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13090004R CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22391 SALEM AVE CONTRACTOR: TAI PEI CONSTRUCTION PERMIT NO: 13090004 OWNER'S NAME: WU IMEI L AND TIMMY 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 4 CONTRACTOR'S RE QC—LARATION JOB DESCRIPTION: RESIDENTIALCOMMERCIAL License Class krlf Lic.#--Vk0— TO CLEAR CODE ENFORCEMENT CASE: UNIT 2 -DEMO FRAME WORK TO BE USED AS STORAGE SPACE, Contractor A/0M AJ Wbate 011 11) Z-t Q REMODEL I hereby affirm that I am licensed under the provisions of Chapter 9 KITCHEN 113 SQ FT AND BATHROOM 110 SQ FT, REMOVE (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: $8000 Aave and will maintain Worker's Compensation Insurance, as provided for by APN Number: 32615043.00 Occupancy Type: action 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 DAYCALLED INSPECTION• indemnify and keep harmless the City of Cupertino against liabilities, judgments, City in of the =T costs, and expenses which may accrue against said consequence Issued by: Date: granting of this permit. Additionally the applicant understands and will comply with all non-point source re ati per the Cupertino Municipal Code, Section RE_-ROOFS. 9.18, Date Signature ­J— �10 —2,0t? All roofs shall be inspected prior to any roofing material being installed. If a roof is e 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) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (See.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. 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,S 2 05, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this 4etio /I Owner or authoriz age Date: -2 ed% 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 I Enzaam CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - buildinqgc�rfino�,Or M nVATTQTnm /nT7VrT)I?Pr) ORTaINALPFRMIT4 "NEW CONSTRUCTION " ADDHION PROJECT ADDRESS �f A APN 9 2_e� -- o 3 • OWNER NAME PHONE 43, E-MAIL e �Irl �lm �1 STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAMEJ I PHONED rgU} 33 E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX OWNERARCHITECT ❑ ENGINEER INEER 0 DEVELOPER 0 TENANT 0 OWNER-BuILDER 0 OWNER AGENT 0 CONTRACTOR 0 CONTRACTOR AGENT CONTRACTOR NAME R NUMBER LICENSE Nu"BERn7 LICENSE 7 LICENSE TYPE BUS, LIC ff NAME t I-LLICEN E MAIL E-MAILOMPANY FAX C4, CO/I STREET ADDRESS CITY' TE, Z11 CITY, STATE, g4il 05e g4 PHONE/ 1,09 ARCHITECTIENGINEERNAME LICENSE NUMBER BUS. LIC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK ae ...... EXJSTINGUSE PROPOSED USE UONSTR.TYPE 4 STORIES USE TYPE OCC. SQFT. VALUATION Mas`rG NEW FLOOR DEMO AREA y TOTAL NET AREA AREA AREA BATHROOM REMODEL AREA //V S): KITCHEN RFMODFLAF.EA//ZSF OTHER REMO DEL PORCH AREA DECK AREA TOTAL DECK/PORCH AREA 0 ATTACH # DWELLINGUNITS: ISA SECOND UNIT OYES SECOND STORY []YES BEING ADDED? ONO ADDITION? ONO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN 0 YES HOME? n NO TOTAL VALUATION: le% PLANNING APPI, A n NO PLANNING APPROVAL LETTER EICHLER G By my signature below, I certify to each of the following: I am the property owner or authorized ge to act on the property owner's behalf I have read this local information I have is correct, I have read the Description of Work and arify it is accurate. I agree to comply with all applicable application and the provided ordinances and state laws relating to building constructi I authorize representatives of Cupertino to enter the above -identified property for inspection purposes, Signature of Applicant/Agent: 6 Date: REQUIRED SUPPLEMENTAL INFORMATION 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 M] V, farm if any Hazardous Materials are being used as part of this project. Copy Planning Approval Letter or Meeting with Planning prior to of submittal of Building Permit application. BldgApp_,201 Ldoc revised 06121111 i I CITY OF CUPERTINO k�LW/A ; FEE ESTIMATOR — BUILDING DIVISION ADDRESS- 22391 salem ave #2 7 A7DRV II DATE: 09/03/2013 REVII IEWED II BY: Mendez MISC ITEMS INAMN&W A, $0.00 *PERMIT TYPE: Building Permit off ffl.q N .. ...... PRIMARY SFD or Duplex USE: .. ---- PENTAMATION I R3SFDREM' PFRMIT TYPE $0.00 PME Plan Check: $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Paotic,worics, Pireaamiary 3eweruistrict, 3cnoot Divtript_ otn). Thine fees are hared on the Dreliminary information available and are only an estimate. Contact the Dept for addnl info. FEE ITEMS Tee Resolution 11-053 ff.' 711112) FEE QTY/. MISC ITEMS Plan Check Fee: $0.00 = sf. $626.001 Remodel, Kitchen (<=300 sf) IREMRESKIT I Suppl. PC Fee: 19 Reg. 0 OT��s $0.00 PME Plan Check: $0.00 FJ_j _0s.f $626.00 Remodel, Bath (<=300 sf) 1 IREMRESBAT I Permit Fee: $0.00 Suppl. Insp, Feer Reg. 0 OT Q,Q hrs $0.00# Window Sliding Glass Door F$418.001 I WINREP Replacement PME Unit Fee: $0.00 PME Permit Fee: $0.00 F A'eAniptistraiive Feel: 0 E) Work Without Permit? 0 Yes 0 No $1,670.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 Travel Do(.71mentalion 1°" 3.. Strong Motion Fee: IBSEISMICR $0.80 Select an Administrative Item 1 Bldg Stds Commission Fee: J1BtCBSC $1.00 SUBTOTAL& $167 70 [$1,670.00 TOTALyrE.j $3,341.80 1 '(5u) o z 0' Lu CL : n- OE uj 0 7c Cc Z ,Aj '(5u) o z 0' Lu CL : n- OE uj 0 CX"