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14010120El� CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10280 PLUM TREE LN CONTRACTOR: HONG FENG YIN PERMIT NO: 14010120 OWNER'S NAME: HONG FENG YIN 10280 PLUM TREE LN DATE ISSUED: 05/02/2014 OWNER'S PHONE: 4088880652 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E] CONSTRUCT ONE STORY ADDITION (710 SQ FT); License Class Lic.# BATHROOM REMODEL (130 SQ FT); OTHER INTERIOR REMODEL (800 Contractor Date SQ FT); PANEL UPGRADE (200 AMP). 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: 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: $100000 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: 31633013.00 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 DAYS F M—UA-S LLED INSPECTION. 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 co Issued by: Date: Z r y with all non -point source regulations per the Cupertino Municipal Code, ction 9.18. RE -ROOFS: Signature Date 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, ill do the work, and the structure is not intended or offered for sale (Se5.7,044, 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. -Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: ���%� Da permit is issued.te: 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.I8. / �L Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10280 PLUM TREE LN CONTRACTOR: HONG FENG YIN PERMIT NO: 14010120 OWNER'S NAME: HONG FENG YIN 10280 PLUM TREE LN DATE ISSUED: 05/02/2014 OWNER'S PHONE: 4088880652 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CONSTRUCT ONE STORY ADDITION (710 SQ FT); License Class Lie. # BATHROOM REMODEL (130 SQ FT); OTHER INTERIOR REMODEL (800 Contractor Date SQ FT); PANEL UPGRADE (200 AMP). I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business &Professions /lU/-2 4�RT' dSIOI51-#t1 =REVT E' Ji.O®RaPL�1 LAYOUT (INCREASE Code and that my license is in full force and effect. AN A.0 RTSSDk8/7/2014 a� 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: $100000 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: 31633013.00 Occupancy Type: permit is issued. p T EXPIRES IS NOT STARTED 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 W 180 SOF 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 DAYS AST CALLED INSPE TI N. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Issued by: Date: granting of this permit. Additionally, the applicant understands and will comply I with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, l agree to remove all new materials for inspection. OWNER -BUILDER DECLARATION Signature of Applicant: Date: 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 1, 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) owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE k,as s ct the project (See.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. Section 3700 of the Labor Code, for the performance of the work for which this 0/ 0 O ter r�authorrzed agegt�_ a!-� Date: / permi is issued. ify that in the performance of the work for which this permit is issued, I shall t 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 shal I be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Leader's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. 1 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. � Z;gitattrre - - _ Date AZI CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10280 PLUM TREE LN CONTRACTOR: HONG FENG YIN PERMIT NO: 14010120 OWNER'S NAME: HONG FENG YIN 10280 PLUM TREE LN DATE ISSUED: 05/02/2014 OWNER'S PHONE: 4088880652 CUPERTINO, CA 95014 PHONE NO: I� LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL [] CONSTRUCT ONE STORY ADDITION (710 SQ FT); License Class Lic.# BATHROOM REMODEL (130 SQ FT); OTHER INTERIOR REMODEL (800 Contractor Date SQ FT); PANEL UPGRADE (200 AMP). I hereby affirm that I am licensed under the provisions of Chapter 9 -M (commencing with Section 7000) of Division 3 of the Business & Professions RUQ""„— $ '4TISIFb #2i�A�DD'RE��GESSEID CEIIsING`IN I,IYI1a1GyRO0iVI, R MO Code and that my license is in full force and effect. REMO+ )1N I O�FIDDOOS 23,D 4rIt�1V1"SCPEOF WOISSIED 5/6/15 �_.'$ — r _ 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: $100000 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: 31633013.00 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 DAYS FROM LAST CALLED INSPECTION. 