13120039CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18620 RUNO CT
CONTRACTOR: QSP CONSTRUCTION
PERMIT NO: 13120039
OWNER'S NAME: SHEN KANG-PING TRUSTEE & ET AL
732 SCOTT BLVD
DATE ISSUED: 12/04/2013
OWNER'S PHONE: 4083132769
SANTA CLARA, CA 95050
16
PHONE NO: (408) 921-8752
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
KITCHEN REMODEL (60 SQ FT); BATHROOM REMODEL
License Class_ Lic. #��
c
(35
Contractor Date 2_4 3
SQ FT); INSTALL NEW FORCED AIR UNIT; REPLACE (2)
I hereby affirm that I am lic nsed under the provisions of Chapter 9
WINDOWS AND (1) DOOR.
(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: $25000
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 37525033.00
Occupancy Type.
Section 3700 of the Labor Code, for the performance of the work for which this
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 FR AST 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 the
Issued by: Date: r
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signature Date �%
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:
1 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. 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(a) should I store or handle hazardous
1 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.
'�'�,A_
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: L 3Z
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
l�—
not employ any person in any manner so as to become subject to the Worker's
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
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
ARCHITECT'S DECLARATION
indemnify and keep harmlessthe 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
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
r
ADDRESS: 18620 Runo Ct
DATE: 12/04/2013
REVIEWED BY: Mendez
Mech. Permit Fee: IMPERMIT
APN:
BP#: _ _VID
*VALUATION: 1$25,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex
ll/wnb. Insp, Fee:
PENTAMATION
PERMIT TYPE: 1 R3SFDRE
WORK
KITCHEN REMODEL 60 SQ FT • BATHROOM REMODEL 35 SQ FT); INSTALL NEW FORCED AIR
SCOPE
UNIT; REPLACE (2) WINDOWS AND (1) DOOR.
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 based on the preliminary information: available and are only an estimate. Contact the Deptfor addn 7 info.
FEE ITEMS (Fee Resolution 11-053 E . 7ff 11113)
Mech. Plan Check F0_01hrs $0.00
Plumb. flan 0,,eek
tac. P14111 Check
Mech. Permit Fee: IMPERMIT
Plumb. Pe rmir
$0.00
Other Mech. Insp. 0.0 hrs$47.00
Oiher Plumb Insp.
oilwr-Elec. In, p.
Alerh. hisp. Fe"
ll/wnb. Insp, Fee:
Flee. hasp. F6..':
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 based on the preliminary information: available and are only an estimate. Contact the Deptfor addn 7 info.
FEE ITEMS (Fee Resolution 11-053 E . 7ff 11113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
35 s.f.
$626.00
Remodel, Bath (<=300 sf)
IREMRESBAT
Suppl. PC Fee: (F) Reg. () OTT
0.0
hrs
$0.00
PME Plan Check:
$0.00
EEI s. f.
$626.00
Remodel, Kitchen (<=300 sf)
IREMRESKIT
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0,0
hrs
$0.00
# Mechanical
$139.00 IMFR=<100 Furnace, Forced -Air
PME Unit Fee:
$0.00
PME Permit Fee:
$47.00
0 # Window / Sliding Glass Door
$418.00 1WINREP Replacement
Consiruction ou"F-1
Administrative Fee: 1ADMIN
$44.00
0
G
Work Without Permit? ® Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
0
i
Travel Documentation Fee: 1TRAVDOC
$47.00
Strong Motion Fee: IBSEISMICR
$2.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS: 1
$141.50
$1,809.00
TOTAL FEE:
1 $1,950.50
Revised: 10/01/2013