13120170CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10981 ACACIA WAY
CONTRACTOR: SUNSATIONAL
PERMIT NO: 13120170
SUNROOM
OWNER'S NAME: CHAN WALLACE C AND HELENE W TRUST
1825 MAPLEGROVE LN
DATE ISSUED: 12/192013
OWNER'S PHONE: 4085953166
TRACY, CA 95376
PHONE NO: (408) 439-4514
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
PATIO ENCLOSURE 285 SQ FT
�
A �3� %6
License Class Lic. #
56,,, 19 J9ACC1rV be1 aol3
Contracto,S' l/f S f,t,0da/ Pa: M Date
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.
1 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: $1 ��00
have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 32602072.00
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 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 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
Issued by: Date:
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 X Date M
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.
13OWNER-BUILDERDECLARATION
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. 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 upertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sectio g 25505, 2 33, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
nn
Owner or authorized agent: Date U Q �/
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.
Signature Date
CONSTRUCTION PERMIT APPLICATION A (�
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION (D
10300 TORRE AVENUE CUPERTINO, CA 95014-3255
GUPL ERT NO I (408) 777-3228 • FAX (408) 777-3333 • building(ftupertino.org \�\
❑ NEW CONSTRUCTION 9ADDITION ❑ ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS
ca
APN # 31 ` U v
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OWNER NAME
PHONE
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E-MAIL
STREET ADDRESS finn C G��
OGJKi
CITY, STATE, ZIPCl/ r
e/'�ni)
FAX
CONTACT NAME
a Z
PHONE
91C
E-MAIL ,
STREET ADDRESS 15. 71A
CITY, STATE, ZIP FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT yJ CONTRACTOR. ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMELICENSE
S Jn ou�l
NUMBER
LICEj� E TYPE
[�
BUS. LIC N
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS 63b 2I �t
l
CITY, STATE, ZIP 611 305Q
PHONEOA /
b
ARCHITECT/ENGINEER NAME /
LICENSE NUMBER
BUS. LIC N
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS l,/G
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
EXISTING USE
PROPOSED USE CONSTRTYPE
#STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
BATHROOM
REMODEL AREA
KITCHEN
REMODEL AREA
OTHER
REMODEL AREA
PORCH AREA DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
BEING ADDED? ❑ NO
SECOND STORV ❑YES
ADDITION? [:]NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPL9 E] NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLER HOME? [3 NO
RECEIVED BY:
___.------ -
TOTALVALt�4ON:
/
5 ,3By
my signature below, I certify to eao 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 hav rovided 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 uilding construction. uthorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INVORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
t'J OVER-THE-COUNTER
❑ EXPRESS
BUILDING PLAN REVIEW
n - _
-0r "PLANNING PLAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for w
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
_ 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
submittal of Building Permit application.
❑ MAJOR
❑ SANITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
Bldg,4pp_201 1. doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, Sc 00
__ _ _ _ --.L- a ,.a,.►,io nd aro nnk nn P.0imahl- Contact the Dent for addn'l info.
Ulsirici, ei"j. Ine3v ceJ u.e uua— v.. ...
FEE ITEMS (Fee Resolution 11-053 Eff. 7,%1!13)
ADDRESS: 10981 Acacia Way
DATE: 12/19/2013
REVIEWED BV: Mendez
of ch. Pc>rniit Pee:
APN:
BP#:
'VALUATION: 1$15,500
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE:
Alteration / Repair
PRIMARY SFD or Du lex
p
PENTAMATION 1 R3SFDADD
PERMIT TYPE:
USE:
$0.00
h l
WORK
Patio enclosure 285 sq ft
Permit Fee:
SCOPE
Suppl. Insp. Fee -0 Reg. Q OT
O,Q
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, Sc 00
__ _ _ _ --.L- a ,.a,.►,io nd aro nnk nn P.0imahl- Contact the Dent for addn'l info.
Ulsirici, ei"j. Ine3v ceJ u.e uua— v.. ...
FEE ITEMS (Fee Resolution 11-053 Eff. 7,%1!13)
tt:, h. I'lurr t 'kap c
i'himb. Plun Cheel,
Elec. Plan Check
of ch. Pc>rniit Pee:
Plnmb. Pc r-..
Elec. Permit Fee:
other :blech. Insp.
Other Plumb Insp. Lj
Other Elec. Insp.
limb. Insp. 1 cc
/Ci Imp. Fcc
hrs
$0.00
h l
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, Sc 00
__ _ _ _ --.L- a ,.a,.►,io nd aro nnk nn P.0imahl- Contact the Dent for addn'l info.
Ulsirici, ei"j. Ine3v ceJ u.e uua— v.. ...
FEE ITEMS (Fee Resolution 11-053 Eff. 7,%1!13)
FEE
- -
QTY/FEE
---- --- --
MISC ITEMS
Plan Check Fee:
$0.00
285 s.£
$834.00
Patio Cover / Sun Room
IPATIOENCM Metal, Enclosed
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -0 Reg. Q OT
O,Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
xldl illi.5tratity Fec:
E)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
O
Tran c I
Strong Motion Fee: IBSEISMICR
$1.55
Select an Administrative Item
1
Bldg Stds Commission Fee: 1BCBSC
$1.001
SUBTOTALS:
$2.55
$834.00
TOTAL FEE:
$836.55
Revised: 10/01/2013
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: f
PERMIT #
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR: JCJA t °U�t� c�
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:
V
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