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```���1G granting of this permit. Additionally, the applicant understands and will comply Issued by: 1 V Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date 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. lar 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) .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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sections 25505, 25533, and 25534 : - 3r sn __ a� '"5�0 Owner or authorized agents �� 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 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 _ " 'eta Signature= v t+", Date CCUPEII&INO 1 NFW C ONSTRTIC TTON V CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 103010'TORRE AVENUE • CUPERTINO, CA 95014-3255 \� 408)777-3 228 • FAX (408) 777-3333 • buildingaacupertino.org . ADDITION. X AT.TF.R ATTCIN / TT IinI RAVTSTON / T)RFF.RRF.D ORTC'TTNAT. PERMIT # PROJECT ADDRES 290 (�tw� `fir lam— APN # �r 33-rf13 O RNAMEPONE / E-MAIL ' —�� _P i VL 4D� c� Pyra _ no " At". C, 7, STREET ADDRESSi %t�w> �YZ� LaYI C}TY, STATT, ZIP Let G.,,,� C FAX CO CT NAME WN PONE CH4o 48� 16� MAIL Ceryl__. 1-� -C,E-f L I A-0 / STREET ADDRTiSS C STATE ZIP 3 �i V P/i2.�t GLYO` o GL ElilOWNER ❑ OWNER-BUB.DER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT El ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME % LICENSENUMBER LICENSE TYPE BUS. LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE AR HITECT/ENG ER1 NAME t p LICENSENUMBER BUS. LIC # COMPANY N - MAIL �n FAX LH 2�� a c 0GIA�.G�-wL- STREET ADDRESS. CITY, STATE, ZIP PHONE DESCRIPTION Of WORK i 1 �+ fC "eke -FAIVZ l Ty A m'l e 9 1 � o t A iPX A- : aurt C UEy Le- St,,(/o rt 5 L - b �o v�v cam) b�.t� -rio A �oLo� a c�-l� I-v�rrL--, cin l�to�s o• EXISTINGp USE PROPOSED USE CONSTR. TYPE # STORIES F" I C f � V 1 e, V USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA 1 f7� „1.�,� NEW FLOOR AREA 7 f D DEMO' AREA TOTAL NET AREA 71 a BATHROOM KITCHEN OTHER REMODEL AREA` REMODEL AREA REMODEL AREAV ✓ V /T' _ wDP V,5 a PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGE AREA: DETACH OAT[ACH #DWELLINGUNITS: 1 IS A SECOND LTNrr YES BEING ADDED? SECONDSTORY DYES ADDITION? O I PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF PLANNING APPL# []NO PLANNING APPROVAL LEITER IS THE BLDG AN ❑ YES EICHLER HOME? NO RECEIVED BY v �' '` ✓,a'> x �` s 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 bav6 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 relatin t building constnAction. I autho� e representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicanUAgent: i{ INt� Date: SUPPLEMENTAL INFORMATIO UIRED =`rLa;Itici>EcxT%E°° ° rrrs>pne New SFD or Multifamily dwellings: Apply for 'is demolition permit for ❑1 OVER THE-COT7NTER: E { QRovr BUILDINGPL"ANREVTEW existing building(s). Demolition permit required prior to issuance of buildingJI permitnew. building. p � � ❑ 1;x� �� �- � rxEs9 Prnlv�vnvcrLnlvxEorEw .for Bldgs: Provide Hazardous Materials Disclosure � z, I " _Commercial a completed form if any Hazardous Materials are, being used as part of this project. s?rANDATZD m Ott 4r�i�Ew' PUBLICwoP . ❑ LaRc>y� -�� ❑ � � � � � � � �E,p�rr � � _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR a Y SANITARY SEWER DISTRICT submittal of Building Permit application.a. ENYIROIIVIETAr ITPiLiH, 4 BldgApp_2011.doc revised 06/21/11 (ose� CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT of 10300 TORRE AVENUE • CUPERTINO, CA 950'14-3 (408) 777-3228 ° FAX (408) 777-3333 • building aacuoertinD.org ❑ NEW CONSTRUCTION 0 ADDITION ❑ ALTERATION / TI 14'i EVISION EFERRED ORIGINAL PERMIT � O /aD P OJECTADDRFSS APN 4 I go PI ERNP.ME M10 I �ekCV Fluna_ � k1 - 1 G Cir � STREET DRESS I C�i-i 1, ST.A, ZIP - FAX C I�T,4CT NAI E PHONEU 1 p /� -MAIL CV/_ M DR Sara 'ZIP FAX t ,l �Slurk _ C ?-C-026 1:1OWTER ❑ OWKJ-BL•IIAER 13OWNERAGENT 13CONTIRACTOR El CONTRACTOR AGENr �ARCHITECT ❑ LNGINTER ❑ DEVELOPER ❑ TENAlTr CONTRACTOR ACTOR NAME I LICENSE NUMBER LICENSE TYPE BUS. LIC R COMPANY NAME E-MAIL F.AX STREET ADDRESS Crii Y. STATE, ZIP PHONE kkRCHITECTIENGINTEER. NAI\4E LICENSENUMBER BUS. LIC Pau T C `Z8 4 COMPANY NAME E-MAIL - I FAX L -HC, RkAiqyL -tnc. STREET ADD s �l 3 4-v&) 2GC ` •- CITY, STATE, ZIP sG1 (: W a PHONE p / QMO 4'O -j b-(— ESCRIPTION OF WORK =STINGL'SE PROPOSED USE CONSTR.TITE :STORIES I USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG =FLOOR DEMO 11 TOTAL AREA' ?ED -4�71 AREA O AREA NET AREA 2- Z BATHROOM TJTCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA 2� PORCHAREA DECK AREA TOTAL DECKIPORCH AREA GARAGE.AZYA: DETACH ❑ .4'rrACH �' DWELLING UNITS: r5 A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? 