13070153 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20087 SOMERSET DR CONTRACTOR:ROY CHEUNG'S PERMIT NO:13070153
CONSTRUCTION COMPANY
OWNER'S NAME: BACHTEL ARTHUR R AND ELIZABETH 3616 CARICK PLACE WAY DATE ISSUED:07/24/2013
OWNER'S PHONE: SAN JOSE,CA 95121 PHONE NO:(408)489-5988
L�1" LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL EI
License Class — Lic.#
G�j `j REPLACE 8(E)WINDOWS(ONE TO BE(1)BAY WINDOW)
Contractor f ADate
ID°`' 2(E)PATIO DOORS.INSTALL(N)DESIGNATED GAS LINE
I hereby affirm that I am licensed under the provisions of Chapter 9 FOR STOVE/OVEN
(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:$8800
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:36930001.00 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 DAYS OF PF 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 DAYS FR. � 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 the
granting of this permit. Additionally,the applicant understands and will comply Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature � Date / ' j All roofs shall be inspected prior to any roofing material being installed.If a roof is
r installed without fust 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
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 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 5505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date-7-
permit
ate: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
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(See.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 Ix
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•building W-cupertino.orq
[:1 NEW CONSTRUCTION ❑ ADDITION O ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS �- 0 0 I
APN#
OWNERNAME
cr CG` FAX
7ao�� GC`1( �l.l 1 J
CONTACT NAME _ PHO �f.a -57q-60(861
5 r 6 0l^6 FJ(J E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME ,/��y( l•f LICENSENUMBER mG� 2 LICENSE T PErO BUS.LIC h!
COMPANY NAME E-MAIL 1'i' GGJLI FAX
STREET CTfY,S
K. L�Z sm\l •�
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`�e 5I�i
ARCHITECT/ENGINEER NAME LICENSE NUMBER J BUS.LIC#
COMPANY NAME E-MAI, FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
�,I s hI 170GS f4
1'NSTAi L
EXISTINGUSE PROPOSED USE CONSTR TYPE I #STORIES
USE TYPE OCC, SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGE AREA: DETACH
[]ATTACH
#DWELLING UNITS: IS A SECOND UNIT []YES SECONDSTORY El YES
BEING ADDED? []NO ADDITION? ❑NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RE TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? F]No
S oc
By my signature below,I certify to each of the following: I am the property owner or authoriz en o act on the perry owner's behalf. 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 agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: [
SUPPLEMENTAL INFO TION UIRED PLAN CHECK TYPE ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for OVER-THE-COUNTER UILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS LANININCPLANREVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS
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
submittal of Building Permit application. ❑ MA.rox ❑ SANITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
Bldg4pp_201 Ldoe revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
:1.aJADIDRESS: 20087 SOMERSET DR DATE: 07/24/2013 REVIEWED BY: MELISSA
PN: 369 30 001 BP#: VALUATION: 1$8,800
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: p PERMIT TYPE: i
WORK REPLACE 8 E WINDOWS ONE TO BEN BAY WINDOW) &2 E PATIO DOORS. INSTALL N
SCOPE DESIGNATED GAS LINE FOR STOVE/OVEN
kfech.Pion Check Plumb.Plan Check 0.0 hrs $0.00 Elec.flan Check
Meeh. Permit Fee: Plumb.Permit Fee: IPPERMIT E(ec. Permit Fee:
L
,Wech.Insp. Other Plumb Insp. 0.0hrs $47.00 Other Elea.Insp.
_, p.Fae: phanh. h�sv. hc>e: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7ff 11112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 10 # Window/Sliding Glass Door
Suppl.PC Fee: E) Reg. Q OT0.0 hrs $0.00 $557.00 197NREP Replacement
PME Plan Check: $0.00 = # Plumbing
Permit Fee: $0.00 $70.00 IPGASRES Piping,Gas<=4 Outlets
Suppl.Insp.Fee:Q Reg. ® OT0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $47.00
C a,-7St,z!CtiGn Tctr:
Administrative Fee: IADMz1V $44.00 0
Work Without Permit? 0 Yes E) No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Fee: ITRAVDOC $47.00 Building or Structure 0
i
Strong Motion Fee: 1BSEIS1ffCR $0.88 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: s139.881 $627.00 TOTAL FEE-T $766.88
Revised: 07/01/2013
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
CUPERTINTelephone: 408-777-3228
® Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR
JOB ADDRESS: O S- PERMIT# 1
OWNER'S NAME: N(* g pP T V , Cl PHONE# '
GENERAL CONTRACTOR: RolC4z-u&X7BUSINESS LI ENSE#
ADDRESS: ( C , ( s 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: t
S" nature 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
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2cO87 56 k E-RsET 1)9., cup&eTlr�(o, CA 450(4
SCALE: APPROVED BY: DRAWN BY
DATE: REVISED
`Olt;45-3
DRAWING NUMBER