12010115 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20550 BLOSSOM LN CONTRACTOR:RYAN HU PERMIT NO:12010115
OWNER'S NAME: PO-YANG TIEN 401 S NORFOLK ST DATE ISSUED:03/26/2012
OWNER'S PHONE: 4082192390 SAN MATEO,CA 94401 PHONE NO:(650)759-6325
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lie.# ! rw_
MECH' RESIDENTIAL COMMERCIAL
Contractor 1 / 1�� Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-BUILD CONSTRUCT 2 STORY SFDWL,LIVING
(commencing with Section 7000)of Division 3 of the Business&Professions SPACE(2609SQFT)
Code and that my license is in full force and effect. GARAGE(450SQFT)PORCH(120SQFT)INCLUDES ATTACHED 2ND
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.
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 Sq.Ft Floor Area: Valuation:$600000
permit is issued.
APPLICANT CERTIFICATION APN Number:35918026.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point so regulations per e Cupertino Municipal Code,Section
9.18. I n__
Issued by: --- Date
Signature r 2 Date
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,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,
Business&Professions Code) Signature of Applicant: Date:
I,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
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
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
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner horized (�
Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
�•
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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
correct.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 building 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 of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
EE ESTIMATOR—BUILDING DIVISION
ADDRESS: 20550 blossom In. DATE: 01/18/2012 RE%gEWEID Y: bobs.
APN -��-/J -,�� 1 : �� i ��/ �oCf�/��i VALUATION: $600,000
PERMIT TYKE: Building Permit PLAN CHECK TYPE: New Construction
PRINLARY BF® or Duplex 2nd Unit? Yes No PENT TION 1 R3SFC►W
USE: PE IIT TYPE:
Id
wORK rebuild 2 story sfd living spa e- f, ara e=450 s.f. porch= 120 s.f. _
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA SPC FEE ID BP FEES BP FEE IID
CONSTR. s.f
R-3(Custom) II-B,111-B,IV,V-B 3,546 $2,908.69 ' r 3PLNCK $3,006.62 IR3INSP
TOTALS: 3,546 $2,908.69 $3,006.62
NOTE. This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These,Les are based on the relirrsna information available and are only an estimate. Contact the De t or addn'I in o.
FEE ITEMS (1'ee Pesolulio 11-053 Ef 3°,11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $2,908.69 Select a Misc Bldg/Structure
Suppl.PC Fee: } Reg. Q O I Q.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $3,006.62
Suppl.Insp.Feer Reg. OT QaQ hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax: IBCONSTAXK2 � new ants $583.
Work Without Permit? 0 Yes 0 No $0.00
Advanced h'la-rj'n2 Fee: PLLONGRNGR $460.98 Select a Non-Residential Q
Building or Structure 0
Strc n-7 P,, ton Fee: IBSEISMKCR $60.00 Select an Administrative Item
Bld,} ;Stds Cera-mmission Fee: IBCBSC $24.001 1
S TOTALS: $7,044.09 $0.00 TOTAL FE: $7,044.09
Revised: 1/01/2012
a
CITY OF CUPERTINO BUILDING PERMIT :r
BUILDING ADDRESS: 20550 BLOSSOM LN CONTRACTOR:RYAN HU PERMIT NO:12010115
OWNER'S NAME: PO-YANG TIEN 401 S NORFOLK ST DATE ISSUED:03/26/2012
OWNER'S PHONE: 4082192390 SAN MATEO,CA 94401 PHONE NO:(650)759-6325
❑ LICENSED CONTRACTOR'S��
BUII.DING PERMIT INFO: BLDG� ELECT F PLUMB
License Class ie.# r— �""
MECH` RESIDENTIAL COMMERCIAL
ContractorZ!yKL4Date
I hereby arm that I am licensed under the provisio s of C apter 9 JOB DESCRIPTION:RE-BUILD CONSTRUCT 2 STORY SFDWL,LIVING
affirm
(commencingwith Section 7000 of Division 3 of the Business&Professions GABASPACEz(450SQT)
) GARAGE(450SQFT)PORCH(120SQFT)INCLLTDES ATTACHED 2ND 10/17/12-REV#1-CHANGE THE
Code and that my license is in full force and effect. LOCATION OF MASTER BEDROOM DOOR;RECESS THE CEILING IN FAMILY,NOOK AND
KITCHEN(SEE REVISED PLAN SHEETS A2,A9,S3 AND S4)-REV#1 ISS'D 10/17/12
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.
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
permit is issued. Sq.Ft Floor Area: Valuation:$600000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:35918026.00 Occupancy Type:
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,
costs,and expenses which may accrue against said City in consequence of the PERMIT EXPIRES IF WORK IS NOT STARTED
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point so c regulationKre upertino Municipal Code,Section
9.18. / 180 DAYS FROM LAST CALLED INSPECTION.
Signature Date /
Issued by: Date:
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
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, installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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 HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I certify that in the performance of the work for which this permit is issued,I shall Additionally,should I use equipment or devices which emit hazardous air
not employ any person in any manner so as to become subject to the Worker's contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health& ode,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. Owner orSaferued a C ��
Date /
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. ARCHITECT'S DECLARATION
Signature Date I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20550 Blossom Lane DATE: 10/17/2012 REVIEWED BY: Sean
AI
BP#: 12010115 "VALUATION: $0
;PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1GENRE
WORK Revision#1: Change the location of master bedroom door- recess the ceiling in family, nook and
SCOPE kitchen. (See revised plan sheets A2, A9, S3, and S4)
A-fecb. Plan Check Plumb,Plan Check Flec—Plan Check
Lech.Permit Fee: Plumb.Permit Fee: Elec.Permit Pee:
Other Akch.hssp. Orlier Plumb Insp. Other flec.Imp,
1IJech.Insp.Fe:e: Plumb. hisp.Pee: Fl(m Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These ees are based on the prehWdna information available and are only an estimate Contact the De t or addn'l info.
FEE ITEMS(Fee Resolution 11-053 E . 711/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? ()Yes Q No $0.00 hours Plan Check,Hourly
Suppl.PC Fee: Q Reg. ® OT 0.0 hrs $0.00 $133.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? ()Yes Q No $0.00
Suppl. Insp.Fee:Q Reg. ® OT0 0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
C0nSN71CZi0n Tax:
Adin inistrative.Fee: 0
Work Without Permit? 0 Yes E) No $0.00
Advanced Planning Fee: $0.00 hours Inspections
Trm;el Documentation Fees: $266.00 ISTINSP Inspection,Hourly
Strong Motion Fee: $0.00 Select an Administrative Item
Bldg Stds Commission Fee: $0.00
SUBTOTALS: $0.00 $399.00 TOTAL FEE: ` $399.00
Revised: 10/01/2012