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15030006�p CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: 19051 BARNHART AVE CONTRACTOR: JEREMY MAO INC PERMIT NO: 15030006 OWNER'S NAME: QING HONGRONG AND LI YI 13212 CARRICK ST DATE ISSUED: 06/04/2015 OWNER'S PHONE: 4088079289 SARATOGA, CA 95070 PHONE NO: (408) 449-9942 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL LICENSED CONTRACTOR'S DECLARATION CONSTRUCT 2 STORY SFDWL, 1ST FLOOR (1,177 SQ FT); License Class_ Lic. # e'13 e� 2ND FLOOR (814 SQ FT); ATTACHED GARGE 416; PORCH, Contractor �/Ll�/� 1G LDate PATIO &DECK (1,140 SQ FT) 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. Sq. Ft Floor Area: Valuation: $350000 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 37509036.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 18 PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this 'city to enter 18 AST CALLED INSPECTION. 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 Issue Date: ,S granting of this permit. Additionally, the applicant understands and will co m y with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature_ �� Date�4 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is 10, 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, 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. 1 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: z, 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 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 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 ARCHITECT'S DECLARATION 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 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. Sienature Date i CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION Doi 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildino(Q)cupertino.oro CUPERTINO n u1 ur rnt`rcTut Ir'TInNi n A nnrmnN n AT.TFRATInN / TI n REVISION / DEFERRED ORIGINAL PERMIT # u — PROJECT ADDRESS cto V APN;4 �r 1 o O CI — 0`2 ( = W ONER NAME PHONE Lj{�� U�� E-MAIL] ``I t'T�rV�`VIvCT 1��11�►wli STREET ADDRESS qv�` &A" ' " ivC ' -" � cxwCITY, STATE, ;IIP .��b ,c iL C1SU1 l (. FAX I�JJ� CONTACT NAME (^-Z pt \ � i� PHONE C E-MAILT�-V r C�F'S�V ` VO STREET ADDRESS CITY, STATE, ZIP ��T�(p�tFAAX ',14p � lJ ❑ OWNER ❑ OW'NER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 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 WORT: H Cot, EXISTING USE PROPOSED USE CONSTR TYPE k STORIES (Z Iz USE TYPE OCC. SQ..TOTAL VALUATION (S) -f� EAREAG `G.4g NAREA EW OD� o� �1 , t♦V! DREG 1 G.-TgIJ NET AREA ?CL-)� 1 .FF -T.. l I 1 BATHROOM REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA PORCHAREA DECKAREAA�,ECK/POORCHAREA ppll((__��``r```te+*+ GARAGE AREA: ��DETACH ATTACHU1.�1. `i� 11\\ q(r<56 �_u1 `` ��f[[//_ �d k DWELLING UNITS: IS A SECOND UNIT ❑ YES BEING ADDED? IWO SECOND STORY YES ADDITION? ffNO PO r ` PRE -APPLICATION JjVES IF YES, PROVIDE COPY OFIS THE BLDG AN ❑ YES RECEI D.BY - TOTAL 11 ^' " PLANNING APPL9 E] NO PLANNINGAPP jj FER EICHLER HOME? 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 aeree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: ?- SUPPLEMENTAL INFORMATION REQUIRED PAiv cliEcicTVPE -.- RouTlnc sLlr ❑Tx>rcour,TER Buu DING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building pen -nit for new building. :' ❑ aPRESS LAl\NING PLA.NREV2E1i' Bldgs: Provide acompleted Hazardous Materials Disclosure T bsr,>t\nARD PusLlcwoaxsz _Commercial form if any Hazardous Materials are being used as part of this project. YO Copy of Planning Approval Letter or Meeting with Planning prior to r nt<r �SANn'A1tYSE 'ERISISTRICT _ submittal of Building Permit application. MAJOR d'' � �, �N Ss j Q ENVIRONTA NTAL HEALTH. . BldgApp_2011.doc revised 06/21/11 -11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION OCCUPANCY TYPE: 19051 barnhart ave DATE: 03/02/2015 REVIEWED BY: Mendez PC FEE ID rADDRESS: PN: BP#: 63 `VALUATION: $350,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: 2nd Unit? Yes No PENTAMATION 1 R3SFDW PERMIT TYPE: WORK construct 2 storysfdwl 1 st floor 1 177 s ft); 2nd floor 814 s ft); attached ar a 416' orch atio & SCOPE I deck (1,140 sq ft) 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 3,547 $3,190.71 IR3PLNCK $3,297.93 IR3INSP $0.00 PME Plan Check: $0.00 Permit Fee: $3,297.93 Suppl. Insp. Fee.S Reg. Q OT 0,0 his $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 3,547 $3,190.71 Construction Tax: 1BC0NSTAXR[7TiTunits $3,297.93 new NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanuary Sewer District, Schoo bd li th ina in ormation available and are onl an estimate. Contact the Dept or addn'l into. District, etc . Ton hese ees are as a re m FEE ITEMS (Fee Resolution II -033 EfL 7i1i13) FEE Phunh, Plan( Elec. Plan Check :Tech. Permit Fee' /'ltrmJ� I'. Elec. Permit lee Oilier illec•h. Insp. 01her Plurnh ln,�pLi ,her E'lec. Insp. Lj 14ech. Insp. Fee: Suppl. PC Fee: Q Reg. Q OT 1 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanuary Sewer District, Schoo bd li th ina in ormation available and are onl an estimate. Contact the Dept or addn'l into. District, etc . Ton hese ees are as a re m FEE ITEMS (Fee Resolution II -033 EfL 7i1i13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,190.71 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $3,297.93 Suppl. Insp. Fee.S Reg. Q OT 0,0 his $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 1BC0NSTAXR[7TiTunits new $670.76 O 0 Work Without Permit? Yes 0 No $0.00 Advanced Planning Fee: IPLLONGR $496.58 Select a Non -Residential Building or Structure 0 � Trowel Documentation Feer: Strong Motion Fee: IBSEISMICR $45.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $14.00 SUBTOTALS: $7,715.48 $0.00 TOTAL FEE: $7,715.48 Revised: 02/14/2015 Building Department City Of Cupertino J 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: 15fl51 6ARAJ Q—AVE PERMIT # 15-03 0006 OWNER'S NAME: C, PHONE # GENERAL CONTRACTOR: j�---eG-1L4 X4AfV IN L . BUSINESS LICENSE # ( S Z ADDRESS: -z("L t C ° — CITY/ZIPCODE: 5AP/A 1 old} --a D *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date Owner / Contractor Signature Lfll 6 Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical _ S— IC /Aft- J Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating 2 S-CF $ Insulation Landscaping Lathing Masonry Painting / Wallpaper Plastering Plumbing NL 40 lq! e Roofing Dov INFO 2-:z �- 3 Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Lfll 6 Date