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15110100
*41 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10162 BILICH PL CONTRACTOR: TIMELINE PERMIT NO: 15110100 CONSTRUCTION OWNER'S NAME: CHIN WAYNE F AND JOAN L 14401 BIG BASIN WAY DATE ISSUED: 11/16/2015 OWNER'S PHONE: 4087413000 SARATOGA, CA 95070 PHONE NO: (408) 741-3000 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL REMODEL (3) BATHROOMS (180 SQ FT); INTERIOR License Class ['t}.. �''�7 Li,. #3q9-41 (0 REMODEL TO CREATE CLOSET (56 SQ FT). Contractor-JJRE:L4Wre C,[iMC Date i014 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: $160000 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: 31621064.00 Occupancy T p y yam' 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 WITIiIN 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, costs, and expenses which may accrue against said City in consequence of theF Issued bye Date: granting of this permit, Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18. /— +U SignatureDate<< !� t7 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 I store or handle hazardous I have and wilt 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, Xctions 25505, 25533, alhd 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 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 COMIdiUNI TY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildino(-.cuoertno.om CUPERTIt�tO VJt—,N)C©tL, 15iJoiov ❑ NTEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION / DEFERRED ORIGIN.kL PERMIT PROTECT ADDRE d I 4PN r 1 amp, C4114 STREET ADDRESS CITY, STATE, ZIP I FAX CONTACT NAME P' X. E-N.AIL S = i P D ^SS , , I� Y. STAT FAX RM �El 0 014'NER ❑. OR'N'ER-B=ER o\ Rw .R Acm, r ❑ C01.7RACTOR ❑ CON -R ACTOR AGENT ❑ P.RC=CT ❑ EN'GA=cR ❑ DEVELOPER ❑ TzNAh'T 'NSB N ✓!ER I LICENSE TYPE BUS. LIC R CONI/, 'ADE E -NAIL/ FAX �S E T AD E ST i t ZiP WE 3 ARCHTTECT/ENGDNBER NAME LICENSE NUMBER BUS. LIC m COMPANY NAME E-MAIL FAX STF.EET A.DDR.ESS I CITY, STATE, ZIP I PHONE DESCRIPTION OF WOP.K E)7STI11'USE PRO OWED USE CONS -TR - TYPE 4 STORIES I?7 i USE TYPE OCC. SQ.FT. VALUATION (S) EXLTG NEW FLOOR DEMO TOTAL AREA AREA I AREA - NET AREA - BATHROOM KITCHEN OTHER REMODEL AREA TFLEMODELAkEA KE -MODEL AREA PORCH AREA DECK AREA TOTAL DECKIPOP.CH AREA GARAGE AREA: DETACH ❑ ATTACH I :DN'ELLINGIJhTTS: ?N� S SECOND A.TADDITION?ORY BEING DDED/—! X0 PRE-.SnPLIC.ATION ❑ lES JF YES, PROVIDE COPY OF PL,' NWING APPL R ❑ NO PLA.N'N�G APFROVA.L LETTER IS THE BLDC AN ❑ YES EICHLER HOME? ❑ No TMECEI D $1 - _ OTAL VALUATION: = - �- �O Q 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 h ve provided is cor, ect. I have read the Description of Work and verif' it is accurate. I agree to comply with all applicable local ordinznces and state laws relating a 'ding c t' Ti. I auth ize representatives of Cupertino to enter the above-' entified proper y for inspection purposes. Si--natureofApplicant/Agent: Date: {� SUPPLEMENTAL INFORMATION REQUIRED` - O«R TEGrGOL�TER v IIILDL'�GPL�N REtTIEFY New SFD or Multifamily dwellings: Apply for demolition permit forME existing building(s). Demolition permit is required prior to issuance of building permit for new building. ExrEss = PL 4\ ZtGPI 4N x> FBF . _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 1� �T��DARD �PUEI ICRorsts form if any Hazardous Materials are being used as part of this project. — ❑ LARGE — �s Copy ofPlanning Approval Letter or Meeting with Planning prior to - — k•IREDEPT _ submittal of Building Permit application. Mv?oR ,ri�xY ER�isrxrcr