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13040144 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1562 POPPY WAY CONTRACTOR:KUANG'S PERMIT NO:13040144 . CONSTRUCTION CO OWNER'S NAME: PEIJING YE PO BOX 4802 DATE ISSUED:04/18/2013 OWNER'S PHONE:''4088333850 ELDORADO HILLS,CA 95762 PHONE NO:(916)941-2378 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALS License Class Lie.# `?7 b 3 2 CONVERT(E)KITCHEN PANTRY TO(N)SHOWER IN(E) �,, HALL BATH Contractor tbate 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. Sq.Ft Floor Area: Valuation:$4000 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 APN Number:36610109.00 Occupancy Type: permit is issued: APPLICANT CERTIFICATION I certify that I have.read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED comet..1 agree to comply with all city and,county ordinances and state laws relating WITHIN 180 DAYS O RMIT ISSUANCE OR. to building construction,and hereby authorize representatives of this city to enter upon:the above mentioned.property for inspection purposes. (We)agree to save 180 DAYS LA CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs and.expenses',which may accrue against said City in consequence of the granturg:of this perml Additionally,the,applicant understands and will comply Iss Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9i18, 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. ❑ 1 OWNER-BUILDER.DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the'Contractor's License Law for one of the following two reasons:, ' ! ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner,of the property,or my employees'with wages as their sole compensation, will do the work;:an d the Structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec,70,44 Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby;affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have,and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. section I .. 7.. of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:[ 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 Compensatioklaws of California.:If,aftei making this certificate of exemption,I CONSTRUCTION LENDING AGENCY r become'Subject to,the Worke's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwithe omply wrth.such provisions'or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certr�,}hat,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 donstructio and hereby authorize representatives of this city to enter upon the'above mentioneo property fo.'r inspection purposes.(We)agree to save ARCHITECT'S DECLARATION indemnify and.keep harmless the City,of Cupertino against liabilities,judgments, costs and exp enses which may acenle against said City in consequence of the I understand my plans shall be used as public records. , { granting o£this pemir 'Additionally,the applicant understands and will comply with all non point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature N Date CONSTRUCTION PERMIT APPLICATION 12 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building c(D.cupertino.orq \� [:]NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS �'-/� /� APN# �3/ / - to OWNER NAME \�� P p ?7 E-MAIL —T- STREET ADDRESS !1 CITY,STATED,ZIP FAX CONTACT NAME i COW STREET ADDRESS o '9il/l��j�V 2 CITY,STATE, -7 ZIP �C�- f FAX (3' ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CKCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME, 1 w� */_ LICENSE NUMBER 7'7 _�j 3 Z LICENSE TYPE /j BUS.LIC# COMPANY NAME `�,_ , ` o, e w .TC� E-MAIL ttO,� r l' FAX STREET ADDRESS m © ` � rJ CITY,ST E, t�pt/ 74� PHONE`_.�c�_ p k ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK T O EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXLSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NEPAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: Ll DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY ❑YES BEING ADDED? []NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES CEIVED TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LEITER EICHLER HOME? -4 By my signature below,I certify to each of the following: I am the property owner or authorized agent to ac�on the property owner's behalf. I ha?e read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building cons on. authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: ; Date: SUPPLEMENTAL 16VORMtTION REQqJRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for �VFR-THE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ ExPREss ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to 11 MAJOR ❑ SA9 ARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION r•` ; ADDRESS: 1562 poppy way DATE: 04/18/2013 REVIEWED BY: melissa APN: 36610109 BP#: *VALUATION: 1$4,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDRE USE: PERMIT TYPE: WORK CONVERT E KITCHEN PANTRY TON SHOWER INE HALL BATH SCOPE imam ;E ;kfech.Pht m Check Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check Xtech.Permit Fee: Plumb.Permit Fee: IPPERMIT Elec.Permit Tee: Other•Ak,,,ch.Insp, Other Plumb Insp. 0.0 hrs $45.00 Other Elec.Inrp. Alech.Insp.Tee: Plumb. hal).Fee: Elec.Imp.Tee NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District eta). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 15 Js.f Remodel,Other Suppl.PC Fee: (D Reg. 0 OT 0.0 ht's $0.00 $400.00 IREMRESOTH PME Plan Check: $0.00 1 # Plumbing Permit Fee: $0.00 $10.00 IBPF=RE I Fixture set on One Trap Suppl.Insp.Feer Reg: ®OT F0.0 brs $0.00 PME Unit Fee:. $0.00 PMEPermit Fee: $45.00 C ns.1niction TaxT-F .Administrative Fee: 1ADMIN $42.00 ® . Work With Permit?."' Yes a) No $0.00 Advanced Planning ee: $0.00 Select a Non=Residential t St Building or Structure Travel Documentation Fee: 1TRAVDOC $45.00 Bu � .Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldi1 Stds'Commission Feer . 1BCBSC $1.00 $133.501 $410.00 Revised: 04j01/2013 Building Department City Of Cupertino Lo 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O _ Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST` JOB ADDRESS: PERMIT# OWNER'S NAME: C PHONE# GENERAL CONTRA TOR: BUSINESS LICENSE,#. ADDRESS: Zj 4 t, CITY/ZIPCODE: *Our municipal code requires all fiusinesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACT RS HAVE OBTAINED :A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signa Date Please check applicable subcontractors and complete the following information: V 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 CUPERT 1"i"'in9 Depa I NO APR 1 we 7 2013 nt Reviewed B,CDUE CCMP1-1AtVCE Y _ 'k Vr e- a 10 �� Q Llb AlV P CO AMUNITY DEVELOPMENT DEPARTMENT `�I1 BUILDING DIVISION-CUPERTINO b APPROVED This set of plans and_apecifications MUST be kept at the job site during construction. It is unlawful to make any QL changes or alterations on same,or to deviate L therefrom,without approval from the Building Official. The stamping othis.plan-and specifications SHALL UQ ,4*,f - p to be Pn approval of the violation of any pr of ty Ordinance or State Law. M PERMIT NO. p --� - -- =� IV -vl qF V () t 2 (_ %R 18 201133 � r"