13010003 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10072 SCENIC BLVD CONTRACTOR:BROTHERS HOME PERMIT NO: 13010003
IMPROVEMENT
OWNEWSNAME:TSUWEI CHEN. 2510 DOUGLAS BLVD DATE ISSUED:01/022013
OWNER'S PHONE: 6504924818 ROSEVILLE,CA 95661 PHONE NO:(408)295-0680
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL Ll COMMERCIAL
License Class Lic.# REMOVE AND REPLACE 12 WINDOWS AND 3 PATIO
� � DOORS
Contractor iQJY Date Z 3 LIKE FOR LIKE
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 o 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:$10784
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:35709039.00 Occupancy Type:
permit is issued.
'APPLICANT CERTINICATWN
I certify that have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.l agree to comply with all city and county ordinances and state laws relating WITIIIN 180 DAYS OF PERMIT ISSUANCE OR
to building construchon,'and hereby authorize representatives of this city to enter
upon the above mentioned property.for inspectionpurposes. (We).agree to save 180 DAYS FRONFLAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in 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
9.18.
I RE-ROOFS:
Sigmamre Date Z/ All roofs shall be inspected prior to any roofing material being installed.If a roof is
47 installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
113 O R-B IILDER DECLARATION_
Signature of Applicant: Date:
I be 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(Sce.7044,
Business&Professions Code)
L 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 providedfor,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 pemntis issued. . will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and;.
I have and will mai main Worker's Compensation htsurisom as provided for by the Health&Safety Code,Secllat 25505,2 33,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: NF Date: 2��
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 Dare
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10072 Scenic blvd DATE: 01/02/2013 REVIEWED BY: mendez
APN: BP#: *VALUATION: $10,784
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Dup lex PENTAMATION 1GENRES
USE: PERMIT TYPE:
WORK Remove and replace 12 windows and 3 patio doors like for like
SCOPE
d1§ U' T i . 11k7A
-
Atech. Plan Check Plnmb. Plan Check Dec. Plan Check.
:Wech. Perini!Fee: Plumb. Powe(Fee: I Dec. Permit Fee"
Orhev Afech. Insp. Ocher Plumb Insp. Ocher Elce.Insp. Li
.b/ede Insp. Fee: Plu ib. hasp.Fee: Elec.Insp. Fee:
NOTE:This estimate does not include fees due to other Departments 0.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District etc). Thesefees are based on the prelimina in ormadon available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 EfX 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 F-15-1 # Window/Sliding Glass Door
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $533.00 IWINREP Replacement
PME Plan Check: $0.00
Permit Fee.: $0.00
Suppl. Insp.Fee-.0 Reg. 0O T0.0 Thrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax.
Administrative Fee: O
Work Without Permit? 0 Yes Q No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Travel Docrunentation Fees: Building or Structure O
Strong Motion Fee: . IBSEISMICR $1.08 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
�i 11 sill ' $2.081 $533.00 aT01ALFEE`i $535.08
Revised: 10/01/2012
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CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION d0�
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 ^�6
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinaliDcuoertino.orG
[]NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS - 00-? V- API# /�`, r` 15U�
OWNERNAME ot4WvC1415
I
PHONE ,70 92'yg EMAIL
STREET ADDRESS CITY,STATE,ZIP o (ern FAX
CONTACT NAME � / PHONE E-MAIL
STREET ADDRESS L ,�// CITY.STATE,ZIP FAX
OWNER 11OwtE:R.B=ER . E3OwNEt AGENT IP CONTRACTOR 13 CONTRACTOR AGENT ❑ ARCimm 0 ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME6 FOTt&s WCENSENIAIBER LICENSE TYPE15a BUS.LIC#
COMPANYNAME '5&A6V {W l EMAIL FAX
STREET ADDRESS 19S
l 111N ^ ,C, CITY,STATE,ZIP , ��' PHONE _ - 7�^
ARCHITECTIENGINEER NAME I`�/ LICENSE NUMBER BUS.LIC# 7
COMPANYNAME EMAIL FAX
STREET ADDRESS CrrY,STATE,ZIP PHONE
DESCRIPTION OF WORK WW ct78
rd 6NA9 LZ role
EXLSTINGUSE PROPOSED USE - CONSTATYPE I #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA =AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODELAREA
PORCH AREA DECK AREA TOTALDECK/PORCH AREA GARAGEAREA: ODErAcH
❑ATTACH
#DWELLINGUNITS: ISASECONDONII ❑YES SECONDSTORY [I YES
BEING ADDED? 13140 ADDITION? []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF ISTBEBLDGAN- ❑YES -�$ OTAL VALUATION:
PLANNINGAPPL# []NO PLANNING APPROVAL LEITER EICHLER HOME? QNO K t' 4D C)V
By my signature below,I certify to each of the following: 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 provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin wilding -on. I authorize representatives of Cupertino to enter the ab ve-1 enti2fied property for inspection purposes.
Signature of ApplicanUAgent Date: ,�� /3
SUPPLEN=,YINFORMATIONREQUMED I C oil S R
_New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building o -9 ERt G. I v>E
permit for new building.
u
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form
if any Hazardous Materials are being used as part of this project
Copy of Planning Approval Letter or Meeting with Planning prior to '.ao O R sEwER n
submittal of Building Permit application.
I
BldgApp_2011.doc revised 06121/11
Building Department
City Of Cupertino
10300 Tone Avenue
Telephone: 408-777-3228
C O P E RT I N O Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: 166-72. L PERMIT#
OWNER'S NAME: �44)&( CPHONE# &150 -'V9/8
GENERAL CONTRACTOR: H BUSINESS LICENSE#
ADDRESS: Ig1Pj7 CITY/ZIPCODE: 611-1 95—/Z5—
*Our municipal code requires,aB businesses working:in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR ANW ALL. SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractoraar
IQM(a'ture Date
Please check applicable subcontractors hil complete the following information:
t/ SUBCONTRACTQR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Milloork
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
� zlt3
r Cont ^ or•Signaiture Date