13070170 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10420 PINEVILLE AVE CONTRACTOR:REBOZZI INC PERMIT NO: 13070170
OWNER'S NAME: JING ZHANG 5765 WINFIELD BLVD STE 4 DATE ISSUED:08/19/2013
OWNER'S PHONE: 4083905338 SAN JOSE,CA 95I23 PHONE NO:(408)229-9689
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT r— PLUMB
License Class Lic.4 7Y :7q
L j MECH RESIDENTIAL COMMERCIAL
Contractor Q OeI Z'Z_ P Date `r �`
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:ADDITION OF 476 SQ FT TO REAR OF SFDWL,INTERIOR
(commencing with Section 7000)of Division 3 of the Business&Professions REMODEL OF 320 SQ FT(153 SQ KITCHEN),(167 SQ TO
Code and that my license is in full force and effect. FAMILY ROOM,RELOCATE(E)ELECTRICAL METER,ADD
fhereby affirm under penalty of perjury one of the following two declarations: 11/8/13 REVISION NI ELECTRICAL PANEL UPGRADE TO 200 AMPS-ISSUED OTC
I have and will maintain a certificate of consent to self-insure for Worker's 11/8/13
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$90000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION APN Number:36913040.00 Occupancy Type:
certify that 1 have read this application and state that the above information is
correct.1 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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,the applicant understands and will comply
with all notj-point source regulations per the Cupertino Municipal Code,Section ���
��9.18. ff Issued by: N Date:��•� •�
Signat Dated_-
❑ OWNER-BUILDER DECLARATION RF,-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.if a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons:
inspection.
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, Signature of Applicant: Date:
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.I2 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should 1 store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.t2 and the
1 certify that in the performance of the work for which this permit is issued,I shall H Ith&Safety Code,Se ions 25505,25533,and 25534.
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,1 Ow r d t: /
become subject to the Worker's Compensation provisions of the Labor Code,I must Date:[
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
1 certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18,.
Licensed Professional �
Signature_ Date
\I
7e.) 70
GENERAL PERMIT APPLICATION MEP
is COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333•building aDcupertino.org MISC
❑PLUMBING ❑MECHANICAL T&LECTRICAL []MISCELLANEOUS
PROJECT ADDRESS(�p / r (n U ^�O 'PN 9 3&q /3 O �D
37
OWNER NAME AI�VV 5, '/ `-i C•, PHS U � E-MAIL
-40
STREET ADDRESSeo .e / /P CITY, STATE`,ZIP�-p ,D '.,L ` j2 g5,yr' FAX
CONTACT NAME I \ l PHONE�_��Zp/ �O� E-MAIL V
STREET ADDRESST-7 1/1 to CITY,STATE,ZIP!;., C(O FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
COMHWtAME/1/ /` \ LICENSE NUMBER TY -7 Z LICENSE TYPE BUS.LIC N
I` (/[ 6
COMPANY NAME D E-MAIL FAX
STREET ADDRESS /. , e l n e `� CITY,STATE,ZIP 6-4, Q� HONE Z[-
p) ��
ARCHITECT/ENGINEER NAME 1/ ( LICENSE NUMBER ( 'G BUS.LIC N C
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF FD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA IrkNO FLOOD ZONE 0 EICHLER HOME? NO
DESCRIPTION OF WORK
TOTAL VALUATION: / O RECEIVED BY
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I ha @ provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to i ing construction. I authorize a esentatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent Date:V� 1(
SUPPLEMENTAL INFORM-AT ONQUIRED - OFFICE USE�ONLV .
p W_� „❑ OVER-THE-COUNTER° �.
❑ EXPRESS -
t
STANDARD 4tq` a:
❑ LARGE
p� ❑ .MAJORS
MEPMiscApp_201 Ldoc revised 06/21/11
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRF,SS: 10420 PINI VII,Lfi AV1: CONTRACTOR: RL13OZZI INC PERMIT NO: 13070170
OWNE'R'S NANME: ,TING%HANG 5765 N1'INIAE'LD BLVD STE 4 DATE ISSUED:08/19/2013
OWNER'S NIONE: 4083905338 SAN JOSE,CA 95123 PHONE NO:(408)229-9689
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F_ ELECT r– PLUMB r
l,iccnsc Class Ltc.N 7r 7
L
t MECIi r RESIDENTIAL I— COMMERCIAL r
ContractorContractor�lC�'/,
9&
7_L, Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: ADDITION OP 476 SQ FT TO REAR OF SPDWI.,INTERIOR
(conuncuciug with Section 7000)of Division 3 of the Business&Professions RfiMODliI,OP 320 SQ 1'"I"(153 SQ F I"I"CI IGN),(167 SQ"I"O
Code and that my license is in full force and effect. FAMILY ROOM,RI:[.00ATE(E)LL,I CTRICAL,METER,ADD
I hereby affirm under penally of perjury one of the following two declarations:
I have and will maintain it certificate of consent to self-insurc 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.
