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14030082 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20652 PARK CIR WAY CONTRACTOR:'JON RAPZIy PERMIT NO: 14030082 C4Iry 5-4wan0K� OWNER'S NAME: CHENG CHUAN NIU DATE ISSUED:03/13/2014 OWNER'S PHONE. 4083710705 PHONE NO: i' LIC NSED CONTRACTOR'S DECLARATION 3011 DESCRIPTION:RESIDENTIAL E] COMMERCIAL 0 _ REPAIR UNIT 3 BALCONY DRY ROT,REPLACE License Class Lic.4 ��aas 7 + AFFECTED 77 MEMBERS AS NEEDED. REMOVE AND REPLACE FACIA Contractorid" ��� lAate 3 = +'� BOARD I hereby affirm that Tam licensed under the provisions of Chapter 9 IN-KIND AS NECESSARY FOR BLDG 20652 (commencing with Section 7000)of Division 3 of the Business&Professions Codc 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 eertificate of consent to self-insure for Workcr'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:$3285 ' Z1 have and will maintain Worker's Compensation insurance,as provided for by Section 3700 of the Labor Code,for the performanee of the work for which this APN Number:32632016.20652 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 P < UANCE 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 DA INSPECTIO indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may aeerue against said City in consequence of the 3 granting of this permit. Additionally,the applicant understands and will comply c i with all non-point regmlatio er tl a Cupertino Municipal Code,Section 9.l 8, RE-ROOTS: Signatu 11Date 5*v)1 //1_/ 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 1,as owner of the properly,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 HAZARDOUS MATERIALS DISCLOSURE construct the project(See.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. l 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(x)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 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 Arca 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,Sectio aY35 5,25533 and 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 Califamia. If,aflcr making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,1 must 1 hereby affirm that[here 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 properly for inspection purposes.(We)agree to save ARCHITECT'S DECi,ARATION 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 DD COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 V (408) 777-3228•FAX(408)777-3333•building(c?cupertino.org CUPI=kTlNO 1 ❑NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION/TI ❑ REVISION I DEFERR/ED ORIGINAL PERMIT# PROJECr-ADDRESS P3✓ 4 (—,If. fit/ APN k OWNER NAME C {/ PHOS «O3 E-MAIL 71-6 STREET ADDRESS ! A��(/l / �r &P, Cr STATE,ZIP�7y 1 qy� �'� FAX :L 15e CONTACT NAME PHONE EMAIL 4-105� 2Y1 STREET ADDRESS }�// CITY.STATE,ZIP FAX 11OwNE:R ID OwmR-Buu-DER. U3OwNERAGEN'C � CONTRACTOR ❑CONTRACTOR AGENT 0 ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CON TRACTOR NAME 1� i LICENSE NUMBER, !� LICENS TYPE 3 BUS.LIC 4 COMPANY NAME ,f E-MAFL FAX Jt Dr- 1 s7 6%p S -hs m l e cITY T z� �. �. P� ,S15 Z3 q 6 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC H COMPANY NAME E-MAIL PAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK dK -iDi al r,—)OZ, C c EXISTING USE PROPOSED USE CONSTII TYPE O STORIES • USE TYPE OCC. SQ.FT. VALUATION(5) E)U TG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATEROOM KITCHEN OTHER REMODEL AREA REMODEL.AREA REMODEL AREA PORCHAREA DECKAREA TOTAL DECKIPORCHAREA GARAGEAREA: DETACH ❑ATTACH 9 DWELLING UNITS: IS A SECOND UNIT Q YES SECOND STORY YES BEINGADDEDT NO ADDITION} CINO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDC AN ❑YES TOTAL VALUATION: PLANNING APDL tI []NO PLANNING APPROVAL LETTER EICHLER HOME' ❑ND '" iA By my signature below,l certify to each of the ft) g: I am the property owner or authorized agent to act the pr owner's behalf. I have read