12060133CITY OF CUPERTINO BUILDING PERMIT ' ""
(Z.
BUILDING ADDRESS: 20601 MCCLELLAN RD
OWNER'S NAME:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
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.
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
OWNER -BUILDER DECLARATION
1 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,
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).
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, 1 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
1 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 Municip 1 Code, Section
9.18.
Signature �Z
CONTRACTOR: LEE JEN S AND JA-LIH IT NO: 12060133
1502 JUARCEYS CT DATE ISSUED: 06/22/2012
SAN JOSE, CA 95120 IPH0
1 NO:
BUILDING PERMIT INFO: BLDG r ELECT f— PLUMB 1—
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: KITCHEN REMODEL 70 SQ FT, BATH 40 SQ FT
7/30/12-REV#1 REMOVE EXISTING GARDEN WINDOW AND REPLACE WITH
SLIDER, ADD DOOR AND CLOSETS TO EXISTING DEN, REMODEL MASTER
BATHROOM SHOWER, AND DELETE BEAM/FOOTINGS AT NON -LOAD BEARING
WALL AT KITCI EN-REV#1 ISS'D 7/30/12
Sq. Ft Floor Area: I Valuation: $15000
APN Number: 35916001.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date:
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
1 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 I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner
AGENCY
1 hereby affirm that there is a construction lending agency for the performance of mrk's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
CITY OF CUPERTINTO BUILDING PERMIT
BUILDING ADDRESS: 20601 MC CLELLAN RD I CONTRACTOR: LEE JEN S AND JA-LIH I PERMIT NO: 12060133
OWNER'S NAME:
JOB DESCRIPTION: RESIDENTIAL LJ COMMERCIAL
License Class Lic. p
Contractor
1 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
1 certify that 1 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,
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.
KITCHEN REMODEL 70 SQ FT, BATH 40 SQ FT
Sq. Ft Floor Area: I Valuation: $8500
APN Number: 35916001.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: / : &
RE -ROOFS:
Signature Date 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.
❑ OWNER -BUILDER DECLARATION
1 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,
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.
1 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.
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
Compensation laws of California. If, after making this certificate of exemption, 1
become subject to the Worker's Compensation provisions of the Labor Code, 1 must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
1 certify that 1 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,
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 al I non- Municipal Code, Section
9.18. � _
Signature Date (/y
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 I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District 1
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, s 25505, 25533`, and 25534.
Owner or authorized agent: Date: Z (�-
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
FM-1 FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 20601 McClellan Road
DATE: 07/30/2012
REVIEWED BY: Sean
Imb
APN:
BP#:
*VALUATION: 1$6,500
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1GENRES
PERMIT TYPE:
WORK
Revision #1: Remove existinggarden window and replace with slider, add door and closets to existin
SCOPE
den, remodel master bathroom shower, and delete beam/footings at non -load bearing wall at kitchen.
Ir. Plan C'h CkT-T
Plumb. Plan Check 0.0 1 hrs $0.00 1
h-;;
birch P"r." I.c',
Plumb. Permit Fee: 1PPERMIT
I , P"i';! Iec
' ' • �' • ' . M-NI'
Other Plumb Ins 0.0 hrs p.L$45.00
O/Itrililt°r Ins13
... i ..+'.'7 �t1, t'4.'L'.
Pifi77i f�. �': / i
�, /Cf'. i➢i 51L NE'
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 nreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 ETf 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
=#
$400.00
Window / Sliding Glass Door
1 WINREP Replacement
Suppl. PC Fee: 0 Reg. 0 OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
F__27 #
$20.00
Plumbing
IBPFIXTURE Fixture or Trap
Permit Fee:
$0.00
Suppl. Insp. Fee.S Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$45.00
onstruction Tay.
Administrative Fee:
1ADMIN
$42.00
Q
0
Work Without Permit? 0 Yes Q) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
0
i
Travel Documentation Fee: ITRAVDOC
$45.00
Strong Motion Fee:
IBSEISMICR
$0.65
Select an Administrative Item
Bldp, Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$133.651
$420.00
TOTAL FEE:
$553,65
Revised: 07/01 /2012
CITY OF CUPERTINO
F-M-1 FEE ESTIMATOR - BUILDING DIVISION
19
ADDRESS: 20601 McClellan Rd
DATE: 06/22/2012
REVIEWED BY: Sylvia
APN:
BP#:
'VALUATION:
1$8,500
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex
PENTAMATION
PERMIT TYPE: 1 R3SFDREM
WORK
Remodel Kitchen remove wall 70 sq ft Remodel Bath 40 sq ft
SCOPE
. h. Plan ( heck
New C l"'C4�T-T
_. _ V h;: , ( ek
Wec f1.
11il;s, "114mh Iru'h.
O(leer Ele.c . MSA Li
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 only an estimate- Contact the DeDt for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
=s.f.
$588.00
Remodel, Kitchen (<=300 sf)
IREMRESKIT
Suppl. PC Fee: Q Reg. () OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
F 40 s.f.
$588.00
Remodel, Bath (<=300 sf)
IREMRESBAT
Permit Fee:
$0.00
Suppl. Insp. Fee.e Reg.
Q OT
0 0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C(in suction TCIX.
,l di rirr ,wrativ Fcc_
Q
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
I
Q
0
i
1 r.�t e 1 l.1ur rrFrar nluriorr r
Strong Motion Fee:
IBSEISMICR
$0.85
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$1.85
$1,176.00
TOTAL FEE-T
$1,177.85
Revised: 06/30/2012