12080248CITY OF CUPERTINO BUILDINC PERMIT
BUILDINGADDRESS: 1599POPPYWAY
CONTRACI'OR: NOR CAL CONSTRUCTION
PERMITNO:12080248
AND
OWNER'S NAME: WU RONG-SAN AND CHEN PEE -LING ET AL
4181 1ST S'1'
DATE ISSUED: 08232012
OWNER'SPBONE: 4084461257
LIVERMORE. CA 94551
NIONENo:(925) 449-7774
❑ LICIiNSIi1) CO\ fRACI'OR'S DECLARATION
INFO: BLDG F. ELECT r PLUMB r.—
License Class1_ Lic.N 3 0
,BUILDING PERMIT
r r r
y�
Contractor •tomA' n o o_ Q &Date
J
NIECII RESIDENTIAL COr•IPIERCIAL
hereby affirm that l min licensed under file prorisiuns of Chapter 9
JOB DESCRIPTION: KITCHEN REMODEL (103 SOFT)
(commencing with Section 7000) of Division 3 of the Business S Professions
Code and that my license is in fall force and effect.
1 here[)%affirm under penalty o1' perjur) one of the fallowing two declarations:
I have and evil] maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for file
performance of ilic work for which this permit is issued.
Sq, Ff Floor Area:
Valuation: $23579
I lime and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for [lie Performance of Orae work forwhich this
permit is issued.
APN Number: 36615035,00
Occupancy Type:
.U'1'LIC,\N'I' Clili'fIFICA'TION
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 stale laws relating
to building construction, and hereby authorize representatives oflhis city to enter
PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned propertyforinspection purposes. (We) agree to save
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
180 DAYS FROM LAST CALLED INSPECTION.
graining ofmispermit. Additionally. tile applicant undcrstandsandw,ill comply
with all non -point source regulations per the Cupertino Municipal Code. Section
9.18.
Issued hy: F / Cfiil�f� Date: p-
Signature Date -s-"
RE -ROOFS:
❑ OWNER -BUILDER DECLARATION
All roofs shall be inspected prior to any roofing material beiig installed. If a roof is
herelrr affirm that 1 am exempt from the Contractor's License Lie, fortune of
installed without first obtaining an inspection, I agree to remove all new materials for
the following mo reasons:
inspection.
I, a 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.
Signature of Applicant: Date:
Business R Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business S Professions Code),
ALI, ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIA( S DISCLOSURE
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
I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation, as provided for by Section 3700 of the Labor Code, for the
Cali fornia I lealth S Safety Code. Sections 25505, 25533, and 25534. I will maintain
perfommnce of the work for which this permit is issued.
compliance with the Cupertino Municipal Code, Chapter 9.12 and the (lealth S
I have and will maintain Worker's Compensation Insurance, as provided for by
Safety Code, Section 25532(a) should 1 store or handlehazardous material.
Section 3700 of the Labor Code, for the performance of the work for which this
Add lionally, should 1 use equipment or devices which emit hazardous air
contaminants as defined by the Ray Area Air Qualily Management District I will
am
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
I certify that in the perfommnce of die work for which this pemtit is issued, I shall
(lealth S Si fet_v Code, Sections 25505, 25533, and 25534.
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
On, 112 n 'zed nI: -
become subject to the Worker's Compensation provisions of the Labor Code, I oast
Date: 'Z
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSlRUCNON LENDING AGENCY
\I'I'LIC.\N'I' CI•:R'I'IPIC.\'I'I(1N
I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application laid state that the above information is
for which this permit is issued (Sec. 3097, Civ C.)
correct. I agree to comply with all city and county ordinances mid state laws relating
Lender's Name
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Address
indemnify and keep tameless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting ofthis permit. Additionally, the applicant understands and will comply
ARCAITEC.-I" S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
00L666b5Z6 Zb:TT ZTOZ/EZ/80
CONSTRUCTION PERMIT APPLICATION
I COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildingQcuoertino ora
❑ NEW CONSTRI TCTTON n nnnrnf... K -X
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11
----- ru.lmvulvry/11 IJ M- REVISION IDERRED ORIGINAL PERMiT0
63 pan^ PROTECT ADDRESS
Y
OWNER NAME
EMAIL
3'1Rf?ET ADDRESS ' �� Po a
1V
C.STATE ZIP r' n d
FAX
CONTACT NAA
PNONE
EMAIL
STREET ADDRESS
CrrY, STATE, ZIP
FAX
❑ OWNER ❑ OvNEazuaAHR ❑ OwNERAGRNr ❑ CONTRACTOR ❑ CON'TRACTOR AGENT ❑ ARCI,m, ❑ E,mNE,E ❑ Dm' Ftat ❑ TENANT
CONTRACTOR NAME
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LICENSE
SUS LICA
COMPANY NANEE E-MAIL
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STREET ADDRESS idol �% Cm srARE
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ARCIMECRENOWEFR NAME LICENSE NUAmER
BUS. LIC e
COMPANY NMIE
E-MAIL
