13060004 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6457 BOLLINGER RD CONTRACTOR:ALVIN WANG PERMIT NO:13060004
OWNER'S NAME: ALVIN WANG 6457 BOLLINGER RD DATE ISSUED:06/14/2013
OWNER'S PHONE: 4082506744 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALE]
License Class Lie.# INTERIOR REMODEL TO INCLUDE:BATHROOM(100 SQ
FT);
Contractor Date KITCHEN(132 SQ FT);MASTER SUITE(120 SQ FT);ADD
I hereby affirm that I am licensed under the provisions of Chapter 9 NEW A/C;REMOVE AND REPLACE FURNACE;
(commencing with Section 7000)of Division 3 of the Business&Professions RELOCATE
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations: REV#1-REMOVE PROPOSED DOOR NEXT TO FP.INSTALL(1)
I have and will maintain a certificate of consent to self-insure for Worker's WINDOW IN MASTER BEDROOM-ISSD/31/2013
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:$50000
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:36920032.6457 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
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-F OM 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 1,,
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
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
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 Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent:_024,1111 lon,_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 California. It 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(See.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 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
�� � 3
CITY OF CUPERTINO
FEE ESTIMATOR--BUILDING DIVISION
ADDRESS: 6457 BOLLINGER RD DATE: 07/31/2013 REVIEWED BY: MELISSA
APN: 36920032.6457 BP#: *VALUATION: Iso
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: PERMIT TYPE:
WORK REV# 1 - REMOVE PROPOSED DOOR NEXT TOE FP. INSTALL N WINDOW IN MASTER
SCOPE BDRM (MAIN B.P. # 1,3o6 00014
'r8„v.
El
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitcuy Sewer District,School
District,etc.). These.fees are based on the preliminai.y information available and are only an estimate. Contact the De t for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 0 hours Plan Check,Hourly
SuppL PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $139.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl.Insp.FeeQ Reg. 0 OT0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? 0 Yes 0 No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential G
Building or Structure
Strong Motion Fee: $0.00 Select an Administrative Item
Bldg Stds Commission Fee: $0.00
SUBTOTALS: $0.00 $139.00 TOTAL FEE: 1 $139.00
Revised: 07/01/2013
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6457 BOLLINGER RD CONTRACTOR:ALVIN WANG PERMIT NO:13060004
OWNER'S NAME: ALVIN WANG 6457 BOLLINGER RD DATE ISSUED:06/14/2013
OWNER'S PHONE: 4082506744 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL❑
License Class Lic.# INTERIOR REMODEL TO INCLUDE:BATHROOM(100 SQ
FT);
Contractor Date KITCHEN(132 SQ FT);MASTER SUITE(120 SQ FT); ADD
I hereby affirm that I am licensed under the provisions of Chapter 9 NEW A/C;REMOVE AND REPLACE FURNACE;
(commencing with Section 7000)of Division 3 of the Business&Professions RELOCATE
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:$50000.
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:36920032.6457 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
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 00 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 DA M LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, i
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 per the Cupertino Municipal Code,Section
9.18.
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
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 Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this T
Owner or authorized agent: ' y � 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 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 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 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 fJ U U��A Date / t
CITY OF CUPERTINO /e-71
FEE ESTIMATOR-BUILDING DIVISION
[ME, -ADDRESS: 6457 BOLLINGER RD DATE: 06/03/2013 REVIEWED BY: mendez
VALUATION: $50,000
APN:
s,/�Q �Q�' `
*PE MIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PENTAMATION 1 R3SFDREM
PRIMARY
USE: SFD or Duplex BP#: PERMIT TYPE:
WORK INTERIOR REMODEL TO INCLUDE BATHROOM 100 SQ FT KITCHEN 132 SQ FT M. SUITE 120
SCOPE CONVERT M. CLOSET TO M. BATH,ADD NEW A/C REMOVE AND REPLACE FURNACE,
,fedi.Plan C'Iteck Phwlb.Plan Check
Elec.Plan Check 0.0 hrs $0.00
Ueda.hr�Ymit Fee: Plumh. Per nit J ee: Elec.Permit Fee: IEPERMIT
�rher Rlech.hxsP. ED-L-- EJ7her Phanb Insp. Other Elec.Insp. 0.0 hrs $45.00
11"ICC17.Insp.Fee: Pholb. h)aV).F"'?: E<ec_Insp.I~ee:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc . These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 711/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 100 s.£ Remodel,Bath(<=300 sf)
Suppl.PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $600.00 1RE?,flESBAT
PME Plan Check: $0.00 D32 s.£ Remodel,Kitchen(<=300 sf)
Permit Fee: $0.00 $600.00 1REN1RESKIT
Suppl.Insp.Fee-(F) Reg. 0 OT 0,0 hrs $0.00 120 s.£ Remodel,Other
PME Unit Fee: $0.00 $400.00 1REESOTx
PME Permit Fee: $45.00 = # Window/Sliding Glass Door
Constt-uciion Tax: $400.00 1; VREP Replacement
Administrative Fee: 1ADMIN $42.00 17 ## Electrical 0
Work Without Permit? 0 Yes ) No $0.00 $67.00 1BREMFIXT Fixtures,Lighting 0
Advanced Planning Fee: $0.00 Select a Non-Residential )
Building or Structure 0
Travel Documentation Fee: 1TRA VD0C $45.00 -E==
Strong Motion Fee: IBSEISMICR $5.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $2.00
SUBTOTALS: $139.00 $2,067.00 TOTAL FEE: $2,206.00
Revised: 04�L 1
02
CITY OF CUPERTINO `
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: DATE: REVIEWED BY: SjG(
APN: *VALUATION: Iso -�
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Du lex PENTAMATION 1REAP10
USE: p PERMIT TYPE:
WORK
SCOPE
Mech.Plan Check 0.0 1us $0.00 Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check 0.0 brs $0.00
Mech.Permit Fee: IMPERMIT Plumb.Permit Fee: 1PPERMIT Elec.Permit Fee:
Other Mech.Insp. brs $45.00 Other Plumb Insp. 0.0 brs $45.00 Other Elec.Insp. El hrs _
1ilInsp
—Fee:in Ie�e: 0.0 Plumb. hasp_Fee: Dec.Hasp.Fce:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the prelimina information available and are onl an estimate. Contact the Dept-for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Electrical
Suppl.PC Fee: Reg. Q OT Fo7o hrs $0.00 $45.00 IBREMRECEP Recep/Switch/Outlets
PME Plan Check: $0.00 L__I_j # Mechanical
Permit Fee: $0.00 $133.00TJ Furnace,Forced-Air
Suppl. Insp.Fee:Q Reg. Q OT 0,0 hrs $0.00 1 # Mechanical
PME Unit Fee: $0.00 $67.00 1BREMAIR A/C Units(<=1OK efm)
PME Permit Fee: ` � {� # Plumbing
conswz!cEion Tax: F-1 $27.00 1PRWHEATR Water Heater
Administrative Fee: IADAMV
Work Without Permit? 0 Yes No $0.000
Advanced Planning Fee: $0.00 Select a Non-Residential E
Travel Documentation Fee: ITRAVDOC Building or Structure 0
Strong Motion Fee: $0.00 Select an Administrative Item
BldgStds Commission Fee: $0.00
SUBTOTALS: ��7 L --2-7R,Z TOTAL FE
ETJ,
Revised:�04/29/20