this application and the information I have prov' Ed is cct I have read the Description of Work and verify i Is te. I agree to comply with all applicable local ordinances and state laws relating to bui mg co clan. I a thorize representatives of Cupertino to enter the above-i ntifted roperty for inspection purposes. Signature ofApplicant/Agent: Date: •� SUPPLEMENT ORMATION REQUIRED , Latvc> c r E '., 'a.RQUMG$L�, F ~}`New SFD or Multifamilydwellings: APP1 for demolition permit for OVER TIr1iCOUNTCR a ©rIBUII nIl1G PLAN REVIEW a existing building(s). Demolition permit is required prior to issuance of building w' Y permit for new building. p g y T, EXPiF.35 PLANIVIG PLAN REVIEW! ;'yt Commercial Bldgs: Provide a completed Hazardous Materials Disclosure °;sTAn�Alin�ay °Fa tYClusc Form if any Hazardous Materials are being used as part of ibis project. -` r Fs� srvt,. c $ yr r ty.:y ,a i s. i LAAt=> } r y ❑+Irm II jl0.1;0 y1 qn y rx Copy of Planning Approval Letter or Meeting with:Planning prior to 2'. IL a Y: submittal of Building Permit application." MAJORr� t 5 wr ElESiNrTARYSEWnRDiSTRIC �� z g pp 1::� .•«aM,.:yA li L._a...~s.t1 s! :e�d''ENVIR NAIENTAT:�HEALTHtr� • B1dgApp 2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION W'PERMIT DDRESS: 20652 PARK C1R WAY DATE: 03/1312014 REVIEWED BY: MELISSA PN: 326 32 016 BP#: �3�0�_ "VALUATION: $3,285 PE: Building Permit PLAN CHECK TYPE: Alteration 1 Repair PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1 R2REM USE: 3 Stories 0 Yes (:-) No PERMIT TYPE: A WORK BLDG 20652 - REPAIR UNIT 3 BALCONY DRY ROT REPLACE AFFECTED MEMBERS AS SCOPE I NEEDED. REMOVE AND REPLACE FACIA BOARD 1N-KIND AS NECESSARY OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. R-2 (Apartment) II-B,III-B,IV,V-e $0.00 $0.00 TOTALS: 0 $0.00 $0.00 MECH, HOURLY 0 Yes Q No PLUMB,HOURLY 0 Yes 0 No ELEC, HOURLY 0 Yes 0 No ,Lfudl Plan Chrc6' Phwrh Plurt ChccA 15'1ec. flair C"hcr�k �7'1711-1 h pertxtt Fe" Pliant, Pc 0-mil!�e. lily c !'c l'rurr/.•.t Other Uch, 1ny Olher P11frr7b 1mn Uther'Cr'ec lnspET 11ccb hzap.P'c Plm+rb. hr'-p. 1Yec 17,y, 1"v NOTE: This estimate does not include fees clue to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Thesefees are based on the prelintina information available and are only an estimate. Contact the De t or addit 1 info. FEE ITEMS (ree Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1-7 # Deck/Deck Railing Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $976.00 1DECKWOOD Deck&Deck Railing PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conswitclion Tcn-. A(bnilll.t-trejtive T-ee: 0 Work Without Permit? 0 Yes (j) No $0.00 G Advanced Planning Fee: $0.00 Select a Non-Residential 0 Travel Dvc lullenialion h'ees: Building or Structure 0 i Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.001 1 1 SUBTOTALS: $1.50 $976.00 TOTAL FEE: $977.50 Revised: 01115/2014 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 2-0 !: WY PERMIT# r Yd 3 00 Z OWNER'S NAME: /rJ PHONE# OS -)L'/ r GENERAL CONTRACTOR--' ,jet„ 131,,/+7 c BUSINES LICENSE# ADDRESS: Qf l�f t F Zd G4 sal5s' CITY/ZIPCODE: *Our municipal code requires all 6usinesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND AL 7BCO�TRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: /Y Signature Date Please check applicable subcant ctors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date eNnel0ilis By r MAR � a PLOT 3 j, DATkiep mm a- f. a' 4 f 4 1L CA b Eaw r ..,� ;a .y t73 c::' , C _ , y g g 3 4 , g#Q 4 NN Nil ellt i : F a' 3 wwn.-www..r<w...ec-...w.......m«.,"wu.W...,,m*.....�........>....,..-».".,-�....,..,.,,..,..�... --..«.-. - � _. ti { 1 u 6 q. d3 { � 7 dd c t pq, yg _ _ VY 71 C_Q7ail DRAWN � fCHECKED. yy DATE Ps !Z1 C»,.. .........,,. �« ..,...-.per..,, t nPvx . .. S'f, AY, , �h 3 a Y' ! JOS MO. i P, CAJ " SHEET raitulvvi31A6 141 C 5 --15 . OF BMEETl9i PftWT90 ON CL EARPRIW 1