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15030144 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21886 HYANNISPORT DR CONTRACTOR:HSBC BROTHER CO PERMIT NO:15030144 OWNER'S NAME: LIN JING C AND MICHELLE YANG TRUSTE 6512 ALMADEN RD DATE ISSUED:03/23/2015 OWNER'S PHONE: 6508611991 SAN JOSE,CA 95120 PHONE NO:(408)644-3112 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL E] REMODEL(E)250 S.F.KITCHEN,NO STRUCTURAL License Class_ Lic.# CHANGES,LIKE FOR LIKE Contractor S• �_�`. Y' ate 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:$15000 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:35614059 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 FROM LED 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 Issue Date: 3 Z3 1 granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 918. -ROOFS: Signature /�l�//�( Date / 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 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,Sections 25505,25533,a 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: 7 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 918. Signature Date ---- - APPLICATION CONSTRUCT[ON PERMIT -jv� COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION O 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 l O LUPI=RTINC} (408)77-7-3228• FAX(408)777-3333•building c1cupertino.org \ ❑NEW_CONSTRUCTION.:,, ❑_ADDITION ❑ ALTER.ATION/TI ❑. REVISION/DEFERRED ORIGINAL PERMIT 4 PROJECT ADDRESS APN# 3o52 7 OWNER NAME ( I PHONE 6 E-(MAIL f _ STREET ADDRESS ^ I CITY, STATE,ZIP. FAX - CONTACT NA.WE 1 S I PHO2\ .l�iJ v J ��I E-MAIL e447 c STREET ADDRESS CITY,STATE,:ZIP F.AX OWNER -01ARvTR-BUR DER 11 OWNERAGENT CTOR r ❑CONTRACTORAGEATT 11 ARCHITECT 13ENGINEER c❑ DEVELOPER .TENANT CONTRACTORNAME LICENSEI�M4BER S LICENSETYPE AR BUS.LIC,- COMPANY NAME G E-MAIL l FAX S- f STREET ADDRESS F 1 CITY,STATE,ZIP ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC m COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORKCa&' d. Ye EXISTING USE PROPOSED USE CONSTRTYPE STORIES USE TYPE OCC. ( SQ.FT. VALUATION(S) EXZSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA2&• PXN40DFL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: ❑DETACH ATTACH DIVELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY []YES BEING ADDED? A NO ADDITION? 131"0 PRE-APPLICATION ❑1 ES IF YES,PROVIDE COPY OF I IS THE BLDG AN ❑YES I TOTAL VALLiATION: PLA.M.NINGAPPLff E]NO PLANNTrNTG APPROVAL LETTER EICHLERHOME? By my signature below,I certify to each of the following: I am the property owner or authorized agentto t ie proper,),o\amer'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 relating to build' construction. I authori�z presentatives of Cupertino to enter the above-id ntified ropcerty for inspection purposes. Signature of Applicant/Agent:_e \C Date: 6� SUPPLEMENTAL INFORMATION REQUIRED � rcc> �iPEi ::: _ >zNew SFD or Multifamily dwellings: Apply for demolition permit for �- _ t' � 3j ,O3�C'OTJNTER s� c.. `�1 BL-II:DLNGPL�`REATIr\3' �— existing building(s). Demolition permit is required prior to issuance of buildingVEI4T av 9 @ �5.��. ',� M, permit for new building. ExPREssA1NINGPLRELE\A'5 Wd `- PM _Commercial Bldgs: Provide a completed M Hazardous Materials Disclosure sx BARDx 1-J Pr7$Lrczvnr�cs form if any Hazardous Materials are being used as part of this project. � ? Copy of Planning Approval Letter or Meeting with Planning prior to '��G'IJOR -" - "_- "SAI�ITARYSER'ERD�ST.RICS = submittal of Building Permit application. Bld App_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21886 HYANNIS SPORT DR DATE: 03/23/2015 REVIEWED BY: MELISSA APN: 35614 059 BP#: "VALUATION: 1$15,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 R3SFDREM WORK REMODEL E 250 S.F. KITCHEN NO STRUCTURAL CHANGES LIKE FOR LIKE SCOPE a o s � Meeh. Plan Check Phunb. Pkn Cheek f lec.Plan Check, ,llech. Permit Fee Plumb. Permit Fee: l lec. Permit F('e Other;l/ech. Irnsp Other Plumb Imp, Other Elec. Insl:r. Mech,Irish. Fee, Plrtmb. trash.Fee: E16c_Insp. Fee: aij NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelhiniina information available and are on an estimate. Contact the De t or addn7 info, FEE ITEMS (Fee Resolution 11-053 E . 7111131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel,Kitchen(<=300 sf) Suppl.PC Fee: 0 Reg. ® OT 0.0 ht's $0.00 $645.00 1REMRESKIT PNM Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-0 Reg. ® OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C'onstr�uetion Tax: Administrative Fee: Work Without Permit? ®Yes No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential E) Travel Doclunenialion /fees: Building or Structure Strong Motion Fee: IBSEISMICR $1.95 Select an Administrative Item Bldg Stds Commission.Fee: IBCBSC $1.00 £I r� � $2.95 $645.00 f T EE $647.95 Revised: 02/14/2015 a:—) t &S-6 )q YaAvpt) * �—r— tc� 7C It ` CM COMMUN"T DEVE-Cpm.`EI4 BUjL7lNC C,:{SSICN -CUrEKTI o APPROVED =Thi of plans and specifications9UST be kept at to during construction. it is u ;iuwful to rna ct changes or alterations en carne{ or to rom, without apprcal from the Bim, Th stamping of this plan and specifics i%C: _ ..� eid to permit an app;wa; OQ 00 � Y ^�rn pr Ord; :�� C !s oA �So 3 0/ pERMIT NO. _.... icoi N ................___..._.... i o n� C3 X pERTINO m Buliding Department i-, E O MAR 2 3 2015 { rFOR CODE COMPLiFiNCE 1 REVIEWERevieD �eNl i aeza >~ �# edea Me ' — �,� ED s�aznn a� n �' `-� etiti F FICE C 0 Py LIAR 2 a 2015 BY