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09040095 - PUB41, =ile Edit Actions Details Links Favorites Help Permit Information Permit Number " 09040095 Status ' v Master Number Notes Project Apply Date " 04/20/2009 Operator Permit Issue Date 05/21 /2009 Operator Certificate Issued 11 /23/2009__= Operator Certificate Type Certificate Number j r Location Information Address 10364 DEMPSTER AVE City/State/Zip'CUPERTINO —� ® 95014 31 APN 32647076.00 - Unit patg - - -- - -� Owner Entity Information patg —� Owner Name" ELANE PAO FE &J0E NG — i--------- ---- PALM Use Default Address Home 10364 DEMPSTER City/State/Zip CUPERTINO � CA 95014 _ J Permit Property Zoning 11 Applicant Contractor' Defined Fields Permit Details - --- PermitType" 1R3SFDADD 1GL SINGLE FAMILY DWELLING ADDITIO Usage Gass "All B, II/III B, IV-HT,V-B NEW AppliedValue' 80000 SQUARE FT. 245 Calculated Value 0 ®I US C-404 Type 434 ADD: RESIDENTIAL Permit Form ` AUTOPERM - PERMIT v Ownership 1 - Private *+! Project Size 1EXPRESS -EXPRESS 'ermit issued 0512112009 Inter permit status Purpose/Special Conditions ADD(245SQ)6RtmL(360)KITCHEN,DININGSN00K,ADD A/C, ELECTRIC PANEL UPGRADED 200ANP-HLHCTRICAL THRU KITCHEN a DINING RM. FILMED-2011 J[DAdd Default T _ v WOK �~ 8ack Contractors Fees Plan Reviews Inspections Print Permit I�?= Adjustments �C`yr Holds Copy Permit l� Close Permit �"' DOverrides I1�5Supplemental fields Notes l Attachments CITY OF CUPE � PERMIT BUILDING DIVISIONSION BUILDING ADDRESS: PERMIT NO- 10364 DEMPSTER AVE TBD - TO BE DETERMINED OWNER'S NAME: PERMIT L%-UF DATE PHON :A�F A CONTROL NO. ARCHrrEC'r/ENGINEF7t BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cade, and my license is in full force andeftet7. yQ 0 �_/ -7 ADD(245SQ)&RMDL(360)KITCHEN,DINING&NOOK,ADD A/C, License Class ,--�1�-- Lam. Date Contraetar ELECTRIC PANEL UPGRADED 200AMP-ELECTRICAL THRU ARCHITECTS DECLARATION I understand my plans shall be used as public records KITCHEN & DINING RM . Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which inquires a permit to conswct, alter. improve, demolbm. or repair any structure prior to its issuance, also requires thc applicant for such permit to file a signed statement Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 0 0 0 that he is exempt therefrom and the basis for the alleged exemption. Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more man five hundred dollars ($=. 32647076. 00 ❑ L as owner of the property, or my employees with wages as their sole compensation, Required Inspections will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such wort himself or through his own employers, provided that such improvements are not intended or offered for We. If, however, the building or improvement is sold within arse year of completion, the owner - builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li - cc= Law does not apply to an owner of property who builds or Improves thereon, and. who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ❑ I am exempt under See. B & P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑ I hsve and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the wort for which this permit is Issued. ❑ 1 have and will maintain Workers Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ' My Workers Compensation Insurance carrier and Policy number are: Cartier: Sid 7T- q; C2 Policy No.: SS'" 3 9 %-t- le CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This secdon need not bo completed if the permit is for ane hundred dollars (S I00) or less.) 1 certify that in the performance of the work for which this permit is issued. 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. i CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C_) ' L.endcrs Name , 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 authorise representatives of this city to enter upon Use above -mentioned property for inspection purposes. (We) agree to sate, indemnify Lad keep harmless the City of Cupertino against liabilities. Judgments, costs and expenses which may In any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. 2-/-05 Re -roofs Type of Roof Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hanrdous material as defined by the Cupertino Municipal Code. Chapter 9-12, and the Health and Safety Code, Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑ Yes If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants fined by the Bay Area Air Quality Management all new materials for inspection. District? ❑ Yes Nu I have mad the bazardous materials mquvcmcnts under Chapter &95 of the Califor- nia Hcalm & Safety Code. Sections 25505, 25533 and 25534.1 understand that if the building Jos not currently have a tenant, mat it is my responsibility to notify the occupant of the requirements which most bF met prior to issuance of a Cerifiam of occupancy. Signature of Applicant Date 5 All roof coverings to be Class 'A" or better I Owner Date J or authorimd agent . aCITY0 CUPEKrINO CITY OF CUPERTINO ADDITION/REMODEL PERMIT APPLICATION FORM APN # 3 Zb - 4e 7— 0 7L.4 /.4 Q Date: — — 0 Building Address: / D 3 6 � h� e� Mailing Address (if different from building address): Owner's Name: Clet'N� �a v � �Tde �piK I Phone # � -2f 2 - d 7 8� Contractor: ¢� Phone #: Fax #: Contractor License #: 13 Cupertino Business License #: Contact: , p 1 ? (-° " Phone #: Fax #:�� L� - 3 Building Permit Info: Bldg. Elect. Plumb. Mech. Hillside ❑ Job Description: Addition -What is being added?(Be Specific): xiYC�aw tv j c ` What is being remodeled (not including addition)?� c� Remodel Includes Re -Roof: Yes No If yes list number of squares Remodel Includes Structural: Yes No Do you have the pre -application planning approval? Yes ❑ No If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: 2 !tf— Porch: Deck: Garage: Detached Attached 0 Remodel: Kitchen :Flo Bath Other Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V-B Valuation: �d► v�o d Please check this box if the project is a Project Size: Express Standard Lar e ❑ Major ❑ second -story addition ❑ Please complete releva t portion of the Green Building Checklist & attach it to the application or if applicable, Green Building Points Achieved: (02 include in plan set & the sheet index. ***For Office Use Only*** Over -the -Counter ❑ Revised 01/07/09