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14060194CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19160 TWIG LNI CONTRACTOR: JEREMY MAO INC I PERMIT NO: 14060194 OWNER'S NAME: LIN FELIX CHANGMIN AND RUBY C 13212 CARRICK ST IODATE ISSUED: 12/01/2014 OWNER'S PHONE: 4082688668 Cl LICENSED CONTRACTOR'S DE�C•LARATION License Class_ Lic. # 2-- Contractor�iVG - Date_LV" 7-N 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 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 permit is issued. '( M tJ 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. �_ Date �W Signature ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) 1, 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 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 permit is issued. 1 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 9.18. Signature. Date SARATOGA, CA 95070 I PHONE NO: (408) 449-9942 JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ CONSTRUCT 2 STORY SFWL 3458 LIVING, GARAGE 507 SQ FT AND PORCH 304 SQ FT Sq. Ft Floor Area: I Valuation: $690000 U'N Number: 37508021.00 1 Occupancy l ypc: PERMITEXP S IF WORK IS NOT STARTED WITH F PERMIT ISSUANCE OR 180 DAY R L T CALLED INSPECTION. Issued by: Date: RE -ROOFS: 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: 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 (lie Health & Safety Code, Section 25532(a) 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 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. / Owner or authorized ager Date: CONSTRUCTION LENDING AGENCY I hereby affirm that 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 Professional — 9-> I CUPERTINO n — CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building aQcupertino.org r -7n e T TLD A-ri nm / TT I RFVTCTn1 J I nFFFR RFn �a nRTG AL PERMIT n LJ NEVA! W C 0NSTRuL.11Vry I— I t�LL111V,V u - PROJECT .ADDRESS � � i I 0 _TVJ t `(7 /v)i1 L�C APN 4 OWNERNAME PHONE E-MA_ILX�5L "3!A STREET ADDRESS ,7O/i ��'�n �� i /i� I CITY, STATE, ZIP C�� ` G SQ gsr ( FAX C / PHO;�t l�� _ "c'-`� r (Qj E-MP.IL �i C k ® L IY16i / i Af­ CONTACT NAME M (ne_ �,^ rY� i Ii ♦ 4 C STREET.ADDRESS CITY, STATE , ZIP S�1��� c � IC; ?0 z a C" Yr- —S��v►� vc , ❑ ORTTER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTILACTOR ❑ CONTRACTORAGENT RCHITECT ❑ ENGLNEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME I LICENSE NUMBER LICENSE TYPE BUS. LIC R COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP I PHONE CHITS GR_ EER NAME LICENSE NUMBER BUS. LIC k COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK Lk- L��11 EXISTING USE PROPOSED USE CONSTR TYPE 1 STORIES Z USE TYPE OCC. SQ.FT. VALUATION (i) 12— —' V EXISTG / NEW FLOOR AREA DEMO AREA TOTAL NET ARE / �i E� 3# (-BUD GO .'^. AREA i {�(L r 4 li I �:- BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA /�� D 1•J, -C.• d Q (� PORCH AREA DECK AREA TOTAL DECK/PORCH AREA DU GARAGE .AREA: DETACH �,eCI'TACH Vll' G� 7j G \ -/ G':JU D�4'ELLING UNITS: ISA SECOND UNIT S BEING ADDED? NO SECOND STOR1' ❑YES ADDITION? E3 NO PRE -APPLICATION- IF YES, PROVIDE COPY. OF PLANNING APPL9 ❑N PLA.NNLNCtAPPROVAL LETTER I IS. THE BLDG.AN❑YES EICHLERHOME? No RE�EIVEDBY ,� , - - 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 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 bui ing construction. 1 authorize representatives of Cupertino to enter the above -identified property for inspection purposes. 1 Signature of ApplicanUAeent: Date: SUPPLEMENTAL INFORMATIONREQUIRED riAn'cHsCKTYPEL sLTP New SFD or Multifamily dv�Tellings: Apply for demolition permit for Wft�t"R� ©xl bVER TH�COUNTER k B€TJII 06'6 ;1I RE -a - existing building(s). Demolition permit is required prior to issuance of building existing e �h� W. r�'�x permit for new building. ©E?3RESS z yfl1PJ A I�GPL �2EVIEs' "r�00�� t Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTAI DARDS r PUBIdQi90RKS t I _ form if any Hazardous Materials are being used as part of this project. " Z �� �� �� --n"'-1 s — x tea`` DEPS i ,� r �t� _ Copy of Planning Approval Letter or Meeting with Planning prior to Building Permit application. rte" + submittal of '�;� �T �.�.:,s.• 'IRONT4ENTAL` HEALTH g� �.,�x-����,z��- . - BldgApp_2011.doc revised 06/21/11 ,��,����� CITY OF CUPERTINO I.