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14050103/r ,L I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 21918 LOMITA AVE CONTRACTOR: JUNRE ZHENG PERMIT NO: 14050103 OWNER'S NAME: JUNJIE ZHENG 161 MUIR AVE DATE ISSUED: 08/29/2014 OWNER'S PHONE: 4089167988 SANTA CLARA, CA 95051 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ CONSTRUCT 2 STORY SFDWL LIVING SPACE 3426, License Class Lic. # ATTACHED GARAGE 448 AND PORCH 458 SQ FT Contractor 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. 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. 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, Se 918. Date OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of 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) I, 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 (7 —// *- REV # 2 - REVISE LANDSCAPE LAYOUT INCLUDING HARDSCAPE - ISSUED 6/11/15 Sq. Ft Floor Area: I Valuation: $659000 APN Number: 35715002.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LA.SZJ9A*tED INSPECTION. 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 Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) 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 I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. 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 Professional ,C CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 - 3228• FAX (408) 777 -3333 - building ancuDeriino.orq ❑ NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION / TI ❑ RFVISIOTQ / DEFERRED ORTCTTNIAT. P- PTIMT -r E / Vzlra l e) 3 PROIECf ADDRESS 2 1 n1? 1 eyt,� 2 OWNER NAME �BS�/ PHOh At)�) E- I✓LAIL� ®��f�. �, Je' /,, C���� STREET ADDRESS e e CITY, STATE, A I FAX �f CONTACT NAME M s4� PHONE f/ E -MAIL STREET ADDRESS Crry, STATE, ZIP FAX El OWNER OWNER- BUILDER ❑ OWNERAGENI ❑ CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGA'EER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME v�N/J LICENSE NUMBER LICENSETYPE BUS.LIC� COMPANY NA S E -M.AIL FAX STREET ADDRESS I CITY, STATE, ZIP PHONE AR-=ECT/ENG'EFR NAME Iq/ - JL /e LICENSE NUMBER BUS. LIC R COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK L and -Qe,1 F C[STING USE PROPOSED USE CONSTR TYPE n STORIES - USE I TYPE I OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR- DEMO TOTAL AREA AREA AREA NET AREA -.. BATHROOM. KITCHEN., OTHER. REMODEL AREA I REMODEL AREA REMODEL AREA " PORCH AREA DECK AREA TOTAL DECK /PORCH AREA GARAGE AREA: DETACH ' U ATTACH m DVrELLLNG UNITS: IS A SECOND UNIT ❑ YES SECOND STORY []YES I BEINGADDED? NO ADDITION? []NO PRF- APPLICATION []YES IF YES, PROVIDE COPY OF - IS THE BLDG .AN TOTAL VALUATION: PLANNNUNG APPL �- ❑ NO PLANNING APPROVAL L -'TTER I EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: I am the property o-,j"Ter or authorized a, act owt e propery oNmer's behalf. TFadthis application and the information I have provided is correct. I have read the Description ofVJork an It is accurate. I agree to comply with all applicable local ordinances and state lays relating to building c ns ction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: 6 SUPPLEI�5-NTAL INFO LA TION REQUIRED - F _; PtR CHECK 31PE - «I� - - _OUTL G SLIP. ri _ o�ERT�coI 7 New SFD or Multifamily d«,ellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building nTER BUILDING PL�h RES�I1 F3 �xP ss — r;� Lsl:n31 permit for new building. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure. l sTL�DARD =0 Pu c�oxxs` form if any Hazardous Materials are being used as part of this project.' . . . . . . . . . . . . . . . . _ Copy of Planning Approval Letter or Meeting with Planning prior to u MA70R� 5�1NIIAItY � submittal of Building Permit application. SEfiR�IS RICA BldgApp_2011.doc revised 06/21/11 io FM77 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION a ,� ..—s.. .. s iu_ xt..