13100209 (4) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21351 VAI AVE CONTRACTOR:ALPS CONSTRUCTION& PERMIT NO: 13100209
REMODELING
ONN'NER'S NAME: PANG JASON L AND WUWANICH WOLALAK 1011 S DE ANZA BLVD• DATE ISSUED:03/26/2014
OWNER'S PHONE: 4083099555 SAN JOSE,CA 95129 PHONE NO:(408)898-6474
❑ LICEN'SED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E]
CONSTRUCT 2 STORY DWELLING(4437 SQ FT)WITH
License Class_ Lie.# ATTACHED GARAGE(657 SQ FT); FRONT AND REAR
C f� PORCHES (776 SQ FT).
ContractoriP( J/l/I / Date6 1
'
i hereby affir�I am licensed under the provisions oP hap 9 6/30/14-DEF#1 TRUSS CALCULATIONS-ISSUED 7/15/14
(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:$820000
1 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:36205044 00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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 constriction,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 tile Issued b Date:
granting of this permit. Additio orally,tl applicant understands and will comply Y'
with all non-point ource regul tions r the Cupertino Municipal Code,Section
9.18. f L RE-ROOFS:
Signature . Dat4 l 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.
❑
OWN411-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 evices 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 Ianagement District I
performance of the work for which this permit is issued. will maintain compliance with th pertino Midi-1 al, ode,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti 25505,2553 ,and 534.
Section 3700 of time Labor Code,for time performance of the work for whichthis � 1
Owner or authorized agent• Date: i
permit is issued. oy
I certify that in the performance of the work for which this permit is issued,I shall 1'
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 1 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.)
Leader'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 time City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of time 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
CONSTRUCTION PERMiT APPLICATION
� COMMUNITY DEVELOPMENT,DEPARTI\AENT- BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408) 777-3228• FAX(408)777-3333•buildino(5cuoertino.org
CUPERTINO
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI REVISION 11 EFERRED ORIGINrAL PERMIT#
PROJECT ADDRESS < y 3 1 , / APN
O\ATERNP.ME ` tom �)V` ��CF� Y� I PHOT 9 ?LJ,r1 . `C�/ E-MAIL
/1 J 1
STREET ADDRESS . I ti 7 I CITY, STATE,ZIPf+ f 1 / F�
CONTACT NAME ?HONo / 1 E-MP.IL Y'
tTy
STREETADDRESS CITY,STATE, ZIP F"� , V G
OR'NEK ❑ O A NER.BuILDER ❑ ONT'ER AGENT ❑ C01\"IRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑EHGLNEcR ❑ DEVELOPER ❑ TENANT
CONTRACTORN.AME. I LICENSENUMBER(}n[y LICENSE TYPE �• BUS.LIC
Lc "�G \
COMPANY -�—
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r i I T{���it t1 Ea SAI L.t i LCl l l C k'�'a - COM
STREET ADDRESS � r � (�' �^i r CIiY,STATE,ZIP I PH 1vE /.`- •'
ARCHITECT GINEERN�ME 1 �\ LICENSE NUMBER BUS.LIC
a FAX
COMPANY NAME E-MAIL
STREET ADDRESS CITY,STATE,ZIPPHONE
DESCRIPTION OF WORK
c
b�5 /Zv (� 4 . Y\
E)CSTING USE I PROICSp USE CONSTR.TYPE I R'STORIES USE TYPE I OCC. SQXT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA I AREA AREA NET AREA -F
BATHROOM I KITCHEN OTHER
REMODEL AREA REMODEL AREA I REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH.AREA GARAGE AREA: ❑DETACH
❑ATTACH
m DWELLING UNITS: ISA SECOND UNIT ❑YES SECOND STORY ❑YES
BEINGADDED? ❑NO ADDITION? ❑NO
—PR$-A-PPL-IC-ATION-0-JT—S IF—%W,-PAOYIDELOPLOF I�S�E BLDG:Ln ❑
YES `r'� a' TOTAL VALUATION:
PLA'�`I.7NGAPPLm ❑NO PLA.NNTNGAPPROVALLETTER EICHLERHOME? ❑NO
x
By my signature below,I certify to each of the follo-,ving: I am the property owner or authorized agent act on the owner's behalf. I have read this
application and the information I have p ovided is correct. I have read the Description of Work and verify it is acc . I agree to comply with all applicable local
ordinances and state laws relating to b 11 g construction. I authorize representatives of Cupertino to enter the above-ide tified prop 'for inspection purposes.
Signature of Applicant/Agent: r > Date:ZkoA
SUPPLE?\FTIAL II�r TION REQUIRED �k4
Q TLS CHECK T1TE� a ROUT7;�G,�LTPv_r ._
anti 3 s� �
New SFD or Multifamily dv�'el
in
Apply for demolition permit for coon ER" 4��4' D`Buub� PL�.REVIv1
existing building(s). Demolition permit is required prior to issuance of building sa r}> s , 7 syr �
P
permit for new building. R
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure; �t a3¢ � LiC�yoRl:s,
*�
` � :
�� qtr ..
Form if any Hazardous Maferials are being used as part of this project. D*A GE D sUP
em
_Copy of Planning Approval Letter or Meeting with Planning prior to 5 0 rao�t � 3._D 5 ��1TtI'SRDISTr icn ' F
submittal of Building Permit application.
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 21351 VAI AVE DATE: 06/30/2014 REVIEWED BY: MELISSA
APN: 362 05 044 BP#: *VALUATION: Iso
'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: p PERMIT TYPE: i
WORK 6/30/14- DEF # 1 TRUSS CALCULATIONS
SCOPE
I JJ, t'?crn. ('1W(..-k 'ru1???> I'FcrJ7(';*czc.'?; i.i2:. l'rzra Cinck
{.rphluab. PY, /Yep..
(?tiri::r ikrh. (nal, Other P12r)11)InsT, 07i2er insp.
a.r 1 %'izJnJ,`,. lrs�a. Fee: 1�aer..ins J
t..:,e.' 1
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the prelinzina information available and are only an estimate. Contact the Det for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff 711/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = # Deferred Submittal
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $278.00 IDEFSUBM
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? 0 Yes Q No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure 0
Strom Motion Fee: $0.00 Select an Administrative Item
Bldg Stds Commission Fee: $0.00
SUBTOTASc. $0.00 $278.00 TOTAL EEE:;` $278.00
Revised: 04/01/2014