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13050142 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19991 MERRITT DR CONTRACTOR:KUANC'S PERMIT NO: 13050142 CONSTRUCTION CO OWNER'S NAME: STEVE LEU PO BOX 4802 DATE ISSUED:09/20/2013 OWNER'S PHONE: 4089963896 EL DORADO HILLS,CA 95762 PHONE NO:(916)941-2378 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL[] License Class Lic.# d ?j ADDITION TO REAR RIGHT OF SFDWL TO INCLUDE 1 �1�� a —2rv– GAME � Contractor_ (, �' ( to ROOM,BATHROOM,ENLARGE M.SUITE AND KITCHEN 1 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. 1 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:$38000 ave an �e . maintain Worker's Compensation Insurance,as provided for by 36 W. 0the Labor Code,for the performance of the work for which this APN Number:31630071.00 Occupancy Type: pe tiss 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 0 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 DAY M 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 theex d•% granting of this permit. Additionally,the applicant understands and will comply Issued by: Date. � with all non-point source regulations pe the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature ate f 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 1 hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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 1 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 l performance of the work for which this permit is issued. will maintain compliance with the Cupertino Munici I 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,a 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: Date: L117/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,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 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. Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION /b 10300 TORRE.AVENUE•CUPERTINO, CA 95014-3255 (4Q8).777-3228• FAX(408)777-3333•building(a cupertino.org 1 CUPERTINO NEW CONSTRUCTION ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROIECC ADDRESS , 7PNO t b '—� —.7f d OWN ERNAMEr L&v PHONP LQ pn �3 M�7MAIL STREET ADDRESS V�- CITY, STA(T�EE'Pte) t l o a (� FAX CONTACT NAME PHONE E i STREET ADDRESSCITY,STATE,ZIP FAX ❑ OWNER .❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ARCHI ECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME *T E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGWE R NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR-TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S). EXISTG „-a�1 NEW FLOOR DEMO TOTAL '-F R AREA 1-7 6 I AREA O Q AREA /C NET AREA �•.7 S s r tt BATKITCHEN OTHER REMODEL AREA .. / REMODEL AREA �, REMODEL AREA .PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH []ATTACH . #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY YES . ' BEING ADDED? O ADDITION? 'O .PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RE C 1 Y:. TOTAL V I N: PLANNING ADPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO By my signature below,I certify to each of the following: I am the property owner or authovf4agent 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 ordinances and state laws relating,to uilding construction. I quthorize representatives of Cupertino to enter the above,identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLENTMWENFORMATION Q PLAN CHECK TYPE ROUTING SIAP New$FD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-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 O FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRON.'NENTAL HEALTH.I BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 19991 merritt dr DATE: 05/20/2013 REVIEWED BY: Mendez APN: BP#: "VALUATION: 1$38,000 %PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Du2nd Unit? Yes No PENTAMATION USE: plex OTC? 0 Yes 0 N PERMIT TYPE: I R3SFDADD WORK construct 1 story addition to sfdwl 308 sq ft SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. R-3 (Custom) II-B,111-B,IV,V-B 308 $1,512.00 IADDPLCK $1,230.00 IADDINSP TOTALS: 308 $1,512.00 $1,230.00 MECH,HOURLY Q Yes (D No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes E No .9 CC//, Plan Check 0unfb. flail Check Llec:. flan X ch. Permit Fee: Plumb.Permit Tee: Llec. Permit Fee. Other,Vech.Insp. Other Plumb Insp Other Elec.Insp. Meek Insp.Fee: Plumb. hish. Fee: Elec.Insp. Fee: NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District etc.). Thesefees are based on the prelimitia information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/12 FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,512.00 Select a Misc Bldg/Structure Suppl. PC Feer Q Reg. () OT0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $1,230.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Te iv: Administrative Fee: 0 Work Without Permit? 0 Yes O No $0.00 G Advanced Planning Fee: 1PLLONGR $40.04 Select a Non-Residential O Travel Documentation Fees: 1 Building or Structure 0 i Strong Motion Fee: IBSEISMICR $3.80 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: 1 $2,787.84 $0.00 TOTAL FEE: 1 $2,787.84 Revised: 04/29/2013 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# OWNER'S NAME: PHONE# GENERAL CONTRACTOR: /G BUSINESS LICENSE# ADDRESS: o CITY/ZIPCODE: *Our municipal code requires all businesses 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 SUBCONTRA� RS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. `� I am not using any subcontractors: USienature 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/ t r -ignature D to ��