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13120177CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11204 MOUNT CREST DR CONTRACTOR: BOTAD CONSTRUCTION PERMIT NO: 13120177 COMPANY OWNER'S NAME: SANDEEP CHOPRA 2675 GLEN ELK CT DATE ISSUED: 11/21/2014 OWNER'S PHONE: 4154204156 SAN JOSE, CA 95148 PHONE NO: (408) 758-8850 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL' COMMERCIAL E] CONSTRUCT FIRST FLOOR ADDITION(S) (1076 SQ FT); License Class Lic. # ATTACHED GARAGE (488 SQ FT); FRONT PORCH (160 SQ Contractor (L �GUti Date G^ �p y /S FT); COVERED DECK (690 SQ FT); SECOND STORY DEF # 1 - STRUCTURAL DETAILS FOR INTERIOR ELEVATOR - ISSUED I hereby affirm that I am licensed under the provisions of Chapter 9 8/4/15 (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: $450000 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 permit is issued. APN Number: 35626017.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT E IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WIT 118 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 CALLED INSPECTIO 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 co y Date: with all non -point source regulations per the Cupertin Municipal Code, Section 9.18. Si ature J RE -ROOFS: Date D 0 S 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 13 O-BUI ER DECLARATION inspection. I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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) 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. 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 Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino N"icipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sec7—s 25505, 255335 and 25534.Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized age t:Date: 0 6 /6 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 CONSRUCTI N LDNDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction tiding 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 1 'T1RI�Ir 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUP1=R,itNO (408) 777-3228 • FAX (408) 777-3333 • buildingQcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION . F� ALTERATION 1 T7 L"J REVISION D.EFERRE ORIGINAL PERMIT T PROJECT ADDRESSQ y e, 6 R �� APN n 7 S-76 Z-6 V OWNERNAI� I PHONE r E-MAm _ PVA I STREET ADDRES CITY, STAT ZIP FAX CONTACT NAME I PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FFAX OWNER ❑. OWNTR.BUIIAER ❑ OWNiR AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAIfMLICENS T E � I LICENSE TYPE 3 I BUS. LIC C Ol✓PANY NAME - 6073MC -ate s-�/ E-M.AIL 4-07" FAX 1, CZ)'� STREET ADDRESS J� Q CITY, STATE, Z]�y� PHONE ARCHUECTIENGINEER NAME LICENSE NZIMBER BUS. LIC R COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK i EXISTING USE PROPOSED USE CONSTR. TYPE r STORIES USE TYPE I OCC. SQ.FT. I VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA ._ BATHROOM KrrCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCHAREA DECK AREA GARAGEAREA: DETACH 7DECY)PORCHAREA ❑ ATTACH I T DFVBLLINGUNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES BEING ADDED? E]NO ADDITION? ❑NO PRE•APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES VEp� _ - TOTAL VALUATION: PLANNINGAPPL: ❑NO PLANNING APPROVAL LETTER I EICHLERHOME? ❑NO _ - .z -.r - - By my signature below, I certify to each of the following: I am the property o�;mer or auth ri _ nt to act on the rty o�mer' alf. I have read this application and the information I hav provided is correct. I h read the Description of 7ork and verify itrate. o comply with all applicable local _ ordinances and state lays relating t uilding constructio horize representatives'of upertino t9-4 o enter the ove-id tified p petty for inspection purposes. Signature of Applicant/Agent: Dater / / AL ]FIFO TON UIRED SUPPL72y'd-wellinas: ,� PS.AT,CHECK�'1PE� '� r, `� ,«.;VIE . New SFD or Multif AD fo�dem ition permit for ��Y existing building(s). Demolition permit is require issuance of building - - permit for new building. EicPr ❑ . ss � s � PL..9�'%'II�GPLA_N REVLEW �. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure tj sTAItpARD�a ❑ �IfisLTC�vfo xs �� form if any Hazardous Materials are being used as part of this project.-. -i-• - _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. Bld,-App_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR — RITILDING DrvrcrnN 1AADDRESS: 11204 MOUNT CREST DR DATE: 08/04/2015 REVIEWED BY: MELISSA Elec..Plan Chec/c APN: 356 26 017 BP#: 6 VALUATION: $0 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair ON PRIMARY SFD or Duplex PERMIT PERMIT TYPE: 1 GENRE S TYPE: WORK DEF # 1 - STRUCTURAL DETAILS FOR INTERIOR ELEVATOR - ISSUED 8/4/15 SCOPE Ar/1TC. TL.'