13110048CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10628 LONNA LN
CONTRACTOR: TIGER BUILDERS INC
PERMIT NO: 13110048
OWNER'S NAME: YUE LIU
5905 DIAL WAY
DATE ISSUED: 01/10/2014
OWNER'S PHONE: 4085691873
SAN JOSE, CA 95129
PHONE NO: (408) 865-1251
❑ LICENSED DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
/CONTRACTOR'S
License Class 1 , C ���(! Lic. # 4 33 P417
ADD 731 S.F. REAR ADDITION TO CREATE 2 (N) I$DltMS &
2 (N) BATHROOMS
Contractor h
/dM TU/&?;-7 5 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.
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: $150000
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as provided for by
tion 3700 of the Labor Code, for the performance of the work for which this
APN Number: 35919012.00 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. 1 agree to comply with all city and county ordinances and state laws relating
WITHINOF 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 DAY ROM VAST 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/,
/a,
granting
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:! I
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18.
/
RE-ROOFS:
Signature Date O
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. R 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 a
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: Date: r � /
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
ED��
COMMUNITY DEVELOPMENT DEPARTMENT e BUILDING DIVISION \
10300 TORRE AVENUE e CUPERTINO, CA 95014-3255 �\
(408) 777-3228 ^ FAX (408) 777-3333 ^ building a(kupertino.org \
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/ TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 10628 LONNA LN, CUPERTINO
APN# 359-19-012
OWNERNAM}E.,�^ V. �, a
PHONE ®� -'
408 317 8886
F. -MAIL den eff @Yahoo.com
9J
STREET ADDRESS 10628 LONNA LN,
CITY, STATE, ZIP CUPERTINO
FAX
CONTACT NAME YIN SU
PHONE 650-265-8676
E-MAIL yinsu2002@gmail.com
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITFCr ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHIT N ER NAME Q
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
P ONE 17— 9 09 4
DESCRIPTION OF WORK 731 SF ADDITION TO THE REAR YARD TO INCLUDE TWO BEDROOM SUITES
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
R-3
R-3
V
ONE
USE
TYPE OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA 1,558SF
AREA 731 SF
AREA OSF
NETAREA 2289SF
BATHROOM
KITCHEN
OTHER
REMODELAREA N/A
REMODELAREA NIA
REMODELAREA N/A
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DF,TACH
[]ATTACH
# DWELLING UNITS:
UNIT []YES
SECOND STORY []YESADDED?
FISACOND
[]NO
ADDITION? []NO
PRF -APPLICATION []YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YESREC
-
TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
14
By my signature below, I certify to each of the following: I am the property owner or authorized agent t0 < property owner's behalf. 1 have read this
application and the information I have provided is correct. I have read the Description of Work and veriis accurate. I agree to comply with all applicable local
ordinances and state laws relating to build onstructi authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent Date: it /,v I
SUPPLEMENTAL INF RM TION 9YQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑
PLAN
New SFD or Multifamily dwellings: Apply for demolition permit for
_
existing building(s). Demolition permit is required prior to issuance of building
OVER -TILE -COUNTER
BUILDING REVIEW
permit for new building.
ElEXPRESS
LANNING PLAN REVIEW
YL—,F
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
ANDARD
PUBLIC WORKS
_
form if any Hazardous Materials are being used as part of this project.
❑
LARGE
FIRE DEPT
of Planning Approval Letter or Meeting with Planning prior to
❑
_Copy
submittal of Building Permit application.
MAJOR
L,d SANITARY SEWER DISTRICT
�/
❑ ENVIRONMENTAL HEALTH
B(dgApp_2011.doc revised 06121/11
MM -17
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
I&
ADDRESS: 10628 LONNA LN
DATE: 11/08/2013
REVIEWED BY: MELISSA
PC FEE ID
APN: 35919 012
BP#: 3 �V
`VALUATION: 1$150,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
2nd Unit? 0 Yes : No
OTC. Q Yes (F) No
PENTAMATION 1R3SFDADD
PERMIT TYPE:
WORK I
ADD 731 S.F. REAR ADDITION TO CREATE 2 N BDRMS & 2 N BATHROOMS
SCOPE
Suppl. Insp. Fee.e Reg. Q OT
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE IID
R-3 (Custom)
II-B,111-B,IV,V-B
731
$2,577.00
IR3PLNCK
$1,617.00
IR3INSP
Elec. Insp. Fee:
$1,617.00
Suppl. Insp. Fee.e Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Consiruction .Tax:
Administrative Fee:
Q
0
Work Without Permit? Q Yes (F) ;No
$0.00
TOTALS:
731
1 $2,577.00
1
$1,617.00
Strong Motion Fee: IBSEISMICR
MFCH, HOURLY Q Yes E) No
PLUMB, HOURLY Q Yes Q No
ELEC, HOURLY Q Yes 0 No
Nfech. Plan Check
Phmrb. Plan Check
I.Jec. Plan Check
i! -tech. Permit Tee:
Plumb. Permit ree:
Elec. Permit Fee:
Oilier Afech. Insp.
Other Plumb Insp.Li
Ocher Dec. Insp,
,1lech. Insp. Fee:
Plumb. hrsp. Tee:
Elec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments fl. c 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 Dept for addn I info.
FEE ITEMS (Fee Resolution 11-053 E : 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,577.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: (F) Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$1,617.00
Suppl. Insp. Fee.e Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Consiruction .Tax:
Administrative Fee:
Q
0
Work Without Permit? Q Yes (F) ;No
$0.00
Advanced Planning Fee. 1PLLONGR
$102.34
Select a Non -Residential
Building or Structure Q
Travel Doemnentufion Fees:
Strong Motion Fee: IBSEISMICR
$15.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$6.00
SUBTOTALS:
$4,317.341
$0.00 TOTAL FEE:
1 $4,317.34
Revised: 10/01/2013