13030010 CUTY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10168 RANDY LN CONTRACTOR:YOUZHONG LIU& PERMIT NO: 13030010
WEIYING ZHAO
OWNER'S NAME: YOUZHONG LIU&WEIYING ZHAO 10168 RANDY LN DATE ISSUED:05/16/2013
OWNER'S PHONE: 4087961008 CUPERTINO,CA 95014 PHONE NO:
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL0
License Class Lic.9 CONSTRUCT ONE STORY ADDITION(397 SQ FT)AND A 29
SQ FT ADDITION TO THE ATTACHED GARAGE.
Contractor Date
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:
1 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:$88000
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:31623073.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is PERMIT EXPIRES)[E'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 Ii T 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 Date-
with all non-point source regulations per the Cupertino Municipal Code,Section
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:
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,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
lusiness&Professions Code)
as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
hswet 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 h•eby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
dMrations: Health&Safety Code,Section 25532(a)should 1 store or handle hazardous
1 hav and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compnsation,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
performmce of the work for which this permit is issued, will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 5534.
Section 3100 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: �6I.2t71
permit is issued.
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 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,1 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 harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 1 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 f 3
CETT OF CU P]ERTINO
FEE ESTIMATOR— BUILDING DIVISION
TA
DDRESS: 10168 Randy Lane DATE: 03/01/2013 REVIEWED BY: Sean
PN: BP#: "VALUATION: 1$88,000
PERMIT TYPE: Building Permit PLATY CHECK TYPE: Addition
PRIMARY SFD or Duplex 2nd Unit? Yes m No PENTAMATION 1R3SFDADD
USE: OTC. 0 Yes (F)No PERMIT TYPE:
WORK Construction of a one story addition 397 sq ft garage addition 79 sq ft).
SCOPE
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 476 $1,512.00 IADDPLCK $1,230.00 IADDINSP
TOTALS: 476 $1,512.00 $1,230.00
1ECH,HOURLY Yes E) No PLUMB, HOURLY Q Yes 0 No ELEC,HOURLY O Yes Q No
I fec.h. flan Check Plumb. Plan Check Flue, Plan Check
Lfccft. Permit Fee: Plumb. Permit Fee: Elec. Perinir Fee:
other Afec•h.Insp. El other Plumb Insp. Other Elec. Insp.
AfecA Insp, Fee: Plumb. InspFee:: Glee.Insp,Fee:
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 preffinWdna information available and are on! an estimate. Contact the De t or addn 7 into.
FEE ITEMS (Fee Resolution 11-053 Eli`' 7111121 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $1,512.00 Select a Misc Bldg/Structure
Suppl. PC Fee: E) Reg. Q OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $1,230.00
Suppl. Insp. Fee:Q Reg. Q OT 0,0hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0,00
Conswuction Tax:
Administrative Fee: Q
Work Without Permit? Yes No $0,00
Advanced Planning Fee: IPLLONGR $61.88 Select a Non-Residential Q
Travel Documentation Fees: Building or Structure 0
e
Strong Motion Fee: IBSEISMICR $8.80 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $4.00
SUBTOTALS: $2,816.68 $0.00 TOTAL FEE: $2,816.68
Revised: 01/01/2013