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0807018211 701e;l 3s" Aa�fi-�io`I N6 File Edit Actions Details Links Favorites Help Permit Information Permit Number x j08070182�� Status' Master Number Notes 5� Project Apply Date' 07/25/2008 p Operator SylviaM Permit Issue Date 02127/2009 Operator patg Certificate Issued 09/25/2009 J Operator 1PALM Certificate Type Certificate Number PermitProperty Zoning 11 Applicant 11 Contractor Ij Defined Fields Location Information - Address " 10635 CULBERTSON DR City/State/Zip CUPERTINO CA 9.5014 APN 37536028.00 Unit ni.-mer Entity fnformation lOwner Name " PIUS NG Use Default Address Home -10635 CULBERTSON DR v City/State/Zip CUPERTINO CA 95014 Permit Details Permit Type J1R3SFDADD -- — -- -- SINGLE FAMILY DWELLING ADDITIO Usage Class " II/III B, —� II/III B, IV-HT,V•B NEW Applied Value ' 100000 SQUARE FT. r 499 Calculated Value 0(31 US C-404 Type 1434 GL ALT. RESIDENTIAL Permit Form' CiTTOPERM --PERMIT *� Ownership CPrivate �y Project Size STANDARD - STANDARD Ic Permit issued 0212712009 Enter permit status PurposelSpecialConditions- - ---- ADD 499'HASTERBED/BATHRM,LIVINGRM,PORCH 80-REAR OF HOHE,REHODEL 726'LIVING, NIASTERBED/BTH- SANITARY I ISUNNYVALE'S JURISDICTION. 5/19/9 - REV #09050113 FILMED- Z011 I h [Add Default T wr y,/ OK 14m Back �r Contractors ��p Fees (� Plan Reviews yl jInspections p7 Print Permit l "'Adjustments lyr Holds IF4 Copy Permit l� Close Permit J Overrides l Supplemental Fields Notes i Attachments JVR N OF CUPERTINO �+7���� BUILDING DIVISION PP�1�.LY111 BUILDING ADDRESS: 10635 C OWNER'S NAME: ARCHITECT/ENGINEER: od u O p LICENSED CONTRACTOR'S DECLARATION I hemby affirm that I am licensed under provisions of Chapter 9 (commencing Z wi th Section 7000) of Division 3 of the Business and Professions Code. and my license is y in full force and effect j rA Z License Class Lle• 0 Dam Contractor 3 p ARCHITECTS DECLARATION 5n, I understand my plans shall be used as public records �yU u. t— Licensed Professional yoy y � OWNER -BUILDER DECLARATION n I hereby aflrm that I am exempt from the Contractor's License Law for the 0 o following reason. (Section 703 L5, Business and Professions Code: Any city or county K m ( which mquies a permit to cons uel, alter, improve, demolish, or repair any structure a Z iy- prior to its issuance• also requires the applicant for such permit to file a signed staLemml < that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 F $ (commencing with Section 7000) of Division 3 of the Business and Professions Code) or >. .. that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500). 0 1, 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 and Professions Code: The Contactors License Law does not apply to an owner of 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 We. Ir, 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 Qj 1, as owner of the property, am exclusively contracting with licensed contractors to construct Ute project (Sec 7044, Business and Professions Code') The Contrttctors U- ernse Caw does not apply to an owner of property who builds or improves thereon, and who contacts for such projects with a contractor(s) licensed pursuant to the Contractors License Caw. ❑ i am exempt un Sec. , B & P C for this reason owner IL) S �C' Date � 17 W RKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations ❑ I have and will maintain a Certificate of Consent to self -insure for Workers Compen- sadon, 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 Workers Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued My Workers Compensation Instuanlx carrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (SL00) or less.) 1 certify that In the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to heeornc subject to the Workers' Compensation Laws of California. Date 71 L T 2Uci' Applicant� NOTICE TO APPLICARTT: If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provisionx of the Labor Code, you must 0 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY (—+ 1 hereby affirm that there is a construction lending agency for the performance of o--i pj > the work for which this permit is issued (Sec. 3097. Civ. C.) a4Q Lenders Name az Lenders Address V 0 1 certify that I have read this application and state that the above information is (y — correct. I agree to comply with all city and county ordinances and state laws relating to 0 V building construction, and hereby authorim representatives of this city to enter upon the y WU above -mentioned property for inspection purposes G " a (We) agree to save, indemnify and keep harmless the City of Cupertino against ,..� rn liabilidm, judgments, costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE R)fib�SNS. ti 2-7/C / Signature of Applicam/Contractor Date HAZARDOUS MATERIALS DISCLOSURE 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 Code, Section 25532(a)7 ❑Yes UNo Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants at defined by the Bay Area Air Quality Mamgcmcnt District? ❑ Yes Z No 1 have read the hazardous materials requirements under Chapter 6.95 of dtc Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building does not currently haw a tcrtant, that it is my responsibility to notify the occupant of the requircmc hick must be met prior toissuancc of a Certificate of Occupancy. I( __b;7&[ Owner or authoriyrd aecnt Date PERMIT NO. PERMrr ISSUE DATE 9 A CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description ADD 499'MASTERBED/BATHRM,LIVINGRM,PORCH,80'REAR OF HOME,REMODEL 7261LIVING, MASTERBED/BTH. SANITARY IS SUNNYVALE'S JURISDICTION. Sq. Ft. Floor Area 37536028.00 Required Inspections Issued by; Re -roofs Type of Roof Valuation AM Occupancy Type 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. Signature of Applicant Date All roof coverings to be Class "A" or better aITYF CUPERTINO CITY OF CUPERTINO ADDITION/REMODEL PERMIT APPLICATION FORM y„ G2k APN# 375 �� OZ$ Date: gLAW 25-( 24b2) Building Address: I a63�; DRY Mailing Address (if different from building address): r Owner's Name: p1 vs NG Phone # Contractor: Phone #: Fax #: Contractor License #: (� Cupertino Business License #: 1 Contact: � .DS Phone #: &,.570 .. C, /8 2 Fax #: (So — Building Permit Info: Bld0g. Elect. © Plumb. E,Mech. EA Hillside ❑ Job Description: /��y� ��� Addition (adding sq footage):M61111�_" (�����v �'2�� P'���O6f,9 / / What is being remodeled (not including addition)? �,^Z "OM MFMO& A D14K 4 (3 ! Remodel Includes Re -Roof: Yes No ❑ If yes list number of squares Remodel Includes Structural: Yes ❑ No Square Footage: 'Zo 5 Addition: Porch: Deck: _� Garage: Detached Attached Remodel: Kitchen Bath 9 Q Other f 464 kA-s Type of Construction (Usage Class): Occupancy Type: 1-A, 1-13 ❑ II/IIVV-A ❑ 11/111 B, IV -HT, V-B [� Valuation: `00, 6D0 a— Please check this box if the project is a Size: Express ❑ Standard [V� Large ❑ Major ❑ second -story addition El Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, Green Building Point Achieved: include in plan set & the sheet index. 3 ***For Office Use Only*** Over -the -Counter ❑ Revised 7/01/08