12010144CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22530 ALCALDE RD CONTRACTOR: YANG ERN-HUAN AND PERMIT NO: 12010144
SHEW LANA B
OWNER'S NAME:
CUPERTINO, CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ' ELECT PLUMB
License Class Lie. #
MECH Jr RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I 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.
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
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
OWNER -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)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
indemnity 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 tlr' it. Additionally, the applicant understands and will comply
with all no
/ / Datel / 0"'oM► 46— I Licensed
CITY OF CUPERTINO
ICJ FEE ESTIMATOR - BUILDING DIVISION
ikADDRESS:
-.1441
22530 alcalde rd.,
DATE: 01/24/2012
REVIEWED BY: larry s
APN:
BP#:
"EVALUATION:
1$25,000
`- PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
WORK
remodel kitchen replace counter and counter top, appliances, garden window. install new gas line.
SCOPE
upgrade electrical panel, 200 amps. no structural work.
77
Lj Li Li
NOTE: This estimate does not include fees due to other Departments (Le Planning, Public Works, Fire, Sanitary Sewer District, School
District, eta). These fees are based on the prelinsnary information available and are only an estimate Contact the Dept for addn 7 info.
FEE ITEMS (Fee Resolution 11-053 L; . 7IL111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 50-1 s.f.
$588.00
Remodel, Kitchen (<=300 sf)
IREAMESKIT
Suppl. PC Fee: Q Reg. () OT
0.0 1
firs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee-0 Reg.
Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
G
Work Without Permit? 0 Yes (F) No
$0.00
Advanced PlanninL- Fee:
$0.00
Select a Non -Residential
Building or Structure
G
0
Strong Iviotion Fee:
1BSEISMICR
$2.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
1 $1.00
SUBTOTALS:
1 $3.501
$588.00J
TOTAL FEE:
$591.50
Revised: 1 /19/2012