12060006 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1487 JAMESTOWN DR CONTRACTOR:RYAN HU PERMIT NO:12060006
OWNER'S NAME: LEE SHIOW-SHYA TRUSTEE 401 S NORFOLK ST DATE ISSUED:06/01/2012
OWNER'S PHONE: 4084463797 SAN MATEO,CA 94401 PHONE NO:(650)759-6325
0 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r, ELECT r PLUMB
License Class L i c �-72 r
Contractor- AN791 klX" Date--f MECH RESIDENTIAL COMMERCIAL
.9 # JOB DESCRIPTION:KITCHEN REMODEL(145 SOFT)BATHROOM REMODELS
I hereby affirm that I am licensed under the provision of Chapter 9 (215
(commencing with Section 7000)of Division 3 of the Business&Professions SOFT)RE-ROOF ENTIRE RESIDENCE 22 10 SOFT CLASS A
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.
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:$30000
permit is issued.
APPLICANT CERTIFICATION APN Number:36610089.00 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 son e regulations per t)e Cupertino Municipal Co e,Section
9,18,
Issued by: Date:
;/�,-r e, Date 44T
Signature_
0 "—'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
1,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:
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
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. 1 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 21505,25533,and 25534
Compensation laws of California. If,after making this certificate of exemption,I I
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or an e a cut A
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
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(See.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. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR--BUILDING DIVISION
ADDRESS: 1487 James Town Dr DATE: 08/01/2012 REVIEWED BY: Sean
APN: BP#: > ( VALUATION: $30,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION
USE: SFD Or Duplex PERMIT TYPE: 1 R35FDRE
WORK Kichen remodel 145 sq ft 2 Bathroom remodels 9215 sq ft Reroof entire residence: remove
SCOPE shake and replace with composition (2210 sq ft).
I'iar('heck 7'<raat,l>, I'.trrr; (71(."ek Ll1,,7ee r`>i n(,duff.'
:
Ph f,.I't it Fee
'it#te:s .s r cli,Jns>. Other Insp. Ether r'.i'ec.rasp,
Al(."c} tn,sp, l ::s: t Turnh; fnsp, Fee: Elec,I srx,Fee
NOTE. This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . TheseLees are based on the prelimina information available and are onjL an estimate. Contact the De t or addn'd info.
FEE ITEMS Fee Resolution 11-053 Efl.' 711111) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = .£ Remodel,Bath(<=300 so
Suppl.PC Fee: iq Reg. 0 OT0,0 hrs $0.00 $588.00 IREMRESBAT
PME Plan Check: $0.00 145 s.f. Remodel,Kitchen(<=300 sf)
Permit Fee: $0.00 $588.00 IREMRESKIT
Suppl.Insp.Feer Reg. 0 OT LEI hrs $0.00 2,210 s.£ Re-roof
PME Unit Fee: $0.00 $322.00 IREROOFRES
PME Permit Fee: $0.00
(.`rad„r,st;ru ction 1sl:;
Work Without Permit? ® Yes •, No $0.00 E)
Advanced Plannin� $0.00 Select a Non-Residential E)
I rc lwl Building or Structure 0
i
Strong Motion Fee: 1BSEISMICR $3.00 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC 1 $2.001 1
SURTOTA.LS; $5.001$1,498.001 TOTAL FEE. $1,503.00
Revised: 05/01/2012