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13070096 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10471 HENEY CREEK PL CONTRACTOR:EMPIRE FLOORING& PERMIT NO:13070096 DESIGN CENTER OWNER'S NAME: LEE DICK T AND SOPHIE S 495 E BROKAW RD DATE ISSUED:07/15/2013 OWNER'S PHONE: 6509628185 SAN JOSE,CA 95112 PHONE NO:(408)213-0996 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALL License Class Lie.# 9 ai Q , INSTALL 14 RECESSED LIGHTS,4 SWITCHES IN SFDWL // KITCHEN Contractor �O(Qf C,QiyY, -I AGI Date I 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. Sq.Ft Floor Area: Valuation:$2800 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:34248014.00 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 A0 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 DAY R 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 Issued by: Date: granting of this permit. Additionally,the applicant understands and will comply with all non-point so4rcgregulations per the Cupertino Municipal Code,Section 9.18. _ RE-ROOFS: Signature ' Date / 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 Signature of Applicant: Date: I hereby affirm that I am exempt from 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 contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.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. I 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(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 I 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 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,Sections ,25533,.and 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: Dater 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 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 property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION 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 GENERAL PERMIT APPLICATION 0\u MEP COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ob 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 bA CUPERTINO (408)777-3228•FAX(408)777-3333•building(c cupertino.org MISC ❑PLUMBING ❑MECHANICAL ELECTRICAL ❑MISCELLANEOUS PROJECT ADDRESS f f 1 - C glee I/ if APN# OWNER NAME -0: PHONE Lc. G PHONE �'/_. '�1 rE-MAIL �. /��.t�7l�� /1�� ✓�� e STREET ADDRESS b o,1-94 ,yc-n e a�Ce-r- el CITY, STATE,Zip - �(�® v I' t�j FAX CONTACT NAME y,��`„ /#� ���/ PHONEb`u8 av q E-MAIL STREET ADDRESS . r�� / CITY,STATE, ZIP, o_- f � FAX 4&45 ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER 7LICENSE TYPE BUS.LIC# I CS QVYI G7Gc 39 3Z 15 & C) Its 3Z2 .D COMPANY NAME D.J� D6 h Com` u E-MAIL FAX a13. 1/ 3 j STREET ADDRESS CITY,CITY,STATE, P P ONE -4qs �rt�ILrcu3 ; San t A 7?�//� w, 113-u`tgG ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑SFD.,DUPLEX ❑ MULTI-FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑ YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? O DESCRIPTION OF WORK Iq �,�Cl'le..✓� S NIC� 5 TOTAL VALUATION: RECEIVED BY: By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pr a owner's behalf. I have read this application and the information I have pr d i correct. I ve read the Description of Work and verify it is accurate. agree to comply with all applicable local ordinances and state laws relating to bu'dt c struc i n. uthori representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: St EMENT INFO ATION REQUIRED OFFICE USE o .OVER-THE-COUNTER ;a F+ ❑ EXPRESSO k iV w ❑ STANDARD 5 .'U ❑ LARGE cw ❑ MAJOR MEPMiscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10471 HENEY CREEK PL DATE: 07/15/2013 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$2,800 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1REAP1 USE: PERMIT TYPE: i WORK INSTALL 14 RECESSED LIGHTS 4 SWITCHES IN SFDWL KITCHEN SCOPE t tech.Plan Check Plumb.Plan Check Elec.Plan Check 0.0 hrs $0.00 -f-h.Permit Fee: Plumb.Permit Fee: Elec.Permit Fee: 1EPERMIT - —t Other•Alech.Inds. Other Plurals Insp. Other Elec.Insp. 0.0 hrs $47.00 -7ech.Insp, Fee. Plumb. Insp.Fee: Elec.Inds.Fee: NOTE.This estimate does not include fees due to other Departments(La Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). These-fees are based on the prefinWina information available and are only an estimate Contact the De t or addn7 info. FEE ITEMS(Fee Resolution 11-053 E . 7� FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Electrical Suppl. PC Fee: (E) Reg. ® OT 0.0 hrs $0.00 $70.00 IBREW= Fixtures,Lighting PME Plan Check: $0.00 4 Electrical Permit Fee: $0.00 $47.00 IBREMRECEP Recep/Switch/Outlets Suppl. Insp.Feer Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 C`©nso-fiction ::Tax: Administrative Fee: IADMIN $44.00 Work Without Permit? ®Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Travel Documentation Fee: ITRAVD0C $47.00 1 Building or Structure i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $139.501 $117.00 ' $256.50 . n Revised: 07/01/2013 10,117 r r rel. GC.PIe4-Ana 5'c e�'/ 1�c��✓(c /1/ �e-e�,sed L�` � 13�� 152"- 3 vi 57,6 �33 , 61,6 76;8 756" 92"- 2" 2411�36" 2730H DC24 0HL B126WBK18 B36 24.DISH LS C4 -- ----- — --------------- N OOOO tj -4 0OD N m m W m Q W 0 0 O 1 M -4 r N O o IMa N VMS ZO-3 vopm: � RRPB36-3 630 W361527 W3630 W3030 COMMUNITY G BUIL el 1 w 'M02-7 IP"R.309MI IP--1Vr-�VWV4Ar r-%'1Vr-QVW 69$„ This set of plans an s ec'fi tool job site enuring,construction. It is unlawful to make any changes or alterations on sairne,or to de;viaa therefrom,without approval from the Building Official. 109" The^A aping of this plan and specifications SHIALL NOT be held to permit or to be an approval of they vloi�xiicn of any provisions of any City Ordinance or S ta't z.Law. CUPERTINO BY 4:6.11 V1 fl >> f Building Department DINE 1 PERMIT NO. JUL 1 5 2013 All dimensions_size signations 20 This is an original design and must Designed:5/19/2013 REVIEWED FOR CCS 00 MA� cationon TECHNOLOGIES not be released or copied unless Printed:7/13/2013 site and,adjustment to fit job applicable fee has been paid or job Revieweorder placed. d BY: Dick Lee(10471 Heney Creek Pl,Cupertino,CA) Print Drawing#: 1 No Scale.