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12070085 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11644 OAK SPRING CT CONTRACTOR:SP HOME PERMIT NO: 12010085 IMPROVEMENT OWNER'S NAME: LIOU KER-CHUNG AND CHEN LIH-YN 1030 WINDSOR ST DATE ISSUED:0711112012 OWNER'S PHONE: 4086463828 SAN JOSE,CA 95129 PHONE NO:(408)777-8918 ❑ LICENSED CONTRACTOR'S DECLARATION 30B DESCRIPTION: RESIDENTIAL COMMERCIAL[] License Class 3 Lic.l1 8/ 13 1 3 REMODEL BATH IN HALLWAY NON-STRUCTURAL 52 SQ e� 2-012- FT Contractor � ///•}/✓ Dale 7' / 1 hereby affirm that I em 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 Compcnsmion,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:54200 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:36652064.00 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 LAST CALLED 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 granting of this permit, Additionally,the applicant understands and will comply Issued by:,_: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature 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-BIIILDER DECLARATION Signature of Applicant: Date: I hereby affirm that 1 oat exemptfrom 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 conlmetons to HAZARDOUS MATERIALS DISCLOSURE construct the project(Scc.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safely Code,Sections 25505,25533,and 25534. 1 will I hereby alarm under penally of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Ileallb&Safety Code,Section I5532(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 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 Area Air Quality Management District 1 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&Safely Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Dale: —1 -11 - I — permit is issued. I certify that in the performance of the work for which this permit is issued,I shall not employ any person inany manner so as to become subject to the Worker's Compensation laws of Cal ifomin. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY 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 properly for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCIIITECT'S DECLARATION 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 `: t w N ?RoP&KTY OG WeP, J bgAJ d- Lid yN L►od A P120Pe►2T " /�DDIQESS I I o I Z 1 644 OAK spkik) GT. O 0 COMMUNITY DEVE'n - A�iif(,y/® r ��] / SD►4' N ^ T BUILDING DIVISION- CUPERTINO `��_t x o APPROVED w• ,1' This set of plans and specifications MUST be kept at job site during the wconstruction. It is unla chars es alter ful to make any or tions on same,or to deviate therefro , wit .o t o ty� CC pproval from the Building Official. The N `1to/" be i lit or to be d specifications ecifications SHALL NOT to p I� I i approval of the violation N f y provift Is of any City Ordinance or State Law. DATE i y PERMIT NO. i o � oItF0 reg b z fh `� till db BOOMHJ `ff-� CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 7121 ADDRESS: 11644 oak spring ct. DATE: 07/11/2012 REVIEWED BV: bobs. APN: BPN: 'VALUATION: 1$4,200 "PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1R3SFDREM USE: PERMIT TYPE: WORK sfd bath remodel non structural. SCOPE 16,7 1'l,:r i'Lr '- !'4unl•. I'hm l"I,tr A l n i'Irn:( :., rA-n'r I;nd: /n": lbhrr l'Lurr7 lap "L , } N:, NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Public IVorks, Fire,Sanitary Sewer District,School District,etc. . These fees are based on the preliminary information available and are onh'an estimate. Contact the Dept for addn'I info. FEE ITEMS !I'ee Rcsnlarion 11-IIjJ lit. %%Cl 11 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.(. Remodel, Bath (<=300 so Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $600.00 /Re,taRESB 1r PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT 0,0 I hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 O Work Without Permit? 0 Yes 0 No $0.00 1 G Advanced Planning Fee. $0.00 Select a Non-Residential t) / !6„ ru:r .,r.,n ,,; F,e c Building or Structure 0 Strong Motion Fec: IBSEISMICR $0.50 Select an Administrative Item Bide Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.501 $600.001 TOTAL FEE: 1 $601.50 Revised: 07/0112012 CONSTRUCTION PERMIT APPLICATION t u COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX(408)T77-3333 • buildinG(Gilcuoertino.orG CUPERTINO ❑NEW CONSTRUCI?ON ❑ .ADDITION ALTERATION/TI ❑ REVISION/DEicdRED ORIGINAL?ERb[IT#- PROntcT.kDDREvsl t� S �I KI mo( _ AFN' (�(� OWNER NAME I L( I LOU PHONE40E 64 6- 352 b' EMAIL TMI-7 ADDRESS CITY. STATE ZIPVT :AX CONTACT NAME PHONE EYMAIi 5AN1 PA� /fog-�Rs-azzzs r_/ti�� ay.coti siLSET ADDRESS CITY,STATE � { FA%y/DJD UINo3G/2 J/ QC v0- 772 - ygP$ ❑ OwvEa ❑ OwNERBURDEA ❑ OWNE]IAGFNT CONTRACTOR ❑CONTRACTORAGENT ❑ Ait=CT ❑ENGINEER ❑ DEVELOPER ❑ Nw qT CONTRACTOR NAME� � 1D NL rM Du�� LICENSE NUMBER Cll ) z LICENSE TYPE I� BUS.IUCD �/ COMP.4NYNA.ME 54M -I /4A) E-MAIL� O I_7(�IJL 41 -oCCAI F�)d - 77 S7.4=ADDRESS /D L) (JUS[7 R S� CITY STATE,TIP PHONE 3 W/ .54A/ J os` GA j s/z deg- Rt-022 ARCHITECT/EIOMFER NAME Ll SE NUMBER BUS.LIC Y COMPANY NAME E-MAEL FAX STREET ADDRESS CITY,STATE,LIP PHONE DESCE=ION OF WORK �LA• � I,^,l SMD CL C�Q 157RU6701zG 11c�V� M Cr E)CSTNG USE PROPOSED USE CONSTR.TYPE ISTORIFS USE TYPE CCC. SQ-FT. VALUATION(S) F�D05�7G �2 SF RCOR 0 E10 ANET AREA L �' �/ dZ7 S-277 2Q0 BATHROOM KITCHEN OTHER REMODELAAEA REMODEL AREA REMODEL AREA PTR-H FA I DECKAIA TOTAL OECK/POACH AREA GNUGEARE OETACH ATTACH p DwELLNG UNITS: M A SECOND UNrI OYES SKCONM STORY YES B®YG ADDED? []NO ADDITION'. QNO PRE-APPLIUION ❑YES IF M.PROVIDE COPY OF ISTEZaLDGAN ❑YES RECEIVED By: ' ' � TOTAL VALUATION: PLANNiNGAPPLA ❑NC PLAIMDIGAPPROVALLETTE]l sacmmt HOME? []NO 4L2lrD By pry signatur_below,I ccndfy to=11 of the following I am the property owner or authorized agent to act on the prpperyowner's oenalf. I have rad this application and the information I have provided is cum I have tad the Description of Work and verity it is accurate. I agree to comply with all applicable local ordinances and state laws relating m buil'dine cous¢peCgn I authorim representatives of Cupertino to enter the above-identi5ed property for inspection pm-poses. Signature of Applicanr/Agency Qi..t/ Daze: 7 'I/ — 'YOI -2i SLPPLEAMENTAL INFORMATION REQUIRED PLkN CHECK TYPE - ROUrLNG ME? New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THELOONTZR ❑ BUILDING PtAN RKV[EW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ ExPBrss ❑ PLANtmvG PLAN REvrEw Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBucwORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ I=DEPT _Copy of Planting Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SAINrTARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIIomrnxru-ay.r ra BI gApD_?011.doc revised 06/21/11