�/.l�l FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 19160 twig lane DATE: 06/30/2014 REVIEWED BY: Mendez PC FEE ID APN: BP#: ! *VALUATION: 1$690,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY USE: SFD or Duplex 2nd Unit? Yes " No PENTAMATION PERMIT TYPE: 1 R3SFD i WORK construct 2 story sfwl 3963 living garage 507 sq ft and porch 304 sq ft SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 4,774 $3,238.00 IR3PLNCK $3,860.20 IR3INSP $0.00 PME Plan Check: $0.00 Permit Fee: $3,860.20 Suppl. Insp. Fee -0 Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 4,774 $3,238.00 $3,860.20 NOTE: This estimate does not include fees due to other Departments ('tie. Planning, Public Works, Fire, Sanitary Sewer District, School Metrirt otr 1 Th~ foot oro hacod an tho nroliminary infnrmation available and are aniv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E,f. 7/1113) ,u /1 (r�3ii Irltt�lt l7, I1 r,�I7. I'8E'. F NOTE: This estimate does not include fees due to other Departments ('tie. Planning, Public Works, Fire, Sanitary Sewer District, School Metrirt otr 1 Th~ foot oro hacod an tho nroliminary infnrmation available and are aniv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E,f. 7/1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,238.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $3,860.20 Suppl. Insp. Fee -0 Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR # new units $659.99 0 0 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: IPLLONGR $668.36 Select a Non -Residential Building or Structure 0 0 Strong Motion Fee: 1BSEISMICR $69.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $28.00 SUBTOTALS: $8,523.55 $0.00 TOTAL FEE: $8,523.55 Revised: 04/01/2014 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19160 TWIG LN CONTRACTOR: JEREMY MAO rNC PERMIT NO: 14060194 OWNER'S NANIE: LIN FELIX CHANGMIN AND RUBY C 13212 CARRICK ST DATE ISSUED: 12/01 /2n 1-1 OWNER'S PHONE: 4082688668 SARATOGA, CA 95070 PHONE NO: (408) 449-9942 L' LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ CONSTRUCT 2 STORY SFWL 3458 LIVING, GARAGE 507 SQ License Class��,j_� Lic. # Z— FT AND PORCH 304 SQ FT / Contractor glff llibe Date I hereby affirm that I am licensed under the provisions of Chapter 9 1/2/14 - REV #1 -ADD ADDITIONAL 21 SQFT TO GUEST RM IN IST UNIT & (commencing with Section 7000) of Division 3 of the Business & Professions RELOCATE WATER HEATER LOCATION TO OUTSIDE UNIT 2 Code and that my license is in full force and effect. BEDROOM- ISSD 1/15/15 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: $690000 } erformance 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 abor Code, for the performance of the work for which this APN Number: 37508021.00 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 gF 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 comp ate: O / with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: 4IVLAll Signature Date 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: [ 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 1 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 1 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. / Owner or authorized agent:�r�=`/��i /% Da 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. Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building0cuoertino.org / O Ja V ❑ NEW CONSTRUCTION ❑ ADDITION 1-1 ❑ ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT # / 7 0,6 Q 7-05 PROJECT ADDRESS ` I r 'V W l ` Y(/ APN # .� — 0 b OWNERNAME 17 a 4 A PHONE e— E-MAIL STREET ADDRESS / 4o 4/1G ,! CITY, STATE, ZIP /,� FAX CONTACT NAME. �FAI/ p PHONE"_ Q 1J� J(r E-MAIL STREET ADDRESS �� �/!/�`/ lz: CITY, STATE, ZIP O iin FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME JWr LICENSE NUMBER //�j� t? LICENSE TYPE BUS. LIC # Z L Z COMPANY NAME , I,( /we ­ E -MAIL d ` J ('.•-' /�'��� FAX STREET ADDRESS3 J-/ y eOlzirk s % /C CITY, STATE, ZIP v PHONE �L 70- ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC ## COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK�DD GL (2) ?'4 YM T OW 40" 4 D Y• V 'J�^ � I L_,( ROD") 1,4( EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES I USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODELAREA PORCH AREA DECK'AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES ' BEING ADDED? []NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECAL VALUATION: NO PLANNING APPROVAL LEER PLANNING APPL # ❑ TT EICHLER HOME? [:]NO By my signature below, I certify to each of the following: I am the property owner or authorized agent to a 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: /A yam SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN 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. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑;; LARGE ❑ FIRE DEPT —Copy of Planning Approval Letter or Meeting with Planning prior to ElMAJOR ❑ submittal of Building Permit application. SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO WENN FEE ESTIMATOR — BUILDING DIVISION 1AADDRESS: 19160 TWIG LN DATE: 01/02/2015 REVIEWED BY: MELISSA APN: 375 08 021 BP#: 14060194, 14060209 *VALUATION: $0 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 0.0 PENTAMATION I PERMIT TYPE: WORK 1/2/14 - REV # 1 -ADD ADDITIONAL 21S.F. TO GUEST RM IN 1ST UNIT & RELOCATE WATER SCOPE HEATER LOCATION TO OUTSIDE UNIT 2 BEDROOM NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School n:s_:,.. „•,. 1 Wt. - A. ,4 . 06" nrolisssinnne in fnimntinn nvnitn6lo and OTO OdIV an O.Ct[/n/IiP_ Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 11-053F, . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 i)fr7v 1' 1'Iir•'it%? ?? ;i' L)d'e, 1:tcc, Ir`;,'.1,jec.h�'p. Fv: 0.0 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School n:s_:,.. „•,. 1 Wt. - A. ,4 . 06" nrolisssinnne in fnimntinn nvnitn6lo and OTO OdIV an O.Ct[/n/IiP_ Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 11-053F, . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F) Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 7 PME Unit Fee: $0.00 PME Permit Fee: $0.00 f3?i.511'!1C'7IC>3i Ildi': G) Work Without Permit? Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 � s /t"!d'v'c'a ./.�,C1C:11771c'1#PLYi7c%d2 /'t t',�: Strong Motion Fee: $0.00 F-7-1 # $859.00 Revisions IREVSFDWL I SFDWL Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $859.00 TOTAL FEE: $859.00 Revised: 10/01/2014 CITY OF CUPERTINO BUILDING PERMIT IIUILDING ADDRESS: 19160 TWIG LN CONTRACTOR: JEREMY MAO INC PERMIT NO: 14060194 OWNER'S NAME: LIN FELIX CHANGMIN AND RUBY C 13212 CARRICK ST DATE ISSUED: 12/01/2014 OWNER'S PHONE: 4082688668 SARATOGA, CA 95070 PHONE NO: (408) 449-9942 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL (�j Z" CONSTRUCT 2 STORY SFWL 3458 LIVING, GARAGE 507 SQ License Class__ Lic. # a / FT AND PORCH 304 SQ FT Contractor_r d -A-0— /G Date r I hereby affirm that I am licensed under the provisi ns o Chapter 9 REVISION #2=.#EVIVE STRUCTURAL MODIFICATIN TO STAIRWAY - (commencing with Section 7000) of Division 3 of the Business & Professions ISSD OTC 2/27P2015 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 th Sq. Ft Floor Area: Valuation: $690000 performance of the work for which this permit is issued. � I have and will maintain Worker's Compensation Insurance, or by Section 3700 of the Labor Code, for the performance of the w or which this APN Number: 37508021.00 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 D YS 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 O 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 7 `Y granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18. � Signature Date y 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 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) 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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sections 25 OS 25533, and 25534. Owner or authorized agent: 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. Signature Date CITY OF CUPERTINO L,% I FEE ESTIMATOR - BUILDING DIVISION 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 nreliminary information available and are only an estimate. Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 11-053 E,f'. 7/1!13) ADDRESS: 19160 twig In DATE: 02/27/2015 REVIEWED BY: Mendez imN APN: BP#: 'VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: I PENTAMATION 1GENRES PERMIT TYPE: WORK REVISION #2- REVIVE STRUCTURAL MODIFICATIN TO STAIRWAY- ISSD OTC 2/27/2015 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 nreliminary information available and are only an estimate. Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 11-053 E,f'. 7/1!13) ;/tech. flan Check Phrrnh. Plan Check 1,lec. Plan Check 1LfeC/7. Per/n!r F. 11111mb, Perrnn Fee: �siiC 1','rn17r Fee" Oi,wr .Vech. lnsp. Vier Plum 1) is Other tiler. Irttp. /.'- 1 r; risp. Fee: 17Pr Insp. 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 nreliminary information available and are only an estimate. Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 11-053 E,f'. 