13010139CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11622 SEVEN SPRINGS DR
OWNER'S NAME: XISHENG ZHANG
OWNER'S PHONE: 4088324327
W. LICENSED CONTRACTOR'S DECLARATION
License Class Lic. 4 83 i
ContractorCGlryt iCgto/ J,if#ffate
I hereby affirm that 1 am licensed under the provisions of Cha '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.
1 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 all non -poi o me regulations pmt a Cppertino Municipal Code, Section
9.18. /��,( t
❑ OWNER - BUILDER DECLARATION
1 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: AMERICAN KITCHEN &
PERMIT NO: 13010139
BATH
1758 JUNCTION AVE UNIT D
DATE ISSUED: 01/28/2013
SAN JOSE, CA 95112
PHONE NO: (408)436 -8151
JOB DESCRIPTION: RESIDENTIAL u COMMERCIAL
REMODEL (E) KITCHEN & DOWNSTAIRS BATHROOM,
REPLACING FIXTURES, APPLIANCES, CABINETS &
FLOORING
Sq. Ft Floor Area: I Valuation: $50000
APN Number: 36654014.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAY CALLED INSPECTION. /
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
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 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(x) 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 Cu ti Municipal e, Chapter 9.12 and
the Health & Safety Code, Section 5 5, 25533 34.
Owner or authorized agent: 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
ALL GFCI OUTLETS WILL
BE DEDICATED 8 TAMPER
RESISTANT ,
XISHENG & XIAOLING ZHANG
11622 SEVEN SPRINGS DRIVE
CUPERTINO, CA 95014
408 - 832 -4327
GARBAGE DISPOSAL WILL BE ON
DEDICATED CIRCUIT.
2RW3612
Js
SCOPE OF WORK f�
PULL AND REPLACE CABINETRY
APPLIANCES
COUNTERTOPS
FLOORING
UPDATE ELECTRICAL TO MEET ALL CODES /�
REPLACE TOILET A J41V
REPLACE VANITY CABINET V
PULL AND REPLACE TILE DOWNSTAIRS BATHROOM
Al I GFCI OUTLETS WILL
AMPER
All dimensions size designations
given are subject to verification on
job site and adjustment to fit job
conditions.
IS NOT LED OCUPENCY SENSOR
WILL BE INSTALLED
O BE LED
HIGH EFFICIENT
AKB IThis is an original design and must
not be released or copied unless
applicable fee has been paid or job
order placed.
Designed: 1/28r2013 II
Printed: 1/28/2013
Zhane Kit- sm -rev3a City NKBA Drawing N: 1 No Scale.
II
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125 BO'
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LL LIGHTING BE LED
i i
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��IGH
EFFICIENT
T
Ib
m
n
F
F LL LL
LL LL
2RW3612
Js
SCOPE OF WORK f�
PULL AND REPLACE CABINETRY
APPLIANCES
COUNTERTOPS
FLOORING
UPDATE ELECTRICAL TO MEET ALL CODES /�
REPLACE TOILET A J41V
REPLACE VANITY CABINET V
PULL AND REPLACE TILE DOWNSTAIRS BATHROOM
Al I GFCI OUTLETS WILL
AMPER
All dimensions size designations
given are subject to verification on
job site and adjustment to fit job
conditions.
IS NOT LED OCUPENCY SENSOR
WILL BE INSTALLED
O BE LED
HIGH EFFICIENT
AKB IThis is an original design and must
not be released or copied unless
applicable fee has been paid or job
order placed.
Designed: 1/28r2013 II
Printed: 1/28/2013
Zhane Kit- sm -rev3a City NKBA Drawing N: 1 No Scale.
CUPERTINO I
n NEW CONSTRUCTION
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION \�
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 /) 0
(408) 777 -3228 • FAX (408) 777 -3333 • buildinaCa cuoer ino.ora
M ADDITION M ALTERATION / TI M REVISION/ DEFERRED ORIGINAL PERMIT #
PROJE AD RESS
APN # 2 j Ci A O /
L
OWNER AME / / ' C
1
PHONE 408 8� -(OJ
7
E- MAIL_`
ST T ADDRESS A
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FAX
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NTACT E - PHONE
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STREET ADDRE N (/IF
❑ OwNER ❑ OWNER- BUnDER ❑ OwNERAGENr R�comraAmroR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
for CTOR NAME
NUMB
LICFNSETYPE
BUS. LIC# 2-3 /j/4P
A C MPANYNA�MgE
/
FAXa$ Y3te -763
V ✓/V✓/ / ✓N Ave A( h
,STATE
c ee
ARCHITECT/ENGMEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
&MAR.
