13020049 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 781.1 ORION LN CONTRACTOR.? Uk PERMIT NO:13020049
OWNER'S NAME: TfANLHUI TEMPLE DATE ISSUED:03/1912013
OWNER'S PHONE: 4085298618 PHONE NO: 09 '
® LICENSED CONTRACTOR'S DECLARATION 3OB ESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lic.# CONVERT PORTION OF OFFICE AREA TO LIVE IN UNIT,
RECONFIGURE ONE BATHROOM(300SF).ADD NEW
Contractor Date ACCESSIBLE RAMP TO EXTERIOR
I hereby affirm that I am licensed under the provisions of Chapter 9
(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:$14flOfl
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:36218010.00 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 WITHINt180DAYS OF IT ISSUANCE OR
to building construction,and herebyauthorize representatives of this city to enter CALLED INSPECTION,
upon the above mentioned property for inspection purposes. (We)agree to save 180
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the slued Date' 3 t
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.
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)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS YIATERIALS 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. Lwill.
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(x)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 C ,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Seco s 5,25533,and 25
t
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age t: f, ate'
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 CONSTRU ON LENDING AGENCY
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 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 ap icant understands and will comply
with all non-point so ce regulations per Cupertino Municipal Code,Section Licensed Professional
918: r
Signat e 4 Date
CITY OF CUPERTINC3
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 7811 ORION LN DATE: 02/11/2015 REVIEWED BY: MELISSA
APN: . 362 18 010 BP#: C f�? VALUATION: 1$10,000
*PERMIT TYPE Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARY PENTAMATION 1A TI
US
PERMIT Building PERMIT TYPE:
WORK CONVERT PORTION OF OFFICE AREA TO LIVE IN UNIT RECONFIGURE ONE BATHROOM,ADD
SCOPE NEW ACCESSIBLE RAMP TO EXTERIOR
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID,
CONSTR. s.f.
A(Tenant Improvements) II-B,III-B,IV,V-B $0.00 $0.00
TOTALS: 0 - $0.00 $0.00
1vI1i CII,'aEIO RT Y Yds 1\tt ' PLUMBS HORI Y Yes 'Na ELFC,,
l ix,h.Plan Check I'hrrrrh, Plan CheckElec-Plan Che,'k
1Aech_1'errnii f-'ee.� r`'tr;m.1't'rmet l�°ee: Ilay.Permit I ee:
Other,,Wechl Insp. other F'Irarrb Irtspr 01hcr Ek"c.Insp.
:Iccn.In.s?. Fee: la/trrrL sat.sl. ;>{: Elee.Inin Fee
NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District eta). These ees are based on the relimina information available and are onl an estimate Contact the De t or addn'l in o.
FEE ITEMS,(Fee Resolution 11-053 Eff' 711112? FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes No $0.00 2 hours Plan Check,Hourly
Suppl.PC Fee: E Reg, 0 OT 0.0 lzrs $0.00 $266.00 ISTPLNCK
PME Plan Check:. $0.00300 s.f. Remodel,Other
Permit Fee:` $0.00 $400.00 IRENMESOTH
Suppl.Inspfee-0 Reg. 0 OT 070hrs $0.00
PME Unit Fee: $0,00
PME Permit Fee:: $0.00
C.on irue"tion gar.
��area7istr^�rtrv�`.1%ce:
Work Without Permit? 0 Yes (j) No $0.00
Advanced Planning lee: $0.00 Select a Non-Residential
Building or Structure
Strong Motion Fee: IBSEISMICO $2.10 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
ST `SAL $3.10 $666.00 , ' � $669.10
Revised: 01101/2013