11050147 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20300 STEVENS CREEK BLVD CONTRACTOR:BAY AREA BUILDERS INC PERMIT NO: 11050147
ONVNER'S NAME: LANE PARTNERS 318 MARTIN AVE DATE ISSUED:06/22/2011
( ;R'S PHONE: 6508380100 SANTA CLARA,CA 95050 PHONE NO:(408)648-4500
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r PLUMB
License Class Lic.9 MECH r RESIDENTIAL T— COMMERCIAL
Contractor 'y ««� :'(�c f S Date C, 2
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:(APPLE)-EXTERIOR ONLY ACCESSIBILITY
REQUIREMENTS
(commencing with Section 7000)of Division 3 of the Business&Professions PER TITLE 24 CHAPTER I 1 2010
Code and that my license is in full force and effect.
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 1p
Compensation.as provided for by Section 3700 of the Labor Code,fix the
performance of the work for which this permit is issued.
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 Sq.Ft Floor Area: Valuation:$20000
permit is issued.
APPLICANT CERTIFICATION APN Number:36901019.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
w ith all non-point source regula' s er t e Cupertino Municipal Code,Section
9.18 Issued by.,
Date:
– �Z
Signature _Date
L OWNER-BUILDER DECLARATION
RE-ROOFS:
hereby affirm that 1 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:
1,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: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of die 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. 1 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&
Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this 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 1 will
I certify that in the performance of the work for which this permit is issued,I 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 Cod et• s 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 Owneror G Z�-
Date•
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct. I 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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
and expenses which may accrue against said City in consequence of the
dig of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
wnn all non-point source regulations per the Cupertino Municipal Code,Section
I understand my plans shall be used as public records.
9 18
Signature Date Licensed Professional
('s
I
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20300 STEVENS CREEK BLVD CONTRACTOR:BAY AREA BUILDERS INC PERMIT NO:11050147
i
OWNER'S NAME: LANE PARTNERS 318 MARTIN AVE DATE ISSUED:06/22/2011
i
OWNER'S PHONE: 6508380100 SANTA CLARA,CA 95050 PHONE NO:(408)648-4500
i
❑ LICENSED CONTRACTOR'S}DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
r7L �License Class Lic.# r
U t
MECH' RESIDENTIAL COMMERCIAL
Contractor a y
��,`ffICf 5 Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:(APPLE)-EXTERIOR ONLY ACCESSIBILITY
(commencing with Section 7000)of Division 3 of the Business&Professions REQUIREMENTS
Code and that my license is in full force and effect. PER TITLE 24 CHAPTER 112010
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 t
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
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$20000
permit is issued.
APPLICANT CERTIFICATION APN Number:36901019.00 Occupancy Type:
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 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 regula ions er t e Cupertino Municipal Code,Section
/.
9.18. ..®-.-_-pA�_..,._... _0.--a�nP...
Signature Date .. Z 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
1,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: HAZARDOUS MATERIALS DISCLOSURE
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 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,I 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 Cod gti s 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I �=
or m
become subject to the Worker's Compensation provisions of the Labor Code,Imust Owner - .- a te:
forthwith comply with such provisions or this permit shall be deemed revoked. Da
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of vmrk's
correct.I 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
indemnify 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. 1 understand my plans shall be used as public records.
i
Signature Date Licensed Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
(408)777-3228 - FAX(408)777-3333 -buildingacuipertino.org
C IJ P 1E Wr I N 0
El NEW CONSTRUCTION ALTERATION TI [:1 REVISION DEFERRED ORIGINAL PERMIT#
El ADDITION EM&
PROJECT ADDRESS r jt 5
OWNERNAME ' E IL
4-ri ,c r,5/4" ,
'TEEETrADDR FAX
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CONTACT NAME
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I Eyre / e 1 0,v1
STREET ADDRESS CITY,STATE ZIPFAX
IC
El OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT `�CONTRACrOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER 0 DEVELOPER ❑TENANT
7=CTORN
LICENSE NUMBER LICENSE TYKE BUS.LIC#
COMPANY NAME
FAX L/
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C
STREET ADDRESS { CITY,STATE IP PHONE
n. 5 V,
fSrNGINEE N LICENSE NUMBER -7 17 -Z
BUS.LIC
COMPANYNAMEE_ III
V FAX
STREET ADDRESS STAT ZIP PHONE
-7 0
C_ L(
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DESCRIPTION OF WORK '
-2
EXISTINGUSE PROPOSED USE CONSTR.TYPE 9STORIES z grJi OUSE 'y'
� 3
EXISTG NEW r;
W FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA
REMODEL AREA R
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA:❑ DETACH
El ATTACH
7-
..............-
7
7 a 77 77,77,77,57 77.
9 DWELLING UNITS: IS A SECOM UNIT ❑YES SECOM STORY ❑YES j�773,
BER4GADDED? EJ NO ADDrrION?
NO
PRE-APPLICATION ❑ YES IFYES,PROVIDECOPYOF PLANNER'S NAME:
PLANNNO APPL 0 ❑NO PLANNNO APPROVAL LM7n
By my signature below,I certify to each of the following: I am the property owner or authorized agent 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 verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building p0 ction-Jauthorize representatives of Cupertino to enter the above-identified property for ins tion purposes.
C-7
Signature of Applicant/Agent:anDate:
SUPPLEMENTAL INFORMATION REQUIRED
528
New SFD or Multifamily dwellings: Apply for demolition permit for ❑ _,R
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
1❑`,ITFII W" 'W-9-
Torm if any Hazardous Materials are being used as part of this project.
Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
-q
BldgApp.2011.doc revised 03116111
i
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20300 stvns crk blvd. DATE: 05/19/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: 1$20,000
r'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
RPRIMARY Commercial Building PENTAMATION 1 BOFF
USE: PERMIT TYPE:
WORK exterior only accessibility requirements per title 24 chapter 11 2010
SCOPE
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. sJ
B (Offices) II-B,III-B,IV,V-B 0 $0.00 $0.00
i
TOTALS: 0 $0.00 $0.00
MECH,HOURLY 0 Yes (j) No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes Q No
?tz�'.rt. Titrtt£ri ?;; -','ianr t z �i}t%i-: �h"c.I_Ilt a f r�t'1,
i
i
NOTE: These ees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info. j
FEE ITEMS Lee Resolution 09-051 Elf. 7/111() FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? Q Yes E)No $0.00 ® hours Plan Check,Hourly
Supp!.PC Fee: 0 Reg. 0.0 OT hrs $0.00 $504.00 ISTPLNCK
PME Plan Check: $0.00 I
Permit Fee: $0.00
Suppl.Insp.Feer Reg. 0 OT 161.01 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Acoustical Fee: 0 Yes 0 No $0.00 0 !
Work Without Permit? 0 Yes 0 No $0.00 G
Plasmin Fee: $0.00 Select a Non-Residential G
fr=,��-J.Tr <:rrrrrrsrarzr �; .�`£E�: : Building or Structure 0
i
Strom Motion Fee: 1BSEISMICo $4.20 0.5 hrs Admin./Clerical Fee
Bldg Stds Commission Fee: 1BCBSC $1.00 $39.00 1ADWN
SUBTOTALS: $5.20 $543.00 TOTAL FEE:. $548.20
Revised: 04/29/2011
i