-,. -; FEE Nfech, Plan Check Phirnb. Plan C'heek Elec..Plan Chec/c Tech. Permit Fee: Plumb. Permit Fere: lilac. Permir Fee: Other Herh. Irup. Other F'lumb rasp. Other• glee. Irnp,E3 irlech. (asp. Fee: Phiwb. hisp. Fee. Elec. Insp. Fee: Ar/1TC. TL.'-,. $0.00 Suppl. Insp. Fee: Reg. 0 OT � _ A J— esilmate does not 1nctuae fees aue to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the nrnliminary infnrmaiints nvn:)nhlo ....J.....L. ,. —4-- 1- - n — X__ _�-_,1!__— FEE ITEMS (Fee Resolution_] 1-053 Eff L 131 FEE QTY/FEE NLG LC L ur ""Uri L L/{ o. MISC ITEMS Plan Check Fee: $0.00 = # Deferred Submittal $286.00 IDEFSUBM Suppl. PC Fee: ( Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee: Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: -$0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fere: 0 E) Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Q Building or Structure 0 A Travel Dcx•umentalivn Fees: Stroniz Motion Fee: $0.00 Select an Administrative Item BldF, Stds Commission Fee: $0.00 SJBTlCYJ'ALS $0.00 $286.00 ' E wi, TOTAL FFA $286.00 Revised: 07/02/2015 h, CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11204 MOUNT CREST DR CONTRACTOR: BOTAD CONSTRUCTION PERMIT NO: 13120177 COMPANY OWNER'S NAME: SANDEEP CHOPRA 2675 GLEN ELK CT DATE ISSUED: 11/21/2014 OWN R'S PHONE: 4154204156 SAN JOSE, CA 95148 PHONE NO: (408) 758-8850 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ .r CONSTRUCT FIRST FLOOR ADDITION(S) (1076 SQ FT); License Class Lic. # s_ `� ' ATTACHED GARAGE (488 SQ FT); ( Q FRONT PORCH 160 S FT); COVERED DECK (690 SQ FT); SECOND STORY Contractor ateMINIP I hereby affirm that I am licensed under the provisions of Chapter 9 I� X34 2 Y 6T I1 H�°�U'RiA-05—TED, X" 1 MISS'SlJ D'$';41 j201 (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 Sq. Ft Floor Area: Valuation: $450000 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 APN Number: 35626017.00 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 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 DAYS FROM 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 `\ Q �V 113 190��� granting of thi ermit. Addition y, the applicant and stands and will comply Issued b Y (( Date: U with all non- oint source regula io s per the Cupertino unicipal Code, Section 9.18. �; h� RE -ROOFS: Si ature -� • 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. ❑ WNER-B ILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I a empt 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(x) 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 ejj��it hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Managghient District I performance of the work for which this permit is issued. will maintain compliance with the upertino Municipal Code, C yapter 9.12 and 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 the Health & Safety Code, Section 25505, Mand 25534. Y Owner or authorized agent. %I1" '' t F i"" 1 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 CONST UCTIO LEND AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a constructio din ency 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 indemnify and keep harmless the City of Cupertino against Iiabilities, judgments, ARCHITECT'S DECLARATION 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 COMh4UNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building o1cupertino.orq ❑ NEW CONSTRUCTION ❑ ADDITION . ❑ ALTERATION / TI Rf REVISION / DEFERRED ORIGINAL PERMIT T /3 l ZOl ;�� PROJECT ADDRESS./� Mfi, I APN,°, OWNER NAME �a _ ,® - I PHONE / (T � � E-M.0.'IL 1 I�Vf STREET ADDRESS �) x �y FAX k� � � a 6 CITY, STATE, ZJIP CONTACT NAME PHONE STREET ADDRESS CITY, STATE, ZIP FAX OWNER ❑. OWhZR-BUILDER ❑ 011'hrR AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER 11 DEVELOPER ❑ TEN 4Nf CONTRACTOR NAI Ifta't q LICENSE m fl LICENSE 6 BUS.L1Cm CO ANY NAIE E -WAIN FAX STREE4 C JCC �� PHONE �a ICx�6� ARCHITECT/ENGINrERNA]vIE LICENSENMBER BUS. LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK XI ESTING USE PROPOSED USE CONSTR TYPE I STORIES I USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA `- BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH A-REA GARAGE AREA: LJDETACH ❑ ATTACH nDN\TLLAGUNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? El NO ADDITION? ❑NO PRE -APPLICATION F-1 YES IF