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09020061 77777777777 CITY OF CUPERTINO G�1T]fAC' tT jIQiN BUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: 020061 22271 KENDLE ST JEREMY MAO IN PERMIT IS'SUEDATE OWNER'S NAME: SA CONTROL NO. 'rON BUILDING PERMIT INFO BLDG EPLUMBMECH� ARCHITEC IENGiNEER: WOOD SILTING TO FRONT SIDE C] aoz LICENSEDCONTRACrOR'SDECLARATION CHANGE 7'0 S'T'UCCO TO lob Description UI hereby affirm that I am licensed under provisions of s Code, 9(commencing 5 with Section 7000)of Division 3 of the Business Provision" Code, my license is n a in full force and effect Lic.# J j z License Class ComracWr t-p Date r RCHr EC•f'S DEC LAR ON n 1 understand my plans shall be used as public records Doui„U O y Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License law for the in O following reason.(Section 7031.5,Business and Professions Code:Any city or county Valuation K$� which requires a permit to construct,aIter' improve,demolish,or repair any structure Ft.Floor Area y"H prior to its issuance,also requires the applicant for such permit to file a signed statement =< that he is licensed pursuant.to lbe provisions of the Contractor's License Law(Chapter 9 S�' 2 t=-C (commencing with Section 7000)of Division 3 of the Business and Professions Code)or Occupancy Type Y.y that he is exempt therefrom and the baso for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number not more than five hundred dollars(5500). ❑1,as owner of the Property,or my employees with wages as their sole compensation, Required Inspections will do the work,and the structure is not intended or offered for sale(Sec.7044, neBusiness and Professions Code:The Contractor's License Law does not apply to an property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed matt es u. to construct the project(Sec.7044,Business and Professions or improves thereonsand. cense Law does not apply to an owner of property pursuant imp to dee Contractor's who contracts for such projects with a contractor(s)licensed License Law. B&P C for this reason ❑I am exempt under Sec. Date Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- _etion,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 oC the Labor code,for the performance of the work for which this permit is issued. My Worker s Compensation insurance carrier and Policy number are: O Carrier. Policy No.: - CERTIFICATE COMPENSAT ON INSURANCE RKERS' (This section need not becompleted if the permit is formic hundred dollars($100) or Tess.) 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 Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:if,after making this Certificate of Exemption,you ould become subject to the Worker's Compensation provisions of the Labor Code.you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z 0 CONSTRUCTION LENDING AGENCY performance of lu H 4 1 hereby am that there is a construction lendingagency for the a> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name Do Lender's Address I certify that]have teed this application and state that the above information is V� correct.I agree to comply with all city and county ordinances and state laws relating to C)E" buildingconswction,and hereby authorizt representatives of this city to enter upon the V above-mentioned property for inspection purposes (We)agree to save,indemnify and keep harmless City of Cupertino against t liabilities judgments,costs and expenses which may in any accrue against.said City Date 2 ♦� �� V Z in consequence of the granting of this permit APPLICANT UNDERSTANDS AND WILL COMPLY WiTH ALL NON-POINT Issued by: 6 SOURCE REGULATIONS. Re-roofs —Z--� Signature of Appli ontractor WineType of Roof ISCLOSURE HAZARDOUS MATERIALS D Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety of s shall be inspected prior to any roofing material being installed. Code,Section 25532(a)? All ro ❑Yes ro If a roo- is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which all new materials for inspection. it hazardous air contaminants as defined by the Bay Area Air Quality Management strictO A.N. Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building Date docs not currently have a tenant,that it is my msP°nsrbdny to notify dte occupant of the Signature of Applicant requirements which must be met prior to issuance of a Certificate of occupancy All roof coverings to be Class rn,'or better Date Owner or authorized ag nt atCITY OF CUPERTINO CUP Of GENERAL BUILDING C �. PERMIT APPLI1ZATION FORM Date: Building Address: 2 27 / J<ERD�� 5r Mailing Address (if different from building address): Phone#: 40 J-¢,z_ �j6 / Owner's Name: �� GIGt HOA: (Exterior work only) Yes ® No ❑ If es, rovide letter from HOA phone: 4Q? _44 Contractor: Fax: Contractor License#: Cupertino Business License#: 2- Z v phone: 44— 11(4f`! Z- Contact: Fax: Residential Commercial Job Description: "law C/� ��s?��j G✓�o��l ��ioi� �r lNlsl��.�•�ti`�"!� /✓�t,l�" � ,cuc�RrC,N'TS�c�- �Rev✓sk�) � �u- Building Permit Info: Plumb ❑ Mech ❑ Bldg Elect ❑ Occupancy Type: Type of Construction (Usage Class): IUIII B, IV-HT,�I-B }� 1-A, I-B ❑ II/III/V-A ❑ Square Footage: Valuation: 5 - roject Size: Express Standard ❑ Large❑ Major El Green Building: Please complete relevant Porti 3n of the Green Building/LEE he t nd xt & attach it to the application or if applicable, include in plan set& the Points Achieved: For help, contact Build it Green at www.builditreen.or Revised 02/05/09 (tat, -.1 , CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEkTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1 GENCOM 1STUCOAP Stucco A-)plications (up to 400 sf) B additional stucco ap lication 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1 WINMEWSTR New Window-structural shear B wall/masonry (includes plan ck fee) IEPERMITFEE Electrics. Permit Fee E 1 MPERMITFEE Mechani,:al Permit Fee M 1 PPERMITFEE Plumbin;;Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E 1 MECPLNCK Stand AJ one Mechanical Pln Ck (hrly) M 1 PLMBLNCK Stand A'one Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone 1 BCBSC Cal Bld,; Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B 1 TRAVDOC Travel & Documentation B 1 BUSLIC Business License B 5 of 5 Community Development ;<p 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 r.UPEKTINO Building Department JOB ADDRESS: �227/ I PERMIT # `0 OWNER'S NAME: ,t�G! L.iu PHONE # GENERAL CONTRACTOR: r /,lrG FAX # I am not using any subcontractors: ._��--3- y Signature Date Please check applicable subcontractors and cora lete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owne ontractor Signature Date