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14010002CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7665 PEACH BLOSSOM DR CONTRACTOR: SCL CONSTRUCTION PERMIT NO: 14010002 CO. OWNER'S NAME: WU TONY HSU-YUNG AND LARRISA TSUI M 1664 SAMEDRA ST DATE ISSUED: 04/14/2014 OWNER'S PHONE: 4082501267 SUNNYVALE, CA 94087 PHONE NO: (408) 497-1556 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CONSTRUCT A 1390 SQ FT ONE STORY ADDITION; 11, License Class__ Lie. # 2— Z INTERIOR REMODEL (836 SQ FT); UPGRADE Contractor_ L Date_ e-- yo - ELECTRICALPANEL (200AMPS) I hereby affirm that I am licensed on r the provisions of Chapter 9 REV #3 - INCREASE AREA OF REMODEL AND INSTALL (commencing with Section 7000) of Division 3 of the Business & Professions FIRE SPRINKLERS. ISSUED 8/20/14 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 Sq. Ft Floor Area: Valuation: $170000 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 APN Number: 3661 l 147.00 Occupancy Type: 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 FROM LAST CALLED INSPECTION, indemnify and keep harmless the City of Cupertino against liabilities, judgments, j costs, and expenses which may accrue against said City in consequence of the Issued by: ri/� ��� /_/�� p ��e� granting of this permit. Additionally, the applicant understands and will comply ��/G�' /�/ Date: G with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. � RE-ROOFS: Signature o Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, l 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 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 (See. 7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sce.7044, Business & Professions Code). 1 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: Ifealtb & 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 1 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 �d Owner or authorized agent: Date: permit is issued. - 1 certify that in the performance of the work for which this permit is issued, l shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. It; after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, 1 must l 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 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, ARCHITECT'S DECLARATION 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 COMMUNITY DEVELOPMENT DEPARTMENT - BF19W #ION7. 10300 TORRE AVENUE • CUPERTINO, CA 950146? �'i _ . D (408) 777-3228 • FAX (408) 777-3333 • building cuD4d'eii mo. G+ ❑ NEW CONSTRUCTION ❑ ADDITION ❑ AL"I FRATIONI / TI I]Q REV1SION / DEFERRED ORIGINTAL PERMIT 4 1,440 -6"") PROrCrADDRESS /el APNR O�✓NER 1 P.14E `? �r p PHO E ©� E-MAIL STREET ADDRESS 1 CITY, STATE, ZIP FAX CONTACT NAME � � PHONE �f STREET ADDRESS S"" CITY, STATE, ZIP ' F.• X h N ❑ OWNER ❑ OR;NER-BU[LDER ❑ OP'NERAGENI' &C67717RACTOR ❑ CON7R.4CTORAGF1,7 ❑ ARCH1yBCT ❑ E:GA'EER ❑ DEVELOPER ❑ TENANT i n CONTRACTOR NAM_ ' r LICENSE NUMBER LICENSE TYPE BUS. LIC m COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGINEER MMMT LICENSE NUMBER BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIP'T'ION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE t STORJ.S USE TYPE OCC. I SQ.FT. VALUATION (5) EXISTG NEW FLOOR DEA10 TOTAL AREA AREA AREA NET AREA BATHROOM RITChEN OT -TIER REMODEL AREA REMODEL AREA REMODEL AREA PORCHAREA DECK AREA TOTALDECK/PORCHAREA GARAGE AREA: DETACH []ATTACH I mDWELLING UNITS: ISA SECOND UNIT ❑7'Es SECOND STORY []YES BEING ADDED? []NO ADDITION? NO +I -PRE-A�Lleanov-pYEs—>raEs,�Ro��Ecor�oF _Is.Lx_EstDc.