0 ADDITION? KIO TS PROV2DESDlL' OF �$ THE BLDG AN 111 rs mann BMS t> 6x - a TOTAL V TON: PLANTNINGAPPL-4 ❑NO PLA2`T�GAPPROVAL LBITER EICHLERHOh1E? 2. - r - MON 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 relati g t buildin�con ction. I a thorim representatives of Cupertino to enter the above -identified property ;for inspection purposes. SignatureofApplicant/Agent: —V—f7 Date:�fw' �7 SUPPLE? ?ENTAL INFORM ION REQUIRED err. a r5, New SFD or Multifamily divellings: Apply for demolition permit for C7 D\ER THECOURTERc xBL7IIDL\GPL11tRE�iE\V 1 existing building(s). Demolition permit is required prior to issuance of building , F permit for new building, '•'.c. pREss, 4 s h •r.,,� L6iT\'hIT�GPLAL.' _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure P n y fi ,r -.�sTDA'j 3�s _ ��ZT�£� �usz is woxxs� l form if anHazardous Maferials are being used as art of this )` g P project. t� s`. _ Copy of Planning Approval Letter or Meeting with Planning prior to y I$GE Ho- 'UM ragtE.DEP7 z }Lk a sti �.- ss ,je y SAniTRIrSE\{RDISTRICT submittal of Building Permit application. submittal Bldg.4pp_2011.doc revised 06/21/11 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228• FAX (408) 777-3333 • buildingGQcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI YREVISION /DEFERRED ORIGINAL PERMIT # P n "TI o'zyrvRES wu N C/ (D ER NAMEPHONE i ®/ -7 fig Y I I norl r STREET RESS �r (jr2.�. �AVIQi TTY, STAT , ZIP FAX GLVvL 'Yl,�"CA 2-ol O ACT NAM _ P ONE MAIL 'cls ®�d.c p �EADORE S S nSTATE ZIP OWNER ❑ OWNER -BUILDER ❑ VANEtRAAGEENNr ❑ CONTRACTOR ❑CONIRACTORAGENTXIARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE HITECs/F I`R NAME LICENSE NUMBER BUS. LIC k L COMPANY NAME ` MAIL Lau F (4o cim -"l' � -�3 S RE ADORES. r C ZIP /��i r �� Gt�TE' //304P2- D C ON OF ORK Tey 7 ?•C -f - tdl;" (/ vl (e) 7/y�d ynwL ' . EXISTING USE PROPOSED USE CONSTR.TYPE #STO S S 5 I USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR, .DEMO TOTAL AREA AREA AREA NET AREA -- BATHROOM. KITCHEN. OTHER. REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA . DECK AREA TOTAL DECKNORCH AREA GARAGE AREA: LJ DETACH '®''ATrACH JYES 9 DR'ELT D G UNITS: IS A SECOND UNIT E]YES SECOND STORY ` A BEING DDED? 5\ o ADDITION? 0 ., PRET-APPLICATION 171 YES IF YES, PROVIDE COPY OF PLANNING APPL ❑ NO ' PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO TOTAL TIO 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 relatit uilding constructs n. I authoriz1p....ntatives of Cupertino to enterthe above- identifi d property for ins tion purposes. ` Signature of Applicant/Agent: ` Date: SUPPLEMENTAL INFORMATION RED _ PSANaCI�C7�. _ � � _� ROUTInG`SLIP a OVERTICOUhTER BUbDII�GPLA7YREVIER' New SFD or Multifamily dwellings: Apply fo. emoli on permit for existing building(s). Demolition permit is required prior to issuance of building ,§ F permit for new building. o ] EXPRESS "� # ,� � PLANJ�LTtGPLANREVTEYV .v,r �3 � ,�'* Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sT�NnATZD0 PiIBLlrrwm zcs� _ if any Hazardous Materials are being used as part of this project. l]� t Y RNform -•; � T,ARtsl: � � EIItE DEPT 5 :� '$�: � _ Copy of Planning Approval Letter or Meeting with Planning prior to = ©MA70R�sA1 _ T�I?sE�RDTsRIc submittal of Building Permit application. BIdgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10280 Plum Tree Lane DATE: 01/21/2014 REVIEWED BY: Sean PC FEE ID APN: BP#: "VALUATION: $100,000 %PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? ' Yes ' No OTC? 0Yes No PENTAMATION 1R3SFDADD PERMIT TYPE: WORK Construct one story addition 710 sq ft); bathroom remodel 120 sq ft); other interior remodel 200 s SCOPE ft). OCCUPANCY TYPE: TYPE . CONSTR. s.f.FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 710 $2,577.00 IR3PLNCK $1,617.00 IR3INSP F,lee, Insp, Fee: $0.00 EKI s.f. $418.00 Remodel, Other IREMRESOTH Permit Fee: $1,617.00 Suppl. Insp. Fee:(F) Reg. Q OT 0,0 hrs $0.00 PNM Unit Fee: $0.00 PME Permit Fee:. $0.00 TOTALS: 710 $2,577.00: $1,617.00 MECII,:HOURLY