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13040126CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21761 SANTA BELLA PL CONTRACTOR: OMEGA CONSTRUCTION PERMIT NO: 13040126 OWNER'S NAME: PU HUANG 451 FENLEY AVE DATE ISSUED: 06/14/2013 OWNER'S PHONE: 4085041854 SAN JOSE, CA 95117 PHONE NO: (408)243-0404 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Class Lic. /i CONSTRUCT 655 SQ FT ONE STORY ADDITION AND A 296 Contractor �F� '� Date 3 vT l T- SQ FT KITCHEN REMODEL. 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: $80000 performance 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: 35622025.00 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 D S FROM 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 cf granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: / with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. / RE -ROOFS: Signature_ 1 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(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 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 Code, Sections 25505,25533 udl,1�34. /�� Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date�b 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, l 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 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 �g4.YDj.P • CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(c cuoertino.org ❑ NEW CONSTRUCTION D§ ADDITION M ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT AE)DR�SS / AIN # r / r I > L G O R NAME pii PHONE STREET ADpRFsS ) "Z SCS ill\ C STATE, P L-" FAX 1 f7 ( n1r2 GSC t i c? r� I CONTACT N E l i - MAIL Gl " C l-� r1 Cv az), STRE ADDRESS 14. ' esu -- C;TY, STATE, ZIP sc 0 FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEERNAME LICENSE pNUMBER BUS. LIC# - I -Zoe% COMPANY N MAIL lG`j%2.. FAX L�71 C tF�/C"2G STREET ADD RES CITY, PHONE /121-( 3 �tdt ne. D CRIPTI N.OF WORKI � � �� , -1 L I o 1 W) 6X D�-►'�G�l Gk ezwt i q y, -E TM Y e Wl Gzic, tL (C) IC +tc"- . , EXISTING USE PROPOSED USE CONSTRTYPE # STORIES / ; i r r- \ V /� j n USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA(' Q� AREA / 6�"�`� AREA NET AREA 4 G 4 1 v > E tc BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA j� REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT E] YES BEING ADDED? 141 N0 � SECOND STORY E] YES ADDITION? 'ANO PRE -APPLICATION , YES IF YES, PROVIDE COPY OF IS THE BLDG AN El jy TOTAL VALUATION: PLANNING APPL # O PLANNING APPROVAL LETTER EICHLER HOME? [:]NO O oO/, V 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 orize representatives of Cupertino to enter the above -Id entifed pr pe rty for inspection purposes. ordinances and state laws relating tq building cc truction. It-1, Signature of Applicant/Agent: — f! vi 6LV Date: r% SUPPLEMENTAL INFORMA- REQUIRED PIAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW 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 ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO FEW FEE ESTIMATOR - BUILDING DIVISION 1AADDRESS: 21761 SANTA BELLA PL DATE: 04/16/2013 REVIEWED BY: MELISSA PC FEE ID APN: 356 22 025 BP#: 13 0 5401,_::?_� 'VALUATION: 1$80,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? 0 Yes . No OTC. 0 Yes ONo PENTAMATION 1R3SFDADD PERMIT TYPE: WORK ADDITION OF 655 SQ FT TO CREATE N MASTER BEDROOM & N FAMILY ROOM. REMODEL SCOPE I (E) KITCHEN 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-B,MV-B 655 $2,468.00 1R3PLNCK $1,549.00 1R31NSP PME Plan Check: $0.00 Permit Fee: $1,549.00 Suppl. Insp. Fee:Q Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 655 $2,468.00["""l' $1,549.00 , ec/� . r'[an C'heck Odf,"ir Afech. Ins", . ilcrh, lwrp. Fce: 'It.� qth. T t_r Fl�>r Parrrlir I�'��: NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Aivtrirt ot.- L Thace foes are hasod nn the nroliminary infarmadan availahle and are anly an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E f 7,/1/12 FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,468.00 A s.f. 150 $600.00 Remodel, Kitchen (<=300 sf) 1REMRESKIT Suppl. PC Fee: 0 Reg. 0 OT FO.O hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,549.00 Suppl. Insp. Fee:Q Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: ��(�Il't]ilLStl"a11ve Fee: 0 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: 1PLLONGR $85.15 Select a Non -Residential Building or Structure I 0 0 i 1 rargil Doculnentution Fres: Strong Motion Fee. 1BSEISMICR $8.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $4.00 SLtBTOAL: $4,114.15 $600.00 TOTAI,FEE $4,714.15 Revised: 04/01/2013 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: ! '4, PERMIT # OWNER'S NAME: PHONE # y -- GENERAL CONTRACTOR:- 69CO3 BUSINESS LICENSE # ADDRESS: L CITY/ZIPCODE: it *Our municipa code requires all businesses working m the city to have a City of Cupertino busine s 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: ig Date Please check applicable subcontractors and complete the following information: ✓ SUBCONTRACTOR BUSINESS NAME BUSINESS LI ENSE # 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 Tan Sheet 2tal Sheet Rock Tile Owner / or Signature Date