�„ su r..., w .3_ � <€ ��_n,� �w -� 21918 LOMITA AVE DATE: 06111/2015 REVIEWED BY: MELISSA JimADDRESS: APN: 35715 002 BP #: 14050103 *VALUATION: Iso Other Rh%A Insp. '-PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex Phtnrb. hisp. Fee: PENTAMATION PERMIT TYPE: 1GENRE WORK REV # 2 - REVISE LANDSCAPE LAYOUT INCLUDING HARDSCAPE - ISSUED 6/11/15 SCOPE 0.0 a ,� ..—s.. .. s iu_ xt..�„ su r..., w .3_ � <€ ��_n,� �w -� gg r� " S [. Ny tl..v E Y .. i4..•� � a �� a a��",R.� n._�t �u'tF . �a"'„�� '�!rcP. s -�- �o; e t� ,l tech. Plan ('heck Phunb. Plan Check Elec. Plan Check Ltech. Permit Fee: Plumb. Permit 1 "ee: Rec. Permit Fee: Other Rh%A Insp. Other Plunsb ln%a Other Lss "lec. 1na11. ED �14ech, 1nsp. Fe': Phtnrb. hisp. Fee: Elec. Lisle. Fee: NOTE: This estimate does not include fees due to other Departments ('tie. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta-). These fees are based on the oreliminary information available and are only an estimate. Contact the Dent for addn'I info. FEE ITEMS (Fee Resolution 11 -053 Eff. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 0 hours Plan Check, Hourly $143.00 ISTPLNCK Suppl. PC Fee: 0 Reg. 0 OT 1 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:O Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 cons1ructton lax. -FT Adinipilstrt7tive Fe?e: G Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee- $0.00 Select a Non - Residential I Building or Structure 0 i Tr 4A:el Doc umentathm Fees: Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission .Fee: $0.00 i sUBTOTAI,s, $0.00 �,,e �° `e, $143.00 t - 4z'.� ,{ . ,`.TOTAr. FEE $143.00 Revised: 05/07/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21918 LOMITA AVE CONTRACTOR: JUNJIE ZHENG PERMIT NO: 14050103 OWNER'S NAME: JUNHE ZHENG 161 MUIR AVE DATE ISSUED: 08/29/2014 OWNER'S PHONE: 4089167988 SANTA CLARA, CA 95051 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL CONSTRUCT 2 STORY SFDWL LIVING SPACE 3426, License Class Lic. # ATTACHED GARAGE 448 AND PORCH 458 SQ FT Contractor Date I hereby, affirm that I am licensed under the provisions of Chapter'9 Deferred #1- gas pipe diagram- issd otc 3/24/15 (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: $659000 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: 35715002.00 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 DAY 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 b Date: G� 3' (7 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 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) as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE onstruct 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 Labor Code, for the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I -Compensation, as provided for by Section 3700 of the 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:, - Z 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 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 918. Date Signatur CONSTRUCTION PERMIT APPLICATION COPVJViiUNI 1 Y DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 T ORRE AVENUE • CUPERTINO, CA 95014 -3255 'i4..''r• -- 1-1 I .- .. (408) 777-3228 • FAX (408) 777 -3333 • buildino(d,)cuDerJno.oro CUPERTINC Q 7 TSFW CONSTRUCTION .. ❑ ADDITION ❑ ALTERATION / TI REVISIO EFERRED ORIGINAL PERMIT 9 PROJECT ADDRESS APN R I OWNER NAME _ I PHONr. E- 1.4AIL STREET ADDRESS I CI Ii Y, STATE, ZIP • Sa G! I FAX ... 1,114 UIP-01) LL CONTACT NADIB .. PHONE I E -A4AIL STREETADDRESS--- CITY, STATE,, ZIP FAX , .0.01�T*=R `` ' 'OWNER- BbILDER" "'I ' ❑ OWNTEERAGENT ❑ CONTRACTOR : ❑ CONTTR_ACTOR- AGENT'' ' ❑ .ARCHITECT' ❑ ENGINEER'.:;:,_[] :DEVELOPER : ❑, TENAhZ CONTRACTOR NAME LICENSE NUh4BER LICENSE TYPE BUS. LIC m COMPANY NAME I E- 114AIL FAX STREET ADDRESS I CITY, STATE, ZIP PHONE ARCHITECT /E2\'GINTEERN.A],4E /�/] ` ( LICENSENUA4BER BUS.LICR COWANYNAA4E J J E -MAIL FAX �f '� n m� ` 11, STRET 1 ADDRESS 2tfo Se;)-a -e� STATE. ZIP ?