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13090061!0 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22391 SALEM AVE CONTRACTOR: TAI PEI CONSTRUCTION PERMIT NO: 13090061 OWNER'S NAME: WU IMEI L AND T1TVMIY T ET AL 4493 MANZANITA DR DATE ISSUED: 09/10/2013 OWNER'S PHONE: 6504921383 SAN JOSE, CA 95129 PHONE NO: (408) 887-3345 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class [X Lic. # R • -7S lg UNIT 1- REMODEL (2) BATHROOMS 90 SQ, INSTALL Contractor_T cs Ik A/& Date —_/O CIRCUIT IN KITCHEN AREA 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: $7000 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 32615043.00 Occupancy Type: > 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 PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT 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 DA F M LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, against said City in consequence of the loo costs, and expenses which may accrue Issued by:,, Date:�J granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is 9.18. Date /� �r Signature=� 3 installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ 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, 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 HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, 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. I 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 2550 2553 , and 25534. Section 3700 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 CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of forthwith comply with 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 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 ofthis city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingacupertinO.org ❑ NEW CONSTRUCTIONElADDITIOI PROJECT ADDRESS -7- 7 _- /y1 I IQ le M" OWNER NAME STREET ADDRESS CONTACT NAME STREET ADDRESS, VZ- * 1 ?_ ve,f el CITY, STATE, ZIP PHONE CITY, STATE, ZIP REVISION / DEFERRED ORIGIN) APN # 37- — 1 / , 0 2 13&3 EE ---MAIL E-MAIL FAX FAX ❑ OWNER ❑ GWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # AREA COMPANY NAME (fir ` cJ N � , / � N VV EMAIL BATHROOM AREA FAX KITCHEN REMODEL AREA �� STREET ADDRESS/,, a p ,l ` / 1"( j 6_ r CITY, STATE, ZIP �U, � r2 / PHONE - %%7 3 A fj D v/ T ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # FAX E-MAIL COMPANY NAME STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WO,ti 1,001M 1-e flY`Gd e I EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM AREA KITCHEN REMODEL AREA �� OTHER REMODEL AREA REMODEL 9� - ATTACH USE I TYPE I OCC. I SQ.FT. VALUATION ($) 9 F UNITS: IS A SECOND UNrr u YES 6MUnu a-. u. wBEING ADDED? []NO ADDITION? []NO PRE -APPLICATION ❑ E YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES . C TOTAL VALUATION: PLANNING APPL # ❑ NO PLANKING APPROVAL LETTER EICHLER HOME? ❑ NO t I% By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's rbehalf. I have 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 ion authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date. SUppLEMENTZ-fNfORMATION REQUIRED _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of buildin permit for new building. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. —Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. BldgApp_2011.doc revised 06121/11 CITY OF CUPERTINO T. T. T, 1 QT7M A rrnI? — RTTTT.11TH(:' D11VIRICIN A,fcch. Plan Check Phanb. Pian Check Elec. Plan Check 0.0 hrs $0.00 iLlecr`r. Permit Fee: Plumb. Permit Pee: Elec. Permit Fee: IEPERMIT Oiher• Afech. Insp. Oiher Plumb Insp. Other Elec. Insp.EEhrs $47.00 Alech. Insp. Fee: Plumb. Insp. Fee: Elec. Insp. Fee: n� T. O..L....l NOTE: This estimate does not inctude fees aue to otner vepanmenrs (aee reurining, ruuuc .. _ { �..{{{{{.•y T•-�• --•��• -•-�-- _ _ ,... ,. ., __ _._ _ _� _,____�__ __.:�� _.�....•,... ,...,.;1,.>,1,. ,..,a n.,, ,,.,i , ..» ocAH,nta �'nH%n Pi ihn ,/PHl FOT addn'1 info. /ILJLlLIl9, US" . =/{... cw M{.c. r. ...w.. w..... I FEE ITEMS (Fee Resolution 11-053 E . 711112) ADDRESS: 22391 salem ave #1 DATE: 09/10/2013 REVIEWED BY: Mendez APN: BP#: `VALUATION: 1$7,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Du lex p 0.0 PENTAMATION 1 R3SFDREM PERMIT TYPE: USE: PME Plan Check: WORK unit 1- remodel 2 bathrooms 90 sq, install circuit in kitchen area Electrical 1 1BREMRECEP Recep/Switch/Outlets SCOPE $0.00 A,fcch. Plan Check Phanb. Pian Check Elec. Plan Check 0.0 hrs $0.00 iLlecr`r. Permit Fee: Plumb. Permit Pee: Elec. Permit Fee: IEPERMIT Oiher• Afech. Insp. Oiher Plumb Insp. Other Elec. Insp.EEhrs $47.00 Alech. Insp. Fee: Plumb. Insp. Fee: Elec. Insp. Fee: n� T. O..L....l NOTE: This estimate does not inctude fees aue to otner vepanmenrs (aee reurining, ruuuc .. _ { �..{{{{{.•y T•-�• --•��• -•-�-- _ _ ,... ,. ., __ _._ _ _� _,____�__ __.:�� _.�....•,... ,...,.;1,.>,1,. ,..,a n.,, ,,.,i , ..» ocAH,nta �'nH%n Pi ihn ,/PHl FOT addn'1 info. /ILJLlLIl9, US" . =/{... cw M{.c. r. ...w.. w..... I FEE ITEMS (Fee Resolution 11-053 E . 711112) ...-- -. _________ FEE __ QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. $626.001 Remodel, Bath (<=300 sf) IREMRESBAT Suppl. PC Fee: Q Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 1 $47.00 Electrical 1 1BREMRECEP Recep/Switch/Outlets Permit Fee: $0.00 Suppl. Insp. Feer Reg. ® OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 Conslt-iwtion Tay: Administrative Fee: 1ADMIN $44.00 G) Work Without Permit? ® Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G ®A Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: 1BSEISMICR $0.70 $673.00 Select an Administrative Item _ { `� $812.70 Bldg Stds Commission Fee: 1BCBSC $1.00 v _ $139.70 Revised: 07/01/2013 r V t A/) c f C > I 'OFFICE �# x Parent IANCZ L -b F -I x � -� � ivc-� SEP 10 2013 Wet) FOR CODE IANCE