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13120184 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 871 LILY AVE CONTRACTOR:LNB CONSTRUCTION, PERMIT NO: 13120184 INC OWNER'S NAME: TIAN WANG-MENDEZ 861 SEQUOIA AVE DATE ISSUED:03/11/2014 OWNER'S PHONE: 4087399988 MILLBRAE,CA 94030 PHONE NO:(415)585-3884 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑ ADDITION(247 S.F.) & CONVERT(E)GARAGE AREA TO License Class [[ � �1,� Lia# (N)UTILITY ROOM(78 S.F.) Contractor LN 6 Cot< Tt` Da+to t Z 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:525000 I ave 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:35903018.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that l 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 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 F LED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, f costs,and expenses which may accrue against said City in consequence of the / granting of this pe pit. Additionally,the applicant understands and will comply Date: f 14/ y with all non-poi t s urce r ulations per the Cupertino Municipal Code,Section 9.18. 1 RE- ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is t installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNFR-BeILDER DECLARATION Signature of Applicant: Date', hereby affirm that I a�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 lBay Area AioQuality Management District I performance of the work for which this permit is issued. will maintain compliance with the .upe ino M nicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Section 25_ 5,2 53 ,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. 1 certify that in the performance of the work for which this permit is issued,I shall c 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,t CONSTRUCTION LEP DYNG AGENCY become subject to the Worker's Compensation provisions of the Labor Code,l 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 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 l 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. Date CONSTRUCTION PERMIT APPLICATION Is COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION O 10300 TORRE AVENUE• PERTIN A 14- 2 U CU O, C 950 3 55 0� CUPERTINO (408)777-3228• FAX(408)777-3333•building a@cupertino.org ❑NEW CONSTRUCTION jj ADDITION ALTERATION/TI ❑ REVISION/DEFERRED O UGINA�}L PERMIT# �� PROJECT ADDRESS (�(J / i�G�. f//� APN# �nn[[J/ OWNER NAME -1 l,a►1 ✓` n� �� Bn PHONE a_v )1 3 Q'_q y Y�� E-MAIL h f rnende� STREET ADDRESS �� J I J`/` CITY, STATE,ZIPP C �``�((((UU////r^ FAX CONTACT NAME G' r'�/ .GY r/�ry.d1 PHONE/yCfq��/ y�/r E-MAIL Jn (q, n hiv-, /.I STREET ADDRESS / /� �J' �pylr/��1. /l.j�� CITY,STATE,ZIP /�n b ��1 [ / FAX l:.i I/ ,i ❑OWNER ❑ OWNER-BUILDER ❑1/OOATTER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT A ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS t CITY,STATE,ZIP J PHONE ARCHITECT/ENGBJEER NAME f I{ _ALICENSE NUMBER /„ /j "•� BUS.LIC# COMPANY NAME rYa 1!_A"'� E-MAIL �/1 i rni/n40410o. fa f-Zn. FAX STREET ADDRESS ibqC O ; gUJA-ve CITY,STATE,ZIPCA 4I DESCRIPTION OF WORK � m 14U O y/` 5,5�5 V� V - E3STINI4GUSE P POSFID SEA 1, CONSTR TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR Y/�"V'D-EMO V TOTAL 7, i AREA y,.�/ AREA L AREA NET AREA, ,L BATHROOM ((JJ KITC"''TTTT N OTHER REMODEL AREA 0 REMODEL AREA O REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGEA: DETACH qv WTTACH #DWELLING UNTIS: IS A SECOND UNIT YES SECOND STORY ❑YES BEING ADDED! IEP O ADDITION! PO PRE-APPLIC TION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME! N 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 ha4c 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 bww,99construct!9n. I authorize representatives of Cupertino to enter the above-identified pro rty for inspection purposes. Signature of Applicant/Agent: Date: y j SUPPLEMENTA INFORMATION REQUIRED "5'dm't' y 1*LA S GK 1YR a _New SFD or Multifamily dwellings: Apply for demolition permit for .tIEA4C{1tA+IT�CR existing building(s). Demolition permit is required prior to issuance of building �5 a permit for new building. [) ' XPRS pf; ttl +t � # yIW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part ofthis projectrT axd G, _Copy of Planning Approval Letter or Meeting with Planning prior to submittal ofBuilding Permit application. � ,MAtc1R' §EVVi1�i � BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 871 LILY AVE DATE: 12/23/2013 REVIEWED BY: MELISSA APN: 359 03 018 BP#: / a� 'VALUATION: 1$25,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex 2nd Unit? 0 Yes . No PENTAMATION 1 R3SFDADD USE: OTC. 0 Yes 0 N PERMIT TYPE: WORK ADDITION 247 S.F. & CONVERT E GARAGE AREA TON UTILITY ROOM 78 S.F. SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.t. R-3 (Custom) II-B,111-B,IV,V-B 247 $1,059.00 IADDPLCK $1,026.00 IADDINSP TOTALS: F 247 $1,059.00 $1,026.00 MECH,HOURLY 0 'Yes 0.No PLUMB,HOURLY 0 Yes 0 No ELEC,HOURLY 0 Yes 0`No �. ,... NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These ees are based on the prelimina information available and are only an estimate. Contact the Deptor addn'1 info. FEE ITEMS(Fee Resolution 11-053 UL 7/LA131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,059.00 = s.f. Remodel,Other Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $418.00 I.REMRESOTH PME Plan Check: $0.00 Permit Fee: $1,026.00 Suppl. Insp. Fee-0 Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 o;7"N1F%li'Y1oi? 1F�IiYi(tl.t(l'(ffli't'/ �'; 0 Work Without Permit? 0 Yes 0 No $0.00 0 Advanced Planning Fee: 1PLLONGR $34.58 Select a Non-Residential 0 'I efe ,{Jnc /"c�%�: Building or Structure 0 Strom Motion Fee: 1BSEISMKCR $2.50 Select an Administrative Item Bldg Commission Fee: 1BCBSC $1.00 SUBTOTALS: $2,123.08 $418.00 TOTAL FEE: $2,541.08 Revised: 10/01/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 CU P ERTI NO Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: L I 1 PERMIT# 131 Z-0 OWNER'S NAME: j-GrA PHONE# 30 GENERAL CONTRACTOR: �j l ' hf -BUSINESS LICENSE# ADDRESS: 1 S�ja Z l A' CITY/ZIPCODE: t ��n�. v v *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: -oil" Signature Date Please check applicable subcontractors and complete the following information: 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 A ' Owner�Co tractor Signature Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: ( `� PERMIT# I - o OWNER'S NAME: PHONE # GENERAL CONTRACTOR: W6 C' ( &JSINESS LICENSE# ADDRESS: A-vr-- CITY/ZIPCODE: 40)c *Our municipal code requires all businesses working 'n the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCC PANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL S NT CTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Sign ture ate Please check applicable subcontractors and complete the following information: 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