15030039 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 8139 HYANNISPORT DR CONTRACTOR:LARRABEE& PERMIT NO: 15030039
ASSOCIATES INC
OWNER'S NAME: DING CHENG-LIANG AND TING LUH-LUH 36 RAILWAY AVE DATE ISSUED:03/06/2015
OWNER'S PHONE: 4082198061 CAMPBELL,CA 95008 PHONE NO:(408)364-9000
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
_ VOLUNTARY FOUNDATION REPAIR AT PERIMETER OF
License Class /'f Lic.# `-�5 GARAGE
Contractore�(A Z- Z-4,17124 2-4( Date C— /S�
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.
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:$10000
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:35611018.00 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 F ST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which ma accrue against said City in consequence of the
granting of this permit. Ad 'ionally,the applicant understands and will comply Issued by: Dat lc
with all non-point s rce gulatio per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date Al I roofs shal I 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
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
I,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
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/thepertino
ipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined byArea Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with unicipal Code,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S ,2 33,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 mentione roperty for inspection purposes.(We)agree to save
indemnify and keep h less the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,and expenses w ich may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this a it.Addi io ally,the applicant understands and will comply
with all non-po'n ourcc r ations per the C ertino Municipal Code,Section Licensed Professional
9.18. n � C
Signature /� Date �?
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 8139 HYANNISPORT DR DATE: 03/09/2015 REVIEWED BY: SUEW
APN: BP#: 15030039 *VALUATION: j$10,000
"PERMIT TYPE: Building Permit PLAN CHECK"TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: PERMIT TYPE:
WORK VOLUNTARY FOUNDATION REPAIR AT PERIMETER OF GARAGE
SCOPE
NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Puhlie Works, Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the reliminary information availahle and are onI an estimate. Contact the De t or addn'l in ).
FEE ITEMS (Fee. Resolution 11-053 Eg: 7////3) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes D No $0.00 hours Plan Check, Hourly
Suppl. PC Fee: (D Reg. 0 OT 0.0 hrs $0.00 $143.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes Q No $0.00
Suppl. Insp. Fee:Q Reg. 0 OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
O
Work Without Permit? 0 Yes No $0.00 (D
Advanced Planning Fee: $0.00 hours Inspections 0
$286.00 /ST/NSP Inspection, Hourly 0
Strong Motion Fee: /BSEISMICR $1.30 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $2.30 $429.00 TOTAL FEE: $431 .30
Revised: 02/14/2015