11010146CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20557 BLOSSOM LN
CONTRACTOR: RYAN HU
PERMIT NO -. 110 10 146
OWNER'S NAME:
M T 0, C 9
SAN MATEO, CA 94401
PHONE NO: (650)343-8038
JOB DESCRIPTION: RESIDENTIAL n COMMERCIAL El
LIGE NSED CONTRACTOR'S DE I TION
CONSTRUCT 2 STORY 2,950 SQ FT W/ ATTACHED 443 SQ
,,--,,F
FT GARAGE -INCLUDES 371 SQ FT 2ND UNIT ATTACHED TO
License Class Lic..
,b
THE MAIN HOUSE.
Contractor IM Date
/
I hereby affirm that I am licensed tinder tile provisions f Chap er 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:
Sq. Ft Floor Area:
Valuation: $540000
i, I have and will maintain a certificate of consent to scif-insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for th
performance of the work for which this permit is issued.
APN Number: 35918033.00
Occupancy Type:
2. 1 have and will maintain Worker's Compensation Insurance, as provi e or"
Section 3700 of the Labor Code, for the performance of tile work for which this
permit is issued.
PERMIT EXPIRES IF WOR11,'IS NOT STARTED
APPLICANT CERTIFICATION
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
i
I certify that I have read this application and state that the above inforl i's Y
180 DAYS FROM LAST CALLED INSPECTION.
correct. I agree to comply with all city and county ordinances and statelitCe
to building construction, and hereby authorize representatives of this city to enter
inspection agree to save
upon the above mentioned property for purposes. (We)
Issued b Date:
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses wh�"ay accrue against said City in consequence of the
'i *11 comply with
is P, erstands and
'rinie at und
granting of ti tionally, the a pli
all non -point score Municipal Co ection 9 8.
RE -ROOFS:
Date
All roofs shall be inspected prior to any roofing material being installed. If a roof is
Signature
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
El OWNER -BUILDER DECLARATI
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
the following two reasons:
1. 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
HAZARDOUS MATERIALS DISCLOSUR
sale (Sec.7044, Business & Professions Code)
I have read the hazardous materials requirements under Chapter 6.95 of the
2. 1, as owner of the property, am exclusively contracting with licensed contractors to
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
construct the project (Sec.7044, Business & Professions Code).
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material,
I hereby affirm under penalty of perjury one of the following three declarations:
Additionally, should I use equipment or devices which emit hazardous air
i. I have and will maintain a Certificate of Consent to self -insure for Worker's
contaminants as defined by the Bay Area Air Quality Management District I will
Compensation, as provided for by Section 3700 of the Labor Code, for the
a ith the Cupertino Municipal Code, Chapter 9.12 and the
om�
in intain c' 'w"
performance of the work for which this permit is issued.
Halth & S IT - Tile, Sectlo 505, 25533, and 2553,�r
2. 1 have and will maintain Worker's Compensation Insurance, as provided for by
3. 1 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
CONSTRUCTION L NDING AGENC
Compensation laws of California. If, after making this certificate of exemption, I
I hereby affirm that there is a construction lending agency for the performance of work's
become subject to the Worker's Compensation provisions of the Labor Code, I
for which this permit is issued (Sec. 3097, Civ C.)
must forthwith comply with such provisions or this permit shall be deemed
Lender's Name
revoked.
Lender's Address
APPLICANT CERTIFICATTO
I certify that I have read this application and state that the above information is
ARCHITECT'S DECLARATION
correct. I agree to comply with all city and county ordinances and state laws relating
I understand my plans shall be used as public records.
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Licensed Professional
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of tile
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.
Signatur Date
CITY OF CUPERTINO
EE ESTIMATOR - BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS:
I
DATE:
REVIEWED BY:
PC FEE ID
A PN:
BP#:
*11 %LUATION:
F$540,000
___FPLAN
-PERMIT TYPE: Building Permit
CHECK TYPE: New Construction
PRIMARY SFD or Duplex I
2nd Unit? 0 Yes (E) No
PENTAMATION 1 R3SFDW
I
USE:
$3,003.08
PERMIT TYPE:
WORK
construct new 2 story sfd with attached 2nd unit
$0.00
S OPE I
$0.00
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
(s.f.)
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom) J
11-B,111-B,1V,V-B
3,764
$2,860.12
IR3PLNCK
$3,003.08
IR31NSP
Permit Fee:
$3,003.08
Suppl. Insp. Fee. -G Reg. 0 OT
"
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Constr. Tax: IBCONSTAXR
M
u'
nits
$558.80
Acoustical Fee: 0 Yes (D No
$0.00
0
E)
Work Without Permit? 0 Yes E) No
$0.00
TOTALS:
3,764
$2,860.12
Tnwel Docionenhilion Fees:
1 $3,003.081
Strong Motion Fee: 1BSE1S1vffCR
N()M.- Ttj e foac arp hagpd nn tho prPfimbiary information available and are only an estimate. Contact the Dept for addn'l in/o.
FEE ITEMS (16?e Resolytion 09-051 Eff. 7/1/1D
Xfcch. Plan (_'hcek
17und). Phn? Che(I
Elec. Phin Owvl(
IWech, PermilFec,,
I P111111h. Pernlit Fec,
El"c' Pci-mit Fee:
Alech. lnsp� E:F-I-
Olho- P11111,11) Insp,
Oilier Elec. Insp. L]
hlsp� Fc():
Plumb. Illy. Fee:
Elec, Insp, Fee.,
N()M.- Ttj e foac arp hagpd nn tho prPfimbiary information available and are only an estimate. Contact the Dept for addn'l in/o.
FEE ITEMS (16?e Resolytion 09-051 Eff. 7/1/1D
FEE
QTY/
MISC ITEMS
Plan Check Fee:
$2,860.12
Select a Misc Bldg/Structure
—1 or Element of a Building
—
Suppl. PC Fee: E) Reg. 0 OTTO.0
___F
hs
$0.00
PNIE Plan Check:
$0.00
Permit Fee:
$3,003.08
Suppl. Insp. Fee. -G Reg. 0 OT
"
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Constr. Tax: IBCONSTAXR
M
u'
nits
$558.80
Acoustical Fee: 0 Yes (D No
$0.00
0
E)
Work Without Permit? 0 Yes E) No
$0.00
PLLONGRIVGR
$489.32
Select a Non -Residential G
Building or Structure 0
Tnwel Docionenhilion Fees:
Strong Motion Fee: 1BSE1S1vffCR
$54.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$22.00
SUBTOTALS:
F$6,987.321
$0.00 TOTALFEE
.32
Revised: 01/15/2011