�� S REOEI _BYE TOTA VALUATION: PLAA'N1NG A?PL. ❑NO PL.AN'N`D\1G APPROVAL LETTER EICHLER HOh4E7 ❑f`0WK By my siatrature 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 cf Work and verify it is accurate. I agree 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 iin�sp-ection purposes. SignatureofApp) icant/P.gent: Date: -" '-1 T- SUPPLENIENTAL INFORMATION REQUIRED _ r F. �OVERTHE COiJhTER ,,,BUIIDIIGPL�1tEiIEVV� M ' `# New SFD or Multifamily d.v'ellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building � W g� permit for new building. . L�1 aPRESS��=� �� {Tz-,sag""-''i�*x'a�' 1� N! pg s _ �IUB _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure s A vrA[iD k 1 zVp�xl.s Y form if any Hazardous Materials are being used as part of this project. Approval Letter Meeting Planning to`Y IRE��*3�r _ Copy of Planning or with prior submittal of Building Permit application. B1d&4pp_M1.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION w ADDRESS: 7665 Peach Blossom Dr DATE: 08/20/2014 REVIEWED BY: Sean APN: BP#: "VALUATION: $5,000 YPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: 7 $0.00 PENTAMATION 1 PERMIT TYPE: 1R3SFDRE WORK Revision #3: Increase area of remodel and install firesprinklers. SCOPE 0.0 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 baser[ on the preliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-05 C/' 7'1 1 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 404 S. $503.00 Remodel, Other IREMRESOTH Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -.(2) Reg. 0 OTF0.O Trs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? 0 Yes ) No $0.00 Advanced Planning, Fee: $0.00 Select a Non -Residential Building or Structure E) Q Strong Motion Fee: IBSEISMICR $0.65 Select an Administrative Item BI& Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.65 $503.00 TOTAL FEE,.T $504.65 Revised: 07/10/2014 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7665 PEACH BLOSSOM DR CONTRACTOR: SCL CONSTRUCTION PERMIT NO: 14010002 CO. OWNER'S NAME: WU TONY HSU-YUNG AND LARRISA TSUI M 1664 SAMEDRA ST DATE ISSUED: 04/14/2014 OWNER'S PHONE: 4082501267 SUNNYVALE, CA 94087 PHONE NO: (408) 497-1556 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL 0 CONSTRUCT A 1390 SQ FT ONE STORY ADDITION; License Class Lic. # INTERIOR REMODEL (836 SQ FT); UPGRADE Contractor `j`P Date w"" �' - % ELECTRICAL PANEL (200AMPS) REV # 2 TO REVISE STRUCTURAL SHEARWALL & 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 DECREASE WINDOW SIZE IN FAMILY ROOM AREA - (commenciog with Section 7000) of Division 3 of the Business & Professions ISSUED 4/30/14 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 Sq. Ft Floor Area: Valuation: $170000 erformance of the work for which this permit is issued. I have Ord 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. APN Number: 3661 1147.00 Occupancy Type: APPLICANT CERTIFICATION 1 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 UANCE 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 F INSPECT N. 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 Yt' Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. ��-''"- RE -ROOFS: Signature----Date 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. ❑ 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 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. 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 1 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 ode, echoes 5 5, 25533 and 25534. 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 Compensation laws of California. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY 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 Y CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ` a (4C8) 777-3228 • FAX (408) 777-3333 • buildin cu CUPERTINQ ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION 1 TI REVISION D ORIGINAL PERMIT 4 PROJECT ADDRESS �s 1 ,rL �- OV✓NER NAME j PHONEr/� (�I ? G j F� / E-MAIL r�' STREET ADDRESS CITY, STATE, ZIP FAX 0 �L— CONTACT NAME � PHONE ,! „ e � q `�5� E-MAIL S L ! /' _h4�L4 �N [ / STREET ADDRESS CITY, STATE, ZI(P FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT L.YCo.NTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICE NUMBER Y LICENSE TYPE J BUS. LIC 9 COMPANY NAME E-MAIL �j� f ���� FAX l STREET ADDRESS /rC� CITY, STATE, ZIP PHONE 6 / 7 i 1 7 ARCHITECT/ENGTNEER NAME LICENSE NUMBER BUS. LIC d COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK N Z� 61 EXISTING USE PROPOSED USE CONSTR. TYPE 1 d 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 AREATOTAL DECKJPORCH AREA GARAGE AREA: DETACH ❑ ATTACH k DWELLING UNrrS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NG PRE -APPLICATION ❑l'ES IF YES,PROA'IDE COPY OF PLATT7NGAPPLB ❑NO PLANNING APPROVAL LET—rER ISTHE BLDG AN ❑YES ETCH LER HOME? F-1 NO RECEI VF�$X%{,��f i'' wa, �,�t�F �;��„��,�'l�, rayr7 TOTAL VALUATION: tF�.