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11100018 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10629 FELTON WAY CONTRACTOR:LEE CHIH-CHIEH AND PERMIT NO:11100018 CHENSHUTZU G ,R'S NAME: LEE CHIN-CHIEH AND CHEN SHUTZU 10629 FELTON WAY DATE ISSUED: 10/04/2011 OWNER'S PHONE: 4088739614 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG I— ELECT ' PLUMB License Class Lic.# MECH RESIDENTIAL f— COMMERCIAL Contractor Date JOB DESCRIPTION:SINGLE FAMILY DWELLING TWO BATHROOM I hereby affirm that I am licensed under the provisions of Chapter 9 REMOD(commencing with Section 7000)of Division 3 of the Business&Professions BAR;NO -STR QFT)INCLUDE RELOCATE Code and that my license is in full force and effect. BAR;NON-STRUCTURAL&REPLACE 7 WINDOWS ON 1ST& 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:$20000 permit is issued. APPLICANT CERTIFICATION APN Number:35918018.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the granting of this permit. 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. /J Issued bf: Date k_ LC ,ire Date OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material berg installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,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 for sale(Sec.7044, Signature of Applicant: Date: Business&Professions Code) 1,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 I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. 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 o �utho rzed ge ��i,�� forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION 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 with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) 'ding construction,and hereby authorize representatives of this city to enter Lender's Name he above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of 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 s rce regulations per the Cupertino Municipal Code,Section 9.18. ` d 1 understand my plans shall be used as public records. Signatur / L ��ate �! ` Licensed Professional CITY OF CUPERTINO BUILDING PERMIT DATE BUILDING ADDRESS: 10629 FELTON WAY OWNER'S NAME: ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor Date I hereby affirm that 1 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. 1 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 permit is issued. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 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. Signature Date XOWNER -BUILDER DECLARATION I `hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three declarations: t 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 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulaattionns per the Cupertino Municipal Code, Section / Signature Date CONTRACTOR: LEE CHIH-CHIEH AND CHEN SHUTZU 10629 FELTON WAY CUPERTINO, CA 95014 PERMIT NO: 11100018 DATE ISSUED: 10/04/2011 PHONE NO: BUILDING PERMIT INFO: BLDG f— ELECT F PLUMB I— MECH f— RESIDENTIAL i— COMMERCIAL r— JOB DESCRIPTION: SINGLE FAMILY DWELLING TWO BATHROOM REMODEL(100SQFT) INCLUDE RELOCATE BAR' ON-S RUCTURAL & REPLACE 7 WINDOWS ON I ST & dvJ5 G nd a s-iy�e/�zr_lY �D CeG✓°G� Jr Gt-� t:��� Q�a�y �-1 Sq. Ft Floor Area: I Valuation: $24000 APN Number: 35918018.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYSj FROM LAST CALLED INSPECTION. Issued by: Date: ,3-C?4 %6�t RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should 1 store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of %ork's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10629 FELTON WAY CONTRACTOR: LEE CHIH-CHIEH AND PERMIT NO: 1 l 100018 CHENSHUTZU OWNER'S NAME: CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. # MECH RESIDENTIAL COMMERCIAL Contractor Date 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SINGLE FAMILY DWELLING TWO BATHROOM (commencing with Section 7000) of Division 3 of the Business & Professions REMODEL(100SQFT) INCLUDE RELOCATE BAR;NON-STRUCTURAL & REPLACE 7 WINDOWS ON l ST & 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. I have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area: Valuation: $20000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 35918018.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. 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. Issued DateJ� Signature Date OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that 1 am exempt from the Contractor's License Law for one of All 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 for sale (Sec.7044, Business & Professions Code) Signature of Applicant: Date: 1, 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 I hereby affirm under penalty of perjury one of the following three declarations: l 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 Ihave read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. l will maintain I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & 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 I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued, I shall maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health & Safety Code, Sections 25505, 25533, and 25534. 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 ut comply with such provisions or this permit shall be deemed revoked. ate: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 Aork's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.) to building 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 City of 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 -points rce regulations per the Cupertino Municipal Code, Section 9.18. 1 understand my plans shall be used as public records. Signatur"v� / // Licensed Professional �40 ���,� CITY OF CUPERTINO 1�1 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10629 felton way. DATE: 10/04/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$20,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1 R3SFDREM PERMIT TYPE: WORK I sfd 2 bath remodel include relocate bar non structural. SCOPE Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check 0.0 hrs $0.00 -.,;, ... Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: IEPERMIT ? z. Other Plumb Insp. 10.0 1 hrs 1 $44.00 Other Elec. Insp. 0.0 1 hrs 1 $44.00 i., �. 1rFA%'- 7'•Z'ft" I ..- .... � ... � I.'C'- 11 i?f: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc )_ These fees are hated on the nrelimnary informatinn availahle and are nnly an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 100 s.f. $588.00 Remodel, Bath (<=300 sf IREMRESBAT Suppl. PC Fee: Q Reg. Q OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 7 # Window / Sliding Glass Door $392.00 /H'/NREP7 Replacement Permit Fee: $0.00 Suppl. Insp. Fee.e Reg. Q OT 0.0 hrs $0.00 1 # Plumbing $44.00 IBPVENT Piping, Vent PME Unit Fee: $0.00 PME Permit Fee: $88.00 1 # $9.00 Plumbing IBPFIXTURE Fixture set on One Trap Administrative Fee: IADMIN $41.00 7 # $44.00 Electrical 1BREMIMECEP Recep/Switch/Outlets 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 Travel Documentation Fee: ITPA VDOC $44.00 Stronp- Motion Fee: IBSEISMICR $2.00 0.5 hrs $41.00 Admin./Clerical Fee IADMIN Bldg; Stds Commission Fee: IBCBSC $1.00 17 .Of1 1 118.©0 : :l': ...r • 4.00 Revised: 10/01 /2011 CITY OF CUPERTINO WNW FEE ESTIMATOR — BUILDING DIVISION 10629 Felton Way DATE: 03/26/2012 REVIEWED BY: Sean APN: BP#: 'VALUATION: 1$4,000 ,]!ADDRESS: TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: WORK Revision to promect to include the replacement of 15 windows and a structural improvement to add SCOPE shear wall along grid line #2. t ri; •:�F,'S `mot j ' . [E::i?' Yi•'-. ;r'; NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the Dreliminary information available and are onlv an estimate. Contact the Dent for addn I info. FEE ITEMS (Fee Resolution 11-053 Eff. 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes E) No $0.00 F 15 1 # $522.00 Window / Sliding Glass Door /W/NREP Replacement Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? Q Yes Q No $0.00 ------------ --- -- Suppl. Insp. Fee-.0 Reg. Q OT 0 0 ............ hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C OIIS07tclion Tay-: ,I d� ninistrative F'ee: 1 hours $130.00 Plan Check, Hourly 1 /STPLNCK Q Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 =hours $130.00 Inspections /ST/NSP Inspection, Hourly Q 0 i 00(wirienionon Pecs: Strong Motion Fee: /BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: /BCBSC $1.00 i"=._:; if:,: :?'•=>>. ::•Cf'.::s i1 i:•''' t-:S• �] '�'f�. ::�f,'•;;: i=:::::,:..:"�..x .-'�,f:F,:-::s......r -.\, .'••`, :. $1.50 $782.00 ;... ;... "r;: G<<� r<.:•.r..:=,-' ^i;iL': r ., a. ,'r i!,z`si:4 :r;r•,l i"; ;;.. -��s,.: 4=;'�?-�-r ";r> 83.50 Revised: 1 /19/2012