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DE RIPTI N OF WORK L � L
GSQ Ivl ✓/ I t S ri
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AW Du v t�T d✓✓ 00,01 Glt VZO
IV
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(STING USE PROPOSED USE
CONSTR TYPE
#STORIES
USE
TYPE
OCC.
SOFT.
VALUATIONS)
ERISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA I
AREA
NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REM D REMODEL AREA
.�
VVv
PORCHAREA DECKAREA TOTAL DECKTORCH AREA GARAGEAREA: DETACH
❑ ATTACH
I
#DWELLING UNITS:
IS A SECOND UNIT ❑YES
SECONDSTORY ❑YES
BEING ADDED? NO
ADDITION? NO
PRE-APPLICATION ❑YES IF YES, PROVIDE COPY OF
PNINGAPPL# []NO PLANNINGAPPROVALLEITER
IS THE BLDG AN E] YES
EICHLER HOME?
,
TOTALVALUATION:
[]NO
,
By my signature below,1 certify to each of the following: I am the property owner or authorized agent o act on the property owner's behalf. I have read this
application and the information III pro 'ded is correct I hav rea the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b ' ' g ce traction representatives of Cupertino to enter the ab ve- identifi d property for inspection purposes.
Signature ofApplica /Agent: Date:
SUPPLEMENTAL INFORMATION REQ D
PLANCHECK TYPE 1. t
4°"" '� " ROUTING SLIP
_ New SFD Or Multifamily dwellings: Apply for demolition permit for
❑`-
existing building(s). Demolition permit is required prior to issuance of building
OVER- THE-COUNTERR .
BUILDING PLAN REVIEW
permit for new building.
Cl EXPRESS
.0-"PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
. ❑ STANDARD J,
.❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑, LARGE =
' ❑ ' IkE' DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑, MAaoR,
❑ sANreARY seweR msTmeT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
M"0 B1dgApp_2011.doc revised 06121111
(bt1
����� CITY OF CUPERTINO
IIIY'�G/J�l IREF I .CTYMATnR — RITIi.DTNC. DIVISION
10
ADDRESS: 11622 SEVEN SPRINGS DR
DATE: 01/28/2013
REVIEWED BY: MELISSA
.f
APN:
BP #:
`VALUATION:
$50,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration I Repair
PRIMARY SFD or DU lex
p
:Weep. Permit Fee:
PENTAMATION 1 R3SFDREM
USE:
Other Meth. ln.sp.
PERMIT TYPE:
WORK
REMODEL E KITCHEN & DOWNSTAIRS BATHROOM REPLACING FIXTURES APPLIANCES
SCOPE
CABINETS '& FLOORING
NOTE: This estimate does not includejees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
n:.fr:.e .1, 1 Thee fee. Ore Mmd nn tho m,.H inary infnrmalinn availahle and are only an estimate. Contact the DeDt for addu7 info.
FEE ITEMS (Fee Resolution 11 -053 Efl 711112)
FEE
QTYIFEE
MISC ITEMS
.f
Plan Check Fee:
$0.00
,Uec'h. Plan Check
Plumb, Plan Check
Elec. Plan Cheek
:Weep. Permit Fee:
Plumb. Permit Fee:
Oec. Permit Fee.'
Other Meth. ln.sp.
Other Plumb Insp.
Li
Otter Elec. Inap.
alech. bnp. Fee:
Plumb. 1nap. Fee:
Permit Fee:
Elec. Insp. Fee.*
NOTE: This estimate does not includejees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
n:.fr:.e .1, 1 Thee fee. Ore Mmd nn tho m,.H inary infnrmalinn availahle and are only an estimate. Contact the DeDt for addu7 info.
FEE ITEMS (Fee Resolution 11 -053 Efl 711112)
FEE
QTYIFEE
MISC ITEMS
Plan Check Fee:
$0.00
125 s.f.
$600.001
Remodel, Kitchen (< =300 sf)
IREMRBSKIT
Suppl. PC Fee: 0 Reg. O OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
F 547 s.£
$600.00
Remodel, Bath (< =300 sf)
1REMRESBAT
Permit Fee:
$0.00
Suppl. Insp. Fee O Reg. O OT
F0,0Thrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Administrative /,cc,:
O
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
0
i
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICR
$5.00
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$2.00
$7.00
$1,200.00
i `TOTALFEE,'
$1,207.00
Revised: 10/01/2012
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: I S
.
PERMIT # 3DI O 1 3
OWNER'S NAME: X I f *7-,J
PHONE #
GENERAL CONTRACTOR: C -iU
USINESS LICENSE # 2 l 3 I
ADDRESS:
CITY /ZIPCODE:
*Our municipal code requires all businesses 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 ALL BCONTRACT RS AVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
V
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