�� I PHOI�'E/���+ �J J ` 11&, r CITY. �✓ L/' DESCRIPTION OF WORK EYISTLNG USE PROPOSED USE CONSTR TYPE '' STORIES z USE TYPE OCC, SQ.FT, VALUATION (S) ExISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHR0014 KITCHEN OTHER REMODEL AREA RE.T.40DEL.AREA REN40DEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑ DETACH ❑ ATTACH DWELLINGUNTM. IS A SECOND UNIT ❑YES SECOND STORY E] YES _ BEING ADDED? NO ADDITION? ❑NO PRE-APPLICATION ❑ YES - IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES E EI\�:ED $Y _ E -.rt TOTAL V ATI .'• PLA_NNINGAPPL F1 NO PLANNDIG APPROVAL LETTER I EICHLERHOAIE? ONO � '.c I By my signature below, I certify to each of the following: I am the property owner or authorized agent to act 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 authorize representatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED n cCITiPE . _ = _ROtjru.csL>rF New SFD or Multifamily dv elIinas: Apply for demolition permit for r p �] DERrcou�rEx s r 5: M 4ARE`1i existing building(s). Demolition pennit is required prior to issuance of building r for new building. ❑ ExPRESS err �x Ar��mci PL4IStEViEI permit t a yL Commercial Bldgs: Provide a completed Hazardous Materials Disclosure P sra.DAIZD r �J $LBLIOiinTF.S xs r' :: _ form if any Hazardous Materials are being used as part of this project. Il L}RGE i FIREDEP F : ` e Approval al Letter r or Meetin with Planning prior to .o Plag BE- Y � v�JOR ^� fl sai�IZ sEV ER�Fs�Rfc� rt s ubin ttal Permit B1dgApp_201 Ldoc remised 06121111 ,C CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 - 3228• FAX (408) 777 -3333 - building ancuDeriino.orq ❑ NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION / TI ❑ RFVISIOTQ / DEFERRED ORTCTTNIAT. P- PTIMT -r E / Vzlra l e) 3 PROIECf ADDRESS 2 1 n1? 1 eyt,� 2 OWNER NAME �BS�/ PHOh At)�) E- I✓LAIL� ®��f�. �, Je' /,, C���� STREET ADDRESS e e CITY, STATE, A I FAX �f CONTACT NAME M s4� PHONE f/ E -MAIL STREET ADDRESS Crry, STATE, ZIP FAX El OWNER OWNER- BUILDER ❑ OWNERAGENI ❑ CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGA'EER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME v�N/J LICENSE NUMBER LICENSETYPE BUS.LIC� COMPANY NA S E -M.AIL FAX STREET ADDRESS I CITY, STATE, ZIP PHONE AR-=ECT/ENG'EFR NAME Iq/ - JL /e LICENSE NUMBER BUS. LIC R COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK L and -Qe,1 F C[STING USE PROPOSED USE CONSTR TYPE n STORIES - USE I TYPE I OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR- DEMO TOTAL AREA AREA AREA NET AREA -.. BATHROOM. KITCHEN., OTHER. REMODEL AREA I REMODEL AREA REMODEL AREA " PORCH AREA DECK AREA TOTAL DECK /PORCH AREA GARAGE AREA: DETACH ' U ATTACH m DVrELLLNG UNITS: IS A SECOND UNIT ❑ YES SECOND STORY []YES I BEINGADDED? NO ADDITION? []NO PRF- APPLICATION []YES IF YES, PROVIDE COPY OF - IS THE BLDG .AN TOTAL VALUATION: PLANNNUNG APPL �- ❑ NO PLANNING APPROVAL L -'TTER I EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: I am the property o-,j"Ter or authorized a, act owt e propery oNmer's behalf. TFadthis application and the information I have provided is correct. I have read the Description ofVJork an It is accurate. I agree to comply with all applicable local ordinances and state lays relating to building c ns ction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: 6 SUPPLEI�5-NTAL INFO LA TION REQUIRED - F _; PtR CHECK 31PE - «I� - - _OUTL G SLIP. ri _ o�ERT�coI 7 New SFD or Multifamily d«,ellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building nTER BUILDING PL�h RES�I1 F3 �xP ss — r;� Lsl:n31 permit for new building. