12040155 CITY OF`CUPERTINO BUILDING'P,ERM,I•T
.BUIL'DING•ADDRESS: 20921 DUNBAR DR CONTRACTOR:=TR'DEVELOPMENT&. PERMIT NO;,1.2040155'
CONSTRUCTION INC.
OWNER'S�NAME:+SHIUAN-LEE 61721BOLLINGER RD STE 151 DATEISSUED:07/12/2012
�OWNER'S',PHONE':-4089730720. SA'N'JOSE,CA 95129PHONE;NO:,(408)';329-2831
❑ LICENSED CONTRACTOR'S. E/CLARATiON JOB.DESCRIPTION: RESIDENTIAL L1 ;COMMERCIALS
'License Class_ Lic.# ( CONSTRUCT 2'STORY SFDWL 4,71'4 SQ FT('L`N1NG 3;682•
�Y _ATTACHED'GAR_ AGE 445 SQ FT-PORCH 587 SQ FT").
Contractor f�i�uC, � Date ?. lA(a d•
I_hereby affirm"thatl am licensed under the provisions ol'Chapter 9 t
,(comrm ncing with'Section-7000),,of Division of the Businew&P,_i d'essions
Code and that',my license is.in full force,and effect.
I`hereby
affirm under penaltylof perjury.one of the following%two declarations:
I have;and will maintaina'.certificate"of consent to self-insure for Worker's
Compensation,as;p_rovidedfor•by Section3700,ofthe,.Lab6t-Code„f6r,the
perforniance�of the•woik for which this permit is issued: 'Sq,FGFIoorArea: Valuation:$741460.
1 have::and will maintain WoikeFs'Compensaiion Insurance,as;provided for by
Section3700 of the Labor Code,forthe performance of the•work for which this APN Number:32630163'.00 Occupancy type:,.
permit is issued.
APPLICANT CERTIFICATION
I cettify�that I have read this�application and.state thatthe=abov,e�info_nnation is PERMIT EXPIRES IF WORK KNOT-STARTED
correct.I agree to comply'with all city And,county ordinances and state,laws relating: WITHIN 18U DAYS'.OF'PERMIT ISSUANCE OR
to;buildin construction„and hereby re authority resentatives•of this city to.enter
g. p
upon the;above mentiaied.property forinspection purposes. (We)agree,tosave 180'DAYS FROM.LAST CALLED INSPECTION.
indemnify and'keep harmless the,City of Cupertino against IiabilitiesJudgments,
costs;and expenses which may accrue:against'said City�M,consequence of the.
granting of this:permit. Additionally;the applicanrunderstands,and'wilI comply lssued,by: Date:
with ,
,all non-poinCsource.regulations per the Cupertino Municipal.Code;,Section �
RE-ROOFS:
Signature_ Date y vZ All roofs,shallbe inspected prior to any roofing,Material beng installed.If roof is
installed without-firsrobtaining,an inspection,l.agree to remove all new materials for
inspection.
OWNER-BUILDER DECLARATION
I hereby affirm thatJ am+exempt;fi-om ahe Gontracto_Contractor's License_Law for one of SignaI ture.of Applicant- Date:
the f6llow,ing4wo reasons: ALL ROOF COVERINGS TO BE-CLASS"A”OR,BETITR
I;,as owner ofthe°property,oh,myemployees'with:wages astiieir,sole compensation,
Willi do.the'work,and the',strcture is not_intendedor'offered,for sale(Sec7044,
Business;&Professions•Code);,,
J,as'�6wner of the,property,am`exclusvely contracting with,Iicensed_contractors to HAZARDOUS MATERIALS'DISCLOSURE
construct the,project(Seg:7044;Business'&Professions,Code). I`have read We,hazardow materials requirements under Chapter 6 95tof the
California Health;&,Safety.Code,Sections 25505;,25533,and,25534. I,Will
I herebyaffrm ander penalty of`perjOey oinetofthe'followiiig three maintain compliance with the,Cupertino Municipal.Code,khaptce!9.11and the
declarations: Health&,Safety*Code,Section 2,5532(a)1should I store or handle.hazardous
have and.wilhmaintain:a:Cerfificate of Consent,to;s&-insure for Worker's material. Addifionally,;shouldll use equipment or devices�which emifhazardous
Gompematio,,n;as provided for by.Section,3700 of the Labor'Codej6i the air contamirant_s.as defined by the-Bay Area Air' Qnality IManage.ment`District
i`performanee of the work:for which"this'permiti's issued. will ina�ntarneornphanee"with the Cupertino Municipal Code;.`Chapter 9.12 and
will,maintain _mpensation Insurance,as provided for by the-hOwner or alth&thorety Code;,Sechonsr25505,255 ;.and 25534.
