13030082 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19960 HOMESTEAD RD CONTRACTOR:SUNG CONSTRUCTION PERMIT NO:13030082
OWNER'S NAME: WAYNE&MARY GONG, 1335 KINGFISHER WAY APT 3 DATE ISSUED:05/22/2013
OWNER'S PHONE: 4088651879 SUNNYVALE,CA 94087 PHONE NO:(408)489-4499
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE]
License Class Lie.# �`! LA TERRA BAKERY-T.I.TO CHANGE USE TO BAKERY,
ADD ADA RESTROOM,KITCHEN,ADD(N)EQUIPMENT&
Contractor M� C�`'1 Date 1 (N)
I hereby affirm that I am licensed under the provisions of Chapter 9 WALLS,INCLUDING PLUMBING&ELECTRICAL&
(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:
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:$80000
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:31603039.19960 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
correctA agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAY 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 DAY S ALLED 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 j
granting of this permit. Add'' nilly,the applicant understands and will comply Iss Date:
with all non-point source 13
gulations per the Cu ertino Municipal Code,Section
R
9.18.
E-
�j ROOFS:
Signature ate 'l 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 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)
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&Safety Code,Sections 25505,25533,and 25534. I will
I 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 Cupeepduo Municipal If ode,Chapter 9.12 and
I have and will maintainWorker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 05,25533,and 25 3 ( I
Section 3700 of the Labor Code for the performance of the work for which this Owner or authorized agent: Date: ✓ `
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
Compensation laws',of Califbmia. 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 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
upon'the above mentioned property.for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep ,h'amless the,City of Cupertino against liabilities,judgments,
costs;and expenses'whickmay 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
i
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 19960 Homestead Rd DATE: 03/15/2013 REVIEWED BY: Sean
APN: 3 1,/0 0 39 1 BP#: *VALUATION: 1$80,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY Commercial Building PENTAMATION 1 B TI
USE: PERMIT TYPE: A
WORK Tenant Improvement for bake 1300 sq ft).
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
B (Tenant Improvements) II-B,111-B,IV,V-B 1,300 $1,999.00 IBTIPLNCK $1,182.70 1BTIINSP
TOTALS: 1,300 1 $1,999.00 1 $1,182.70
MECH.-HOURLY O Yes (F) No PLUMB,HOURLY ®'Yes' 'E) No ELEC,HOURLY Q Yes Q No
Mech.flan Check. Plumb.Flan CheckF-F F_lec..Plan Checic ..
Me—ermit Fee: Plum$. Permit Fee: FE lee, Permit Fee:
Other Alech.Insp. ET-L- Oilier Plumb lresp. Other Elec,Insp. EIFL_
11ech.Insp.Fee: Plumh. Insp.Fee: Glee.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 11-053 Eff.' 7/1/122 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $1,999.00 Select a Misc Bldg/Structure
Suppl.PC Feer 0 Reg. 0 OT 0.0 1 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: $1,182.70
Suppl. Insp.Fee:Q Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
ConsOwction :Tax:
Administrative Fee: 0
Work Without Permit? C) Yes (F) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fees: Building or Structure
i
Strong Motion Fee: IBSEISMICO $16.80 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $4.00
SUBTOTALS: 1 $3,202.50 $0.00TOTAL FEE: $3,202.50
Revised: 01/01/2013