14030043I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10690 MERRIMAN RD I CONTRACTOR: HBDT CONSTRUCTION, I PERMIT NO: 14030043
I OWNER'S NAME:
% SANTA CLARA, CA 95054 1 PHONE NO: (408) 803 -8863 1
CJ LICENSED CONTRACTOR'S DECLARATION
License Class Lie.# ?, A13
Contractor 1JEC CO, PJM7%ZVCTC0lJDate 0 ®p°J f 114
1 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.
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 O - Iq
❑ 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 tinder 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.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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.
Si
Date
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL 0
CONSTRUCT SECOND DWELLING UNIT (586 SQ FT) WITH
COVERED PORCH (308 SQ FT).
REV # I - RESIZE & RELOCATE KITCHEN & BEDROOM
WINDOWS (5 WINDOWS TOTAL) - ISSUED 10/7/14
Sq. Ft Floor Area: I Valuation: $117200
I APN Number: 34216148.00 I Occupancy Type:
PERMIT E S IF WORK IS NOT STARTED
WITHIN 1 AY PERMIT ISSUANCE OR
180 DAY R LAS ALLED INSPECTION.
Issued by: Date: 10 (-,
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. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should 1 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 and 25534.
Owner or authorized agent: Date: _W_;147
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
understand my plans shall be used as public records.
Licensed
FEE ]ESTE1D ATOR - BUI LMNG DffVRSffON
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 Deptfor addn'l info.
]FLEE ITEMS (Fee Resolution 11 -1153 E(J.' 7/1.!13)
ADDRESS: 10690 MERRIMAN RD
DATE: 10/07/2014
REVIEWED BY: MELISSA
Wc� 1, Pernti( Fees
APN: 342 16 148
BP #: 14030043
`VALUATION: $0
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
SFD or Duplex
USE: I
"lunti,. hasp. Fee
PENTAMATION
1GENRES
I PERMIT TYPE:
WORK
REV # 1 - RESIZE & RELOCATE KITCHEN & BEDROOM WINDOWS 5 WINDOWS TOTAL -
SCOPE
ISSUED 10/7/14
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 Deptfor addn'l info.
]FLEE ITEMS (Fee Resolution 11 -1153 E(J.' 7/1.!13)
IA'('h. /Tura ('/Y, 4
Phloth. Plan ('rice l
,.., /",1,1 r "���rk
Wc� 1, Pernti( Fees
Piurnh Perr,�ia l•ec.
r "cr ", P".
Onc�r Ucc,'a. h�si�.
Omer /ml
U,; , . '.', t,�;�,
i /"0 1. Im"i I e'( ".
"lunti,. hasp. 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 based on the preliminary information available and are only an estimate. Contact the Deptfor addn'l info.
]FLEE ITEMS (Fee Resolution 11 -1153 E(J.' 7/1.!13)
]FEE
QTY /]FETE
MISC ITEMS
Plan Check Fee: Hourly Only? () Yes Q No
$0.00
hours Plan Check, Hourly
$143.00 ISTPLNCK
Suppl. PC Fee: E) Reg. Q OT 0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee.E) Reg. (D OT 0,0 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C.(l)is /luctir)ri Tux:
�cll7iltll�(Y,.it7C� Fee:
O
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning; Fee:
$0.00
Select a Non- Residential E)
Building or Structure
d,
l awvel Docalnen/ation Fees:
Strom Motion Fee:
$0.00
Select an Administrative Item
Bld.a Stds Commission Fee:
$0.00
SUBTOTALS:
$0.00
$143.00
TOTAL FLEE:
$143.00
Revised: 08120/2014
I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10690 MERRIMAN RD CONTRACTOR: HWANG WIN TSUANG PERMIT NO: 14030043
AND LIN YUHING
OWNER'S NAME:
CUPERTINO, CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL E]
CONSTRUCT SECOND DWELLING UNIT (586 SQ FT) WITH
License Class Lic. # COVERED PORCH (308 SQ FT).
Contractor
Date
1 hereby affirm that 1 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.
1 hereby affirm under penalty of perjury one of the following two declarations:
1 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.
Sign
Date
-R ' 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)
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.
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, aftet 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. n 1
Date_ _� --t 41
Sq. Ft Floor Area: I Valuation: $117200
I APN Number: 34216148.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 1WDAYS OF PERMIT ISSUANCE OR
180 DAYS O LAST CALLED INSPE TIO1�Y.
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
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534, 1 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 9.1Z and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent: ° Date: �� �S I
CONSTRUCTION LENDING AGENCV
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
1 understand my plans shall be used as public records.
Licensed Profess
CITY OF C'UP EllBTINO
FEE IE�']I'�l�IA']COIIB - I��.JI[lLID)�IVO Il������OIV
ADDRESS: 10690 merriman rd DATE: 03/06/2014 REVIEWED BY: Mendez
APN:__ BP #: �� OQ *VALUATION: $117,200
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction
PRIMARY SFD or Duplex 2nd Unit? ° Yes O No PENTAMATION 1 R3SFD2ND
USE: PERMIT TYPE:
WORK construct qranny unit 586 sq ft to include m e 's
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,III- B,IV,v -B
586
$2,577.00
IR3PLNCK
$1,617.00
lR3INSP
Permit Fee:
$1,617.00
Suppl. Insp. Fee: Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: iBCoNST,
1
# new
units
$652.28
,'Idwinisi! -otiCv Fef—
Work Without Permit? 0 Yes No
$0.00
TOTALS:
586
$2,577.00
Travel Docvone!itulion Fe'e.s:
1 $1,617.00
Strong Motion Fee: 1BSEISMICR
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District eta 1_ These fees are haled an the nreliminary infnrmatinn availahle and are nnly an estimate_ Contort tho Dent for addn'l info-
FE
E ITEMS (Fee Resolution 11 -053 Eff 7/1113)
Vech. Phun (',heck
Pliant, P!afl Chc<l,
;_ic;. Pl. yr Ch „k
%let: /!. P.,rn?h Foe.
P111,77h. Permit Fec:
I "o P,.!nt! let
Other lb'v h. lisp.
L1
O:hcr Plurah lash
Orh, I:Ycr. Irish.
1 /rch. hap. i ix "t:
Phuuh Fce:
L!sp, 11-e'.
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District eta 1_ These fees are haled an the nreliminary infnrmatinn availahle and are nnly an estimate_ Contort tho Dent for addn'l info-
FE
E ITEMS (Fee Resolution 11 -053 Eff 7/1113)
FIFE
QTY/FEE
IY ISC ITEMS
Plan Check Fee:
$2,577.00
Select a Misc Bldg /Structure
or Element of a Building
Suppl. PC Fee: Q Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,617.00
Suppl. Insp. Fee: Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: iBCoNST,
1
# new
units
$652.28
,'Idwinisi! -otiCv Fef—
Work Without Permit? 0 Yes No
$0.00
Advanced Planning, Fee: IPLLONGR
$82.041
Select a Non - Residential 0
Building or Structure
Travel Docvone!itulion Fe'e.s:
Strong Motion Fee: 1BSEISMICR
$11.72
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$5.00
SUBTOTALS:
$4,945.04
$0.00
TOTAL FED:
$4,945.04
Revised: 01/15/2014