15010118CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6101 BOLLINGER RD
CONTRACTOR: M-TRAN
PERMIT NO: 15010118
CONSTRUCTION, INC
OWNER'S NAME: ZAW KHIN AND TUN WAI WAI
348 SURBER DR
DATE ISSUED: 01/22/2015
OWNER'S PHONE: 4087722796
SAN JOSE, CA 95123
PHONE NO: (650)996-6099
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
KITCHEN REMODEL (120 SQ FT); BATHROOM REMODEL
License Class Lic.
(90
Z ��
SQ FT); INSTALL NEW SEWER LINE; ELECTRICAL
Contractor /� Ct�1 Date
PANEL
I hereby affirm that I am licensed under the provisions of Chapter 9
UPGRADE AND RELOCATE (200 AMP).
(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
oV6rformance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $35000
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 37538008.00
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 DAYS FROM LAST 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
•�a .l.5
Issued by: c.9f�/ 12 t� Date: ((!!
granting of this permit. Additionally, the a plicant understands and will comply
with all non-point source reg la 'ons per a Cupertino Municipal Code, Section
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
9 18.
Signature a e Z
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
1, 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
'Pal
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino IVI Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 2550553 and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: % 27
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
9 18.
Signature Date
CUPERTINO I
71 aTC111 l nM C TD Tf` rTnXT
l�'alo�l�
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(o)cupertino.org
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PROJECT ADDRESSa' d t� j ��
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OWNERNAME ' 0
rAPN
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PHONE(q�6 ` /%I
E-MAIL
STREET ADDR SS ULLr
CTTY, S E ZI • (� I
FAX
CONTACT NAME
PHONE
E-MAIL
�Gd
STREET ADDRESS
CITY, STATE, ZIP
FAX
OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACT R N,�J4
LIC
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS g ,/ „ r1�n''_
CITY, STATE, ZI_P,l Q-�
PHONE S
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
_7
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF_WORK
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EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA Q//61C) 4
REMODEL AREA �n ',�
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: LJDETACH
❑ 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
�SX CEI,YEMMr�
v :.;„
TA L VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? []NO
o )
Mow
By my signature below, I certify to each of the followi I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provid is co t. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws rPlar ag4@4 i'''� ^p ion. I authorize representatives of Cupertino to enter the above -id tified p operty for in purposes.
Z7i
Signature of Applicant/Agent: Date:
SUPPLEMENTAL FORMATION REQUIRED
P � rc> Cry YrE �..; ;.r,
,testi ' �. , ROU IN GcS r ,
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition is required prior to issuance of building
f h A 1
OUEI2 THE COTJI TER
? p
TJIL�ING PE RE�IER
permit
CJLAIi+ingGr>
permit for new building.�ExPREss
a
c 1 iA.
aNRE_vw
❑.
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosures
ST NI)ARD
TiB1 IcwbRl�s
`�_ U
form if any Hazardous Materials are being used as part of this project.
" i '
❑FIREDEPr
Copy of Planning Approval Letter or Meeting with Planning prior to°'GN
s
_
3r1JOA r
❑ SANI�ARYSEWEItDISTRICT,
submittal of Building Permit application.
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�'NVIROIVLVIENTALREALTii ��.
BldgApp_2011.doe revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 6101 Bollenger Road DATE: 01/22/2015 REVIEWED BY: Sean
APN: BP#: *VALUATION: 1$35,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
'
PRIMARYPENTAMATION 1 R3SFDREM
USE: SFD or Duplex PERMIT TYPE:
WORK Kitchen remodel 120 sq ft); Bathroom remodel 90 sq ft); Install new sewer line; Electrical panel
SCOPE I upgrade and relocate (200 amp).
jag
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FEE
»•- _
QTYIFEE
____ ___ ____
MISC ITEMS
yVe':h Plan Plumb. Plan Check 0.0 hrs
$0.00
Elec. Plan Check 0.0 hrs
$0.00
t-{<>cr`�.'c>=rauP I'ec>. Plumb. Permit Fee:
IPPERMIT
Elec. Permit Fee:
IEPERMIT
011dw, Other Plumb Insp. 0.0 hrs
$48.00
Other Elec. Insp. 0.0 hrs
$48.00
'i7vj)' i' cP: I7I2ttT1�l. II1S7, E'B:
18C. Inn,
NOTE. This estimate does not mctuae fees aue to omer uepurt ne.uo I... _ .��.•�.s, - _ _ __ _, _ ______
tbo [)ant far addn'1 info.
District, etc). ltzese fees are nasea on the reurruuu.
FEE ITEMS LI'ee Resolution 11-053 Eff. 7/1/13)
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FEE
»•- _
QTYIFEE
____ ___ ____
MISC ITEMS
Plan Check Fee:
$0.00
90 s.£
$645.00
Remodel, Bath (<=300 sf)
1REMRESBAT
Supp/. PC Fee: Reg. 0 OT0.0
hrs
$0.00
PME Plan Check:
$0.00
120 s.£
$645.00
Remodel, Kitchen (<=300 sf)
IREMRESKIT
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. ® OT
0,0
hrs
$0.00
L 1 1 # Plumbing
$25.00 IPRSEWER Sewer, Sanitary
PME Unit Fee:
$0.00
PME Permit Fee:
$96.00
200 amps
$48.00
Electrical
1BELEC200 Services
Conswocrion Tax:
Administrative Fee: IADMIN
$45.00
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee.
$0.00
Select a Non -Residential
Building or Structure
E)
C)
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: 1BSEISMICR
$4.55
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$2.00
..
�.°
$195.55
$1,363.00 , _ TONAL FEE:`
$1,558.55
Revised: 01/0sizul5
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EPARTMENT
- B IVISION - CUPERTINO
HPPROVED
This set of plans and specifications MUST be kept at the
�B DEMO�I 14i ring construction: �t is unlawful to make any
changes or after on same, -or to deviate
„ therefrom, without approval from the Building Official.
The Stamping of this plan and specifications SHALL NOT
be held to permit or to be an approval of the violation
of any provisions of any Cit Ordinance or State Law.
BY-�Eglt� /�T�tt`
DATE / • as '�S
PERMIT #
,,-CUPERTINO
De
Building
Parbltent
J'N 2 z 2015
REVIEVVED FOR CODE COMPLIANCE
Pn@01@9U 20001E
1. KITCHEN AND 2 BATHROOMS REMODEL
2. NEW SEWER MAIN
3. RELOCATE AND UPGRADE ELECTRICAL PANELS TO 200AMF
Reviewed By
ND. Revision Uate
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_ Building Department
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REVIEWED FOR LODE COMPLIANCE
Reviewed By Jam.
CONSTRUCTION CO.
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Sheet Title
Project Number:
Scale:
Designed By:
19x
Drawn.By.
,GRR
Checked By:
Date:
_
Sheet Number
La�0O
Of Sheets
Building Department
City Of Cupertino
^(� 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 # C7 O t B
OWNER'S NAME: PHONE # � �®
GENERAL CONTRACTOR: .4 6-Fl-ev BUSINESS LICENSE # 2Z
ADDRESS: 5 CITY/ZIPCODE: Z
*Our municipal code requires all businesses. 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 SUBCO CTO VE OB INED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
Owner /Contractor Signature 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