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14030165 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10385 NORWICH AVE CONTRACTOR:CHEN'S CONSTRUCTION PERMIT NO: 14030165 CO OWNER'S NAME: GREGORY KWOK 1271 WASHINGTON AVE#48 DATE ISSUED:05/09/2014 OWNER'S PHONE: 4088329045 SAN LEANDRO,CA 94577 PHONE NO:(510)639-0853 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL �j s� ADDITION OF 237 S.F. TO ENLARGE(E)LIVING RM& License Class Lic.#4 � � FAMILY RM Contractor t 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:$25000 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:31629079.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 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 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 L ALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of theV/ granting of this permit. Additionally,the applicant understands and will comply a by: S with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. /� RE-ROOFS: Signature �4�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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,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) 1,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. 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 l 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 , f 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 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE^CUPERTINO, CA 95014-3255 CIJPERTINO (408)777-3228^ FAX(408)777-3333 - buildingQcupertino.org [:1 NEW CONSTRUCTION ® ADDITION El ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS o m.r ®� �v` APN# 316`29-o_79 t/ `7 9-o_79 OWNERNAME7 PHONE E-MAIL STREET ADDRESS ® ® CITY, S16,TE,ZIP77 CONTACT NAME e� PHONE s ^-/e - E-MAIL 0.+ Off` , �j n STREET ADDRESS s67 I o tsrr111 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 ARCHITECT/ENGINEER NAME � LICENSE NUMBER i �^ BUS.LIC# L" COMPANY NAME ♦10 1 E-MAIL - 1 FAX STREET ADDRESS 1 O ,o(�� fl 1'l 11-2 (4 C La_n M CITY,STATE,ZIP 0 PHON _(-7 it I ffa 4zo DESCRIPTION OF WORK a C EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXLSTG ��rrr+++ NEW FLOOR DEMO ,,/ TOTAL �y AREA`S j��5 AREA �-y AREA (/I OTHER NEI-AREA/of ? Z69. BATHROOM KITCHEN OTHER REMODEL Cr a•, REMODEL AREA IPY REMODEL AREA 8/ri/rf REMODEL AREA PORCH AREA DECK AREATOTAL DECK/PORCH A GARAGE AREA: DETACH ♦ ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY 'LJ YES BEING ADDED? ?L� 2 ADDITION? 1NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN JJ-171 YESRECEIVED BY: T AL VAL ATION: PLANNINGAPPL# KZ? PLANNING APPROVAL LETTER EICHLERHOME? rf$',N0 - YE By my signature below,I certify to each o e Ing: I am the p erty owner or authorized agent to act on the property owner's behalf. I have read this application and the information I ha a pr vied is c rrect. I have re the Description of Work and verify it is accurate. I agree to compI with all applicable local ordinances and state laws relating to u'di g const ction. I aut a representatives of Cupertino to enter the above-identified property or inspection purposes. Signature of Applicant/Agent ate: S - SUPPLEMENTALP INFORMATION REQUIRED PLAN CHECK TYPE RoteTING SLIP ' New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑'BUILDING PLAN REVIEW- 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 'I ❑ PUBLIC'wORKs ' form if any Hazardous Materials are being used as part of this project. ❑ 'inliGE` ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to i,iAJoR ❑'SANITARY sEwERDISTxrcT: ` submittal of Building Permit application. v ❑.ENVIRONMENTAL HEALTH - BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION ADDRESS: 10385 NORWICH AVE DATE: 03/27/2014 REVIEWED BY: MELISSA APN: 316 29 079 BP#: �' 3 Q *VALUATION: 1$25,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex 2nd Unit? Yes No PENTAMATION 1 R3SFDADD USE. OTC? ®Yes (DNo PERMIT TYPE: IWORK ADDITION OF 237 S.F. TO ENLARGE E LIVING RM & FAMILY RM SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. R-3 (Custom) II-B,111-B,1V,V-B 237 $1,059.00 IADDPLCK $1,026.00 IADDIPISP TOTALS: 237 $1,059.00 $1,026.00 MECH,HOURLY Yes 0 No PLUMB,HOURLY Q Yes (2) No ELEC,HOURLY 0 Yes (F)No 'C,/I Orw 0'e Phan/, Null C;rr.cl Ehc:. Plait Ch�x'k q.fr,,.lr Prnr1 Fc', Pt wt k Pernv!FCC: lifer. Ptrnrii Fe': )lbr .tire r7. Jrrn Olhvr Phirnh Inrt,. 011'RT EICC.1IMI), Phrnih- Inv;rl. Fair, F.,"lee.Insp. Fee. NOTE: This estimate does not include fees due to other Departments(i.e.Planning, Public Works, Fire,Sanitary Sewer District,School District,eta2. Thesefees are based on the Erelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution I1-053 Eff 7i1,1131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,059.00 Select a Misc Bldg/Structure Suppl. PC Feer Reg. ® OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0"00 Permit Fee: $1,026.00 Suppl. Insp. Fee:Q Reg. ® OT 10.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Lo;iRtrilclion _t'ax.- Work Without Permit? 0 Yes (D No $0.00 E) Advanced Planning Fee: IPLLONGR $33.18 Select a Non-Residential 0 Building or Structure Strong Motion Fee: IBSEISMICR $2.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 1177 - SUBTOTALS: 1 $2,121.681 $0.00 TOTAL FEE: 1 $2,121.68 Revised: 01/15/2014 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 (CONTRACTOR SUBCONTRACTOR ILRST JOB ADDRESS: t®g Or/x's-'I a, PERMIT# lVo3 oto OWNER'S NAME: PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipa Bode- realuirehes a busllnes'ses working in tCity ® have a City of Cupertino business license. NO BUILDING FINAL (DR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS AVE OED A CITE' OF CUIPIERTINO BUSINESS LICENSE. I am not using any subcontractors: It� ugnat c 6atef ?lease check appRicable subcontractors and complete the following infformation: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood W zz Glass / Glazing ZZ Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date