15050134 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11525 SUNSET SPRING CT CONTRACTOR:FIVE STAR WINDOWS PERMIT NO:15050134
OWNER'S NAME: HO YU-LAM AND YEN-PING L 1450 DELL AVE STE C DATE ISSUED:05/21/2015
OWNER'S PHONE: 4082539433 CAMPBELL,CA 95008 PHONE NO:(408)370-3331
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL
ii REMOVE AND REPLACE(18)WINDOWS AND(1)SLIDING
License Class 1 c�1 Lie.#��j'Q�2,,[R�� DOOR.
Contract oy2rc1R `A�1�1(.ClilfJDate
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:$23400
AxZ--d 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:36652020 00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
c at 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 WITfIIN 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 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ''����--��/ �1 �7
costs,and expenses which may accrue against said City in consequence of the Issued by: .e'L�CJL� r!� Date: �
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
918.
/� RE-ROOFS:
Signatu Date� ( 1 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 255 5,25533,and
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age Date: t I J
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.
Signature Date
1��013 �
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
GURERTINO (408)777-3228• FAX(408)777-3333•building acupertino.org
❑NEW CONSTRUCTION ❑ ADDITION TERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT;#
PROJECT ADDRESS APN# 34:
OWNER NAME PHONE go � E-MAIL
STREET ADDRESS CITY STATE,ZIP FAX
CONT CT NAME G. PHONE E-MAIL
SIRE ADDRES L' ^ CITE,ST(r� " e�L� � FAX
JW ���L qa,4
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT XCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGD.TEER ❑ DEVELOPER ❑TENANT
CO CTOR NAM-Er LIC ENS ( S T BBA , rJ
USS"L.ICC#
E-MAIL1
N \ 1 G MAIL \ �l V V -70.'
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
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 KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKIPORCH AREA I GARAGE AREA: DETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNrr ❑YES SECOND STORY []YES
BEING ADDED? ❑NO ADDITION? []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES `REGEVED` TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? []NO
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 haveead this
application and the information I have provided is c rrect. I have read the Desc'ption of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relati o ilding const tion. I authorize represe atives of Cupertino to enter the above-' entifi d property for inspection purposes.
Signature of Applicant/Agent: Date:
^_
SUPPLEMENTAL INFORMATYON ErzE
�ROiriII�GSLIP ze
x; N'O
New SFD or Multifamily dwellings: Apply for demolition permit for ���
VERT
existing building(s). Demolition permit is required prior to issuance of buiOUhTER43 € � U¢DINGPLAPTREVIEwlding �` g `l
permit for new building. ® � s Pin19I�INGP%AivvlEw
04$ vnpw
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure AINDAT3D - � Cl uBLtc wouuc };
form if any Hazardous Materials are being used as part of this project. � � yYs
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. s- R � STLARY-MERERISTRr
x` 4 MRO.NMEPITAT#IEALTHc-�'___�,__
BldgApp_201 1.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 11525 Sunset Spring Ct DATE: 05/21/2015 REVIEWED BY: Sean
APN: BP#: "VALUATION: 1$23,400
OPERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION 1 GENRES
USE: SFD or Duplex PERMIT TYPE:
WORK Remove and Replace 18 windows and 1 sliding door.
SCOPE
F777
x va
5; ri
y 6LWA
Ah,ch. flan(heck Pharrih.Ilan Check F Iec.Plain Check
Mech. Permit Fee: Plumb. I'errnir here: Elec. Permit Fee
t)rher Hech Insr. Other Plumb Insp. Oiher-Eiec.Insp.
Li
;Irtech hasp.Fee: Plumb. Insp. Fee: L'lec.Insp"Fee:
NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the prelimina information available and are onl an estimate. Contact the Dept for addn'l info,
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 F 19 # Window/Sliding Glass Door
Suppl. PC Fee: (F) Reg. OOT 0.0hrs $0.00 $717.00 1 WINREP Replacement
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-.0 Reg. O OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction fax:
Administrative Fee:
Work Without Permit? ® Yes O No $0.00 O
Advanced Planning Fee: $0.00 Select a Non-Residential O
Building or Structure O
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICR $3.04 Select an Administrative Item
Bldy-Stds Commission Fee: 1BCBSC $1.00
.77,;77"'.3"' $4.04 $717.00 �,>f AL FEE:m'' $721.04
Revised: 05/07/2015
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MAY 21 2015
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COMMUNITY DEVELOPMENT DEPARTMENT
QP BUILDING D!`,IlSio: j - CUPERTINO ��� ti ,&, OL0S :e�.
ot2x�lC�'> APPROVED - -- - ��t,��� -,,0
s t of plans ard specifications t,,1UST be kept at the
abr si e during ccr, ;ruction. Itis unla.tif l to make any
�n�� chM s or alterations on same, or to deviate
S3X2�( therefrom,without approval from the Builth = iGj �� �c� ��� L k� Z
_ The Stamping of this plan and specifications SHALL NOT t X13
be held to permit or to be an approval of the violation
of any provisions of any City Ordinance r State Law. V
BY
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PERMI1 115
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