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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