Section 3'I have 700,617 the Labor Code,,foCdie performance of,ttie.work foe whichthis �� _
permit is.issued.
p, . _„ized,agent; Dater
[certify thattin'the perf6m anceofthe work.forwhich`this.permit,is issued,1.shall
not employ any.person,in,any manner so.as•to,become:subject torthe Worker's.
'Compensation Iaws�of California. If,after rnaking,,this certificate,of•ekemptibn,,I CONSTRUCTION LENDINGAGENCY
become subject to the Worker's Compensation provisions•of the,LaborCode;I must I'.heieby of rrmthaf.there is a construction lending agency for,the performance of
forthwith comply wi_th_such provisions.or this perm_it:shall be de_emed<r&oked. work's for-which,thi"s:permit"is issued(Sec.3097,CivC°)
Lender's Name;
AP)PLICANYCERTIFICATION Lender's.Address
I certify that l have read this application and statethat the above information is,
correct)agree to comply with.all city,and county ordinances and--,swtcdaws relating
to building,construction,and hereby authorize,representati`ves"ofthis�city torenter,
upon the aabovementioned propertyfor.inspecfion purposes.(We)�agree to,save
indemnify`and,keep harmless the,CityofCupertino against liabilities,judgments, ARCHITEGT'.S DECLARATION
costs,,and:expenseswhich may-accrue against said City iwconsequence,ofthe I understand my'plans shall,be;used as publie records:
granting of�this+permit.Additionally;the appIicantwriderstan&and'wilI.l comply
with,all non-point-source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.1'8::
Signature; Date;
CITY•OF CVf ERTIN,O,.
FEE EST,IlVIATOR BUILDINxG DI' ' ION .
ADDRESS: 20921 Dunbar Dr
04127/201`2 REV.IEWEll.BY:; Sylvia'
APN: BP#: a�. '` S 5;. NALUATIONc $741;,460 _
APER.MI_T TYPE- Building Permit :PLAN.CHECK,TY.PE: New1Gonstrud'tion,
PRIMARY 2nd Unit.. Yes; No PENTAMATION
USE. SFD or Duplex 1R3SFDW, `
_. . .- - _..-......_PERMIT TYPE`::._
wORx GONSTRUCT'2 STORY'SFDWL 47.1'4.,SQ`FT LjVlNGi3'682,SQ-FT-;ATTACHED'GA'RAG`E 445 SQ
SCOPE FT- PORCH 587 SQ'FT
TYPE OF FLR AREA
OCCUPANCY'TYPE P`,TkS PC FEE ID BP F,EE'S BP FEE'.ID
CONSTR., s.f• .
R=3(Gustorp) 11-B,IIhB,IV';V-B 4 714, $3,040 40 7R3PLNCK $3`,625:40 J 3bN k
TOTALS.: 4;714 $3;04.0 40 $3,625 40
� t 01,
a ��
F�
NOTE: This estimate=doernot Include fees due.to:other'Ne artments(i e.,P„lanning;Pic lic'Works,Fire,San tary,Sewer Dis_"trict School"
District,etc.). These, eevare.basedvo ,tile relimina -M ornration,dvaildble_and•are oh&,do estimate: Contact°the�De if or addin,'l,in.o::
FEE ITEMS Eee_Resolution l l;-053 Itk.- 7.1%191' FEE, QTY/EEE MISCI.TEMS
Plan Check Fee:: $3�,040:40 S'eleet:a,Misc Bid"g%Stnicture
Su1. PC Fee: 0 g•Re QT 0.;0 hrs $0.00 or Element.:of�a Building;
PP '(0
PME Plan Check: $0.00
Permit Fee: $3,625.40
Suppl. Insp. FeeQ Reg. "OT 00 his, $0•.00
PPE Unit.Fee: $0.00
PIv1E Permit:Feec
e
Construction.Taa: IBCONSTUR 1 units $590.1,6
Work Without Permit? Yes 0 No $0.00
Advanced Plannina..Fee: PLLONGRNGR $u61'2.82 Select a,Non-Residential Q
Bu1ldtng or Structure 0
Strong Motion V&; 7[3SEISMICR. $74.15 Select amAdministrativeJtem
Bld�T StdS_Commission Fee: McasC $30;00
$7972 .93T
, . . .
Revised: 04/01%2012