14060006I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 18931 BARNHART AVE CONTRACTOR: ` PERMIT NO: 14060006
MKIVIIIN f"r D S��� �O���
OWNER'S NAME: MIKE SHENG I I DATE ISSUED: 08/01/2014 1
OWNER'S PHONE: 4089925833 1 , I PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # ��
Contractor ate
1 hereby affirm that I am licensed under the p visions o 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. l 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 ofthis permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section /
9.18.
Signature Date ,�/ -�
❑ 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 ofthe 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, l
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 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
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
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
CONSTRUCT A ONE STORY ADDITION (770 SQ FT);
ATTACHED GARAGE (441 SQ FT); COVERED PORCH (46
SQ
FT); INSTALL NEW HEAT PUMP.
Sq. Ft Floor Area: I Valuation: $114600
APN Number: 37509021.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 D SUANCE OR
180 M LA ED INSPEC IO
db ae:
RE- ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
Signature of App]
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(x) 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: Da
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
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • buildinq(a�cupertino.orq
❑ NEW CONSTRUCTION ADDITION
oob
o�� B
❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS BQYN parr f /g'YG
/
APN # 3 -�-- 0 9- 0
OWNER NAME
PHONE L�-D p - q q 2 _J lr3 3/
- �� - 3
E-MAIL /
*4-e
STREET ADDRESS B9 �QYr1 / it h /L,��
CITY, STATE, ZIP •n 0• 4 qs o ��
FAX
CONTACT NAME � •�
PHONE ` _ yr J�� Of�
E-MAIL �L/
- L
-03 ��N70V . Gfl,�I
STREET ADDRESS ^O /,J�` �M �bY !�i/�'
[I(/
CITY, STATL IIPV CJ.''QA� OJC
FAX
❑ OWNER ❑ OWNER - BUILDER ❑7 OWNER AGENT E CONTRACTOR ❑ CONTRACT•RJAGENT ❑ ARCHITECT ❑ ENGINEER
❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC 4
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT /ENGINEER NAME Gan /
LI SE NUMBER
BUS. LIC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTIO 1; WORK Fr07'l J J.�`N„ 70 � Sf r
�+,/
/e�ro'm�(, .
vHl.
CAI NI. B c,,.) Rater L� M. k/ c . l st-.
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
X- 3
e _; /4/
1
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG 141# NEW FLOOR
DEMO
TOTAL
AREA A,c , AREA -7411
AREA D
NET AREA
BATHROOM
REMODEL AREA O
KITCHEN
REMODEL AREA
OTHER
REMODEL AREA
D
p
PORCH AR EA
DECK AREA
TOTAL DECK /PORCH AREA
GAR4 A: DETACH
T CH
6
*6
# DWELLING UNITS
/
IS A SECOND UNIT ❑ YES
BEING ADDED? ZNO
SECOND STORY E
ADDITION?
ONO
PRE- .APPLICATION [:]YES IF YES, PROVIDE COPY OF
PLANNING APPL 11 I NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLER HOME? Z N
TOTAL VALUATION:
/
I
/ / O
By my signature below, I certify to each of the following: I am the property owner orq&TTorized agent to a� o e alf. I have ad this
application and the information I have provided is correct. I have read the Description of Work and veri rat agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the e- identified property for inspection purposes.
Signature of Applicant/Agent Date:
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 '.
Commercials 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
❑ MAJOR
❑ SANITARY SEWERDISTRICr
submittal of Building Permit application.
•
❑ ENVIRONMENTAL I 1EALTR
BldgApp_201 1. doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 18931 BARNHART AVE
1 DATE: 06/02/2014
REVIEWED BY: NIELISSA
APN: 375 09 021
BP #:
*VALUATION: 1$114,600
, °PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE
2nd Unit? 0 Yes G No
OTC. 0 Yes E)No
PENTAMATION 1 R3SFDADD
PERMIT TYPE:
WORK
ADDITION OF 764 S.F. TO CREATE N MASTER BDRM /BATH N STUDY N LIVING RM
SCOPE
�FFRONT
(N) LAUNDRY RM. CONTRUCT (N) 441 S.F. ATTACHED GARAGE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R -3 (Custom)
II- B,III- B,IV,V -B
764
$2,577.00
IR3PLNCK
$1,617.00
IR3INSP
U (Private Gar /Ag Bldg)
II- B,III- B,IV,V -B
441
$0.00
I UIPLNCK
$1,252.00
1 UIINSP
Permit Fee:
$2,869.00
Suppl. Insp. Fee:Q Reg.
0 OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
TOTALS:
1,205
$2,577.00
$2,869.00
T_T_
MECH, HOURLY 0 Yes (D No PLUMB, HOURLY Q Yes ) No ELEC, HOURLY Q Yes Q No
FT
Ll _L_
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 11 info.
FEE ITEMS (Fee Resolution 11 -053 Eft 7 %1 %13
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
$2,577.00
Select a Misc Bldg /Structure
or Element of a Building
Suppl. PC Fee: (j) Reg. Q OT
0.0
T hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$2,869.00
Suppl. Insp. Fee:Q Reg.
0 OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
T_T_
0
G
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
IPLLONGR
$168.70
Select a Non - Residential
Building or Structure
0
A
1
Strom, Motion Fee:
IBSF,ISMICR
$11.46
Select an Administrative Item
Bldg, Stds Commission Fee: IBCBSC
$5.00
SUBTOTALS:
$5,631.16
$0.00
TOTAL FEE:
1 $5,631.16
Revised: 04/01/2014
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:
PERMIT #
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR'
LICENSE #
ADDRESS: 4L/
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:
Si re to
Please check applicable subcontra omplete the following information:
Owner / Contractor Signature
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE 4
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