Yes:. ,No` ® ®No :: °1PLIJM�,`)FIOITI2TY Q Yes ; • , ELEC,` IIOURLY =. Q Yes' Q No; 1Lti:ch. Plan -Check PhwlL Plan Cheel, Elec:..Plan (:;heck Mech. Permit Fce:. Plumb. Permit Fee: F,lec. Permit Fee: Other ,Meth. Insp. Other Plumb Insp. Other Elea Insp.L] Hc,ch. Insp. Fee:Plumb. Insp. ('ee: F,lee, 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 hated on the nreliminary information available and are only an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee:. $2,577.00 120 s.f. $626.00 Remodel, Bath (<=300 sf) 1REMRESBAT Suppl. PC Fee: (j) Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 EKI s.f. $418.00 Remodel, Other IREMRESOTH Permit Fee: $1,617.00 Suppl. Insp. Fee:(F) Reg. Q OT 0,0 hrs $0.00 PNM Unit Fee: $0.00 PME Permit Fee:. $0.00 Constivelion Tax: r4.di1nlnmstrative .Fee: 0 E) Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: IPLLONGR $99.40 Select a Non -Residential Building or Structure E) � Travel Documentation Fees: Strong Motion Feer. IBSEISMICR $10.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $4.00 SUBT®TATS: $4,307.40 -77 $1,044.00®TAE`FEE: $5,351.40 Revised: 01/15/2014 CITY OF CUPERTINO Ill FEE ESTIMATOR - BUILDING DIVISION iaADDRESS: 10280 Plum Tree Lane DATE: 07/10/2014 REVIEWED BY: Sean :b9e11h. Permit Fee: APN: BP#: f VD/()/ 1 *VALUATION: $0 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex _7PERMIT PEN TAMATION TYPE: 1GENRE WORK Revision #1: Revise the floor plan layout. SCOPE 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 preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) :19eclr. Plcrrr Check 11hrnrh. Plan Chet/ h,7ec. flan Check :b9e11h. Permit Fee: Plurnb. Pe:rmil Fee: 111"Iec Permit Fee: Other Mcch. Insp. Other Phrmb Insp. Other 1'lec. Insjr. 91 zclt. Imp. 1•Ae: Phtmb. hrsp. Fee: l;iec. Irish. f'ee: 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 preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 hours Plan Check, Hourly $286.00 ISTPLNCK A Suppl. PC Fee: Q Reg. 0 OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT 1 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 COni.s'f uctlon eLy: ,ldinini•4111"alive Fee: 0 E) Work Without Permit? 0 Yes G) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential) Building or Structure 0 Travel Docrttnenlalion fees: Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: 1 $0.00 $286.00;" TOTAL FEES 1 $286.00 Revised: 07/08/2014 CITY OF CUPERTINO W. MW FEE ESTIMATOR — BUILDING DIVISION imADDRESS: 10280 Plum Tree Lane DATE: 05/06/2015 REVIEWED BY: Sean �Vlecln. Per°rnit Fee: APN: BP#: 14010120 `VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex 1117trrzb. hisp. Fee: PENTAMATION PERMIT TYPE:, 1GENRE WORK #2: Add recessed ceilin in livingroom; remove remodel of bedrooms 2 3 and 4 from scope SCOPE LRevioslion k. r'^aa' 9N,�¢ ° p Nfech. Plan (:"heck Pturnnb. Plan Cheek Elect. Plan Check �Vlecln. Per°rnit Fee: plumb. Permit Fee: Elec. Permit Fee: Other Meeh. Insp. 01her Plumb Insp.Li Other Ekee. lnsp. L�j I— I'lech, Insp. Fee: 1117trrzb. hisp. Fee: Elee. Insp. lee: 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 Preliminary information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (j) No $0.00 L__l_j hours Plan Check, Hourly $143.00 ISTPLNCK Suppl. PC Fee: .(j) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee:(E) Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative.Fee: 0 Work Without Permit? 0 Yes i@ No $0.00 Advanced Planning Fee: $0.00 0 hours Inspections G $143.00 ' 1STINSP Inspection, Hourly 0 Travel Documentation Fees: Strong Motion .Fee:. $0.00 Select an Administrative Item Bldg Stds Commission .Fee: $0.00 LJBTOTALS $0.00 $286.00 _NOTAL FES • $286.00 Revised: 04/01/2015 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: t7 z 256 ( (. 