14020070 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10615 GLENVIEW AVE CONTRACTOR:4BB-_TQ_B_E PERMIT NO: 14020070
I]ET-ER iNER
OWNER'S NAME: TU MIN AND WANG YUE , DATE ISSUED:06/17/2014
OWNER'S PHONE: 4082427117 6 1 rL46 f) PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑
/ CONSTRUCT ONE STORY ADDITION TO EXISTING
License Class Lic.# CJ DWELLING
(1114 SQ FT); INTERIOR REMODEL(584 SQ FT);
Contractor �aterl •—� I RELOCATE AND REPLACE FURNACE AND RELOCATE(E)
I hereby affirm that I �ion
ense undil er the provisions of Chapter 9
(commencing with Sec000)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:$179820
I 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:36926025.00 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 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 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.
�) —� RE-ROOFS:
Signature � Date 4 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:
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,
wil I 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 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agen : 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 Taws 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
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10615 glenview ave DATE: REVIEWED BY: Mendez
A] BP#: 'VALUATION: 1$179,820
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex 2nd Unit? Yes No PENTAMATION
USE: pOTC? ®Yes E)No PERMIT TYPE: 1 R3SFDADD
WORK add 1114 sq ft to rear of sfdw to include m.suite 2 bedrooms and family room remodel 584 sq ft thru
SCOPE out, relocate and replace furnace and relocate water heater
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE'ID BP FEES BP FEE ID
CONSTR. s.f.
R-3 (Custom) II-B,III-B,IV,V-B 1,114 $2,617.06 IR3PLNCK $1,760.50 IR3INSP
TOTALS: 1,114 $2,617.06 $1,760.50
MECH, HOURLY Yes E) No PLUMB,HOURLY C) Yes Q No ELEC,HOURLY Q Yes Q No
Mech.Plan Check 0.0 hrs $0.00
Mech. Permit Fee: IMPERMIT
Other Mech. Insp. Fo.0 hrs $47.00 Li
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 prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E/f. 71,13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,617.06 L_L84J s.f. Remodel,Other
Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $488.00 IREMRESOTH
PME Plan Check: $0.00 1 # Mechanical
Permit Fee: $1,760.50 $139.00 IMFR=<100 Furnace, Forced-Air
Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
Work Without Permit? 0 Yes E) No $0.00 7 0
Advanced Planning Fee: IPLLONGR $155.96 Select a Non-Residential E)
Travel Documentation Fee: ITRA VDOC $47.00 Building or Structure Q
Strong Motion Fee: IBSEISMICR $17.98 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $8.00
SUBTOTALS: 1 $4,653.50 $627.00 TOTAL FEE: 1 $5,280.50
Revised: 01115/2014