7/1!13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 1 hours Plan Check, Hourly $143.00 ISTPLNCK Suppl. PC Fee: (F) Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -.0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR Q units # new $0.00 Idinin str(itive Fee: E) Work Without Permit? O Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) i Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: 1 $0.00 $143.00 TOTAL FEE: $143.00 Revised: 02/14/2015 . .. _..--. -. r CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(d)cupertino.org r—I 1-1 . n nci/rcTnwT /iICTtD DCiI nPTr TKAT PT N/TTT;q LJ IVLW VV1�J al\ll �.i aV+tJ ..✓r'...v'. V� _...._�_�___�_.. __ �� _—..-_. PROJECT ADDRESS / / / 0 OWNER NAMELl is L N PH/07NEp�0 JJ E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX 13OWNER ❑ OIANER-BUIIAER ❑ OU'NER AGENT ❑ CONTRACTOR - ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMES rQ n n D v'' ' / y / LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE # STORIES 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 DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNTrS: IS A SECOND UNIT ❑ YES SECOND STORY [:]YES BEING ADDED? ❑NO ADDITION? [:]NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF APPL # ❑NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑YES, EICHLERHOME? ❑NO"^`5 GEIV l.BX ` . „-' ":: TOTAL AL ATI PLANNING LIU PON. 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. AwyLzAWd 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 buildingonstruction. I authorize representatives 9f Cupertino to enter the above -Id tified property for inspection purposes. Signature of ApplicandAgent: IF yDate: - i'-/j�` SUPPLEMENTAL INFORMATION REQUIRED PLAN CxECK 1YPE „� (, ROL I ING Si.n> L .;t u.t�lNc I I .� I:r\ n.\� New SFD or Multifamily dwellings: Apply for demolition permit for (A it TILL cot -NEI2 existing building(s). Demolition permit is required prior to issuance of building permit for new building. I,L1n,rv� rL.asrt�a:%� Commercial Bldgs: Provide a completed Hazardous Materials Disclosure [� STAND P D �- i i,;;! -IC xti _ form if any Hazardous Materials are being used as part of this project.` Q ,GI i _ I nzE DE 11 r Copy of Planning Approval Letter or Meeting with Planning prior to _ submittal of Building Permit application. ro}� ,aNlTAitl SE�� Ir nisl E;;cT E1*-LEN%'fRONMENTAI, li[ �LTJt BldgApp_201 1. doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19160 TWIG LN I CONTRACTOR: JEREMY MAO INC I PERMIT NO: 14060194 OWNER'S NAME: LIN FELIX CHANGMIN AND RUBY C 113212 CARRICK ST I DATE ISSUED: 12/01/2014 I OWNER'S PHONE: 4082688668 ❑ LICENSED CONTRACTOR'S DECLARATION License Class_ Lic. # Contractor. ate I hereby affirm that I am icensed 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 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 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 ^ ver ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 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 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 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 9.18. Signature Date SARATOGA, CA 95070 1 PHONE NO: (408) 449-9942 JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CONSTRUCT 2 STORY SFWL 3458 LIVING, GARAGE 507 SQ FT AND PORCH 304 SQ FT revision #3 remove stair side post- issd ore 3/5/2015 Sq. Ft Floor Area: I Valuation: $690000 APN Number: 37508021.00 Occupancy Type. PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN OF PERMIT ISSUANCE OR 180 DA RO AST CALLED INSP CTI/ON. Issued by: Date.. �S RE -ROOFS: 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 Appli Date: 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(a) 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. � , Owner or authorized agent: Date CONSTRUCTION LENDING AGENCY I hereby affirm that 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 Professional �,,���,,�� CITY OF CUPERTINO 1�''�Y/.