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13010075CITY OF CUP Elly' INO BUILDING PERMIT BUILDING ADDRESS: 22560 ALCALDE RD CONTRACTOR: LNB CONSTRUCTION, PERMIT NO: 13010075 INC OWNER'S NAME: TRACEY & RICHARD MENG 861 SEQUOIA AVE DATE ISSUED: 02/04/2013 OWNER'S PHONE: 4084258559 MILLBRAE, CA 94030 PHONE NO: (415)585-3884 LICENSED CONTRACTOR'S DECLARATION 90B DESCRIPTION: RESIDENTIAL COIi MERCIALE] License Class .. Lic. # � CONVERT EXISTING BALCONY S?ACIE TO DINING AREA Date AND Contractor i�Jf`� %l BEDROOM OOM 217 SQ FT 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. 1 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: $35000 performance of the work for which this permit is issued. 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: 34216146.00 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 WI THINIli® ���� ®� PERMIT ����A�O� (DR building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 110 O S ST CALLED �NSPlEC TffON. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses w ich may accrue against said City in consequence of the L� granting of this pe t. Addition ly, the applicant understands and will comply Iss Date: with all non -points urc egula s per the Cupertino Municipal Code, Section 9.18. 2 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-BIVIDER 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. d 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 C &r no Municipal Code, Chapter 9.12 nod I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 Labor Code, for the the for which this the Health & Safety Code, Sections 53 , nd 25534. / I of the performance of work 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, 1 CONSTRUCTION LEN G AGENCY become subject to the Worker's Compensation provisions of the Labor Code, 1 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 CUPERTIMO Ccs �TF�I CTIOO� FEf�t'T APF'' CaTI© COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION 10300 TORRE AVENUE o CUPERTINO, CA 95014-3255 (408) 777-3228 o FAX (408) 777-3333 o buildin-g a.cuaertina.org ❑ NEW CONSTRUCTION ADDITION ❑ ALTERATION /.TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT 7 !? �A>RESSAPN#AzCAZ-1)i�- KoAD PHONE4 D f�2 �S �MAI)a. Q�2 STREET ASS CITY STATE ZIP FAX _r5_2 -!do ,4 r �' CONTACT NAME PHO E E-MAIL 3 3 4 r e - gill e449 :o�4 STREET ADDRESS'76 e l% CITY, STATE, ZIP AFAX ❑ OWNER OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGINEER NAME LICENSE NUMBERBUS. 6or9 C_ S LIC # COMPANY NAME E e—CEYiR,24 �y,r FAX STREE ADD S CITY, STATE, ZIP PHONE at DESCRIPTION OF WORK l t �U Ar, NV� '1 i S`J i -i O_ Li 0. bJ `rl^D D 'rig► EXISTING US PROPOSED SE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) 7e f"I 0L4 i EXISTG NEW FLOOR DEMO TOTAL AREA 3,D, J Z AREA r y AREA NET AREA BATHROOM J REMODEL AREA �fls KITCHEN/` OTHER REMODEL AREA /y� REMODEL AREA 56 PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AAE DETACH O 'ATTACH I # DWELLINGUNITS: IS A SECOND UNIT ❑ YES SE OND STORY S BEING ADDED? t❑'AO ADDITION? [:]NO PRE -APPLICATION ff< IF YES, PROVIDE COPY OF PLANNINGAPPL# PLANNING APPROVAL LETT IS THE BLDG AN [],YES EICHLERHOME? FN 12ECEiVE Y } 41"n/ " '. TOTAJ VALUATION: ❑NG n..f,' S 5- By my signature below, I certify to each of the following: I am the property owner or authorized age to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and rify 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 id tified property for inspection purposes. Signature of ApplicanUAgent: Date: P Z D �— SUPPLEMENTAL INFORMATION REQUIRED a�� , REVIEW New SFD or.Multifamily dwellings: Apply for demolition permit for _ existing building(s). Demolition permit is required prior to issuance ofbuilding. ON R THEE-COIINT�R�B llVG PL4N y I permit for new building. ExPRESSPLA iNIN&P-1AN REWkVy Commercial. Bldgs: Provide a completed Hazardous Materials Disclosure❑11sT DARD L{] �eusLtcivoRres • _ form if any Hazardous Materials are being used as part of this project.DiaiiG w �� Copy of Planning Approval Letter or Meeting with Planning prior to t BII2E DEP DISTRICT _ germPP