11080131CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20699 RODRIGUES AVE
CONTRACTOR: AC LIU CONSTRUCTION,
PERMIT NO: 11080131
INC
OWNER'S NAME: AC & D LIU INVESTMENTS LLC
1585 WESSEX AVE
DATE ISSUED: 02/28/2012
OWNER'S PHONE: 6504920857
LOS ALTOS, CA 94024
PHONE NO: (650) 492-0857
LICENSED CONTRACTOR'S DECLARATION
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I
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BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. k
MECH � RESIDENTIAL I—COMMERCIAL�
II __
Contractor f�C.. 1-'u G�SlY+cefii,.� ��Date e�—
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: NEW SFDWL WITH PORCH(4,225 SQFT)AND ATTACHED
(commencing with Section 7000) of Division 3 of the Business & Professions
GARAGE (441 SQFT) TOTAL 4,666 SQFT.
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.
I have and will maintain Worker's Compensation Insurance, as provided for by
Sq. Ft Floor Area:
Valuation: $600000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 35910057.00
Occupancy Type:
APPLICANT CERTIFICATION
l 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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point source regulations per the Cupertino Municipal Code, Section
9. l 8.
�_�/ --�
Signature `"'`�`� Date
Issued by: Date:
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. if a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
I, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, l shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Health & Safety Code, Sections 25505, 25533, and 25534.
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
Owner
forthwith comply with such provisions or this permit shall be deemed revoked.
Date:
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
l hereby affirm that there is a construction lending agency for the performance of work's
correct. l agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnity and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
�� CITY OF CUPERTINO
I -MI FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 20699 RODRIGUES
DATE: 08/17/2011
REVIEWED BY: SUEW.BS
APN: 359-10-057
BP#: 11080131
*VALUATION: 1$600,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: New Construction
PRIMARY
USE: SFD or Duplex
2nd Unit? Yes No
PENTAMATION
PERMIT TYPE: 1 R3SFD ;
WORK
NEW 2 STORY HOUSE W/PORCH 4 225' AND ATTACHED GARAGE 441' = 4,666 SQFT
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,III-B,IV,V-B
4,666
$3,033.35
IR3PLNCK
$3,569.85
IR3INSP
TOTALS:
4,666
$3,033.35
$3,569.85
Ll _L__
NOTE: These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$3,033.35
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$3,569.85
Suppl. Insp. Feed Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Constr. Tax: 1BC0NSTAXR
1
a unneitsw
$579.61
Acoustical Fee: 0 Yes 0 No
$0.00
0
Work Without Permit? 0 Yes E) No
$0.00
Planning Fee: PLLONGRNGR
$606.58
Select a Non -Residential
Building or Structure
E)
0
Irrrtlllnrr rr�;tN,. ; +r
Strong- Motion Fee: IBSEISMICR
$60.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$24.00
SUBTOTALS:
$7,873.39
$0.00
TOTAL FEE:
7$7,873.39
Revised: 07/04/2011
FM-7
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 20699 RODRIGLIES AVE
DATE:
REVIEWED BY:
APN:
BP#:
*VALUATION: 1$600,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: New Construction
PRIMARY SFD or Duplex
USE:
nd Unit? , Yes No
P
PENTAMATION 1 R3SFDW
PERMIT TYPE:
WORK
NEW SINGLE FAMILY DWELLING W/ATTACHED GARAGE=—C99-a- Or
SCOPE
a _
WA
OCCUPANCY TYPE:
TYPE OF
CONSTR
FLR AREA
s.f.
P FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,III-B,IV,V-B
'Ara�
$3,012.20
1R3PLNCK
$3,403.20
1R31NSP
TOTALS:
4,380
$3,012.20
$3,403.20
Li I
I
NOTE. These fees are based on the Dreliminary informatio'navailable and ar only an estimate. Contact the Dent for addn7 info.
FEE ITEMS (Fee Resolution 11-053 E . 711111)
FEE
Q EE
I MISC ITEMS
Plan Check Fee:
$3,012.2
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
00
PME Plan Check:
Permit Fee:
$3,403.20
Suppl. Insp. Fee:O Reg. 0 OT
I 0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Constr. Tax: IBCO TAXR
new
units
$579.61
Acoustical Fee: 0 Yes 0 No
$0.00
0
0
Work Without Pe it? 0 Yes 0 No
$0.00
Plannin Fee: PLLONGRNGR
$569.40
Select a Non -Residents
Building or St cture
0
0
i
Strong Motion Fee: IBSEISMICR
$60.00
Select an Administrative Itenl
\�.
Bldg Stds Commission Fee: 1BCBSC
$24.00
SUBTOTALS:
$7,648.41
1 $0.00
TOTAL FEE:
1 $7,648.41
Revised: 07/04/2011