{ 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 agree 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 ,�t.1r 4aV' �r'✓w� �,i �s��i'' <�� �tt',"yr��',°�`�"` Q� OVER Tf{E CC?Ui� ER'v `�,✓ 9'BULLDINGPLA]Y RE IEFV�1 `` �. New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of buildingk for y+��tF�/Mrjk;rXirYui���i%� �,f 4 Z'0�. �"V X54 ('r�r`1)il;✓S �� �5�5j,/I%Ed11(11�4i x"'ltd ,a; ��� ��r/1,���p'�7,i✓��,I�y!,; �917MtgY%fIf YI.+W �i�� V. �i d� yi',�J 1W; Y, permit new building. Bldgs: Provide a completed Hazardous Materials Disclosure❑ �.,. (d F%'. 'NiriR ("✓� d�,"/tt�4�k „Y:"i $' t„A to m v ��y` _Commercial form if any Hazardous Materials are being used as Part of this project. ��xi�l�� hi�ia,'1 �� � � � (�� ,7",r °�� � 7 � ❑r Aa7G��h�> irls���r a� ��i� l � ���.�Pe)✓e'l��rr�,f ������1�„� �, � `f �» fl"'�,f 1'IR r �i3;u^t ,,� rt � �drl 9 � ,(`G7 ��t, r��1���+�A� �rr _ Copy of Planning Approval Letter or Meeting with Plahning Prior to submittal of Building Permit application. ��r�r�„�4{�°(G "MUS"" g�yd(i�„ar SUY 4741 �t,/,� ��N� r5 �,�. Ali '�7,��u'+m 4.�<L,J✓✓ ,,� Yr✓ c,..$,5 'ywrlk'4"�,� n �^ }' ,%" f w u 7 px x 1 '. I.: iTt�� IRONnLEN7 IiEAL71i w l"s "` BldgApp_201 Ldoc revised 06/21/11 410 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School niclr;ri olr ) Thoco fooc nra hacod an lho nroliminary infnrmalinn nvnilahlo and nro nnly an oclimalo_ rnnlarl lho non/ far nddn'l info_ FEE ITEMS (Fee Resolulion 11-033 Eff 7%L113,� ADDRESS: 7665 PEACH BLOSSOM DRDATE: 04/30/2014 REVIEWED BY: MELISSA Plan Check Fee: Hourly Only? 0 Yes Q No APN: 366 11 047 BP#: 14010002 *VALUATION: $0 *PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PME Plan Check: PENTAMATION 1GENRES PERMIT TYPE: WORK REV # 2 -REVISE STRUCTURAL SHEARWALL TO DECREASE WINDOW SIZE IN FAMILY ROOM SCOPE AREA - ISSUED 4/30/14 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School niclr;ri olr ) Thoco fooc nra hacod an lho nroliminary infnrmalinn nvnilahlo and nro nnly an oclimalo_ rnnlarl lho non/ far nddn'l info_ FEE ITEMS (Fee Resolulion 11-033 Eff 7%L113,� FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 1 hours Plan Check, Hourly $139.00 ISTPLNCx Suppl. PC Fee: Q Reg. C) OT 0.0 T hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 G Work Without Permit? 0 Yes Q) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential E) Building or Structure i Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $139.00 TOTAL FEE $139.00 Revised: 04/01/2014 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7665 PEACH BLOSSOM DR CONTRACTOR: SCL CONSTRUCTION PERMIT NO: 14010002 CO. OWNER'S NAME: WU TONY HSU-YUNG AND LARRISA TSUI M 1664 SAMEDRA ST DATE ISSUED: 04/14/2014 OWNER'S PHONE: 4082501267 SUNNYVALE, CA 94087 PHONE NO: (408) 497-1556 I LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] 5 f CONSTRUCT A 1390 SQ FT ONE STORY ADDITION; License ClassLic. 4 INTERIOR REMODEL (836 SQ FT); UPGRADE Gi . y� ELECTRICAL PANEL (200AMPS) Contractors Jx SEA t Date I hereby affirm that I am licensed under the provisions of Chapter 9 REV # 1 - MODIFY FLOOR PLAN IN MASTER BEDROOM (commencing with Section 7000) of Division 3 of the Business & Professions TO INCLUDE (N) PATIO DOOR, MODIFY GUEST ROOM TO Code and that my license is in full force and effect. MAKE FULL BATH FROM 1/2 BATH & CONVERT & SWAP 1 hereby affirnn under penalty of perjury one of the following two declarations: HALL CLOSET TO (N) LAUNDRY ROOM - ISSUED 4/15/14 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 Sq. Ft Floor