14040204 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10420 MORETTI DR
CONTRACTOR: PERMIT NO: 14040204
12 a N coo�STfut o N
DATE ISSUED:04/30/2014
OWNER'S NAME: CELIA CHU
PHONE NO:
OWNER'S PHONE: 4082232625
[( LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E]
REMODEL(E)KITCHEN(99 S.F),REMODEL(E)HALL&
License Class $ Lic. MASTER BATHS(80 S.F.),REPLACE TRANSOM WINDOWS
Contractor L4 �(?.�I,CbN - ate l — UPGRADE EL PANEL TO 200 AMP,SAME LOCATION
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 Valuation:$25000
rformance of the work for which this permit is issued. Sq.Ft Floor Area:
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:37516001 00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION PERMIT EXPIRE S NOT STARTED
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 W THIT AYS OF P IT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
AYS FRO CALLED INSPECTION.
upon the above mentioned property for inspection purposes. (We)agree to save ,
indemnify and keep harmless the City of Cupertino against liabilities,judgments, L
costs,and expenses which may accrue against said City in consequence of the Issu U
granting of this permit. Additionally,the applicant understands and will y
with all non-point source regulations per the Cupertino Municipal C e,Section
9 18. RE-ROOFS:
D
Signature Date �T 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
the following two reasons:
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) HAZARDOUS MATERIALS DISCLOSURE
1,as owner of the property,am exclusively contracting with licensed contractors to
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
the Health&Safety Code,Sections 25505,25533,and 25534.
I have and will maintain Worker's Compensation Insurance,as provided for by '� Is
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age Date:
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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
I hereby affirm that there is a construction lending agency for the performance of
become subject to the Worker's Compensation provisions of the Labor Code,I must
work's for which this permit is issued(Sec.3097,Civ C.)
forthwith comply with such provisions or this permit shall be deemed revoked. 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
918.
Signature Date
CONSTRUCTION PERMIT APPLICATION `t
` COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION hv�,
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
CUP RTlNO (408)777-3228• FAX(408)777-3333•building o1cupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESSD 42 6 b We ' �i V APN# (� — 00/
1+/ /
OWNER NAME �w o / ��� U PHO^tea �2�`�n E-MAIL
STREET ADDRESS 8! Com/ CITY, STATE,ZIP (� I FAX
CONTACT NAME 2-0 PHONF/ 4/A— E MAIL PP-1
',;'60 -[ J
STREET ADDRESS A� (��,1 CITY,STATEEE,��ZIP)) a(�J L� FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT 11 ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAM�,p-. 1(� (l�0 LICENSENUMBER LICENSE TYPE BUS.LIC#
r+ 02191-no
COMPANY NAM ^ /h . I E-MAIL TU �Q F ' _�y
STREET ADDRES V b1- , - 1 N CITY,STATE,ZIP. -,
ARCHITECTIFNGINEER NAME !(/!" LICENSE NUMBER �� BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE n +�
DESCRIPTION OF WORK
LpC.�<oN fNr uN/T 3-FeY 0&we-)4 KIWTUS,1z8 4'A ero w w or��- 7&P,ileippr-�
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N .r.o>NA��,.�
EXISTING USE PROPOSED USE CONSTR TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHENq OTHER
REMODEL AREA O REMODEL AREA 1 QIREMODEL AREA
PORCH AREA ECK 1ISASECONDUNIT
TAL DECK/PO_RCH AREA GARAGE AREA: DETACH
[-]ATTACH
#DWELLING UNITS: ❑YES SOND STORY ❑EING ADDED? ❑NO ADDITION? [-]NO
PRF-APPLICATION ❑YES IF YES,PROVIDE COPY OF - IS THE BLDG AN S ,^^y -M
y'z`x =v-' TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME?
V N. NWINK y -I
By my signature below,I certify to each of the following: I am the property owner or authorize on the property owner's behalf. I have read this
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 construction. I authoTize representatives of Cupertino to enter the abovepidghtified roperty for inspection purposes.
Signature of Applicant/Agent: Date: b/�
T
SUPPLEMENTAL INFORMATION.REQUIRED 01 � E 10.1 �ncsiir ;r
New SFD or Multifamily dwellings: Apply for demolition permit for �� � x
� OWER H3rCQ ERS 4 ° _.;BUIL
DING RER'E{3
existing building(s). Demolition permit is required prior to issuance of buildings 5 _
permit for new building. - � � �
PXRR SS -RI A�I J NGPLAA REV w
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure s 'DARD �� LIG�YORKS
form if any Hazardous Materials are being used as part of this project.
ARG cF�IItE DEP�� r � :
_Copy of Planning Approval Letter or Meeting with PIauning prior to ps IT'nxY SES IivisrN
3 rso
submittal of Building Permit application. ' � �
ENVIROi\'IN4ENAEH-
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10420 MORETTI DR DATE: 04/30/2014 REVIEWED BY: MELISSA
APN: 375 16 001 BP#: *VALUATION: $25,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION 1 R3SFDREM
USE: SFD or Duplex PERMIT TYPE:
WORK REMODEL E KITCHEN 99 S.F REMODEL E HALL & MASTER BATHS 80 S.F.), REPLACE
SCOPE TRANSOM WINDOWS & UPGRADE EL PANEL TO 200 AMP, SAME LOCATION
Ll,iar t t rs C'dc.rk t'trrtrrh t'lcnt C`�reeA Elect.Plan Check 0.0 hrs $0.00
1,1111:. Perimu11-'ee: Plumb. Permit 1""er: Elec.Permit Fee: IEPERMIT
f3f!rcs t s °r. M'�n 01her Phrmb lvfsi> Other Elec.Insp. 0.0 hrs $47.00
PlU mb. Inap. F'ee
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These fre onlyo.
an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/131 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 99 s.£ Remodel,Kitchen(<=300 sf)
Suppl. PC Fee: Q Reg. ® OT 0.0 hrs $0.00 $626.00 1REMRESKIT
PME Plan Check: $0.00 80 s.£ Remodel,Bath(<=300 sf)
Permit Fee: $0.00 $626.00 1REMRESBAT
Suppl. Insp. Fee: Reg. ® OTF7 hrs $0.00 200 lamps Electrical
PME Unit Fee: $0.00 $47.00 1BELEC200 Services
PME Permit Fee: $47.00
(,(pis i-oction Ta,v:
Administrative Fee: 1ADMIN $44.00 0
Work Without Permit? 0 Yes (E) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Building or Structure 0
Travel Documentation Fee: ITRAVDOC $47.00 A
Strong Motion Fee: IBSEISMICR $2.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$141.501$1,299.00j = TOTAL FEE $1,440.50
Revised: 04/01/2014
r
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT 1 N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: 4 OYPi ✓• PERMIT# ` SLI d2a
OWNER'S NAME: C PHONE# D ZZ --Z6
GENERAL CONTRACTOR: 4 /ZaO J6 V5M Z*J BUSINESS LI ENSE 70
ADDRESS:34D8 CITY/ZIPCODE: , N 4056,44-qV1919
*Our municipal code requires all businesses working in the city to have a City ofCupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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
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