Bld'aApp_2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 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 hated on the nreliminary information available and are only an estimate_ Contact the Dent for addn'1 info_ FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) ADDRESS: 10162 Bilich PI DATE: 11/16/2015 REVIEWED BY: Sean APN: BP#: *VALUATION: 1$160,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 0.0 PENTAMATION 1 R3SFDREM PERMIT TYPE. WORK Remodel 3 bathrooms 180 sq ft); Interior Remodel to create closet 56 sq ft). SCOPE $0.00 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 hated on the nreliminary information available and are only an estimate_ Contact the Dent for addn'1 info_ FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 180 s.f. $645.00 Remodel, Bath (<=300 sf) 1REMRESBAT Suppl. PC Fee: 0 Reg. OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 F__5_6__j s.f. $431.00 Remodel, Other 1REMRESOTH Permit Fee: $0.00 Suppl. Insp. Feer Reg. OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (_. uii,'rrucfion Kix: 4dinini5' raiii,e Pee: Work Without Permit? Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 i 1' ,,vel Documentation /°'< Strong Motion Fee: IBSEISMICR $20.80 Select an Administrative Item Bldg; Stds Commission Fee: 1BCBSC $7.00 SUBTOTALS': $27.801$1,076.00 TOTAL FEE: $1,103.80 Revised: 10/01/2015 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 # D /C20 OWNER'S NAME: ` n p' \0an PHONE # - $ —Oc7 c4 , GENERAL CONTRACTOR: 7t Qn ' BUSINESS LICENSE # ' O ADDRESS: VIALkO CITY/ZIPCODE:q50-10 *Our municipal code requir6s all businesses w#king 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 V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation gccie-135 Landscaping Lathing LoOLAAly.,2, �2 Masonry Painting / Wallpaper Paving Plastering Plumbing --Y 4Z V ; 'k�o'eL c Roofing Septic Tank Sheet Metal Sheet Rock P\A j k -u �jOC7) Tile ✓,%tet.. ��,� Owner / Contractor Signature Date H,L INSPECTIONS, Inc. CONSTRUCTION INSPECTION SPECIALISTS 690 SUNOL ST., BLDG. H • SAN .JOSE, CA 95126 (408) 288-8460 • FAx: (408) 271-0902 ANCHOR INSTALLATIO N FILE DSA FILE # DSA Appl. # OSHPD # INSPECTION REPORT City of:—Date: �g r Project Name: �' "'r W-4yw t � � Project # / 0 7 Address: 101 Z, 5�� f � C. Permit # � / 6 / C''> Inspectors Name: ' ID # --------------------------------------- Installation Inspection of: 0 Epectect- inf r ft"eul-Dowels C, poxied Allthread Anchors O_Expaasian..Aachers,, Witnessed the drilling of the holes and verified proper diameter and depth. (or) inspected predrilled holes and verified proper diameter and depth. served the cleaning of the holes and th njecti insertion of po epaxy_cap&W.@s # grout, ICC ER# '? Expiration Date .I WT1 nnessed the proper insertion of: _ ., 7 (No.) J diameter allt*m mors / 7 inches in length, embedded reinforcing-steetlowels / expansiortMVmTs-- inches, at the following location: //'VM tv sx Z-�, �- (No.) diameter allth a hors / reinf„grilag,.�1iutdQwels / expansiou-axast ors inches in length, embedded c inches, at the following location: //y7z /V*¢ zr_. 7Z /�%�6�;CO- ._ 4,V C ffo A-- Z;c3 r 7` 1"Y7 diameter allthread anchors / reinforcing steel dowels / expansion anchors inches in length,gemit2d inches, at the following location: Notes. ` ! M ' f= M961-.MCw7-S , +C"�!i!T.Z°. 'I�TJi /VSCD To the best of my knowledge, work inspected was in accordance with the building department approved design drawings, specifications and applicable workmanship provisions of the C.B.C. except as noted above: y Inspectors' sionature: ay