Area: Valuation: $170000 erformance 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 APN Number: 36611147.00 Occupancy Type: 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 ALLED 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 granting of this permit. Additionally, the applicant understands and will comply Date: J with all non -point source regulations per the Cupertino Municipal Code, Section 9,18 -'R Signature -- Date_ / " E -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. ❑ 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) 1, 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 Cupertino Municipal Code, Chapter 9.12 and 1 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 q►� Owner or authorized agent: - Date: permit is issued. I certify that in the performance of the work for which this permit is issued, 1 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 CONSTRUCTION LENDING .AGENCY 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 4 (408) 777-3228 • FAX (408) 777-3333 • building(d),cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI CA REVISION/ DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS APN H OWNER NAME PHONE r E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ` I 6 14L L CONTACT NAME`jQe/ / PHONE aO I%�rlljV 6i1i c� STREET ADDRESS STATE, ZI PAX 11OWNER ElOWNER-BUILDER❑ OWNER AGENT ❑ CONTRACTOR 1:1CONTRACTOR AGENT 2r ARCHITECT ❑ ENGB.'EER ❑ DEVELOPER ❑ TENANr CONTRACTOR NAME { L ( LICENSE NUMBER /� /� / `7S LICENSE TYPE -r BUS. LIC 9 COMPANY NAME) E-MAIL FAX 0 �� -- STREET ADDRESSCITY STATE, ZIP L� �q PHONE r / / ARCHITECT/ENGTNEERNAME A/ht LICENSE NUMBER BUS. LICK COMPANY NAME GWd E-MAILi FAX l li 1 i K Q D%Y1 %6 STREETADDRESS PHONEArb O2 X 'r;6).._ K) DESCRIPTION OF WORK �,✓� ® i W - " i1 '! / M XISTIN USE P S C N TYPE 4 STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDETACH []ATTACH k' DWELLING UMTS: IS A SECOND UNIT [] YES SECOND STORY ❑ YES BEING ADDED? ❑NO ADDITION? []NO PRE -APPLICATION ❑l'ES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES , ;� f �l �F r TOTAL VALUATION: PLANNING APPL NO PLANNING APPROVAL LETTER ❑ EICHLER HOME? ❑ By my signature below, I certify to each of the following: I am the property own or authorized agent to acton t roperty 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 i ccurate. I agree 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 purposes. %for riinspection Signature ofApplicant/Agent: Date: SUPPLEMENTAL rNIFORMATION. REQUIRED �' "/`%r ✓�FyE �l'rhtr )� Ia" QVER�TI�E-CO�L�Y4TER�j��o-�yr 5��� �`" �'�l"�ur'��r" +r;°t'i �,r` �3,'-=` iF ! roi�i�ILDIIyG R;;,V1EV�y,�n,�� � �W�y ,i'r,, New SFD or Multifamily dwellings: Apply for demolition pen -nit for existing building(s). Demolition permit is required prior to issuance of building a�� LAN permit for new building. ❑ a ESsu x°��i�t",)r�x+ vI°7''G%�� r� r; _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure x�) �s)✓r� �e 1�§ly tifi,�� t a)1 rtn + ��+��itr r, tt� �" ; rrt rg �Jw it r r4,yr. form if any Hazardous Materials are being used as part of this project. Pry rttr 1 �Mf�y�9P Vaa �f�pr�m'"ShYfZM _ Copy of Planning Approval Letter or Meeting with Planning prior to id �I.1'JyW�,iry'" 7r4P�yId ilr QPM a f+ Z��b submittal of Building Permit application. ;r� x�aR"iy,(iMpz "��t}�4rG>�y"�mt�� IrR�izlr�(, BldgApp_2011.doc revised 06/21/11 2W CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 2665 PEACH BLOSSOM DR DATE: 04/14/2014 REVIEWED BY: MELISSA ImADDRESS: I APN: 36611147 BP#: 14010002 'VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1 GENRES PERMIT TYPE: WORK REV # 1 -MODIFY FLOOR PLAN IN MASTER BEDROOM TO INCLUDE N PATIO DOOR MODIFY SCOPE GUEST ROOM TO MAKE FULL BATH FROM 1/2 BATH & CONVERT HALL CLOSET TO (N) 13 NOTE: This estimate does not includefees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Mclrint oln 1 Thoco fooc aro hncod nn tho nroliminnnr infnrmnlinn nvnilnhln and am nnhr an nclimnln Cnntnrt thn Mmf far addn'1 