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14080196 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7401 ROLLINGDELL DR CONTRACTOR:LA ROCA BUILDERS PERMIT NO: 14080196 OWNER'S NAME: HSU CHEN J 3465 CHARING CROSS LN DATE ISSUED:08/19/2014 OWNER'S PHONE: 5102521631 SAN JOSE,CA 95132 PHONE NO:(408)835-5160 ® LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ INTERIOR REMODEL 1204 SQ FT TO INCLUDE M,E,P'S, License Class____ Lia# /q C7 Z?99 PANEL UPGRADE 200 AMP,INSTALL NEW FURNACE A/C Contractor 30 Se A 01 V/I►r Dae & — t ��—�� WATER HEATER 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:$40000 ton will maintain Worker's Compensation Insurance,as provided for by Sec ion 3700 of the Labor Code,for the performance of the work for which this APN Number:35932001.00 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 AST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, i costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. �q ROOFS: Si-nature_f Date�<i� qll roofs shall be inspected prior to anyy 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: ALI,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 1 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 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: Date: 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 indemnity and keep harmless the City of Cupertino against liabilities,judgments, ARCHITEC'T'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 r CONSTRUCTION PERMIT APPLICATION i COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION �O 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX(408) 777-3333• buildingCcDcupertino.org l ❑ NEW CONSTRUCTION ❑ ADDITION [] ALTERATION/TI ❑ REVISION/DEFERRED I ORIGINAL PERMIT# PROJECT AD GE S ^ O APN# 3 S/ ' n a OWNER NAME PHONE E-MAIL STREET ADDRESS CITY, STATE.ZIP TAX-_ D CONTACT NAME PHONE E-MAIL STREETADDRESS CITY,Sr.ATE. ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LI E E NUNBER__ LI CE;SE TYPE BUS.LIC# r A v� O/ \. COMPANYNAMEJ��� E-MAIL FAX ` !//1l STREET ADDRES<SJ C� 1 l �✓ CITY,STATf:,ZIPp PH(�VF�/e Ck ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# to COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DE RI TION OF WORK l c o e rd L EXIS NG USE PROPO D S CONSTR TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA .AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL.AREA REMODEL/!:W PORCII AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA DETACH ❑.ATTACH 4 DWELLING UNITS 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 RECEIVED BYY - - TOTAL VALUATION: PLANNING.APPL a []NO PLANNING APPROVAL,LETTER EICHLER HOME? ❑NO -- By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the properly owner's behalf. I have read this application and the information l have provided is correct. I have read the Description of Work and verify itis accurate. I agree to comply with all applicable local ordinances and state laws relating to buildings. r truction. I authorize representatives ofCupertino to enter the above-identified /property for inspection purposes. SignaturcofApplicant/Agent: /�, "� Date: SUPPLEMENTAL INE RMATION REQUIRED PLANCHECKTVPE ROUTING SLIP NeW SFD or Multifamily dwellings: Apply for demolition permit for Ef OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ElEXPRESS PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 17 STANDARD ��❑ PVH1EjC 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 ❑ SANITARYN£WER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 1.doe revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 7401 rollingdell dr DATE: 08/19/270147] REVIEWED BY: Mendez tAPN:: BP#: (� "VALUATION: $40,000 ;PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: PERMIT TYPE: WORK interior remodel 1204 s ft to include m e 's panel upgrade 200 amp, install new furnace a/c & water SCOPE heater Mech.Plan Check 0.0 hrs $0.00 Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check 0.0 1 hrs $0.00 Mech.Permit Fee: IMPERMIT Plumb.Permit Fee: IPPERMIT Elec.Permit Fee: IF-PERMIT Other Mech. Insp. 0.0 hrs $48.00 Other Plumb Insp. 0.0 hrs $48.00 Other Elec.Insp. FO.0 hrs $48.00 NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District, etc. . These ees are based on the prelimina information available and are only an estimate. Contact the Dept/or addn'l info, FEE ITEMS (Fee Resolution 11-053 Eff ? 1%'13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1,204 s.f. Remodel, Other Suppl. PC Fee: (j) Reg. © OT0.0 hrs $0.00 $4,604.00 1REMRES2 PME Plan Check: $0.00 200 amps Electrical Permit Fee: $0.00 $48.00 IBELEC200 Services Suppl. Insp. Fee:G Reg. ® OT 0.0 hrs $0.00 0 # Mechanical PME Unit Fee: $0.00 $143.00 IMFR=<10o Furnace, Forced-Air PME Permit Fee: $144.00 0 # Mechanical $72.00 IBREMAIR A/C Units(<=I OK cfin) Administrative Fee: IADMIN $45.00 1 # Plumbing 0 Work Without Permit? 0 Yes 0 No $0.00 $29.00 IPRWHEATR Water Heater Advanced Plannin& Fee: $0.00 Select a Non-Residential Travel Documentation Fee: ITRAVDOC $48.00 Building or Structure Strong Motion Fee: IBSEISMICR $5.20 Select an Administrative Item Bldg,Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $244.201$4,896.00 TOTAL FEE: 1 $5,140.20 Revised: 07/10/2014 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C O P E Rl"I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 011j VWilkh PERMIT# OWNER'S NAME: I PHONE# S7D—2S' Z® 63 GENERAL CONTRACTOR: L BUSINESS LICENSE# ADDRESS: 6 L&v�A_ CITY/ZIPCODE: sw, ,2 *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 SUB CO RACTORS HAVE OB '7V CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: / / Signat a 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