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13060063
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10791 BROOKWELL DR CONTRACTOR:PETER CONSTRUCTION PERMIT NO: 13060063 OWNER'S NAME: YUN XIAO AND MENG YU 5925 TOMPKINS DR DATE ISSUED:08/07/2013 OWNER'S PHONE: 6504749395 SAN JOSE,CA 95129 PHONE NO:(408)529-6412 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Class_ Lie.# d 88 CONSTRUCT A 629 SQ FT ONE STORY ADDITION; INSTALL Contractor ate 0--��`3 ' (N)WINDOW IN (E)BEDROOM 93. I hereby a irm 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:$110000 1 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:36921015.00 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 DAYS FROM ED 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 l granting of this permit. Additionally,the applicant understands and will comply I Pde Date: with all non-point source regulations per the Cupertino Municipal Code,Section oo 9.18. ©p� 0 / ��_ Signature Date CJ 1 3 All roofs shall be inspected prior to any roofing 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 I 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) 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. 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 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, 3,.. 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,1 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 1 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, 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 PERM T APPLICATION is COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION o0 10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building(cDcupertino.org ❑NEW CONSTRUCTION ® ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS (!1 tQ Qp►y t;.l l� Cl� 7APIN IV ?/� fJ / `O 1 S,�1 M� 1I OWNER NAME N X. A-0 ,�1i�Cl�,��, yk PHONE 6�d(ov� j qOJ (E-MAIL m G�b� r I � 9,w(,(•co'-- STREET ADDRESS � CITY,STATE,ZIP Cil �ti+ o CA i l! FAX CONTACT NAME R i,F�j t ft 7 PHONE t'�.�fI_�(L t E-MAIL e"� C1 0 @ lP CL; Co STREET ADDRESS V l J N v CITY,STATE,ZIP T T / FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME P E T�j� /-1919 LICENSE NUMBER g7 1 LICENSE TYPE BUS.LIC d COMPANY NAME 1 '\ E-MAIL / / FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION.p ,fid one nmj4w baa( r m, o sltcrlphj a,,d ens. 011 P149 P13 / EXISTING USE PROPOSED USE CONST TYPE 1 #STORIES t/' USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA 1' + AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA �DECKA TOTAL DECK/PORCH AREA I GARAGE AREA: DETACH ❑ATTACH # DWELLING UNrrS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES R C TOTAL VALUATION: PLANNING APDL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO /D C�G� 7 By my signature below,I certify to each of the following: I am the property owner or authoriz agent to ac n property owner's behalf 1 have read this application and the information I have provided is correct. I have read the Description of Work and verify i accurate. I agree to comply with all applicable local ordinances and State laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of ApplicantiAgent: um Date: 0611106 SUPPLEMENTAL INFORMATION REQUIRED PLANCHECKTYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-TILE-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 6V 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.doe revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10791 BROOKWELL DR DATE: 06/1012013 REVIEWED BY: MELISSA APN: 369 21 015 BP#: �Q�00( WALUATION: 1$110,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex 2nd Unit? Yes No PENTAMATION 1 R3SFDADD ONo PERMIT TYPE: USE: OTC? 0 Yes WORK 1629 S.F. ADDITION TO CREATE N MASTER BEDROOM STUDY/DEN & LIVING ROOM. INSTALL SCOPE 11 (N)WINDOW IN (E) BEDROOM 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 629 $2,468.00 IR3PLNCK $1,549.00 IR3INSP TOTALS: 629 $2,468.00 $1,549.00 MECH,HOURLY © Yes 0 No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes Q No Altm.h,Plan Check Plumb- NaII C h, Bleu. Pian C Huck :Lfeclr. Permit Fee: Plumi,. 'omit Fee- Flec. Perrnif Fee: Ocher $tech.Insp. Other Plumb lnsp. Other Elec'.Insp. El 14e.ch.Insp,Fire: Plumb. Insp. Fec: Flec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc.). These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/12) FEE QTYIFEE MISC ITEMS Plan Check Fee: $2,468.00 = # Window/Sliding Glass Door Suppl. PC Fee: (E) Reg. O OT 0.0 hrs $0.00 $799.00 1WINMEWSTR New(Shearwall/Masonry) PME Plan Check: $0.00 Permit Fee: $1,549.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 f;onsouction Tax. Administrative Fee: 0 Work Without Permit? Yes E) No $0.00 0 Advanced Planning Fee: IPLLONGR $81.77 Select a Non-Residential G Trav€ DocumentationT ees: Building or Structure 0 A Strong Motion Fee:. IBSEISMICR $11.00 Select an Administrative Item Bldp,Stds Commission Fee: 1BCBSC $5.00 SUBTOTALS: $4,114.77 $799.00 TOTAL FEE: 1 $4,913.77 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 1 N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: Q ro PERMIT# "' 60 OWNER'S NAME: PHONrE# GENERAL CONTRACTOR: BUSINESS LICENSE# 41= goo ADDRESS: CITY/ZIPCODE: "Our municipal code requires 11 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 CI'T'Y OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: 17) Signature Date Please check applicable subcontractors and complete the following information: 6/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/ Glazing % Heating Insulation Landscaping Lathing Z 'Z Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Date Owner Co t�ctor Signature