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure. l sTL�DARD =0 Pu c�oxxs` form if any Hazardous Materials are being used as part of this project.' . . . . . . . . . . . . . . . . _ Copy of Planning Approval Letter or Meeting with Planning prior to u MA70R� 5�1NIIAItY � submittal of Building Permit application. SEfiR�IS RICA BldgApp_2011.doc revised 06/21/11 io CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21918 LOMITA AVE CONTRACTOR: JUNJIE ZHENG PERMIT NO: 14050103 OWNER'S NAME: JUNJIE ZHENG 161 MUIR AVE DATE ISSUED: 08/29/2014 OWNER'S PHONE: 4089167988 SANTA CLARA, CA 95051 PHONE NO: JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ LICENSED CONTRACTOR'S DECLARATION CONSTRUCT 2 STORY SFDWL LIVING SPACE 3426, Lic. # ATTACHED GARAGE 448 AND PORCH 458 SQ FT License Class Contractor 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: $659000 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 APN Number: 35715002.00 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 PE ISSUANCE OR UI�-- to building construction, and hereby authorize representatives of this city to enter INSPEC ION. 180 DAYS FR 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 Is 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: Date All roofs shall be inspected prior to any roofing material being installed. If a roof is Signature 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 J 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. 1 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 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and performance of the work for which this permit is issued. the Health & Safety Code, Sections 25505, 25533, and 25534. 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 Owner or authorized agent: Date: pen-nit 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 become subject to the Worker's Compensation provisions of the Labor Code, I must 1 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 L -2jd CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 o buildingC�cupertino.orp F NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS i /I i APN # L_ OWNER NAME �c� ° PHONE � ��v� f0c ?— i 6� 8" E -MAIL � �����N 9J , c STREET ADDRESS �F^ CITY, STATE, ZIP 'Sal FAX CONTACT NAME ' �. PHONE E -MAIL r9 U. —1 STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT "CHIPECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE CHITEC NGINEERNAME 1 LICENSET�UMBER !9 1 { �3 v. ( BUS. LIC # COMPANY NAME r I r l E -MAIL /' FAX p m L _2 Jam'vim` i( ►,�� G � ►VC��n$�1�1�1 U LL STREET DRESS �w CITY, STATE, ZIP �y PHONE f (1 ur DESCRIPTION OF WORK EXISTIN E PROPOS);D USE CON [Cn� TYPE # STORIES "Z- USE TYPE OCC. SQ.FT. VALUATION (S) YYYYY EXIST G AREA �;7 / NEW FLOOR AREA �7 raj_ DEMO AREA 1. bl 1✓ l v'OTHER TOTAL NET AREA , y V / �t� J_ /� �1 6 l GO 6 BATHROOM" REMODEL ARE AREA REMODEL AREA IQD� PORCyyH --AREA 411 6 *DE ALDECK/PORCH AREA G ARAGE ARfA: ❑ DD ACH ACH c l �1i. DR'ELLING UND UNIT ❑YES SECOND STORY ❑YES DED? VJ.-J A 0 ADDITION? NO n PRE-'APPLICATION RrYES IF YES, PROVIDE COPY OF PLANNING APPL# EJNO P AL LETTER IS THE BLDG AN ❑ YES EICHLERHOME? NO RECEIVE B ' { '. { ' TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent tact 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 col7stiu ion. I authorize representatives of Cupertino to enter the above- identified property for inspection purposes. f Date: SignatureofApplicant/Agent: �� / �— SUPPLEMENTAL INFORR4ATION REQUIRED �,c`BECKT��E Rozixrncstir ,,. New SFD or Multifamily dwellings: Apply for demolition permit for AN existing building(s). Demolition pen-nit is required prior to issuance of building OVER TxE couI�TER _ BUILDII\GPI xEVIEw r x permit for new building. ©EaPixi ss ;xrPLAI.1\INCPLAi1RE «w Commercial Bldgs: Provide a completed Hazardous Materials Disclosure siADARD' n LlcwoRxs r� ryF^ , _ form if any Hazardous Materials are being used as part of this project. TARGET DEPT ., ti Copy of Planning Approval Letter or Meeting with Planning prior to 0 DISTRICT _ submittal of