on. submittal ofBuildin Pit application. F `��� ���� sa � ' �°x SANTTARI SEWER a >• t: ENVIRONIKENTALHEALTA . B1dgApp_2011.doc revised 06121111 CITY OF C11 ? EII$TffNO FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 22560 ALCALDE RD DATE: 01/14/2093 iREVIDEWED 1B�Y: MENDEZ PC IFEE H) APN: 1BP#: / / 3 D�O� IL *VAUJATIION: $35,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY.. USE: . SFD or Duplex 2nd Unit? Yes o No ®7cC� �No Yes PERMII'II U'YPIE: PENII'AMATIION 1R3SFDADD f, WORK. CONVERT EXISTING BALCONY SPACE TO DINING AREA AND BEDROOM 217 SQ FT SCOPE hrs OCCUPANCY TYPE: TYPE OF CONST R. 1F1L]R AREA s.f. PC PEES PC IFEE H) BPFEES 1BP FEE.IID' R-3 (Custom) II-B,111-B,IV,V-B 217 $1,014.00 IADDPLCK $983:00 'IADDINSP Elce. Insp, Fee: 0,0 hrs $0.00 PME Unit Fee:. $0.00 ,PME. Permit Fee: $0.00 G'[�risrr7rction :T ir_r. :r�'Llln2lr7rStr'atlVe l~'Be: (° Work:Without Permit? 0 Yes C) No $0.00 Advanced Planning Feer 1PLLONGR $28.21 TOTALS: 217 $1,014.00 Strong Motion Fee: IBSEISMICR $983.00 j MEC 1i HOURLY'," Q'Yes O' No' PLUMB, HOURLY Q Ye XC, HOURLY O .Yes ONO j ;Llc:ch.. Plan Check.' Phmtb. Plan Check Elec. Plan Check Adeclr. Pc>rriti[ f"ec:Plumb. P", 'mit Fee: Elec. PerrmY lee: Other' Aleeh. Insp. Other Plumb Imp. Other Elec, Insp.LLJ Dlech.'Insp. Tee: Plumb, Insp, Fee,- Elce. Insp, Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, tire, Sanitary Sewer District, School nictriri otr 1 Thoco foac aro hacod nn tho nrotiminary infarmatian avaitahto and nro anty an octimato_ t antart tho Dont far add" 'I inPn_ 9FEE ITEMS(Fee Resolution 11-053 E f 711112) ]EEE QTYIiFEE MIISC ITEMS Plan Check Fee: $1,014.00 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: $983.00 ;Suppl: Insp. Fee:O.Reg. Q OT 0,0 hrs $0.00 PME Unit Fee:. $0.00 ,PME. Permit Fee: $0.00 G'[�risrr7rction :T ir_r. :r�'Llln2lr7rStr'atlVe l~'Be: (° Work:Without Permit? 0 Yes C) No $0.00 Advanced Planning Feer 1PLLONGR $28.21 Select a Non -Residential Q Building or Structure G' T r�aiW Documentation. Fees: Strong Motion Fee: IBSEISMICR $3.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTAL: $2,030.71 $0.00 TOTAL SEE: $2,030.71 Revised: .10/0112012 C UPIERITUMO 1 111\ I I". ��( 111►I". �l li.( 111\ I I". ��( 111►I". I I` I ]f u lluling Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: Z� 8 PERMIT # O (U® OWNER'S NAME: t" PHONE # Insulation GENERAL CONTRACTOR: CqL4, i,®1J' ( SINESS LICENSE # ADDRESS: I 'U o (l- ) �. CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL DIS FINAL OCCUPANCY INS CTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONO S HAVE OBTAINEDA CIT1Y O CI. P ERTINO BUSINESS LICENSE.r I ani not using any subcontractors: ignItur Date Pllease check applicable subeuntractors and compllete th ffo llowng information: r/ SUBCONTRACTOR ]E$USENIESS N"AMIIE IBUS]lNIESS ILECIENSIE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Owner/ Contractor Signature Date ISr Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date ISr February 19, 2013 Tracey Meng MRTK Associates 21976 McClellan Ro- Cupertino, CA 950 4 Phone: (408) 393- 6, Building DepartmentN City of Cupertino 10300 Torre Avenue Cupertino, CA 95014 Subject: Special Inspection for Holdown Installation For Addition at 22560 Alcalde Road, Cupertino, CA 95014 (Permit No. 13010075) , r MRTK Associates provided a special inspection service at the subject site in accordance with section 1701 of the Uniform Building Code as listed below: Inspection of (9) 5/8"0 x 10" min. embedded all thread rod bolts installation filled with Epoxy and embedded into existing concrete for holdown placement at the locations specified in Drawing S 1. All drilled holes for receiving anchor bolts installation were cleaned of dust and debris and adequate in depth to embed into existing concrete. Based on the inspections performed and upon our substantiating reports that the inspected work was performed, to the best of our knowledge, in conformance with the approved plans and specifications and the applicable workmanship provisions of the Uniform Building Code. Sincerely, Tracey Meng, P.E. f � 7- - {` C Flo? 59