13080236 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10420 LINDSAY AVE CONTRACTOR:ANDERSON PERMIT NO: 13080236
INSTALLATION
OWNER'S NAME: CHEE-KEONG YEE 696 AUZERAIS AVE DATE ISSUED:08/30/2013
OWNER'S PHONE: 4082106331 SAN JOSE,CA 95126 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL
License Class 13 Lie.# S _06_0 / REPLACE ONE(E)SLIDING GLASS DOOR&ONE(E)
3 WINDOW,LIKE FOR LIKE,SAME LOCATIONS(WILL
Contractor .4,t �e�a H s� // Date MEET
I hereby affirm that I am licensed under the provisions of Chapter 9 EGRESS&BE TEMPERED WHERE REQUIRED BY CODE)
(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:$1650
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:36912019.00 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 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 DAY + T CALL SPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Iss 3d
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.
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
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
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 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent Date: 1)
permit is issued.
I certify that in the performance of the work for whic!i this permit is issued,I shall
not employ any person in any manner so as to becom subject to the Worker's
Compensation laws of California. If,after making ths 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 3hall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTHFICAri'ION Lender's Address
I certify that I have read this application and state tha the above information is
correct.I agree to comply with all city and county or inances and state laws relating
to building construction,and hereby authorize represi ntatives of this city to enter
upon the above mentioned property for inspection pu poses.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino a ainst liabilities,judgments,
costs,and expenses which may accrue against said C ty in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant un erstands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CONSTRUCTION PERMIT APPLICATION Q�
COMMUNITY EVELOPMENT DEPARTMENT•BUILDING DIVISION r99
10300 TORRE VENUE•CUPERTINO, CA 95014-3255 1'7v
(408)777-3228•FAX(408)777-3333•building cupertino.org
CUpERTINC3
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT 4
PROJECT ADDRESS /D lJ D L J 1
OWNERNAME t( / L C# PHONE �C�CJ -Z/U- 6-33 E MAI /
STREET ADDRESS //r1 C/t U L I� d I CrrY,STATE,ZIP C FAX
CONTACT NAME C [( PHONE E-MAIL /
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STREET ADDRESS /_ J 2 e r q Com,STATE,ZIP C�� e of J L
❑
OWNER OWNER-BUILDER ❑ OWNERA ENT 04ONTRACTOR ❑CONTRACTORAGENT ❑ ARCHnECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME C) C� /J I LICENSENUMBER LICENSE TYPE BUS.LIC#
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FAX
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COMPANY NAME /1 �S
e nS �/ �K EMAIL 61t�h AnJCrW"-/Nf^y87t-
ay, �..-
STREET ADDRESS CITY,STATE, P PHONE
cl(� 4vZr;r� Z �'S- yc�
ARCHITECT/ENGINEER NAME ILICENSENUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK ne l�6c1�� C)�e
x !2_5
J I 1!2 Q { n J u
EXISTINGUSE PROPOSED USE CONSTR TYPE #STORffiS USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/P RCH AREA GARAGE AREA: CH
❑DET11,ACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? ONO ADDITION? ONO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF Is THE BLDG AN ❑YES - + _ - TOTAL V�O TI .
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑N It
e owner's behalf. I have read this.
By my signature below,I certify to each of the ollowing: I am the property o r or autho' o P rtY
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building c on. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: ,C'-
SUPPL TAL INFOR qATION REQUIRED
_New SFD or Multifamily dwellings: kpply for demolition permit for o o�
existing building(s). Demolition permit is required prior to issuance of building y "
permit for new building. s
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project. r
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
B1dgApp_201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10420 LINDSAY AVE DATE: 08/30/2013 REVIEWED BY: MELISSA
APN: 36912 019 BP#: "VALUATION: 1$1,650
%PERMIT TYPE: Building Pe mit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: I PERMIT TYPE:
WORK REPLACE ONE E SL DING GLASS DOOR&ONE E WINDOW LIKE FOR LIKE SAME
SCOPE LOCATIONS (WILL MEET EGRESS & BE TEMPERED WHERE REQUIRED BY CODE)
".rte
M _ ;
g4Sn
.Wch. Plan Check Plumb.Plan Check Elea. Plan Check
iklech. Permit Fee: Plumb. Permit Fee: Elec. Permit Fee:
Other Alech. Insp. LJ Other Plumb Insp, Other Elec.Insp. Li
.1lech. Insp,Fee: Plumb. Insp. Fee: Elec.Insp.Fee
NOTE:This estimate does not includefees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Theseees are based on the relimina information available and are on an estimate. Contact the De t or addn 7 in o.
FEE ITEMS Fee Resolution 11-0 3 E ._7111121 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 2 # Window/Sliding Glass Door
Suppl.PC Fee: (F) Reg. ® OT 0.0 hrs $0.00 $418.00 I WINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Feer Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
Administrative Fee:
Work Without Permit? ® Yes (E) No $0.00 E)
Advanced Planning_Fee. $0.00 Select a Non-Residential E)
Tr~'Ilvel Documentation Fees: Building or Structure
Strong Motion.Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg;Stds Commission Fee: IBCBSC $1.00
$1.50 $418.00 $419.50
Revised: 07/01/2013
Yee e,-5 . CO'�-ANILIIIIJNTV DEv-
SUILUIf G r>, ; «ta CU,'Enrii30JEiv
/ o`(av AP DPP,
kp/(f 3 69 _ This set of plans and specifications MUST be kept at the
job site during construction. it's unlawful to make
-R e P 1 Ac t 0".2 w i h d o w ' U h e D o r I '^ ?` S T i -+5 0i -e 5
changes or alterations on same,or to deviate any
therefrom,without approval from the Building Official.
The stamping of this plan and specifications SHALL NOT
be held to er
5ean approval of the violation
' aY City Ordinance or State Law.
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