13060002 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19368 SAKURA WAY CONTRACTOR:WOWTRENDS PERMIT NO:13060002
OWNER'S NAME: YIXIN LI 961 CAROLA AVE DATE ISSUED:06/05/2013
OWNER'S PHONE: 4084828437 SAN JOSE,CA 95130 PHONE NO:(408)4644795
El LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ElCOMMERCIALF1
License Class Lic.# 3Z RELOCATE&REMODEL KITCHEN,REMODEL(E)
o MASTER BATH,CREATE(N)ENTRY FROM GARAGE
Contractor Date TO LAUNDRY RM.UPGRADE 100AMP TO
I hereby affirm that I am licensed under the provision of Ch ter 9 200AMP PANEL,SAME LOCATION.ADD
(commencing with Section 7000)of Division 3 of the Business&Professions REV#1-ADD HALL BATH REMODEL TO(E)PERMIT-ISSUED
Code and that my license is in full force and effect. 10/24/2013
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:$20000
ave 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:37503018.00 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 D�LASXCALLED
T. T 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 DA Y�,S R� 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 qL3
granting of this permit. Additionally,the a licant understands and will complyJ.I06ed b • Date:
with all non-poin ource regulations per Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signa tu Date J ® 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 anagement District I
performance of the work for which this permit is issued. will maintain compliance with the Cupe no Municipal ode,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti ,25533,and 534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen Date:tv 1�,all
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 rTRUCTION 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 re 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
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19368 SAKURA WAY CONTRACTOR:WOWTRENDS PERMIT NO:13060002
OWNER'S NAME: YIXIN LI 961 CAROLA AVE DATE ISSUED:06/05/2013
OWNER'S PHONE: 4084828437 SAN JOSE,CA 95130 PHONE NO:(408)464-4795
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL F1 COMMERCIALO
License Class_ Lic.# .�/ RELOCATE&REMODEL KITCHEN,REMODEL(E)
/ MASTER
Contractor Date BATH,CREATE(N)ENTRY FROM GARAGE TO LAUNDRY
I hereby affirm that I am licensed under the provision of C apter 9 RM.
(commencing with Section 7000)of Division 3 of the Business&Professions UPGRADE 100AMP TO 200AMP PANEL,SAME LOCATION.
Code and that my license is in full force and effect. ADD
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:$20000
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:37503018.00 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 WITHINO 0 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 M 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
granting of this permit. Additionally,the applicant nderstands and will comply Issued by: Date:
with all non-point source re ations per the Cup e ino Municipal Co e,Se tion
9.18. 1
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)
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. 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 M nagement District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal o e,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectis 5,25533,and 25 4.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized age Date:4. 4�,,
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
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 19368 SAKURA WAY DATE: 06/03/2013 REVIEWED BY: MELISSA
APN: 375 03 018 BP#: 0/ 0 009 *VALUATION: 1$20,000
xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM
USE: p PERMIT TYPE: A
WORK RELOCATE & REMODEL KITCHEN REMODEL E MASTER BATH CREATE N ENTRY FROM
SCOPE GARAGE TO LAUNDRY RM. UPGRADE 100AMP TO 200AMP PANEL, SAME LOCATION.ADD 2 (f�
,LTech_Plan Check plzw7b. Nun 0?ecti Elec.Plan Check 0.0 hrs $0.00
1 tc=clz.Pcrrnii Fee: Fee: Elec.Permit Fee: 1EPERMT
her.Liecis.Insp. C)t 5er Pizmzt Insp. Other Elec.Insp. 0.0 hrs t $45.00
'Wech.,nsp_P'ee: Plumb. hrsp. Fee: Ekc.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etG). Theseees are based on the relimina information available and are onlyan estimate. Contact the Det or addn'1 in o.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/121 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 100 s.f. Remodel,Kitchen(<=300 sf)
Suppl.PC Fee: E) Reg. () OT 0.0 1 hrs $0.00 $600.00 1REMRESK7
PME Plan Check: $0.00 100 J s.£ Remodel,Bath(<=300 sf)
Permit Fee: $0.00 $600.00 1REMRESBAT
Suppl.Insp.Fee:Q Reg. OT 0.0 hrs $0.00 = # Skylight
PME Unit Fee: $0.00 $800.00 1SKPL<10SF I <= 10 s.f.
PME Permit Fee: $45.00 200 amps Electrical
--]
C01-.so7ictio:7 Tax: $45.00 IBELEC200 Services
Administrative Fee: IADMIIV $42.00 .300 j s.£ Remodel, Other 0
Work Without Permit? 0 Yes (j) No $0.00 $400.00 1REMRESOTII E)
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Travel Documentation Fee: ITRAVDOC $45.00 Building or Structure 0
Strong Motion Fee: IBSEISMICR $2.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $135.00 $2,445.00 TOTAL FEE: $2,580.00
Revised: 04/29/2013