13070155 CffTY OF CUP ERT INO BUM DING PERMIT
BUILDING ADDRESS: 10136 ENGLISH OAK WAY CONTRACTOR:ROBIN SUNG PERMIT NO: 13070155
OWNER'S NAME: WU.JENNIFER&LIU JAMES 498 JEROME ST DATE ISSUED:07/26/2013
OWNER'S PHONE: SAN JOSE,CA 95129 PHONE NO:(408)993-8642
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALD
License Class Lic.# O"� �� CONVERT ATTIC SPACE TO STORAGE AND.ADD STAIR
q (149
Contractor �DU��7 G(h / Date SQ FT).
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&c 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:$15000
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:34232143.00 Occupancy Type:
permit is issued.
APPLICANT CER'T'IFICATION
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 �)(T)F)l)(1� S®DAYS®� PERMIT ISSUANCE ®�
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 DA IF M(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 er the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature DateO7 y6�/3 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
I hereby affirm that II 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)
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&c Safety Code,Sections 25505,25533,and 25534. I will
II 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&c Safety Code,VSectio25 g5,255 , nd 25534.
Section 3700 of the Labor Code,for the performance of the work for which this 'permit is issued. Owner or authorized age 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 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
cCR7YY OF cCUP EgB7RNO
FEE IES71MAA70R—BUILDING DIVISION
ADDRESS: 10136 ENGLISH OAC WAY DATE: 07/24/2093 REVIEWED BY:
APN: II$P#: �'�� *VALUATION: 1$15,000
*PERMIT TYPE: Building Permit PLAN CIIIIECIK TYPE: Alteration/ Repair
PRIMARY 7�2?ERMIT
ENTAMATIION
USE: SFD or Duplex TYPE: 1 GENRE
WORK CONVERT ATTIC SPACE TO STORAGE AND ADD STAIR 149 SQ FT).
SCOPE
Much. Plan Check Plumb. Plan Check Elec. Plan Check
iLfech. Permit Fee: Plumb.Permit Fee: lslec. Permit Fee:
Other Afech. Inrp. EJ Other Plumb Insp. Other F,lec.Insp. Ell I
Hech. Insp. Fee: Plumb. Insp. Fee: Elec.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.). theseLees are based on the prelimina information available and are onl an estimate. Contact the De t or addh I.info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? Q Yes E) No $0.00 2 hours Plan Check,Hourly
Suppl. PC Fee: E) Reg. 0 OT —0-0] hrs $0.00 $278.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes (E) No $0.00
Suppl. Insp. Feer Reg. 0 OT 0.011hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Constr-ittction Tax:
Administrative.Fee:
Work Without Permit? 0 Yes 0 No $0.00
Advanced Planning Fee: $0.00 0 hours Inspections
Travel Documentation Fees: $417.00 1STINSP Inspection,Hourly 01
Strong Motion Fee: 1BSEISMICR $1.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $2.50 $695.001 TOTAL FEE: $697.50
Revised: 07/01/2013