FAX
STREET ADDRESS
CRY, STARE, ZIP
PHONE
DESCRIPTION OF R'OIU:
a c i %c e- I 2 Ca K �oJ
h�ATcr t1oh z4t d'
PAI
ouT e or �o H ,
D reec9scd
R-xuTa+o osR wcoeosm USE ro T Y sroREs
;
f= USE TYPE OCC. SQ.FT. VALUATION (S)
EXL41'G NRwFl.00a REA TOTAL
ARBA AR*- - AREA TTAREA
A
J /
LIG
OL 3
/0-7
BA1HROOM KITCHEN' OTHER
RFTWDEL AREA AREA REMODEL AREA
OODEL
FORCH AREA DECK AREA TOTAL SCKIPORCHAREA GARAGEAREA: DETACH
ATTACH
0 DWELLING UNITS:
ISASHCO"UNIT ❑�m^
=NO DEW
SHCON-USTORY ❑T�$
ADDITION-
H{JO
..ENO
PLANNIUCATION ❑YB5 ffYRS, PROVrog COPY OF
PLANNGq APPLY .GYRI PIANNntG APPROVAL TSrIFfI
IS TIM MDG AN ❑YES
HICtR18p HOMRT �it0
-RECEIVED BY::,�
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VAI,U PON:
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By my signature below, I eLTtify to each of the following: I am the pmperty owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is comet. I Imve read the Dmcription of Work and verify it is accurate. I agree to comply with all applicable local
'ng
ordinances and start laws relating to bu' 'aa 1 authorize representatives of Cupertino to enter Ire abover
entitiod Property for inspection Purposes
Signature of ApplicanUAgent: Dam: R
^ •� /' ,
SUPPLEMENTAL INF RMAT N REQUIRED
- •'- el -UN ^CICTIT6''
ROUrIN SUP 4 - ,
New SFD or Multifamily dwellings: Apply for demolition permit
+•= T
"'•'
existing building(s). Demolition permit is required prior to issuance of budding
'OVER-'
-COUNTER 3'
jaU1IDINC PiaN REVIPwt i�,,,
permit for new building.'❑
EXPRESS
;n
❑ PIANNINO PLAN RIIR71+1V "I,
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
'❑ srnNDAlm..''y
❑ rimiic ''
form if any Hazardous Materials are being used as part of this project
. :'•
a
•❑x rnxcE x.,,,,, r
1 :
, ,..
❑arse DEPrt
_ Copy of Planning Approval Leuer or Meeting with Planning prior to
submittal of Building Permit application.
❑ ntn.Ion t
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❑ i6NTTARI 5E1VER mSTmCT
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❑ R7iYTR0NmhTALr1�YLTR r'•'
BldgApp_2011.doe revised 06/21/11
15
EN���� CITY OF CUPERTINO
O FEE ESTIMATOR -BUILDING DIVISION
A'OTE: This estimate does not include fees clue to other Departments (i.e. Planning, Public Works, Fire, Sanitary Server District, School
District, etc.). 77jese fees are based on the prefintinan information available and are on/t' an ewinatte. Contact the De ! or whin 'I info.
FEE ITEMS (Fce Resolution 11-053 Ef! 7/I//II
ADDRESS: 1599 POPPY WAY
DATE: 08/23/2012
I2EVIER'ED BY: SEAN
Mech. Permit Fee:
APN:
BP#:
-VALUATION:
$23,579
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARYPENI'AMATION
USE: SFDorDuplex
race. Insp. Fee:
PERMITTYPE: 1R3SFDREM
NVORK
kITCHEN REMODEL 103 SQ FT
SCOPE
$0.00
A'OTE: This estimate does not include fees clue to other Departments (i.e. Planning, Public Works, Fire, Sanitary Server District, School
District, etc.). 77jese fees are based on the prefintinan information available and are on/t' an ewinatte. Contact the De ! or whin 'I info.
FEE ITEMS (Fce Resolution 11-053 Ef! 7/I//II
Meeh. Ilan Check
Phunh. Plan Check
Flee. Plan Check
Mech. Permit Fee:
Plumb. Permit Fee:
F•lec. Permit Fee:
OtherMuch. Insp.
Oilier Plumb In,sp.Other
F,lec. I,
dlech. lrup. Fee:
Plumb. /rr.gr. Fee:
race. Insp. Fee:
A'OTE: This estimate does not include fees clue to other Departments (i.e. Planning, Public Works, Fire, Sanitary Server District, School
District, etc.). 77jese fees are based on the prefintinan information available and are on/t' an ewinatte. Contact the De ! or whin 'I info.
FEE ITEMS (Fce Resolution 11-053 Ef! 7/I//II
FEE
QTY/FEE
NIISC ITEMS
Plan Check Fee:
$0.00
103 s.f.
$600.00
Remodel, Kitchen (<=300 sl)
IRFA-MESKIT
Suppl. PC Fee: Q Reg. 1) OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl: Insp. Fee:Q Reg. Q OT
F0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Consit-uction Tax
rl dinMistrat i ve fee:
O
(D
Work Without Permit? O Yes Q No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
0
A
Travel, Docianentation Fees:
Strong Motion Fee IBSFISAHCR
$2.36
Select an Administrative Item
Bldc Stds Commission Pec: IBCBSC
$1.00
SUBTOTALS:
$3.36
$600.001TOTAL
FEE:
$603.36
Revised: 07/01/2012
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
nn
10300
0011Tonnrree Avenue
1_11NQP`II1�,1'11.11�I1IT%
Fax: 408-777-3333
JOB ADDRESS: j o.��
/�Jy/
PERMIT # U C2
OWNER'SNAME`. �,j
n/
PHONE#
GENERAL CONTRACTOR: a,� G
`-,y —
BUSINESS LICENSE #
ADDRESS:. / 1.
CITY/ZIPCODE: Gi[i 7 o Gfl
-vur municipal cone requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED
BUSINESS LICENSE.
am not using any subcontractors:
Signatu
Please check applicable subcontractors and complete t following information:
CITY OF
Date
✓
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement.Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping ,
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing ,
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature Date
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