�il FEE ESTIMATOR — BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, sanitary sewer District, school Th—o /vac aro hacod nn tho nroliminary infarmation available and are onlv an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff.' 7.7%13) ADDRESS: 19160 twig In DATE: 03/05/2015 REVIEWED BY: MENDEZ a9ec;lr- Pervert VC APN: BP#: `VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: p _ ° irrsp. Tee: PENTAMATION 1 GENRES PERMIT TYPE: WORK revision 4 remove stair sidepost- issd otc 3/5/2015 SCOPE Suppl. Insp. Fee.S Reg. Q OT NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, sanitary sewer District, school Th—o /vac aro hacod nn tho nroliminary infarmation available and are onlv an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff.' 7.7%13) r h. I'Ifrn ( /71 I'hunr� - r _ Elec..Plan Check a9ec;lr- Pervert VC $0.00 I raze Permit Fee Odic)- Alech. Insp. (other Plumb Insp Other Elec. Insp. ilecls. Insp. Hee: _ ° irrsp. Tee: $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, sanitary sewer District, school Th—o /vac aro hacod nn tho nroliminary infarmation available and are onlv an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff.' 7.7%13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes Q No $0.00 1 hours Plan Check, Hourly $143.00 ISTPLNCK Suppl. PC Fee: 0 Reg. © OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.S Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: F-71 E) Work Without Permit? Yes (F) No $0.00 Advanced Planning±e $0.00 Select a Non -Residential E) Building or Structure O I i Truvel Documentation Fees. Strong Motion Fee: $0.00 Select an Administrative Item Bldg_Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $143.00 TOTAL FEE: $143.00 Revised: 02/14/2015 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ' (408) 777-3228 • FAX (408) 777-3333 • buildino uoertino.oi 7 vT:w rnNCTlit IrTInN n ADDITION n ALTERATION / TI P REVISIO DEFERRED ORIGINAL PERMIT # PROTECT ADDRESSW/� /I / , � V V `� AP OWNER NAME EL �� /V�i'fV E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAMEC PHONE 4`I STREET ADDRESS ) CITY, STATE, ZIP A ,S` ` J A 3` O (ARCHITECT FAX ❑ Ou'NER ❑ WAINER--BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AAGJEI.�TT ❑ ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER ' /�� J LICENSE BUS. LIC 4 COMPANY NAME €� car lNC E-M.AIL FAX STREET ADDRESS CITY, STATE, ZIP lJ� PHONE /7 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC -9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE k STORIES 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 1 TOTAL DECKTORCTI AREA GARAGE AREA: DETACH ❑ ATTACH DWELLING UNTIS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? ❑ NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES ,RECEIVED B '�- TOTAL V UATION: PLAN'!,TINGAPPL4 ❑N'0 PLANNING APPROVAL LETTER EICHLER HOME? NO 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 onstruction. I authorize representatives of Cupertino to enter the above-identifiedproperty for inspection purposes. Signature of Applicant/Agent: Date: / r SUPPLEMENTA INFORMATION REQUIRED PLA_NCH&�t ,z = Roor GsLIPz ❑i O\ ER THE COL ITER ',BLTI 3 `' DAG PLS REVIEW t New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building ti _ permit for new building. £ Cis ExPaEss A 6q, ?pry �_ PLAt..>rG PLARRESLE\1' _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project.t �z srp_?ARD ❑ PirsL>cwoRxsLNO *" �s Du LAi2GE ' et FIS EPEPI ;jgg Copy of Planning Approval Letter or Meeting with Planning to ?n" _ prior rtAroR xfl sAI�ITARY SER ERDIsrRlcrw submittal of Building Permit application. F, - '- j��,_ETL=II20NTIENTALHE.ALTA ` BldgApp_2011.doc revised 06/21/11 Project Name: Project Address: Project Descripti GNATURE DECLARATIONS I `fD6 orQ� o IL a SECTION 1 - DESIGN VERIFICATION Complete all lines of Section 1 — "Design Verification" and submit the completed checklist (Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the project in accordance with the requirements set forth in the 2013 California Green Building Standards Code as adopted by the City of Cupertino. Owner's Signature Date Owner's Name (Please Print) Design Professions ignature Date id. - C_e►\ DesignPofessional's Name (Please Print) 3 Signature of License Professional responsible for CalGreen compliance Date Name of License Professional responsible for /CalGreen compliance (Please Print) Phone Email Address for License Professional responsible for CalGreen compliance SECTION 2 - IMPLEMENTATION VERIFICATION Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of the 2013 Calif rnia Green Building Standards Code as adopted by the City of Cupertino. Z3'c6 Signature of{License ' Professional responsible for CalGreen compliance Date', Name of License Professional responsible yfor CalGreen compliance (Please Print) Phone Email Address for License Pro ional responsible for CalGreen compliance Page 5 of 5 CalGreen 2014. doe revised 01/15/14