14060166I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 1202 RUPPELL PL
OWNER'S NAME: JI GUIJUN
OWNER'S PHONE: 5105098611
❑ LICENSED CONTRACTOR'S DECLARATION
License Class______ Lic. # gga 17 J
Contractor ��� o�t� Date 0
1 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.
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
permit is issued.
APPLICANT CERTIFICATION
1 certify that l have read this application and state that the above information is
correct. 1 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
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
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature I Date -SP�f
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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 & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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
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
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date
CONTRACTOR: STONE CITY CORP. I PERMIT NO: 14060166
2830 OLIVE AVE 1 DATE ISSUED: 08/20/2014
FREMONT, CA 94539 1 PHONE NO: (5 10) 219-3632
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
CONSTRUCT ONE STORY ADDITION (368 SQ FT);
REMODEL
OF M. SUITE (305 SQ FT); REROOF (2700 SQ FT).
REVISION #1- REVISE BATHROOM LAYOUT- ISSD OTC
1/15/15
Sq. Ft Floor Area: I Valuation: $50000
APN Number: 36230043.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180MML
k PERMIT ISSUANCE OR
180 DAYS VRST CALLED INSPECTION.
Issued by: Date: I I
RE -ROOFS:
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
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District 1
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent: a , Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Profession
t
I CITY OF CUPERTINO BUILDING PERMIT I
I BUILDING ADDRESS: 1202 RUPPELL PL I CONTRACTOR: STONE CITY CORP. I PERMIT NO: 14060166 1
OWNER'S NAME: 1I GUIJUN 12830 OLIVE AVE 1 DATE ISSUED: 08/20/2014 1
OWNER'S PHONE: 5105098611 FREMONT, CA 94539 PHONE NO: (5 10) 219-3632
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL 0
CONSTRUCT ONE STORY ADDITION (368 SQ FT);
License Class Lic. #$0%� REMODEL
Contractor � Date
OF M. SUITE (305 SQ FT); REROOF (2700 SQ FT).
_
1 hereby affirm that 1 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.
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
permit is issued.
APPLICANT CERTIFICATION
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
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
with al I non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature __�, . Date la
o
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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 & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
1 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.
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
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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
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
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date
Sq. Ft Floor Area: I Valuation: $50000
APN Number: 36230043.00 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date:
RE -ROOFS:
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 Appli
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533,I and 25534. s A y
Owner or authorized agent: �"e � � Datc: o �
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Profess
CITY OF CUPERTINO
Fm -N FEE ESTIMATOR - BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.. These fees are based on the relimina information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 ff 7ilil3)
ADDRESS: 1202 ruppell pl
DATE: 01/15/2015
REVIEWED BY: Mendez
APN:
BP#:
'VALUATION: Iso
"PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
0.0
PENTAMATION SOLAR -RE
PERMIT TYPE:
WORK
REVISION #1- REVISE BATHROOM LAYOUT- ISSD OTC 1/15/15
SCOPE
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.. These fees are based on the relimina information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 ff 7ilil3)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= #
$0.00
Alternative Energy System
Photovoltaic System
Suppl. PC Fee: Q Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PM E Permit Fee:
$0.00
0
0
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee:
$0.00
Select allon-Residential
Building or Structure
0
i
Strong Motion Fee:
$0.00
0.5 hrs
$45.00
Admin./Clerical Fee
IADMIN
Bldg Stds Commission Fee:
$0.001
SUBTOTALS:
$0.00
$45.00
TOTAL FEE:
1 $45.00
Revised: 01/06/2015
CITY OF CUPERTINO
FM_5 FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 1202 ruppel pi
TYPE OF
CONSTR.
DATE: 06/25/2014
REVIEWED BY: Mendez
PC FEE ID
APN:
BP#:? , ,
`VALUATION: $50,000
II-B,111-B,Iv,v-B
368
$1,579.00
JADDPLCK
'°PERMIT TYPE: Building Permit
IADDINSP
PLAN CHECK TYPE:
Addition
PRIMARY SFD or Duplex
$0.00
2nd Unit? 0 Yes : No
PENTAMATION 1 R3SFDADD
USE:
Permit Fee:
$1,284.00
I OTC. ® Yes E)No
PERMIT TYPE: 14
WORK
368 sq ft addition to sfdwl to include family room with 1/2 bath remodel of m. suite 305 sq ft reroof 27
SCOPE
sq f
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,111-B,Iv,v-B
368
$1,579.00
JADDPLCK
$1,284.00
IADDINSP
$0.00
PME Plan Check:
$0.00
2,700 s.f.
$432.00
Re -roof
IREROOFRES
Permit Fee:
$1,284.00
Suppl. Insp. Feer Reg.
® OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
TOTALS:
368
$1,579.00
$1,284.00
MECH, HOURLY 0 Yes E) No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY 0 Yes Q No
Ll
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.. These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff: 7,1,13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,579.00
= s.f.
$488.00
Remodel, Other
IREMRESOTH
Suppl. PC Fee: (2)Reg. 0 OT
Fo.o
hrs
$0.00
PME Plan Check:
$0.00
2,700 s.f.
$432.00
Re -roof
IREROOFRES
Permit Fee:
$1,284.00
Suppl. Insp. Feer Reg.
® OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
G
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee:
IPLLONGR
$51.52
Select a Non -Residential
Building or Structure
G
0
Strong Motion Fee:
IBSEISMICR
$5.00
Select an Administrative Item
B1d Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$2,921.52
$920.00
TOTAL FEE:
$3,841.52
Revised: 04/01/2014
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
VV
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION10300 TORRE AVENUE • CUPERTINO, CA 95014-3255(408) 777-3228 • FAX (408) 777-3333 • building(ftupertino.ora \s6
111
[:]NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI E�f REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS ,
APN #
`r
OWNERNAME `
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
, rri �Q_
CONTACT NAME
PHONE 7
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER. ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
`AGENT
CONTRACTOR NAME �(. !/�' (JN
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
I
USE
TYPE OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODELAREA
REMODELAREA
REMODEL AREA
PORCH AREA
DECK AREA
T07A1, DECK TORCH AREA
GARAGE AREA: DETACH
[]ATTACH
I
#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
-. RECEIVED BY:
TOTAL VALUATION:
PLANNING APPL # []NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
fes{/
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 relating to building construction. I authorize representatives of Cupertino to enter the above -identified pr perty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTALINFORMATION REQUIRED
PLANCHECKTYPE
ROUTING SLIP
OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of buildin
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS,
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT -
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_201 Ldoe revised 06121111
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building0cupertino.org
❑ NEW CONSTRUCTION F� ADDITION ❑ ALTERATION / TI ❑
REVISION /DEFERREDORIGINAL PERMIT #
PROJECT ADDRESS
APN # !%
z e!TL
OWNERNAME
PHONE L/b �O
E-MAIL
STREET ADDRESS16� i / CITY, STATE, ZIP
` ` _ FAX
v
c-w ,P- r
CONTACT NAME
PHONE ` E-MAIL,
,5/ O
' 2
STREETADDRESS930 0J: VQ AV
STATE, ZIP
�Y
FAX
-e—CITY,
a
❑ OWNER ❑ OWNER. -BUT -DER ❑ OWNER AGENT dION7RACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAN4ELICENSE
NUMBER
LICENSE TYPE BUS. LIC #
/ ^ A/
COMPANY NAME
E-MAIL
FAX
S ON
STREET ADDRESS
CITY, STATE, ZIP
PHONE.
NGINEER NAIAE
LICENSE NUMBER
BUS. LIC #
2
,�1
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
tt PHONE
DESCRIPTION OF WORK
76
Agy In
i e r CL2�-A ,oy� ,
Qom,
EXISTING USE
PROPOSED USE CONSTR TYPE
#STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG /
AREA
Q�
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
6
b
/
/ v
BATHROOM
REMODEL AREA
KITCHEN OTHER
REMODEL AREA REMODEL AREA
}�
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA
GARAGE AREA: El DETACH
❑ ATTACH
#DWELLING UMTS:
IS A SECOND UNIT [].ES
SECOND STORY ❑YES
BEING ADDED" El NO
ADDITION" ❑NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
RECEIVED BY :. -
TOTpL1/�LU.4T�!!-
PLANNING APPL k ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME" NO
❑
-
_.
[((vJ�A �o �v/
By my signature below, I certify to each of the following: I am the property owner or authorized agent to ton th erty ov roer'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 building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Date:
Signature of Applicant/Agent:14�
0-i
SUPPLEMENTAL INFORMATION REQUIRED
riA ` cicx TPE.
RouTING
❑ 'ovER
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
TxE couNTER
BULLDrnGrLAlvREvl v
permit for new building.
❑.EaPRESS
PIANNI\GPLANREiIEW ,,
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
SDARD
TAT
❑ FirsLlcwoxxs
_
form if any Hazardous Materials are being used as part ofthis project.
❑
vF
❑
°LARGE
FIRE DEPT _
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑
Permit
I14AJOR r
SAI�ITART SERER DISTRICT
submittal of Building application.
r
❑ s E1\�'IRON1vIENTAL HEALTH ..
B1dgApp_2011. doc revised 06/21/11
IL
U