14050143-FBuilding Department
City Of Cupertino
10300 Tone Avenue
Cupertino, CA 95014 -3255
Telephone:-408- 77J--322 8
CUP-E RTIRO Fax: 408- 777 -3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS:
SUBCONTRACTOR
Q 1^
PERMIT #
OWNER'S NAME:
k4/c?
PHONE #
GENERAL CONTRACTOR:
r e
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: J 6
Signature Date
.Please check applicable subcontractors and complete the following information:
V
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
CONSTRUCTION PERMIT APPLICATION o
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300- T -ORRE- AVENUE- •- GUPE- R- T- INO -CA- 95014 -32550
CUPERTINO (408) 777 -3228 • FAX (408) 777 -3333 • buildingna.cupertino.org
M NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 19070 MEIGGS LANE
APN# 375 -35 -051
_ Z
OWNER NAME CONNIE WANG
PHONE 650.
E-MAIL
STREET ADDRESS 1047 VERNIER PL
CITY, STATE, ZIP STANFORD CA 94305
FAX
CONTACT NAME FRANK L. HO
PHONE 408.892.5020 -7
E-MAn- FRANKLHO @yahoo.com
STREET ADDRESS 12480 Saratoga Avenue
CITY, STATE, ZIP Saratoga, CA 95070
FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT N ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAE TBD
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCIRTECT/ENGINEER NAME FRANK HO
LICENSE NUMBER C29889
BUS. LIC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS 12480 SARATOGA AVE
CITY, STATE, ZIP Saratoga CA 95070
PHONE 408.892.5020
DESCRIPTION OF WORK New 1 storg house with 4 bedrooms and 3 bathrooms. Total living area of 2142sf and 439sf
2 cars attached garage.
EXISTING USE
PROPOSED USE CONSTR
TYPE
I STORIES
SFR
SFR
VB
2
I
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
AREA
xEAG 1,249
NEW FLOOR
DEMO
1,249
TOT
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
48
48
432 ® ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
1
BEING ADDED? ®NO
ADDITION? ®NO
91
oLETTER
IS
ALU�N
PLANNING APPLO# E] NOS PLANNINGAPPROVO AL
EICHLE HOME? ® NOS
W
By my signature below, I certify to each of the following: I am the property owner or authori agent on the property er's ehalf. 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 ee to c ply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -id tified perty for inspection purposes.
Signature of Applicant/Agent: Date: S 2 ZO
SUPPLEMEN -PAL INFORMATION REQLJIRED
'
PLAN- -CHECK TYPE .
.ROOTING SLIP °
❑_ OVER -T'
❑ BUILDING PLAN REVIEW
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
'
permit for new building.
❑' EXPRESS
❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ sTANDARD . m
❑ °•PuBLic woRlcs
form if any Hazardous Materials are being used as part of this project.
° ❑ LARGE _
❑ FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
MAJOR
❑ S ANITARY SEWER DISTRICT.
submittal of Building Permit application.
- ENVIRONMENTAL'HEALTH '
BldgApp 2011.doc revised 06121111
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19070 MEIGGS LN
CONTRACTOR: GRAND NEST
PERMIT NO: 14050143
CONSTRUCTION
OWNER'S NAME: JOHN AND CONNIE WANG
13428 CHRISTINE DR
DATE ISSUED: 08/28/2014
OWNER'S PHONE: 6509430690
4
SARATOGA, CA 95070
PHONE NO: (408) 891 -8059
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E]
CONSTRUCT SINGLE STORY SFD (2043 SQ FT);
License Class (P Lic. # ?
ATTACHED
Contractor f Date
GARAGE (432 SQ FT); FRONT PORCH (48 SQ FT).
I hereby affir ha I am lice sed un er 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
Sq. Ft Floor Area:
Valuation: $300000
performance of the work for which this permit is issued.
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: 37535051.00
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 W OT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 OF 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 F 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
-
granting of this permit. Additionally, the applicant understands and will comply
a Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
`"
'
RE- ROOFS:
Signature Date ::F. ` 'd
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(x) 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
permit is issued.
Owner or authorized agent: Date:
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
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 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
DIDRESS 1- 9070- MEIGGS LN
TYPE OF
CONSTR.
ATET 05 /-23/-201A -
-RE- VIEW-- D_BY:_MEUS
AP N: 375 35 051
BP #:
*VALUATION: $300,000
*PERMIT TYPE: Building Permit
II- B,111- B,IV,V -B
PLAN CHECK TYPE:
New Construction
PRIMARY SFD or Duplex
USE: p
$2,478.00
2nd Unit? Yes • No
PENTAMATION 1 R3SFD
PERMIT TYPE: i
WORK
CONSTRUCT N SINGLE STORY SFD 2142 S.F. LIVING SPACE
439 S.F. ATTACHED GARAGE &
SCOPE
48 S.F. PORCH /DECK AREA)
1UIINSP
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s1.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R -3 (Custom)
II- B,111- B,IV,V -B
2,142
$2,817.36
IR3PLNCK.
$2,478.00
IR3INSP
U (Private Gar /Ag Bldg)
II- B,111- B,IV,V -B
439
$0.00
IUIPLNCK
$1,252.00
1UIINSP
Permit Fee:
$3,730.00
Suppl. Insp. Fee:'- Reg. 0 OT
0
hrs.
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
TOTALS:
2,581
$2,817.36
�-
$3,730.00r
#new units
,t
,e
.L.ecl7, Plan Check
1'hwlh1 Plal'l C77cek
E._lec-. Nap C hi? 4
;ble-/i. 11(!ro!il Fee:
F77gmb, Pertni1 Fee:
I " >teC. Pu'rmil l:e:
Other'I'lech, lnq.).
001er 1'lwyll) /rfsp.
Other /a$c. Insp,
Ilech. /i1S17. 1'i'C',:
PT71 ?7117. hl,$p. Fee:
JIec. !Pfy;,. Fe(":
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 vreliminary information available and are only an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 Ef. 7 11113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$2,817.36
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: ,• Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$3,730.00
Suppl. Insp. Fee:'- Reg. 0 OT
0
hrs.
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax: 1BCONST4XR
1
#new units
$659.99
A.clministlative Fee:
0
E)
Work Without Permit? 0 Yes Q No
$0.00
Advanced Planning- Fee: IPLLONGR
$361.34
Select a Non - Residential
I Building or Structure
E)
0
i
TrmW Documentation Fees:
Strong Motion Fee: 1BSEISMICR
$30.00
Select an Administrative Item
Bldg; Stds Commission Fee: 1BCBSC
$12.00
SUB TOTALS:, °
$7,610.69
$0.00
TQTAL FEE:
$7,610.69
Revised: 04/01/2014