infn_ FEE ITEMS (Fee Resolution I1-053 Fff 7,11/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? () Yes Q No $0.00 2 hours Plan Check, Hourly $278.00 1STPLNCK Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 E) Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure Strong Motion Pee: $0.00 Select an Administrative Item Bldg 3tds Commission Fee: $0.00 SUBTOTALS: 1_$0.001:$278.00 TOTAL FEE: $278.00 Revised: 04/01/2014 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7665 PEACH BLOSSOM DR CONTRACTOR: SCL CONSTRUCTION PERMIT NO: 14010002 CO. OWNER'S NAME: WU TONY HSU-YUNG AND LARRISA TSUI M 1664 SAMEDRA ST DATE ISSUED: 04/14/2014 OWNER'S PHONE: 4082501267 SUNNYVALE, CA 94087 PHONE NO: (408) 497-1556 lid LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL CONSTRUCT A 1390 SQ FT ONE STORY ADDITION; License Class Lic. 8 1 72 INTERIOR REMODEL (836 SQ FT); UPGRADE r Contractor x Date r' ELECTRICAL PANEL (200AMPS). 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: have and will maintain a certificate of consent to self -insure for Worker's ompensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $170000 erformance 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 APN Number: 3661 1147.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 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 IT 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 DAY YJt01q I ,BALLED INSPEC ION. 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 comfit Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. �T " RE -ROOFS: Signature—� Date { T 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. ❑ 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 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) 1, 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(x) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should 1 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 die work for which this �[ Owner or authorized agent: o– bate: 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, ( CONSTRUCTION LENDING AGENCY 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 d"Y'rX7 !1T !"'TTTI1rTITTXTA1 OCCUPANCY TYPE: l.11 l Vl` 1.. 111 L'IN, ill\V FEE ESTIMATOR - BUILDING DIVISION FLR AREA s.f. PC FEES ADDRESS: 7665 PEACH BLOSSOM DR DATE: 01102/2014 REVIEWED BY: MELISSA BP FEE ID APN: 366 11 147 BP#: �� `VALUATION: $170,000 $2,657.12 IR3PLNCK $1,904.00 IR3INSP PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex 2nd Unit? ; Yes 0 No PENTAMATION 1R3SFDAD USE: Permit Fee: OTC. O Yes (F)No PERMIT TYPE: WORK���90 S.F. & REMODEL E 930 S.F. SCOPE $0.00 PME Permit Fee: 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-S,IV,V-B 1,390 $2,657.12 IR3PLNCK $1,904.00 IR3INSP $0.00 PME Plan Check: $0.00 200 amps $47.00 Electrical IBELEC200 Services Permit Fee: $1,904.00 Suppl. Insp. Fee.e Reg. 0 OT p,p hrs PME Unit Fee: $0.00 $0.00 PME Permit Fee: $47.00 TOTALS: 1,390 $2,657.12 $1,904.00 M GII ,HOURLY ' Q Yes ISa' 1'"LUMl3 Hou �; Yes' Q N ELEC, H©URLY ; Y +� atG /I, l lfw, ''r�, I ['�r�t;��z, �h4�� E: t,,�_ h Elec. Plan Check0.0 I hrs $0.00 I"'f ,n $2,657.12 Elec. Permit Fee: IEPERMIT �rhr r t lrrr.vr. lrzs �. -------------- ( (hcr Plu, ,"b Ir,,;, Other Elec. Insp. 0.0 hrs $47.00 0.0 hrs $0.00 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). These fees are based on the nreliminary information available and are only an estimate Contact the Dent for addn Y info. FEE ITEMS (Fee Resolution 11-053 Ef 711113) FEE QTY/ EE MISC ITEMS Plan Check Fee: $2,657.12 930 s.f. $628.00 Remodel, Other IREMRESOTN Suppl. PC Fee: 0 Reg. © OT 0.0 hrs $0.00 PME Plan Check: $0.00 200 amps $47.00 Electrical IBELEC200 Services Permit Fee: $1,904.00 Suppl. Insp. Fee.e Reg. 0 OT p,p hrs PME Unit Fee: $0.00 $0.00 PME Permit Fee: $47.00 Dj llll il0'i' Yat r v!'Q_`.' Q E) Work Without Permit? © Yes (F) No $0.00 Advanced Planning Fee. IPLLONGR $194.60 Select a Non -Residential Building or Structure 0 0 i Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISMICR $17.