I have and will maintain Worker's Compensation Insurance;as provided for by
Section 3700 ol'lhc Labor Code,for the performance of the work for which this Sq. Ft Floor Area: Valuation:$90000
permit is issucd.
APPLICANT CERTIFICATION APN Number:36913040.00 Occupancy Type:
I ccrtil•v 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 rclaling
to building consructiun,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agrcc to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnil•v and keep harmless the City of-Cupertino against liabilities,judgments,
costs-and expenses which may accrue against said City in consegnenee ofdte WITHIN 180 DAYS OF PERMIT ISSUANCE OR
rantin of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
With allnf � ('
ot int source regu ations per the Cupertino Municipal Code,Section
9.18. _
r � `? Issued by: ��j9/�/ /G Date: �9 f�
Sizsatur• ate /
❑ ONVNER-BUILDER DECLARATION
RE-ROOFS:
hereby affirm that I am exempt from the Contractor's License Law for one of All roots shall be inspected prior to any roofing material being installed. If a roof is
the following tnvo reasons: installed without first obtaining an inspection,I agree to remove all new materials for
L as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work;and the structure is not intended or offered for sale(Sec.7044,
BIISInCSS&Professions Code) Signature ol•ApplicanL Date:
L as owner of the property,ant exclusively cuntractin,,with licensed contractors to
construct the project(Sec.7044,Business&Professions Code).
ALL 1200E COVERINGS TO BE CLASS"A"OR BF,TFER
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Cerlilicale of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Cornpensation,as provided for by Section 3700 of the Labor Code;for the 1 have read the hazardous materials requirements under Chapter 6.95 of the
performance ofthe work for which this permit is issued. California health&Safety Code,Sections 25-505,25533,and 25534. 1 will maintain
I have and will maintain Workers Compensation Insurance,as provided Ibr by compliance with file Cupertino\Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the perlorntancc of the work for which this Safety Code,Section 25532(x)should 1 store or handle hazardous material.
Additionally,should 1 use equipment or devices which emit hazardous air
permit is issucd' contaminants as defined by the Bay Area Air Quality Management District 1 will
I certify that in the performance ol•the work for which this permit is issucd,I shall maintain compliance with the Cupertino Nlunicipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's li •Ith&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,alter staking this certificate ofcxentption, I
beCUnIC subject to the Workers Compensation provisions of the Labor Code,I forst On' o at ho•• '
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
APPLICANT CF,RTIFICATION CONSTRUCTION LENDING AGF,NCV
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
corrccl. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to build na construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City ol•Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of-the
ganting of'this permit.Additionally,the applicant understands and will comply ;U2CF11'fEC'I''S DECLARATION
all non-point source regulations per the Cupertino Municipal Code,Section
4.18. 1 understand my plans shall be used as public records.
Si2maturc Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 10420 pineville ave DATE: 07/29/2013 REVIEWED BY: Mendez
*VALUATION: $90,000
APN: BP#: (�
*PERMIT TYPE: Building Permit I PLAN CHECK TYPE: Addition
PRINIARY 2nd Unit? •'Yes No PENTAMATION
USE: SFD or Duplex OTC? Q Yes QNo PERMIT TYPE: 1 R3SFDADD
WORK addition of 476 sq ft to rear of sfdwl interior remodel of 320 sq ft 153 sq kitchen 167 sq to family
SCOPE room, relocate (e) electrical meter, add (n)window left of fireplace
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
R-3 (Custom) II-8,111-B,IV,V-B 476 $1,579.00 IADDPLCK $1,284.00 IADDINSP
TOTALS: 476 $1,579.00 $1,284.00
MECH,HOURLY Q Yes Q No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes Q No
Lfi<ch. Flan Check Thumb. Plan Check Elec.Plan(.;hick
Alech. Permil Fee: Plumb.Permil Fee: Elec.Permit Fee:
Other:Tech. Insp. Other Plumb Insp. Li Other ELc•.Insp, EIF
Alk-!ch. Insp,Fee: Plumb. Insp. Fee: Elee.Insp.Fee.,
NOTE: This estimate does not includefees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelhiniina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 E{f 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $1,579.00 153 s.f Remodel,Kitchen(<=300 sf)
Suppl. PC Fee: Q Reg. Q OT 0,0 1 hrs $0.00 $626.00 IREMRESKIT
PME Plan Check: $0.00 167 s.f. Remodel,Other
Permit Fee: $1,284.00 $418.00 IREMRESOTH
Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction :Tax: T-F
4d1ninistrative Fee: Q
Work Without Permit? Q Yes E) No $0.00 Q
Advanced Plannin Fee: IPLLONGR $66.64 Select a Non-Residential Q
Tavel Documentation Tees: Building or Structure Q�
Strong Motion Fee: IBSEISMICR $9.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $4.00
SUBTOTALS: $2,942.64 $1,044.00 TOTAL FEE: $3,986.64
Revised: 07/01/2013