Building Permit application, D4A70R N Z v A1\ Y SEWER s y 6. NTAL.HEADTH 3,EI��'I.RON111 BldgApp_201 1. doc revised 06/21/11 �)2 CITY OF CUPERTINO FFF, ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 21918 Lomita Ave DATE: 05/16/2014 REVIEWED BY: Mendez PC FEE ID APN: , BP #: 5_ 1 C) `3 VALUATION: 1$659,000 II- B,111- B,IV,V -B PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY USE: SFD or Duplex 2nd Unit? Yes D No PENTAMATION 1 R3SFDW PERMIT TYPE: i WORK construct 2 story sfdwl living space 3426 attached garage 448 and porch 458 sq ft SCOPE 0,0 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (s.f. PC FEES PC FEE ID BP FEES BP FEE ID R -3 (Custom) II- B,111- B,IV,V -B 3,847 $3,157.14 1R3PLNCK $3,340.36 1R3INSP Permit Fee: $3,340.36 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tam: IBCONSTAXR 1 new # units $ 659.99 0 Work Without Permit? 0 Yes Q No $0.00 TOTALS: 3,847 $3,157 14 Travel 1.)ri4 rt;nf 7atrxl /c ry Fees: $3,340 36 Strom Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School 1..,..,.11 s1,., nv"1. *_,i., , i.,farn,ndmi avaitahla and arH only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eft: 71%1,`13) FEE I'ltart ,`heck 11h,,mb, Phin C Fc ul, Ei, ?4- ..[,hv,t. Check i ech 'er .r f'lc7mf. Pernir Fee. Flec. t t >.7'7;'tlF Fee, . }S11P7i �6C1 1Y7. =-LA r llho b %P3 %7jPs (:lEG IFS 70!17, i4est, h sp. Fee: 11,q). Fee: 1.76"c'. Ipmp. Fee NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School 1..,..,.11 s1,., nv"1. *_,i., , i.,farn,ndmi avaitahla and arH only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11 -053 Eft: 71%1,`13) FEE QTY /FEE MISC ITEMS Plan Check Fee: $3,157.14 Select a Mise Bldg /Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $3,340.36 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tam: IBCONSTAXR 1 new # units $ 659.99 0 Work Without Permit? 0 Yes Q No $0.00 Advanced Plannintr .Fee: 1PLLONGR $538.58 Select a Non - Residential G Building or Structure 0 Travel 1.)ri4 rt;nf 7atrxl /c ry Fees: Strom Motion Fee: IBSEISMICR $65.90 Select an Administrative Item $0.00 �'�:rr TOTAL FEE $7,788.97 Bldg Stds Commission Fee: 1BCBSC SUBTOTALS , $27.00 $7,788.97 Revised: 04/01/2014 L CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 21918 LOMITA AVE I CONTRACTOR: JUNRE ZHENG I PERMIT NO: 14050103 1 OWNER'S NAME: JUNJIE ZHENG 1 161 MUIR AVE I DATE ISSUED: 08/29/2014 I OWNER'S PHONE: 4089167988 SANTA CLARA, CA 95051 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CONSTRUCT 2 STORY SFDWL LIVING SPACE 3426, License Class Lic. 4 ATTACHED GARAGE 448 AND PORCH 458 SQ FT REV # 1 - REVISE SIZE OF WINDOWS (5 TOTAL, NON - Contractor Date STRUCTURAL) — ISSUED 1/2/15 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. 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. 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. Signature Date �- OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of 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) I, 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 pennit 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. Signature Date % — 7 'Z�3�/ Sq. Ft Floor Area: 1 Valuation: $659000 APN Number: 35715002.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS F T CALLED INSPECTION. Date: Ti S I--- 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 Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) 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 I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Profess Ch k CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 1? +CUPEtiTtNO (408) 777 -3228 • FAX (408) 777 -3333 • build inga)cugertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 1 `, I APN # ✓ �� ' �7 OWNER NAME PHONE �! J i E MAILL� /✓���1 /�G� STREET ADDRESS r CITY, STATE, ZIP FAX CONTACT NAME PHONE E - MAIL P _L41 STREET ADDRESS CITY, STATE, ZIP FAX OWNER OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE HI CT/ENGINEER NAME LICENSE NUMBER _- � BUS. LIC # COMPANY NAME ` E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE , r y DESCRIPTION OF WORK 1 I ti19 'r-a t om- ice% ,. J �, ax) 1=r spa. EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES l� ? — j USE TYPE SQ.FT. VALUATION ($) EXISTG / NEW FLOOR D /EMO POTM'HER TOTAL / 7 AREA / �� }' AREA ?C� �'- AREA 7. NET AREAi1, 12t �` 7G� c/ zlb BATHROOM KKITCHEN !i ) i !