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13080066 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10295 EL PRADO WAY CONTRACTOR: B£ PERMIT NO: 13080066 LCa9F+tR+?D OWNER'S NAME: FONG b4WU >^ r r - �L �? /k/c, DATE ISSUED:08/08/2013 OWNER'S PHONE: 6508672337 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL License Class Lic.# DUPLEX-REPLACE WATER LINE FROM METER..TO BUILDING Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 (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 perfo ance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$3000 ave 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:34230014.00 Occupancy Type: 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 00 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 DA7FR LAST CALLED IN SP ION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue againstsaid City in Onsequence of the granting of this permit. Additionally,the ap cant unde ds and will comply Issued by: Date: with all non-point source regulations per the upert unicipal de, ection 9.18. _ RE-ROOFS: Signature ate 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. ❑ 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 I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure isnot 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 ich emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air uality -agement District I performance of the work for which this permit is issued. will maintain compliance with t e Cupertino t�ae,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety?NSTRUCT7IONLENDING Section 3700 of the Labor.Code,for the performance of the work for which this Owner or authorizeDater 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 Compensation laws of California. If,after making this certificate of exemption,I AGENCY 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 CONSTRUCTION PERMIT APPLICATION "Vo 13 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building0cupertino.org 0 ❑NEW CONSTRUCT��IrrrON ❑ Ammm ❑ALTERATION/TI ❑ REVISION/DEFER�R�ED�) ORIGINAL PERMIT# PROLECC ADDRESS J—L (� WO-AX- 3q2J OWNERNAME PHO E-M.:��h�& , f&Z I AIL STREET ADDRES CITY,STATE,ZIP FAX CONTACT NAME0 — /� E-MAIL ,�t/ n STREET AD S /`�Y /I C ATE ZIP I F ❑OWNER ❑ OWNER-BUILDER ❑OWNERAGMU ❑CONTRACTOR ❑CONTRACTORAGENTT /❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME CJ f /�^ n/s � LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANYNAMEEf� CQ 1-c (i .� C_ )► t( ✓`IIJi �� 7�7 STREEC AODREsSSQ ® D 4 2?4-4z IS4f 1 4 / PO ARCHITECr/EN0NEERNAMELICENSE NUMBER BUS.LIC COMPANY NAME E-MAIL FAX STREEr ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK ` _ ` A 40 EXISTING USE PROPOSED USE CONSTR TYPE I *STORES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODELAREA REMODELABEA REMODEL AREA PORCH AREA DECK AREA 1 TOTALDE(KMtCH AREA I GARAGE AREA: ODETACH ❑ATTACH #DWELLING UNTTS: ISA SECOND UNIT ❑YES SECOND STORY ❑YES BEINGADDEV ONO ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF LS TBE BLDG AN ❑YES RECE Y' TOT ATI PLANNINGAPPL# ONO PLANN NGAPPROVALLUTTER KKHL=TOME? 13NO 1 01-/ / - 20 By my signature below,I certify to each of the following: I the pro pe owner or authorized agent to act on the property owner half I have read this application and the information I have provided is correct. ve read tl Description of Work and verify it is accurate. I agree o comp y ordinances and state laws relating to b ' o resentatives of Cupertino to enter the above' ti p for inspection purposes. Signature of Applicant/Agent: Date: SUPPgfilydZellings: INFORMATION REQUIRED ROU NG sL>p _New SFD or MuApply for demolition permit for By T.t&COUNT.ER ❑.BUILDING PLAN REV" existing building(s). n permit is required prior to issuance of buildhW permit for new building. ❑ EXPRESS ❑ PLANNINGPLANREVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 1] STANDARD ❑ 'PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. 0 LARGE El FIRE DE T' _Copy of Planning Approval Letter or Meeting with Planning prior to 'fCWOR ❑ SAN.TARY SEWER DISTRIC[ submittal of Building Permit application. ENvmor►>►�rrraL]IJEALTH BldgApp_201 1.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10295 el prado way DATE: 08/08/2013 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$3,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 RPD USE: PERMIT TYPE: A WORK duplex- replace water line from meter to building SCOPE Me& Plan Check Plumb.Plan Check 0.0 hrs $0.00 Elec.—Plan.Check ,'1-1,ch.Permit Fee: Plumb.Permit Fee: IPPERMIT Elec.Permit Fee: Other:'Tech.Insp. Other Plumb Insp. 0.0 hrs—,L47.00 Other Elec.Insp. Li ..17ech.Ins/).Fee: Plural. Insp,Fee: Elee.Insp,Fee: NOTE:This estimate does not include fees due to other Departments(Lem Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Theseees are based on the raUmina information available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (Fee Resolution 11-053 E„f' 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F1 # Plumbing Suppl.PC Fee: (F) Reg. ® OT 0.0 hrs $0.00 $47.00 IPREPPIPE Piping,Area PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-.0 Reg. Q OT T0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 Construction Tax: Administrative Fee: IADMIN $44.00 Work Without Permit? ®Yes (E) No $0.00 G Advanced Planning Fee: $0.00 Select a Non-Residential Travel Documentation Fee: 1TRAVDOC $47.00 Building or Structure i Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $139.501 $47.00 $186.50 Revised: 07/01/2013