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11060047 (2)CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 854 LILY AVE CONTRACTOR: WEIGANG ZHANG PERMIT NO: 11060047 OWNER'S NAME: CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION F F BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.N MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: ADDITION OF 818 SQFT INCLUDES NEW ATTACHED (commencing with Section 7000) of Division 3 of the Business & Professions GARAGE, 2 BEDROOMS, STUDY & LIVING ROOM. REMODEL BATH(145 Code and that my license is in full force and effect. SQFT),KITCHEN(123 SQFT)& EXISTING GARAGE REMODELED 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 Sq. Ft Floor Area: Valuation: $128000 permit is issued. APPLICANT CERTIFICATION APN Number: 35903039.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non -point source regulations per the Cupertino Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date Issued by: Date:�� OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE -ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material berg installed. If a roof is I, as owner of the property, or my employees with wages as their sole compensation, installed without first obtaining an inspection, I agree to remove all new materials for will do the work, and the structure is not intended or offered for sale (Sec.7044, inspection. Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain Section 3700 of the Labor Code, for the performance of the work for which this • compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. permit is issued. Additionally, should 1 use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued, I shall contaminants as defined by the Bay Area Air Quality Management District 1 will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation laws of California. If, after making this certificate of exemption, I Health & Safety Code, Sections 25505, 25533, and 25534. become subject to the Worker's Compensation provisions of the Labor Code, 1 must forthwith comply with such provisions or this permit shall be deemed revoked. Date: Z> l� / APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of Mork's to building construction, and hereby authorize representatives of this city to enter for which this permit is issued (Sec. 3097, Civ C.) upon the above mentioned property for inspection purposes. (We) agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section ARCHITECT'S DECLARATION 9.18. p �O I understand my plans shall be used as public records. Signature ,— Date o / Licensed Professional CITY OF CUPERTINO BUILDING PERMIT)ATE BUILDING ADDRESS: 854 LILY AVE OWNER'S NAME: ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic.# Contractor Date 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: [ 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 1 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. CONTRACTOR: WEIGANG ZHANG 854 LILY AVE CUPERTINO, CA 95014 2 OFT PERMIT NO: 11060047 DATE ISSUED:08/04/2011 PHONE NO: BUILDING PERMIT INFO: BLDG r ELECT r PLUMB F MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: ADDITION OF 818 SQFT INCLUDES NEW ATTACHED GARAGE, 2 BEDROOMS, STUDY & LIVING ROOM. REMODEL BATH(145 SQFT),KITCHEN(123 SQFT)& EXISTING GARAGE REMODELED 11/29/2011 - REV# 1 - FRAMING REVISION - REV#I [SS'D 11/29/2011 Sq. Ft Floor Area: I Valuation: $128000 APN Number: 35903039.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Signature Date I Issued by: OWNER -BUILDER DECLARATION 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. Signature ��— Date Date: RE -ROOFS: Al I roofs shal I be inspected prior to any roofing material berg installed. If a roof is installed without first obtaining an inspection, [ agree to remove all new materials for inspection. Signature of 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. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should 1 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, and 25534. Owner or authorized nt: -> Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of mrk's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional Fm-� CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION igADDRESS: 854 lily ave DATE: 11/29/2011 REVIEWED BY: larry s APN: BP#: *VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? Yes •; No OTC? 0 Yes 0 No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK revision SCOPE 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 0 $0.00 $0.00 TOTALS: 0 $0.00 $0.00 MECH, HOURLY Yes (F) No PLUMB, HOURLY Q Yes (Q No ELEC, HOURLY Q Yes Q No Ll 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 vrelininary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7/1111) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes (F) No $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F) Reg. Q OT 0.0 I hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.S Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 4. «,i�trrt lizrrr Too F7 '-WnlinisfralhjC F'et? Q 0 Work Without Permit? © Yes (E) No $0.00 Advanced Plannin_ Fee: $0.00 3 hours Plan Check, Hourly $390.00 ISTPLNCK E) 1':.t7-,r11?vc`tlrnc"nt,.rtlr)l� l �y�r�.' Strom Motion Fee: $0.00 F-6-1 # Revision $0.00 IREvsFDWL SFDWL Bldy, Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $390.00 TOTAL FEE: $390.00 Revised: 10101 /2011 CITY OF CUPERTINO 1�1 FEE ESTIMATOR — BUILDING DIVISION 191 ADDRESS: 854 lily ave. DATE: 06/06/2011 REVIEWED BY: bobs. APN: BP#: "`VALUATION: 1$128,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Du lex USE: P 2nd Unit? , Yes • No OTC? 0 Yes � No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK add new ara e 2 bedrooms stud livin remodel kitchen bath add electrical to 3 existinSCOPE �sfd edrooms and hallway. OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA S.I. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 818 $2,349.00 1R3PLNCK $1,474.00 IR3INSP TOTALS: 818 $2,349.00 $1,474.00 MECH, HOURLY 0 Yes ) No PLUMB, HOURLY ® Yes Q No ELEC, HOURLY Q Yes Q No Elec. Plan Check 0.0 1 hrs $0.00 .. Elec. Permit Fee: IEPERMIT o 01af.'v 1, Other Elea Insp. 0.0 hrs $42.00 NOTE: These fees are based on the preliminary information available and are onlv an estimate. Contact the DeDt for addn7 into. FEE ITEMS (fee Resolution 09-051 I '. 7/11101 FEE QTY/FEE M1SC ITEMS Plan Check Fee: $2,349.00 145 s.f. $570.00 Remodel, Bath (<=300 so 1REMRESBAT Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 123 s.f. $570.00 Remodel, Kitchen (<=300 so IREAlRESKIT Permit Fee: $1,474.00 Suppl. Insp. Fee-0 Reg. 0 OT 0.0 hrs $0.00 = s.f. Remodel, Other $506.00 IREARESOTH PME Unit Fee: $0.00 PME Permit Fee: $42.00 23 # $72.00 Electrical IBREWIXT Fixtures, Lighting [:r,rtslrrr:lrttr3 Tint Acoustical Fee: 0 Yes (F) No $0.00 =# $42.00 Electrical IBREAMECEP Recep/Switch/Outlets 0 Work Without Permit? 0 Yes G No $0.00 Planning Fee: PLLONGRNGR $106.34 Select a Non -Residential Building or Structure E) 0 i Travel Documentation Fee: ITRAVDOC $42.00 Strong Motion Fee: IBSEISAECR $12.80 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $6.00 SUBTOTALS: $4,032.14 $1,760.00 TOTAL FEE: F $5,792.14 Revised: 04/29/2011