14040002CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10231 STERN AVE
CONTRACTOR!" TBB-r�EQ BE
PERMIT NO: 14040002
OWNER'S NAME: CAO VIET ANH AND TRAN CUC THI
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DATE ISSUED: 04/01/2014
OWNER'S PHONE:
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
UPGRADE 9 OUTLETS TO GFCI, REMOVE AND REPLACE
License Class_ Lic. # ��� �J 3
CABINETS, SINK AND INSTALL NEW LIGHT FIXTURE IN
Contractor N 124QWsfox to -90
KITCHEN
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
Sq. Ft Floor Area:
Valuation: $7500
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
APN Number: 37511070.00
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
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 0 AYS 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 DAY M LAST CALLEDINSPE ION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Issued by: Date:
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:
918.
Signature �y��--- Date A 14t
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
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 255 5533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Dater 1011&
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 of this 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
918.
Signature Date
k
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION t O
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 • buildingQcupertino.org 1 v
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS
APN# 3�5 t l a ?o.cs:�)-
OWNER NAME -
PHONE
E-MAIL
STREET ADDRESS
CITY, STAT , ZIP
FAX
CONTACT NAME
PH E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAff E-MAIL
If It 4W Sfiu
FAX
STREET ADDRESSOer CITY, STATE, Z�
—
ARCHITECT/ENGTNEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
t L
:5,kk-
EXISTING USE
PROPOSED USE CONSTA
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA _
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA.
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA
GARAGE AREA: EIDETACH
E]ATTACH
I
# DWELLING UNITS:
IS A SECOND UNIT []YES
SECOND STORY []YES
BEDVC AIDED? []NO
ADDITION? []NO
PRE -APPLICATION F1YES IF YES, PROVIDE COPY OF
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
0AEGEI VED" Y
+
`"" _
Li
TOTAL VALUATI/O�Nr►:
By my signature below, I certify to each of the following: I am the property owner or authorized agent to on the prope er's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it omply with all applicable local
ordinances and state laws relating to buil ction. I authorize representatives of Cupertino to enter the above-idintifif d property for inspection purposes.
Signature of Applicant/Agent: Date:��,
SUPPLEMENTAL INFORMATION REQUIRED
cKT�YPE�
Rauitl�csLir, N_:=
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building"
permit for new building.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
bars +� �`
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form if any Hazardous Materials are being used as part of this project.,
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Copy of Planning Approval Letter or Meeting with Planning prior to
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submittal of Building Permit application.
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EIYERTJhIST+
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ENVIROTTIENTAIsiIEALTA
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FFF FSTIMATOR — BUILDING DIVISION
12
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Non Che(_k Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check 0.0 1 hrs $0.00
t'erilO Fee: Plumb. Permit Fee: 1PPERMIT Elec. Permit Fee: 1EPERMIT
Other Plumb Insp. 0.0 hrs 1 $47.00 Other Elec. Insp. I 0.0 hrs $47.00
P/Und). Hasp. Five.,
1>iec. Insp, 1
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
n—i—# �f' 1 Tho f£e a h—d nn A. nrol:.v.avan, ;nfnrrnat;nn availahlo and aro nnhi nn octimnto_ Cantart the Aunt far addn'1 info_
FEE ITEMS (Fee Resolution 11-053 E,{'. 7/1/13)
10231 stern ave
QTY/FEE
DATE: 04/01/2014
REVIEWED BY: Mendez
JimADDRESS:
APN:
BP#:
0 #
$47.00
*VALUATION: 1$7,500
`,PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex
hrs
$0.00
PENTAMATION
PERMIT TYPE: 1 REAP1
WORK
u rade 9 outlets to qfci, remove and replace cabinets sink and install new light
SCOPE
Electrical
1 1BREMFIXT Fixtures, Lighting
12
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Non Che(_k Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check 0.0 1 hrs $0.00
t'erilO Fee: Plumb. Permit Fee: 1PPERMIT Elec. Permit Fee: 1EPERMIT
Other Plumb Insp. 0.0 hrs 1 $47.00 Other Elec. Insp. I 0.0 hrs $47.00
P/Und). Hasp. Five.,
1>iec. Insp, 1
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
n—i—# �f' 1 Tho f£e a h—d nn A. nrol:.v.avan, ;nfnrrnat;nn availahlo and aro nnhi nn octimnto_ Cantart the Aunt far addn'1 info_
FEE ITEMS (Fee Resolution 11-053 E,{'. 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$47.00
Electrical
1BREMRECEP Recep/Switch/Outlets
Suppl. PC Fee: Q Reg. 0 OT
FO.0
hrs
$0.00
PME Plan Check:
$0.00
=
$70.00
Electrical
1 1BREMFIXT Fixtures, Lighting
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. 0 OT0
0
hrs
$0.00
0 # Plumbing
$10.00 IBPFIXTURE Fixture or Trap
PME Unit Fee:
$0.00
PME Permit Fee:
$94.00
( `onso- is rio Tax:
Administrative Fee: IADMIN
$44.00
G
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
A
Travel Documentation Fee: ITRA VDOC
$47.00
Strong Motion Fee: IBSEISMICR
$0.75
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
TOTAL FEE:
$313.75
Revised: 01/15/2014
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CUPERTINO
Building Department
APR 0 1 2014
REVIEWED FOR CODE COMPLIANCE
Reviewed By: #; yr