12050001CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10490 AINSWORTH DR
CONTRACTOR: TSENG HUI-HUNG AND
PERMIT NO: 12050001
MING-CHU C
OWNER'S NAME:
CUPERTINO, CA 95014
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
r r r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
F r—
MECH RESIDENTIAL COMMERCIAL
Contractor Date
hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: EXTEND KITCHEN INTO EXISTING REAR PORCH AREA(81
(commencing with Section 7000) of Division 3 of the Business & Professions
SQ
FT) ADD FRONT COVERED ENTRANCE (53 SQFT)REPLACE
Code and that my license is in full force and effect.
ALL WINDOWS AND ONE WINDOW CONVERTED TO A SLIDING
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: $40000
permit is issued.
APPLICANT CERTIFICATION
APN Number: 32646003.00
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
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: � �% Date: / • /
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I 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 being 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, I 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.
I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance, as provided for by
California Health & Safety Code, Sections 25505, 25533, and 25534. I 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 I store or handle hazardous material.
permit is issued.
Additionally, should I use equipment or devices which emit hazardous air
I 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.
:
�— Date: l XJ�Z—
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I 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
I hereby affirm that there is a construction lending agency for the performance of Hork'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
9.18.
SignDate
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
F,M-,7 FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10490 Ainsworth Dr
DATE: 06/26/2012
REVIEWED BY: Sean
APN:
BP#: 12050001
"VALUATION:
1$2,000
*PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 REAP11
PERMIT TYPE:
WORK
Revision #1: Upgrade the subpanel to 125 amp,and install 27 new ceiling and recessed lights.
SCOPE
APPLIANCE / EQUIP TYPE
FEE ID
QTY
UNITS
BP FEES
Fixtures, Lighting
1BREMFIXT
27
#
$93
Services
1ERT<200
125
Amps
$44
TOTALS:
$137.00
Elec. Plan Check 0.0 1 hrs $0.00
h!,
Plr •
Elec. Permit Fee: 1EPERMET
Otlrcr Mm.h. ,' , .
011 r Plumb Insp
Other Elea Insp. 0.0 J hrs $44.00
NOTE: This estimate does not inchide fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. eta). These fees are based on the Dreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eft 711111)
FEE
QTY/FEE
MISC ITEMS
Inert Check Fce:
All. PC foc
PME Plan Check:
$0.00
Permit
PME Unit Fee:
$137.00
PME Permit Fee:
$44.00
r' ;istr action lax.
Administrative Fee: [ADMEN
$41.00
Work Without Permit? 0 Yes (F) No
$0.00
I dvanced plar'wing Fees:
Travel Documentation Fee: 1TRAVDOC
$44.00
Strong Motion Fee: 1BSEISMECR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee- 1BCBSC
$1.00
SUBTOTALS:
$267.50
$0.00 TOTAL FEE:
1 $267.50
Revised: 06/30/2012
CITY OF CUPERTINO BUILDING PERM
BUILDING ADDRESS: 10490 AINSWORTH DR
CONTRACTOR: TSENG HUI-HUNG AND
PERMIT NO: 12050001
MING-CHU C
OWNER'S NAME:
CUPERTINO, CA 95014
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
F r— r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. # k 0 Z 6 S-
r r r
lall
MECH RESIDENTIAL COMMERCIAL
Contractor,'fdc,64 � { r�,A 'Date a2s-1/2,
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: EXTEND KITCHEN INTO EXISTING REAR PORCH AREA(81 SQ
(commencing with Section 7000) of Division 3 of the Business & Professions
FP) ADD FRONT COVERED ENTRANCE (53 SQFT)REPLACE
ALL WINDOWS AND ONE WINDOW CONVERTED TO A SLIDING 6/26/12-REVHI UPGRADE THE
Code and that my license is in full force and effect.
SUBPANEL TO 125 AMP AND INSTALL 27 NEW CEILING AND RECESSED LIGHTS-REVHI ISS'D
6/26/ 12
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
Sq. Ft Floor Area:
Valuation: $42000
permit is issued.
APPLICANT CERTIFICATION
l certify that l have read this application and state that the above information is
APN Number: 32646003.00
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
granting of this permit. Additionally, the applicant understands and will comply
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non -
' _ DateX/1
"
Issued by: Date:
(
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, as owner of the property, or my employees with wages as their sole compensation,
All roofs shall be inspected prior to any roofing material being installed. If a roof is
will do the work, and the structure is not intended or offered for sale (Sec.7044,
installed without first obtaining an inspection, l agree to remove all new materials for
Business & Professions Code)
inspection.
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
Compensation, as provided for by Section 3700 of the Labor Code, for the
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
l 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 &
permit is issued.
Safety Code, Section 25532(a) should I store or handle hazardous material.
I certify that in the performance of the work for which this permit is issued, I shall
Additionally, should I use equipment or devices which emit hazardous air
not employ any person in any manner so as to become subject to the Worker's
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
Compensation laws of California. If, after making this certificate of exemption, l
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 oa��
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
CONSTRUCTION LENDING AGENCY
correct. I agree to comply with all city and county ordinances and state laws relating
I hereby affirm that there is a construction lending agency for the performance of Hork'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
9.18.
ARCHITECT'S DECLARATION
Signature Date
1 understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
ICI FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10490 ainsworth drive
DATE: 05/01/2012
REVIEWED BY: larrys
APN:
BP#: 2,0
*VALUATION:
1$40,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
2nd Unit? % Yes . No
OTC. 0 Yes ®No
PENTAMATION 1 R3SFDADD
PERMIT TYPE:
WORK
extend kitchen into existing rear porch area 81 s . ft.), add front covered entrance 53 s . ft.), replace
SCOPE
all windows and one window converted to a sliding door in living room (9 openings), convert laundry p
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,III-BJV,v-B
134
$994.00
IADDPLCK
$963.00
IADDINSP
TOTALS:
134
$994.00
$963.00
MECH, HOURLY 0 Yes O No
PLUMB, HOURLY Q Yes Q No
ELEC, HOURLY Q Yes Q No
"Ian Chef/_
i'Jnr-
ii. '•: , �.,`- '.. ..
Oiler InvP
Li
P/rr,+rl,.h+.1.Iw,
lid,'r 1„til,.I.,e,
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 Dreliminary information available and are onlv an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution II-053 Eff.' 7/I/II)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$994.00
40 s.f.
$588.00
Remodel, Bath (<=300 sf)
/REMRESBAT
Suppl. PC Fee: Q Reg. 0 OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
F,00 s.f.
$588.00
Remodel, Kitchen (<=300 sf)
IREMRESKIT
Permit Fee:
$963.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
1 hrs
$0.00
0 # Window / Sliding Glass Door
$522.00 I wINREP Replacement
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
,sir ncr ion Tax:
IJ"Iiwr wrier Vec.
0
E)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Plannin& Fee: PLLONGRNGR
$17.42
Select a Non -Residential
Building or Structure
E)
Q
i
7.. • ."1 i)r��vrr,rc.ttcrtir.rrr FCC's:
Strong Motion Fee: IBSEISMICR
$4.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$1,980.42
$1,698.00
TOTAL FEE:
1 $3,678.42
Revised: 04/01 /2012