-X CONTACT NAME / � PHONE /�il�_Q� ��� E- MAILVIJ ' Jefn (k, �( l STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME I�� J , A `( N�(./� LICENSE NUMBER n� LICENSE TYPE BUS. LIC # 'S COMPANY NAME % C.. l / EMAIS`r6✓6_10 CSC 0 /VJ�TR C %tt7� rKX 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 0 � . ,� T 0 /-.- \ 9 6F) t PgO ANUe-, w6t `Myo�w -LA w carl F&21 r l' I F Z-A tVr 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 Al ,1A 0� 9 I �06W_l n• •fr 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-.