� v LLL��/ REMODEL AREA ; REMODEL AREA ELAREA t: PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑ DETACH - �t � #DWELLING UNITS: I IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? Ej..NO ADDITION? ❑ NO PRE - APPLICATIO I'�ES IF YES, PROVIDE COPY OF IS THE BLDG AN [] YES a RECENED BY ;� ,� �' TONAL VALUATION: PLANNING APPL # FNO PLANNING APPROVAL LETTER EICHLERHOME? ❑NO 0 0 K By my signature below, I certify to each of the following: I am the property owner or authorized agent to act 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 authorize representatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED "3 Q .. PLAN ROUTING New SFD or Multifamily dwellings: Apply for demolition permit for ❑ ovER zxE COUNTER l� BUII DING PLAN3REVIEw existing building(s). Demolition permit is required prior to issuance of buildingv' S permit for new building.f E YPRE3 � �� Q PLANN N GPLA IgREInEWr Y y, M � � k �`2 _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDATtDy` 4, 12, rusLlc��4RKS form if any Hazardous Materials are being used as part of this project. fr�t ®a L�AGE ri w FIR£ DEPTH P _Copy of Planning Approval Letter or Meeting with Plan ning prior to�� s x A* submittal of Building Permit application. I,7A5oxk sAi\rrARX SEtSERDISTRIcT d �> n tea..��� s _ #„ u , 0' ' , 'VI o x mx ,TAI'. HEALTI� Vii''. BldgApp 2011.doc revised 06121111 5 C� CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 21918 LOMITA AVE DATE: 01/02/2015 REVIEWED BY: MELISSA APN: 375 08 021 BP #: 14050103 "VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: p PERMIT TYPE: WORK REV # 1 - REVISE SIZE OF WINDOWS 5 TOTAL NON - STRUCTURAL - ISSUED 1/2/15 SCOPE ?Yf e.ch.bap. 1'* 1. 'C othei Plw# "b Ph."wi. 1`al -a 1`cc ri /fit.. .f'ei'rsait �`4'. G•. NOTE: This estimate does not inetudejees true to other Vepartntents (i.e. rtanntng, ruuLLc rrutna, l'ue, . to u.y ­_.1 �cu•. .. q "1311 ML, GLI:. ! /LGJG I L u./ G ✓u., cu v.r r.r.. • ..rr.. rr.r ». I FEE ITEMS (Fee Resolution 11 -053.E. 711113) -.. .- ... ____ -"- -_ . — FEE _ - - - - -- - -- - -- - -- - QTY/FEE - - MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 = hours $143.00 Plan Check, Hourly ISTPLVCK Suppl. PC Fee: (j) Reg. Q OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 G) Work Without Permit? 0 Yes •, No $0.00 Advanced Planning Fee: $0.00 Select a Non- Residential E) Building or Structure 0 Strong Motion Fee: $0.00 0 # $0.00 Revisions 1REvSFDwL SFDWL Bldg Stds Commission Fee_ $0.00 f ST7BOTALS $0.00 $143.00 FTOTAL FEE 3 $143.00 Revised: 10/01/2014 \ u CUPERTINO Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408 - 777 -3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: PERMIT -- OWNER'S NAME: PHONE # GENERAL CONTRACTOR: BUSINESS LICENSE # 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 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: V SUBCONTRACTOR BUSINESS NAME BUSINESS LIC(ENSE LICENSE # Cabinets & Millwork Cement Finishing L • �j -y,�� Electrical 3�� Excavation Co 3 443 a Fencing Flooring / Carpeting (A h : +ym ' l( -� 4 L fA r J Linoleum / Wood Glass Heatinj Glazing g pion Lott C (tis S S O i, M f la Insula Landscaping Lathing Masonry Paintit►g / Wallpaper Uh ; Paving, Plaste6ng Plumbing a J? p-Z Roofing Lz- Septic Tank SheetMetalXPGlt�ivP Sheet; Rock L le Yt3 (u ',` f • &i i - e Owner / Contractor Signature Date