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13010001 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10940 DREA RD CONTRACTOR—T-91) TO BE PERMIT NO: 13010001 OWNER'S NAME: HENRY HUANG l DATE ISSUED:01/30/2013 OWNER'S PHONE: 4088065498 PHONE NO: ❑ . LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL L1 COMMERCIAL El License Class Lie. /6ZS=� ADD 40 SQFT TO ENTRY,REMODEL KITCHEN 300 SQ FT, 4/1/2 BATHS 500 SQ FT,ADD TANKLESS WATER HEATER Contractor &t t ,,t1q t)V-A ) Date a ? AND FURNACE, ADD 3 SKYLIGHTS,REPLACE FIXTURES I hereby affirm that I am licensed under the provisions of Chapter 9 AND (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:$60000 1 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:35602055.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that']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 80 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 FM 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 1-304-3 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. • : 14 RE-ROOFS: Signature 1_�V Date 140/21J� All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,1 agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION 1 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(Scc.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Scc.7044,Business&Professions Code). 1 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 1 store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 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 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 1 A 6/ z permit is issued. Owner or authorized agent: -- 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 1 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 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION MDDRESS: 10900 Drea Rd DATE: 01/0212613 REVIEWED BY: Mendez PN: BP#: 'VALUATION: 1$60,000 .*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY2nd Unit? Yes No PERMIT TYPE:PENTAMATION . . SFD or Duplex OTC? Q Yes 1 R3SFDADD USE: ©No WORK add 40 s ft to entryof sfdwl Remodel kitchen 300 s ft 41/2 baths 500 s ft replace tankless water SCOPE heater, and furnace, 3 skylights OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. R-3 (Custom) II-B,111-B,IV,V-B 0 $0.00 $0.00 TOTALS: 0 $0.00 $0.00 MECH,HOURLY Yes No PLUMB,HOURLY Q Yes Q No ELEC, HOURLY Q Yes Q No Mech.Plan Check0.0 hrs $0.00 Plumb. Plan Chack Elec.Plan Check 0.0 hrs $0.00 Mech.Permit Fee: IMPERMIT Plumb, Pcrmii Fee: Elec.Permit Fee: IEPERMIT Other Mech.Insp. 0.0 hrs $45.00 Or1ns Plumb Insp. Li L-1 Other Elea Insp. 0.0 hrs $45.00 ddech-Lt.�/�. 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.). These ees 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. 7/1/12) FEE QTY/FEE MISC ITEMS Plan'Check.Fee: Hourly Only? O Yes Q No $0.00 300 s.f. Remodel,Kitchen(<=300 so Suppl. PC Fee:' Q.Reg. Q OT 0,0 1 hrs $0.00 $600.00 IREMRESKIT PME Plan Check: $0.00 500 1 s.f. Remodel,Other Permit Fee: Hourly Only? ©Yes Q No $0.00 $467.00 1 IREMRESOTH Suppl, Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 71 Electrical PME Unit Fee: $0.00 $249.00 IBREMRECEP Recep/Switch/Outlets PME Permit Fee: = $90.00 121 # Electrical Construction .Tci:�:. $572.00 IBREMFIXT Fixtures,Lighting Adrninislrative Fee: 1 1 # Mechanical O Work Without Permit? O Yes Q No $0.00 $133.00 IMFR=<100 Furnace,Forced-Air G Advanced Planning-Fee: $0.00 = hours Plan Check,Hourly E) Travel Documentation Fee: ITRA VDOC $45.00 $133.00 ISTPLNCK 0 Strong Motion Fee: IBSEISMICR $6.00 4.0 J hrs Inspections Bldg Stds Commission Fee: 1BCBSC $3.00 $532.00 ISTINSPInspection,Hourly SUBTOTALS: 1 $144.001$2,686.00 TOTAL FEE: 1 $2,830.00 Revised: 1010112012 � � q'I O