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14020086 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19883 PORTAL PLZ CONTRACT OrBD-T E PERMIT NO: 14020086 DETERMINED OWNER'S NAME: XIAOMEI LIU DATE ISSUED:02/13/2014 OWNER'S PHONE: 4085405429 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL C FOUNDATION REPAIR TO FRONT PORCH License Class , ! Lic.# Contractor Zq"'( ���i"� Date _21V 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2000 ave and will maintain Worker's Compensation Insurance,as provided for by tion 3700 of the Labor Code,for the performance of the work for which this APN Number:36946006.00 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 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 DAYS FR ST 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 the granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: -21 ,+A with all non-point source regulations per the Cupertino Municipal Code,Section 918. / RE-ROOFS: Signature Date__:-7— ` 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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(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 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 25505 d 25534. _._ Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: 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 CONSTRUCTION LENDING 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 0%U COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION I\n� 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 U G (408)77Z-3228 FAX(408)777-3333•building(c�cupertino.orcl CUPER`INO ❑NEW CONSTRUCTION ❑ ADDITION . ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS Q • [/j.�/^'0 LIC4 . APN# OWNERNAMF 000 f�lel Ita-. PH!" l/U � �v� E-MAIL STREET ADDRESS Z2 CITY, STATE 21 012 02a:L4 010 CONTACT NAME PHONE E-MAIL STREETADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME r� LICENSE NUMBS (w(/ ( L LICENSE TYP BUS.LIC;V `7 COMPANY NAME (' I _n n^ E-MAIL STREET:ADDRES C STATE,ZIP PHONE ARCHECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# TT COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK _ tr ,-G' �u fide !✓ tet '' . cic�/� > �G.S %L,Y��G,�c��� (a✓o�c� CyZ ��•. c�c41 ► . t ^lam; X10%. /�/l u-r1 e C' 1�� 4($) 1 EXISTING USE PROPOSED USE CONSTR TYPE #STORIESUSE TYPE OCC. SQ.FT. VALUATION EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER' REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH . ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? []NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES •EIM - =' T ATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO -. ...... ..-.. 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 ve 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 relating P1 mg cons tion. I authorize representatives of Cupertino to enter the above-i ntified roperty for inspection purposes. Signature of Applicant/AgNE ent: ': e: SUPPLEMENTAL INFORMATION REQUIRED f_dr n„csI 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 form if any Hazardo g Materials are being used as part of this projects Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. zsT B1dgApp MLdoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 19883 PORTAL PL DATE: 02/13/2014 REVIEWED BY: Mendez APN: BP#: "VALUATION: $2,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 GENRES USE: PERMIT TYPE: WORK foundation repair to front porch SC PEIN 11 b/;,`t l'lctYi C t, r Phan,. I'lart P.an Ch,xl, Lf>rr�. k'errtrid Fc>e. P1n»zh.F'c;rmir Fc:e: Fle(. )ilrt a a9ec ki. 7rt,5 . C 1her Plumb lnsp, ottrrr l:icc. insp. Li hi,rv, Flv: Plumb. hr sp. I�ee k>ec.Ini FCC.' r: NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS Lee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? ®Yes Q No $0.00 = hours Plan Check,Hourly Suppl. PC Fee: 0 Reg. ® OT 10.01 hrs $0.00 $139.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: Hourly Only? ®Yes Q No $0.00 Suppl. Insp. Fee-.(E) Reg. ® OT 0.01hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? 0 Yes (F) No $0.00 G Advanced Planning Fee: $0.00 Select a Non-Residential G Building or Structure 0 Strong Motion Fee: 1BSEISMICR $0.50 1.0 hs Inspections Blda_ Stds Commission Fee: IBCBSC $1.00 $139.00 ISTINSP Inspection,Hourly �p. $1.50 $278.00 TOTAL FEE: $279.50 Revised: 01/15/2014 E Pp2 Mike Bioeman <mike@raycomail.com> Wed, Feb 12, 2014 at 9:05 AM To: "miketb022@gmail.com" <miketb022@gmail.c6m> �3 cCkll., , "j T'Y DEVELOPMENT!?EPARTtd,ENT {:L r?-^DIvic,iON- PER T A 'O fWU 6(11�q s..ruc on. it is uniawA torr-i - s on or ' virl'iout app oval from the Building Official. car this plarrarLd pecificatQus SHAJ_L-1`NOT � CUPERTi, or to be arf of the viol-tion . # � uifCJin9 Depa �q y r> Oil:any Prov eons of any City Ordinance or State Law. �°� �, - BY EVI2014 EE �v� �;pQE ReviewCOt�tr'i.inFdC PERMIT NO. � �y,• �,a Pp3 Mike Bloeman <mike@raycomail.com> Wed, Feb 12, 2014 at 9:07 AM To: "miketb022@gmail.com" <miketb022@gmail.com> WE r"e"v —V qty o.Xit i s ' 7.a�, CUPER. any + , '9Uf(ding opo artr'rae•e FEB 1 nt REVIEW, Baa co DE Reviewed By. Ca1t9PLIpNCF Yn • c y'Se> d r= Mike Bloemen Project Manager M: (925) 330-4321 E: mike@raycomail.com www.raycopainting.com In an effort to service our clients in the fastest manner possible, this message was sent from my mobile phone. Please excuse typing errors and brevity. i tgF' n nal 0 went �ad x f Mike Bloemen Project Manager M: (925) 330-4321 E: mike@raycomaii.com www.raycopainting.com In an effort to service our clients in the fastest manner possible, this message mas sent from my mobile phone. Please excuse typing errors and brevity. artment �5� t�lldfnc�D� /VO Rev/eye, C(),O �~: \ » � : J . . I 9 0, NC) ! / �vl� comm !