4, PERMIT ## OWNER'S NAME: 10--), C � "j"/i PHONE # GENERAL CONTRACTOR: '+. !? BUSINESS LICENSE # _ ADDRESS: CITY%ZIPCODE: *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: Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper - Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date M W124 1 �� IM. CUPERTIND OWNER -BUILDER DISCLOSURE FOR[' COMMUNI T Y DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildino(p-�cuoeriino.org Dear Property C)wner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: sI T E ADDPESS APN BFI/yo / 0 / �, 0 �� � �b tel, / ►^-QP_ �-`l1 21,6 X 3 3 — 01 3 Z� OWNER NAI✓E 0wVNER ADDREaS 7 ��� �,^ J � O I V L4 DESCRIPTION OF WORK: /4 3 Zeyw We are providing you v✓ith an Owner-BuilderAcknov✓lodgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our oiilclal address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permHng authority. OWNER'S ACKNOWLEDGI1iENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signiy you understand or veri l this information.) '. l understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - :r" building permit that erroneously implies that the property owner is providing his or her own labor and material nally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by licensed person and his or her employees while working on my property. My homeowner's insurance may not le coverage for those injuries, l am willfully acting as an Owner -Builder and am aware of the limits of my ince coverage for injuries to workers on my property. 2. 1 understand building permits are not requiredto be signed by property.owners unless they are responsible for onstruction and are not hiring a licensed Contractor to assume this responsibility. 3, 1 understand as an "Owner -Builder" I am the responsible parry of record on the permit. I understand that l may ;ct myself from potential financial risk by hiring a licensed Contractor and having the permit' led in his or her Mead of my own. 4. 1' understand Contractors are required by law to be licensed and bonded in California and to list their license ;ellrs on permits and contracts. 5. (.understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the value of my construction is at least five hundred dollars ($500), including labor and materials, I may be idered an "employer" under state and federal law, 3. 1 understand if I am considered an "employer' under state and federal law, I must register with the state and 31 government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to ployment compensation for each "employee." I also understand my failure to abide by these laws may subject series financial risk. . I understand under California Contractors' State License Law, an Owner -Builder who builds single-family ntial structures cannot legally build them with the intent to offer them for sale, unless all work is performed by :d subcontractors and the number of structures does not exceed four within any calendar year, or all of the work ormed under contract with a licensed general building Contractor. � . I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for 01nancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 0-,77e7-B7d1de7-F07,7a 2010. doe revised 04/14/10 sd M: I understand I may obtain more information regarding my obligations as an "employer" from the Internal v` nue Service, the United States Small Business Administration, the California Department of Benefit Payments, a U.the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State Linse Board (CSLB) at 1-800-321-CSLB (2752) or vrww.cslb.ca.gov for more information about licensed 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I ie party legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide I applicable laws and requirements that govern Owner -Builders as well as employers. G1?. agree t0 notify the issuer of this form immediately of any additions, deletions, or changes to any of the V formation I have provided on this form. Licensed contractors are regulated by laws designed t0 protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONST RUC T ION LENDING AGE14CY (DIRECTIONS: Please complete the following construction lending agencyinformation.) 1 hereby afirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verncation acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Properly Owner's Signature:�r, 1 Date: -- ------------------------------------------------------------------------------------------------------------------------------------------- (NOTE. The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution o wwhich I understand is my personal responsibility, I herby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of VVcirk): Project Location or Address: Name of Authorized Agent: Tel No ,^-,ddress of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy o; the property owners driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owners signature. Property Owner's Signature: Date: 0i<merBLilde7ron7i?010.doc revised 01/14/10