12090056 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10325.MEN HART LN CONTRACTOR: DWK CONSTRUCTION PERMIT NO: 12090056
OWNER'S NAME: ZHANG.JINGCHUN AND'TAO JUN 18665 LOREE AVE DATE ISSUED: 10/08/2012
OW,NER'S PHONE: 4087025090 CUPERTINO,CA:95014 PHONE NO:(408)_996-1486
❑ LICENSED CONTRACTOR'S`DECLARATION 17
BUILDING PERMIT INFO: BLDG ELECT "' P.LUMB"
License Class Lic.#
�. � MECH• " RESIDENTIAL COMMERCIAL
Contractor. i� i�5tXLd7G1�fit Dated g 2
Thereby affirm that;I am licensed under the provisions.of Chapter 9 JOB DESCRIPTION:NEW ONE STORY HOUSE W/PORCH 188'4 SQFT AND WITH
(commencing with'Section 7000)of Division 3-of the Business&ProfessionsATTACHED GARAGE,455 SQFT-SANITARY IS 1N'SUNNYVALES
JURISDICTION
.Code and that my license,isin full force and effect.
herebyaffirm 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 bySection 3700 of the Labor Code,forthe
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 p&formance.of the work:for which'this Sq.Ft FloorArea: Valuation:$256000
permit is issued.
APPLICANT CERTIFICA'T'ION APN Number:3751'5037.00 Occupancy Type:
I certify that l have read this application and state thatithe 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 cityao enter
upon the above°mentioned property forrinspectiompurposes: (We)agiee,to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnifyand keep,harmless the City of Cupertino against liabilities,judgments,
costs;;and expenses which mayaccrue against said City in,co nsequerice,ofthe- WITHIN 180 DAYS,OF PERMIT ISSUANCE"OR
granting of thispermit:. Additionally,the applicant:understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section.
9.18.
Signature
Issued by: G174 "Date:�U• -/
❑ OWNER-BUILDER.DECLARATION
RE-ROOFS:
hereby,affirm that I.am exempt from,the'Contractor's-License Law for one-,Of A]1,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-fdrsale(S&7044;
Business.&Professions.Code) Signature of Applicant: Date:
I;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
1 hereby affirm under penalty of perjury one of the-following,th_ree,
declarations:
I have and will maintain;a Certificate of Consent to,self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
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 thispermit is issued. California Health&Safety,Code,Sections 25565,25533,and.25534. I wiWmaiotain,
I have and wilLmaintain.Wofker's Co'mpe'nsation Insurance;,as'provide&I`br by compliance with the'Gupertioo Municipal Code,Chapter9 l2 and the Health&c.
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 Luse equipment or deviccs Which emit hazardous air
permitis issued. contaminants as;defned bythe Bay Area Air Quality Management:District4 will
Lcertify that in,the performance of-the work for which.ihis permit is issued,l.shall maintain compliance•with the Cupertino Municipal Code,Chapter 9.12 and the
not employ'any person.in any manner so'as to become subjectto the Worker's Health&Safety Code;Sections25505,25533,and 25534.
Compensation laws of Califomia: lf,,after making this certificate of exemption„I
become subject to the Worker's.Compensation provisions of the:Labor Code,I must 'Owner or authorized agent:
Date: D
forthwith comply with such provisions or this permit:shall be.deemed revoked.
� �'�� "•f.Z
APPLICANT CERTIFICATION CONSTRUCTION LENDINGAGENCY
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.wiftall city and,countyordinances and sfate;laws,relating for which:this,permi0s issued(Sec.3097,Civ C.)
to Wilding 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',Cityof 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. I understand my plans shall be used as public records.
Signature Date Licensed Professional
J
CITY OF,CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS; 1`0325•Menhartlane DATE': 0919.012012 REVLEWED BY: Sean
APN: BR#: 0,9O "VALUATION: $250;000
PERMIT TYPE; Building.Permit' PLAN:CHECK TYPE: New Construction.
PRIMARY 2nd Unit? •Yes No PENTAMATION -
USE: SFD or Duplex PERMIT TYPE: 1 R3SFDW
WORK Construction of a,oneztor.;residence 1'860 sq ft g With attachedgarage e 45.5 sq ft s and a 24 `ft front
SCOPE porch:
OCC;UPANCY'T,YPE:; TYPEOV FLR AREA PC FEES, PC FEE ID BP FEES BP FEE ID'
CONSTR. (Sl:)
R4(Custom) II-B;III-B,IV V-B 2,339. $2,736.52 IR3PLNCK $2,511.22 11231NSP
I AN
TOTALS:; 2,339 $2,736.62 $2;511.22low
L'"p�
JW,(.h.P1 an(,heck i;'lrriiifi.I'tan CHeckL1et:_'_I'1cam.Cherk
;�fe'c1r. 1' rn ii.f�i>: Plermh. f'ermil i%erc: Fisc:N'!rrrdt Fee:
07he� `.'fcch.7ri:T7�. O.1/rdr.Pbarnlr Insp.
Other 1-lec.In'Y'
4Le�{i. Irz.ip.I i e: Pli;rrr!:. /;rap.Fec: flee:•fnrfr Fee:
NOTE: This esdniale4oes n'o1 include fees,�due to olkerDepartments(ke..Planning;.PublicrWor"ks,,Fire,Sanitary SewerDistrict,Sehool
District,.ete. . These twes are based°on4he relimina. 'in ormatiornavailable;and are°onl" an estiirtate:, Contactsihe,De t or-addn'l in o.
FEE ITEMS (Fee Resolution.]]-05'3,Eff:'7 J/IJP, FEE QTY/EEE MISC ITEMS
Plan Check Fee: $2,736.52 Selecta.Misc Bldg/Structure
Suppl:.PC Fee: ,(2) Reg. 0 OT' 0..0 hrs $0.00 or Element of a.Building
PME Plan Check: $0.00
Permit.F,eea $2,511.22
:$uppl,.,lnsp. Fee. .Reg. OT Q;Q hrs $0:00
'PME Unit Fee: $,Q;Q
PME Permit Fee:, $0.00
#new
Construction Tax:; IBGoNSTAxR 1 units $595 41
_ �dminist�azive.:H'ee:. -
Wor`k.Without-Permit? 0 Yes 0 No
Advanced Planning_Fee. 1P.ELONGR $304.07 Selecta.'Non-Residential E)l-dpel l�lici�rfnc vi1u;J on J r�Es Building or,Structure- 0
Strong,Motion Fee: IBSEISMIGR• $25:00 Select an Adrmrdi trative,,Item
Bldg Stds'ComiriissiofiTee: IRCBSC
SUBTOTALS 51
:$6;182.22 $O:OQ s k� `��,p TOTALF�EE;3 $6,182.22;
.4 . . , ... _
Revised: 07/01/2012