12010174CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22273 N DE ANZA CIR
CONTRACTOR: ALEX HUANG & VICKY
PERMIT NO: 12010174
CAO, TRUSTEES OF
OWNER'S NAME:
r F
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. #
r— f— r
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that l am licensed under the provisions of Chapter 9
JOB DESCRIPTION: REMODEL LIVING ROOM(444SQFT)ADD SOFITT IN HALL
(commencing with Section 7000) of Division 3 of the Business & Professions
&
REMODEL 2ND FLOOR BATHROOM(50SQFT)
Code and that my license is in full force and effect.
2/15/2012- 2ND SUBMITTAL CHANGE -
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: $25000
permit is issued.
APPLICANT CERTIFICATION
APN Number: 35602023.00
Occupancy Type:
l certify that I have read this application and state that the above information is
correct. 1 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,
PERMIT EXPIRES IF WORK IS NOT STARTED
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non -point source regulations per the Cupertino Municipal Code, Section
180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Date
Issued by: �Q� 4 �� Date:
4d
OWNER -BUILDER DECLARATION
I hereby affirm that l am exempt from the Contractor's License Law for one of
RE -ROOFS:
the following two reasons:
All roofs shall be inspected prior to any roofing material berg installed. if a roof is
I, as owner of the property, or my employees with wages as their sole compensation,
installed without first obtaining an inspection, 1 agree to remove all new materials for
will do the work, and the structure is not intended or offered for sale (Sec.7044,
inspection.
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
Signature of Applicant: Date:
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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
performance of the work for which this permit is issued.
l have read the hazardous materials requirements under Chapter 6.95 of the
1 have and will maintain Worker's Compensation Insurance, as provided for by
California Health & Safety Code, Sections 25505, 25533, and 25534. l will maintain
Section 3700 of the Labor Code, for the performance of the work for which this
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should l store or handle hazardous material.
permit is issued.
Additionally, should l use equipment or devices which emit hazardous air
1 certify that in the performance of the work for which this permit is issued, I shall
contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Compensation laws of California. If, after making this certificate of exemption, I
Health & Safety Code, Sections 25505, 25533, and 25534.
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
Owner auth gent
�-, Date:
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
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
1 hereby affirm that there is a construction lending agency for the performance of mrk's
to building construction, and hereby authorize representatives of this city to enter
for which this permit is issued (Sec. 3097, Civ C.)
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Lender's Address
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
ARCHITECT'S DECLARATION
Sign.
/z�
I understand my plans shall be used as public records.
Signature Date � Z�
Licensed Professional
W���� CITY OF CUPERTINO
N7 FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 22273 n. de anza blvd.
DATE: 02/15/2012
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION: 1$25,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
WORK
bed and bath remodel add new new window relocate kitchen and dinin area. Re lace 16
SCOPE �sfd
indows and 2 sliding doors, add 3 new receptacles and new dining location.
LIZ
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Divtri(1_ P/!'_ L ThP_CN fPP.0 ar0 havod an the nrolininaru iniarmnlPnn nVnilnhiv and nr4 an1U an ovdinntP_ rantnM th0 Dont fnr a4fin'I infra
FEE ITEMS (f'ee Resolution II-053 Eff, 7'1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
-5-07 s.f. Remodel, Bath (<=300 so
$588.00 IREMRESBAT
Suppl. PC Fee: (D Reg. C) OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
120 s.f. Remodel, Kitchen (<=300 so
$588.00 IREMRESKIT I V
Permit Fee:
$0.00
Suppl. Insp. Fee-0 Reg. A0 OT
Fo Q
hrs
$0.00
444 s.f. Remodel, Other
$457.00 IREMRESOTH
PME Unit Fee:
$0.00
PME Permit Fee:
$44.00
=# Window / Sliding Glass Door
$652.00 1WINREP VReplacement
...: :%:.;...:;'....,,.. 1-7
Administrative Fee: IADMIN
1-141.00
F-3-1 # Electrical
$44.00 1BREMRECF�P I Recep/Switch/Outlets G
Work Without Permit? C) Yes C) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential E)
Building or Structure
Travel Documentation Fee: ITRAYDOC
✓$44.00
Strong Motion. Fee: IBSEISMICR
$2.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
.......... ............:.:....,...:::::.:.::::::;.:::.
$132.50
$2,329.00 :...-Q:z:'
$2,461.50
Revised: 1 /19/2012
CITY OF CUPERTINO
t 1 FEE ESTIMATOR — BUILDING DIVISION
��p�� % (� Cl
DATE: p
REVIEWED BY:
jigADDRESS:
APN: jp (ia b,a3
BP#: _7V
° VALUATION: $0
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
WORK
%en-7 U —zd1t)'042
SCOPE
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer Districg School
District. etc). Thece feet are hated an the nrelininary information available and are oniv an estimate. Contact the Dent for addn 11 info.
FEE ITEMS (Fee Resolution 11-053 Eff T'l/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
F 444 s.f.
$457.00
Remodel, Other
IREAMESOTH
Suppl. PC Fee: D Reg. () OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
—5-07 s.f.
$588.00
Remodel, Bath (<=300 so
1REWESBAT
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg.
0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Work Without Permit? Q Yes Q No
$0.00
Advanced Plannine Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
Strom Motion Fee:
Select an Administrative Item
S
Bldg Stds Commission Fee:
Revised: 1 /19/2012