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $7.00 SiIBTUTAUS: $4,873.72 $675.00 TOTA1G FES.' $5,548.72 Revised: 10101/2013 C— rIUPERTINO I NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingacupertino.org ADDITION I-1 ALTERATION / Ti n REVISION / DEFERRED ORIGINAL PERMTT # PROJECT ADDRESS 966 ' ?eae4 V+!fes • APN # � /V � / I � q 7 / �r���/�VJI OWNERNAME 1 P O O ^� EMAIL STREET ADDRESS // CITY, STATE, ZIP /a FAX D L ' CONTACT NAME Tao (.j PHONE_ !�`ppj E-MAIL �` 1 STREET ADDRESS PO "L�oy CITY, STATE, ZIP ?% /6 r p C /TO/RvAGENT/7U /ARRCHITEJ FAX B. CT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT ❑ OWNER ❑ OWNER -BUILDER 1:1 OWNER AGENT ❑ CONTRACTOR 11CONTRAC CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME EMAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE 1 ARQ D? T/ENGWEERNAME / A'C1 n `r40 [I �N 15 LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL 11 // LL FAX STREET ADDRESS �i1 '� `,� O�� 1•,(5i 0 CITY, STATE, ZIP F.1 /Q Ii LC /y,� C// /Gt/ l' /`j L/�AI PHONE AM 06. %�� Irr/v ,G� DESCRIPTION OF WORK `C O J 71' CA% Q1S7�7 �W N Ih.0 O�Y►C uac wkraut C-1 391) �e_*4ojej 4t 1 k0CA&A 6AVVI f . exidi Wd,,-4 ; . 4�t ex�r.3 nwOei,6kroam fo kvil"%5 "owl "J u Ievj cow, VP oWt 2le Mme'to J)oo,4{n EXISTING USE t PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EEXISSTTGG• / j b �3 NEW FLOOR AREAt 3 9 o DEM AREA TOT NET AREA /�, �/ O l (, BATHROOM REMODEL AREA KITCHEN REMODEL AREA o OTHER REW9L Ait .7 63 PORCH AREA DECK AREA l]( TOTAL DECK7PORCH AREA GARAGE DETACH [ �J u ATTACH # DWELLING UMTS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES ' BEING ADDED? 1't NO T� ADDITION? 04NO PRE -APPLICATION YES IF YES, PROVIDE COPY OF ❑ LETTER IS THE BLDG AN YES EICHLER HOME. NO - V. TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL ('IO 00V. By my signature below, I certify to each of the following: I am the propertyowner or authorized agent to ac on th perty 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 agree to comply with all applicable local ordinances and state laws relating to building con e tives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: I SUPPLEMENTAL INFORMATION REQUIRED/'r ,y i fu r % ., _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building i permit for new building. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure I form if any Hazardous Materials are being used as part of this project _ Copy of Planning Approval Letter or Meeting with,Planning prior to r, submittal of Building Permit application.�I BldgApp_2011.doc revised 06/21/11 CUPERTINt 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: S' PERMIT # `ab OWNER'S NAME: 1 PHONE # 47 4Pf (f- ZI- GENERAL CONTRACTOR: +/ BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: Z4 7 Z -i *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 Date 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 CUPERTINO STATEMENT OF SPECIAL INSPECTIONS, 2010 CBC COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org SITE ADDRESS x1665 Peack I�IOSSt7iVl T}- APN 396-11-/47 Registered Design Professio al in Charge BP# I401000� Lic.#....................................... Date:......................... Owner...............QY.1Sy$.a................. ........................................................ Contractor.......................................................... Owner's Authorization Si gnatu7e ::,... �- '�. ....... Address........................................................................................................... Inspection Agency / Inspector Name: Address........................................................................................................... City/St............................................. Zip ........................... Phone..................... City/St................................................. Zip ................... Phone ........................ Applicant......................................................................................................... Signalure .............. Engineer/ chi ct..............!t.Ae.1 -6cto ......................................................... Address........................................................................................................... Address...........�..8a ................. .2......................../.f......./........ . City/St............................................. Zip ........................... Phone..................... City/St... P40...41 fp................. 1..11 Zily= aZ.... Phone PROJECT DESCRIPTION: SFD, 0&14- 130 ss. W<d le-woW 93o s,+• This "STATEMENT OF SPECIAL INSPECTIONS" is submitted in fulfillment of the requirements of CBC Sections 1704 and 1705. This form is structured after and used by permission from the Structural Engineer Association of Northern California's (SEAONC) mode statement of Special Inspections. Also, included with this form is the following: ❑ "LIST OF SPECIAL INSPECTION AGENCIES (page 2). A list of testing agencies and other special inspectors that will be retained to conduct the tests and inspections for this project^ ❑ "SCHEDULE OF SPECIAL IS ECTION" (page 3 - 6). The Schedule of Spe, ,al Inspections summarizes the Special Inspections and tests re44in d.eCial Inspectors beef ed> ns and specifications for detailed special inspection requirements. Arty dtional tests and ir� cti` s uipproved plans and specifications shall also be performed. Special Inspections and Testing will be performed in accordance with the approved plan nd specifications, this statement and CBC Sections 1704, 1705, 1706, 1707, and 1708. Interim reports will be submitted to the Building Official and the Registered Design Professional in Responsible Charge in accordance with CBC Section 1704.1.2. A Final Report of Special Inspections documenting required Special Inspections, testing and correction of any discrepancies noted in the inspections shall be submitted prior to issuance of a Certificate of Use and Occupancy (Sectio ). The Final Report will document: • Required special inspections. • Correction of discrepancies noted in inspections. 01� The Owner recognizes his or her obligation to ensure that the construction complie wlth��Rproved per l disc t �� to implement this program of special inspections. In partial fulfillment of these obligati ns, the O er will reta��r a� .dAi bappa) l'fpyi-jh,0 Special Inspections as required in CBC Section 1704.1. p Y` This plan has been developed with the understanding that the Building Official will. 4,4'rfl • Review and approve the qualifications of the Special Inspectors who will rform the inspections.�4 PP q P P P�. • Monitor special inspection activities on the lob site to assure that the �pe�iFinpectdtaVigital)f.c[t r r heir duties as called for in this Statement of Special Inspection. • Review submitted inspection reports. r3>' • Perform inspections as required by the local building code. 1 have read and agree to comply with the terms and conditions of this statement Prepared By: Project LJ Engineer Architect Registered Design Professio al in Charge Signature ............... ..... ......................................... Lic.#....................................... Date:......................... Owner Name: Owner's Authorization Si gnatu7e ::,... �- '�. ....... ...................................................... Date:..��.Y... Inspection Agency / Inspector Name: Si nature ............... ...... Lic.#..G...��7. ....... Date:....ial or desig ee: n Signalure .............. ...................................... Date:.... D " -- SpecialnspeclionForm - revised 02/13/13 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 # l &rut uv v v OWNER'S NAME: y C PHONE # LLQ z ' � GENERAL CONTRACTOR: . PY.�' -�/ 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: t�WW Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature `f •/V -/S Date 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 `f •/V -/S Date