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14050061 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21751 OLIVE AVE CONTRACTOR:Pt CONSTRUCTION PERMIT NO: 14060061 OWNER'S NAME: YAO GONG 20570 ASHLEY WAY DATE ISSUED:06/10/2014 OWNER'S PHONE: 4086749176 SARATOGA,CA 95070 PHONE NO:(408)781-7908 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ r� RECONFIGURE AND REMODEL(E) LAUNDRY, ENTRY, License Class Lic.# qc) LIVING E7 �� r, �� RM,FAMILY RM,DINING RM&3RD BEDRM(700 S.F.). Contractor t e Date REMODEL KITCHEN(200 S.F.),3 BATHS(200 S.F.) 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 erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$80000 Mrve and will maintain Worker's Compensation Insurance,as provided for by ection 3700 of the Labor Code,for the performance of the work for which this APN Number:35718027.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 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 FROM.LAST C-AktUD 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 " granting of this permit. Additionally,the applicant understands and will eorn I Y Date: lO with all non-point source regulations per the Cupertino Municipal Code, i 9.18. ROOFS: Signature _ I Date I 0 All roofs shall be inspected pri any rooting material being installed.If a roof is installed without first obtaining an inspection,1 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. 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(x)should I store or handle hazardous 1 have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 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,Sectio rs 05,25533,and 5534. Section 3700 of the Labor Code,for theerformance of the work for which this p Owner or authorized agent: Date: /0I1 permit is issued. 1 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,1 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 ELI COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228• FAX(408)777-3333• building6a?cupertino.org \ CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS /) I T % o Aye ` APN# 357— J5 027 OWNER NAME t d�� PHONE E-MAIL N't STREET ADDRESS f CITY, STATE.ZIP FAX CONTACT NAME PHONE -117 o}j1 E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE N12R,kf LICENSE TYPE n BUS.LIC# COMPANY NAMEP, c" }.,�, E-MAIL 1 _` J•� � FAX' ` STREET Act(/. 7C� SCITY,STATE,ZIP` PHONE !/0,0.313=� 73 ARCH TECT/ENGINEER NAME -uI VL �{ LICENSE NUMBER c 66 65 BUSt.LLIC# �� COMPANYNAME ^ E-MAIL I-� FAX STREET ADDRESS CITY,STATE,ZIP PHONE �I \��--X11—�� DESCRIPTION OF WORK 60 3 &t+A r,ns. C3 e�� CES. f_-aunr (r "P7 . CEJ to c�) EXISTING ME PROPOSED USE CONSTR.TYPE #STORIES I USE TYPE OCC. SQ.F ALUA 0 () S EXISSTGNE FLOOR DEMO TOTAL AREA Z AREA AREA NET AREA Z0 L BATHROOM 'A KITCHEN OTHER ///�� REMODEL AREAL REMODEL AREA Z00 f F REMODEL AREA 0 0 PORCH AREA DECK AREA TOTAL DECK/PORCH AREA 7�:= #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES I BEING ADDED? NO ADDITION? .Q'INO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN r-c YE CE[VED BY: TOTAL VALU ATION:__X PLANNING APPL# �NO PLANNING APPROVAL LETTER EICHLER HOME? ( �(_�. 1 J]� By my signature below,I certify to each of the following: I am the property owner or auth0 to e operty owner' alf. l have read this application and the information I have provided is correct. I have read the Description of and tt Is om I with all applicable local ordinances and state laws relating to building construction. I authorize representatives o Cup mo to ent e ab entified property for inspection pur Signature of Applicant/Agent: ate: U SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dlvellingS: Apply for demolition permit for VER-THE-COUNTER ❑ BUILDING PLAN REVIEW 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 submittal OfBUllPermitg Permit application. ❑,.MAJOR 1:1 SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH BldgApp 2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 21751 OLIVE AVE DATE: 0611012014 REVIEWED BY: MELISSA APN: 357 18 027 BP#: `VALUATION: 1$80,000 ^PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: PERMIT TYPE: WORK RECONFIGURE AND REMODEL E LAUNDRY ENTRY LIVING RM FAMILY RM DINING RM & SCOPE 3RD BEDRM (700 S.F.). REMODEL KITCHEN (200 S.F.), 3 BATHS (200 S.F.) INSTALL 2 F-1 Ll 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 relimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fees Resolution 11-053 E}' ?%1,,13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F-7-007 s.f. Remodel,Other Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $558.00 IREMRESOTH PME Plan Check: $0.00 200 s.f. Remodel,Kitchen(<=300 sf) Permit Fee: $0.00 $626.00 /REMRESK/T Suppl. Insp. Fee:G Reg. Q OT O p hrs $0.00 = s.f. Remodel,Bath(<=300 sf) PME Unit Fee: $0.00 $626.00 IREMRESBAT PME Permit Fee: $0.00 # Skylight $418.00 ISK)1<10SF <= 10 s.f. Work Without Permit? 0 Yes (D No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) Building or Structure Strong Motion Fee: /BSFISMICR $8.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $4.00 SUBTOTALS: $12.00 $2,228.00 TOTAL FEE: $2,240.00 Revised: 04/01/2014 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C U P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: a% F ( 0 Cr! VQ A V-e PERMIT# r V06 00 6 OWNER'S NAME: oc.v C:r PHONE# '� l `6 GENERAL CONTRACTOR: Pr BUSINESS LICENSE#(4 GOSJ3 i3 - ADDRESS:-)10S,>0 CITY/ZIPCODE: "Our municipal code require all bu esses working in the city to have a City of Cupertino bu mess 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 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 Owner/Contractor Sig ature 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# 4 O f9D OWNER'S NAME: PHONE# GENERAL CONTRACTOR: 0,7 >&,c BUSINESS LICENSE# ADDRESS: e1 63�?6 ( CITY/ZIPCODE: *Our municipal code requires A busine es working in the city to have a City of Cupertino usiness 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. � ��' plL f.�-�l� I am not using any subcontractors: 544 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 Owner/Contractor Signature Date