13030090CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10455 BANDLEY DR
CONTRACTOM49P P9 BE PERMIT NO: 13030090
DEZERAGNEB'
OWNER'S NAME: CHINESE CHURCH IN CHRIST CUPERTINO
DATE ISSUED: 09/11/2013
OWNER'S PHONE: 4083915150ONE
NO:
a.
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIA COMMERCIAL
Kse C Lie. #
INSTALL 144 SQ FT WOOD TRELLIS AND LANDSCAPE
Class
**SEE NOTES**
Contractor Date
1 hereby affir that I am licensed under the provisions of Chapte 9
(commencing ith Section 7000) of Division 3 of the Business & Professions
Code and that y 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: $18000
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 32633102.00
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,
��//2
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.
RE -ROOFS:
Signature DateIlk 13
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.
❑ O R -BUILDER DECLARATION
Signature of Applicant: Date
I hereby affirm that 11,m 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. 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
the Health & Safety Code, Sections 25505, 25533, and 25534.
I have and will maintain Worker's Compensation Insurance, as provided for by
q J
Section 3700 of the Labor Code, for the performance of the work for which this
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
CONSTRUCT N 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
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • build i nq(cDcu pertino.org
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❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/ Ti F- REVISION / nFFFRRFn ORIC;INAT PFiRMTT V
PROJECT ADDRESS �4 S �'V D LC— `r
APN# .2
OWNERNAME C ; C
PHONE (4(0\ /- '6C_17711
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STREET ADDRESS (� S ^ 2
CITY, STATE, ZIP
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CONTACT NAME (� p�
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME T, P
�3 ,
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NRME ��_P�
Y
LICENSE NUMBER
BUS. LIC #
COMPANY NAME .
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►�'O✓_�
E-MAIL
FAX
STREET ADDRESS .� �? .Rh t
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK 4J 6CJ ` Ye t S �C1 L, J C CCX (�
EXISTING USE
PROPOSED USE CONSTR
TYPE
#STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
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 ARE
GARAGE AREA: DETACH
❑ ATTACH
I
# 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
REC p BY:TOTAL
VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
'MI/,'(1�
Ig
By my signature below, I certify to each of the following: I am the property owner or authorizeA ag nt 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 erify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating lding construction. I authorize representatives ofCupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/A Date: — ( "
SUPPLEMENTAL INFORMATIO REQUi!TS
PLAN CHECK TYPE
ROUTING SLIP
11 OVER-THE-COUNTER
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
BUILDING PLAN REVIEW
permit for new building.
SS
❑ZA
PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
ARD
❑ 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
El MAJOR
El SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_201 1. doc revised 06/21/11
CITY OF CUPERTINO
FFF. F.cTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
Lle<:h.
ADDRESS: 10455 BANDLEY DR
DATE: 03/18/2013
REVIEWED BY: MENDEZ
PC FEE ID
APN:
BP#:�A3
'VALUATION: $18,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: New Construction
PRIMARY
USE: Commercial Building
Civil / Religious activities
in BQ zone? CO) Yes No
PENTAMATION
PERMIT TYPE: 1 U
WORK
INSTALL 144 SQ FT WOOD TRELLIS AND LANDSCAPE
SCOPE
OCCUPANCY TYPE:
Lle<:h.
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
U (Private Gar/Ag Bldg)
II-B,111-B,IV,V-B
144
$0.00
IUIPLNCK
$1,199.00
IUIINSP
PME Plan Check:
$0.00
Permit Fee:
$1,199.00
Suppl. Insp. Fee -0 Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
144
$0.00
$3 8
$1,199.00
�
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Puhlic Works, Fire, Sanitary Sewer District, School
TL_ r L d ., �b .. i:...:., ..a ;a inrLsrntinn nvnilnhlo and nry nnly nn estimate Contact the Dent for addn'1 info.
" LL LLL, CLI. . I /L GJG — — ✓a. v.. a - - .
FEE ITEMS (Fee Resolution 11-053 Eff.- 711112)
Man Ch,,, n
!Tomb. Plan Check
Elec..Plan Check
Llec;lr. Pc>rnrit ! °
Plumb. Permit ree:
Elec. Permit Tee:
Other Meeh. Insp.
Other Plumb Insp.E1_L_
Other Eley. Insp. Ea
11<i� :. . 1,ee:
Plumh. t isp. Fee:
I 1:1ec. Inv, F"', �
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Puhlic Works, Fire, Sanitary Sewer District, School
TL_ r L d ., �b .. i:...:., ..a ;a inrLsrntinn nvnilnhlo and nry nnly nn estimate Contact the Dent for addn'1 info.
" LL LLL, CLI. . I /L GJG — — ✓a. v.. a - - .
FEE ITEMS (Fee Resolution 11-053 Eff.- 711112)
... ... ........... —.-_-------
FEE
------ -- -
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 1.£
$0.00
Fence
Fence, Non -Masonry >6'
Suppl. PC Fee: 0 Reg. 0 OT0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,199.00
Suppl. Insp. Fee -0 Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: IBCONSTAXC
$3 8
Administrative Fees:
�
0
Work Without Permit? Yes 0 No
$0.00
Advanced Planning Fee., 1PLLONGC
$38.88
Select a Non -Residential
Building or Structure
—10
0
A
Trmel Documentation Fees:
Strong Motion Fee: 1BSEISMICO
$3.78
Select an Administrative Item
Blda Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$1,634.34
$0.00
TOTAL FEE:
Revised: 01/01/2013