YES, PROVIDE COPY OF IS THE BLDG AN E-1 YES IUEDBI•� - - - r TOTAL. V ATION: PLANNING APPI. ❑ NO PLAM\TINIG APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: I am the property owner or author zed aeent to act on the property owner's behalf. I h Ve read this application and the information I hav provided is correct, ve read the Description of'Work and verify it is accurate. I agree to comply with a applicable local ordinances and state law, relating to wilding constructi authorize representative of Cupertino to enter the above-'dentifie property for inspection purposes. Signature ofApplicant/Agen : Date: SUPPLEMENT L 12�TFORA4A=IONREIRED = s �` o�ERTI COIJhTER y NTeW SFD orI\4ultifamil dv.,ellings: Apption permit for existing building(s). Demolition permit is required prior to issuance of building _W2 �BTJIIDL�GPL0.I\REVSFF�r permit for new building. r — 1� ExrRi ss —Y �LyIat,L GrLA� RxT vLr w Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ©' srn�4ttD_ j� PUBLCRORAS= _ form if any Hazardous Materials are being used as part of this project. 2 _ Copy of Planning Approval Letter or Meeting With Planning prior to LIEGE T _ter _ _ submittal of Building Permit application. 1❑ M}1TKOR - -SA7QITARYSEi;ERDISTRIC w 0It'MENT4Z, AEAITFt . - BldgApp_2011.doc revised 06121/11 CITY OF CUPERTINO FM7§ FEE ESTIMAT®R — BUILDING'DIVISION Y ADDRESS: 11204 MOUNT CREST DR DATE: 08/04/2015 REVIEWED BY: MELISSA :Ltec.h. Fern it Fee: APN: 356 26 017 -7 BP#:QL "VALUATION: $0 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: p Phirnb. 1Rsp. Fee: PENTAMATION PERMIT TYPE: 1GENRE WORK 8/4/15 - DEF # 2 - STRUCTURAL DETAILS FOR STAIRS SCOPE PME Plan Check: NOTE: This estimate does not include fees due to other Departments (i.a Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These -fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Tee Resolution 11-053 Eff. 7/1/13) Me& Hari Check Phnnb, Plan C'hecl filer.. Plan CHeclt :Ltec.h. Fern it Fee: Plumb, Permit Fire: Glee. Permit Fire: Other Alech. Insp. Other Plumb Imp. Other Glee. Imp. Li Rech, 112sp. Fee: Phirnb. 1Rsp. Fee: 1:IeC. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.a Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These -fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Tee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # $286.00 Deferred Submittal IDEFSUBM Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee @ Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction .rax: ,ldininistrative Fee: Work Without Permit? Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) 0 a Travel l�ocunu�nlataon 1�'ees: Strong Motion Fee. $0.00 Select an Administrative Item Bldg Std s Commission Fee: $0.00 - 'SUBTOTALS: $0.00 $286.00, TOTAL $286.00 Revised: 07/02/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11204 MOUNT CREST DR CONTRACTOR: T-Bf) — T� PERMIT NO: 13120177 OWNER'S NAME: SANDEEP CHOPRA 'E�,o--- `r., DATE ISSUED: 11/21/2014 OWNER'S PHONE: 4154204156 PHONE NO: 0 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lic. 4 % CONSTRUCT FIRST FLOOR ADDITION(S) (1076 SQ FT); ATTACHED GARAGE (488 SQ FT); FRONT PORCH (160 SQ Contracto*V*1'to t & FT); COVERED DECK (690 SQ FT); SECOND STORY I 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. 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 Sq. Ft Floor Area: Valuation: $450000 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 permit is issued. APN Number: 35626017.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EFDES IF W IS NOT STARTED 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 WITHIN 1YS OF PE IT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS 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 ft 2-1 granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulatio per the Cupertino Municipal Code, Section 9.18. Signature Date is RE -ROOFS: 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. ❑ OWNE -BU LDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 I hereby affirm under penalty of perjury one of the following three California Health & Safety Code, Sections 25505, 25533, and 25534. I will 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 Cod , Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the,Health & Safety Code, Sect' ns 25505, 533, and 25534 Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent Date: ll �l i 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 CONS RUCT ON ENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is constructs n 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 CUPERTIINO I ❑ NEW CONSTBTJCTTON CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingacupertino.org F1 AnT)ITTTIN ❑ AT.TFR ATTON / TT I I RF.VT.Ci(1N / TIRFFRRR.TI (�D\ �4� CIR TC:TNAT. PFR MIT 9 PROJECT ADDRESS APN # s 1-,/� OWNER NAME e„NP6 Ov E IL-MAC� �� ® �� STREET ADDRESSVJE�CrrY, STATE, ZIP . (� e� A FAX CONTACT NAME.D100 i PHONE ? o EMAIL STREET ADDRESS , aj QJp p I� y b� ..�'�./ CITY„ T TE, ZIP o p 3& j ❑ OWNER ❑ OWNER-BUILDER/'j❑tOWNWNER�AGENT ❑CCONTRACTOR ❑CONTRACTORAGENT 2 ARCC"ICTT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAIA E'. E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME q I �J E-MAILbm FAX G STREET ADDRESS CITY, STATE A PHONE DESCRIPTION OF WORK 164) EXISTING USE PROPOSED USE CONSTR. TYPE i # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) V EXISTG AREA -7 / NEW FLOOR AREA I S e DEMO . AREA TOTAL NET AREA _ BATHROO REMODEL AREA KITCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: U DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY []YES lV BEING ADDED? DTA- ADDITION? [a.Aiff' PRE -APPLICATION []YES IF YES, PROVIDE COPY OF PLANNING APPL 0 if� PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? ODTO� .RFC �r m� .�s , � = ,: OTAL VALUATION: _ By my signature below, I certify to each of the following: I am the property owner or a ze gen o 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 d ii 'r ' is accurate. I agree to comply with all applicable local ordinances and state laws relati building co ction. ize representatives of Cupertino to enter the above -identified property for inspection purposes. �a Signature of Applicant/Agent: Date:j SUPPLEMENTAL INFORMATION RE UIRED Q. ; ` ,3�LANCHPTKTXPI. 'a. „1tpUTINGSLT' . „ t q New SFD or Multifamily dwellings: Apply for demolition permit for ,g 1I3CoiJA1�E0 surLDTn z'LAiv R>av itvv _ existing building(s). Demolition permit is required prior to issuance of building permit for new building.. EXPItESB P,1 NNINGXL T�IREVIEw ' = Commercial Bldgs: Provide of completed Hazardous Materials Disclosure i? AitTi x t Ci puBLlcyPOlt _ form if any. Hazardous Materials are being used as part of this project. ,r �I) i 71`�' _ Copy of Planning Approval Letter or Meeting with Planning prior to mA�ttx submittal of Building Permit application.5Eav>�RDrSTtucr 4.".r,t ` BldgApp_2011.doc revised 06/21/11 ...J e0b -J 10 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION' ADDRESS: 11204 MT CREST DR DATE: 12/20/2013 REVIEWED BY: MELISSA APN: 356 26'0 17 BP#: *VALUATION: 1$450,000 PERMIT TYPE: Building Permit PLAN CHEC TYPE: Addition PRIMARY: SFD or.Du lex 2nd Unit? 0 Yes • No PENTAMATION. USE: P OTC? ® Yes No PERMIT TYPE: 1 R3SFDADD WORK IST FLR ADDITION OF 1 568 S.F. RECONFIGURE &.REMODEL E SFD (3,771 S.F. INCLUDING SCOPE UPGRADING ALL M.E.P'S (N) 200 AMP PANEL, HVAC, ETC 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-13JV,V 13 1,568 $2,697.18 IR3PLNCK $2,047.50 IR3INSP Other Elec. Insp. p: I'?e: Phcmb. Insp. Fee. Elec. Insp. Fee: hrs $0.00 PME Unit Fee: $0.00 PNM Permit Fee: $0.00 i,onsOwction l ax: AdMinistratiVe FCL': 0 Work Without Permit? 0 Yes (D No $0.00 TOTALS: 1,568 $2,697.18JtM�xik`,`j$2,047.50 Travel Uaeutnentation Fees: ' E MECI3, IOURIY HOURLY Yea ' eta; ELIC, Yi(QURLY '` Yes tNo �.. ., Plan- Check Fee: $2,697.18 an Check Phu b. Plan Check Elee. Plan Check blech. Peril -lit Fee: . Eif, Plumb. 1'crmit Fe Elec. Permit Fee: $0.00 Other Plumb' MIT Other Elec. Insp. p: I'?e: Phcmb. Insp. Fee. Elec. Insp. Fee: l.vl c: i nts esumare aoes not tnctuae fees aue to other Departments fLe. Planning, Public Works, Fire, Sanitary Sewer District, School Distridt. etc). i%1e.Ce rP_P_c QYP /)/I.CP/I AH 1hP nYOlisisiwnru in inrss.n►in......h hlo -4 __ --A, FEE ITEMS (Fee Resolution 11-053 E,f : 7/1/13) FEE QTY/FEE MISC ITEMS Plan- Check Fee: $2,697.18 3 7711 s.f. Remodel, Other $6,567.00 IREARES3 Suppl. PC Feer (E)' Reg::0 OT F0701 hrs $0.00 PME Plan'Check: $0.00 Permit Feer $2,047.50 Suppl. Insp. Feer Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PNM Permit Fee: $0.00 i,onsOwction l ax: AdMinistratiVe FCL': 0 Work Without Permit? 0 Yes (D No $0.00 Advanced Planning Fee: IPLLONGR $219.52 Select a Non -Residential Building or Structure 0 A Travel Uaeutnentation Fees: Strong Motion Fee: 'IBSEISMICR $45.00 Select an Administrative Item Bldg S.tds Commission Fee: IBC -BSC $18.00 ' t 4i.• ' �, „11i h N i u� , STfBT(T 4 ; $5,027.20 fl 1��'f^ +I } " 'fir '4': $6,567.00 ; , . . $11;594:20 .Revised: 10/01/2013