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13020153-PUB10093 S BLANEY AVE 13020153 F/P PREG BILTMORE SCANNED BOX #596 TA CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: D CONTRACTOR: JOHNSTONE MOYER, PERMIT NO: 13020153 INC. OWNER'S NAME: PREG BILTMORE 1720 S AMPHLETT BLVD STE 250 DATE ISSUED: 08/02/2013 OWNER'S PHONE: 6509313457 SAN MATEO, CA 94402 PHONE NO: (650) 570-6161 JACENSED CONTRACT/OAR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lic. # `'J ( a BUILDING B- CONSTRUCT 3 FLOORS OF (17) MFDWL Contractor e'% Date UNITS I hereby affi4 that I am licensed nder 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: $2320000 of the work for which this permit is issued. 7ormance I and will maintain Worker's Compensation Insurance, as provided for by ection 3700 of the Labor Code, for the performance of the work for which this APN Number: 36903004.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 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 FR T 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 granting of this permit. Additiona a applicant understands and will comply Is Date: Z with all non -point sooul, ce rrS I ons er the Cupertino Municipal Code ection 9.18. / RE -ROOFS: `' r 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. i ❑ OWN -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 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. 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 l 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 nicipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 Labor Code, for the for this the Health & Safety Code, Sections 2550 55 , '' and�34. / of the the performance of work which G Owncr or authorized agent: Dater permit is issued. 1 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 CONSTRUCTI N 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 (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. 1 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 ail non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10093 S BLANEY AVE CONTRACTOR: JOHNSTONE MOYER, PERMIT NO: 13020153 INC. OWNER'S NAME: PREG BILTMORE 1720 S AMPHLETT BLVD STE 250 DATE ISSUED: 08/02/2013 OWNER'S PHONE: 6509313457 SAN MATEO, CA 94402 PHONE NO: (650) 570-6161 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL License Class F) Lic. # S I R 1 Q BUILDING B- CONSTRUCT 3 FLOORS OF (17) MFDWL UNITS Contractor T0141zloo ` Date /D - g plc% 0 I hereby affirm that I am license under the provisions of Chapter 9 9/25/13 DEFERRED #1 TRUSS CALCS - ISSUED 10/8/2013 (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: $2320000 performance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 36903006.10093 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree comply with all city and county ordinances and state laws relating WITHIN 180 DAYSERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter t upon the above mentioned property for inspection purposes. (We) agree to save 180 ,FR$ 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 granting of this permit. Additionally, the applicant understands and will comply ed by: Date: l6 13 with all - 'nt source regulations per the Cupertino Municipal Code, Section / 9.18. Signature - Date 13 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. ❑ OWNER -BUILDER DE TION 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. 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 Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Se o 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: %D _e-,)0 3 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 (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 Iaws 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 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10093 S BLANEY AVE CONTRACTOR: JOHNSTONE MOYER, PERMIT NO: 13020153 INC. OWNER'S NAME: PREG BILTMORE 1720 S AMPHLETT BLVD STE 250 DATE ISSUED: 08/02/2013 OWNER'S PHONE: 6509313457 SAN MATEO, CA 94402 PHONE NO: (650) 570-6161 RS LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL 13 1License Class Lic. # � T{eAr q BUILDING B- CONSTRUCT 3 FLOORS OF (17) MFDWL �1�Contractor �J � Date — UNIT1 I hereby affi that I am licensed Lder the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Prof 11/26 - REVISION #1- DELETE THE TYPE A WINDOW FROM Code and that my license is in full force and effect.�`o �� PE OF WORK, ADD LOW SLOPE ROOF THAT EXTENDS, aa 1 hereby of one the follow big Ions: FIRE RATED CEILINGS-ISSD 1/16/2014 affirm under penalty perjury of ecl l have and will maintain a certificate of consent to self -insure fdwr's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $2320000 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: 36903006.10093 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 D FROM L T 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 !—[1 granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regu 'ons per the Cupertino Municipal Code, Section 9.18. y RE -ROOFS: Signature � Date All roofs shall be inspected prior to any roofing material being installed. If a roof is dell installed without first obtaining an inspection, 1 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 Iicensed 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 1 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 l 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, Sec ' n 505 3, a 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: / Date: / 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, 1 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 (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address l certify that 1 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 CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10093 S BLANEY AVE CONTRACTOR: JOHNSTONE MOYER, PERMIT NO: 13020153 INC. OWNER'S NAME: PREG BILTMORE 1720 S AMPHLETf BLVD STE 250 DATE ISSUED: 08/02/2013 OWNER'S PHONE: 6509313457 SAN MATEO, CA 94402 PHONE NO: (650) 570-6161 ER( LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL f BUILDING B- CONSTRUCT 3 FLOORS OF (17) MFDWL License Class G Lic. # U� ti ` UNIT Contractor `y 'It % �- Date ��� '��%1'� DEFERRED #2- STAIRCASES - ISSUED 2/14/14 I hereby affirm that I am license 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 performance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance, as provided for by ection 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant u derstands and will com with all on-p mt soce iegulations per the Cupert' o Municipal Code, Secf 9.18. ' l i I t Signature 11OA ff-__ IN] I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, wil I 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 construct the project (Sec.7044, Business & Professions Code). 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 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 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Sq. Ft Floor Area: I Valuation: $2320000 APN Number: 36903006.10093 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OFTPY=Lj ISSUANCE OR 180 DAYS FRO CA D INSPECTION. a e: 7i 0.' 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cu erti o Municipal Code, Chapter 9.12 and the Health & Safety Cod , Sec . ns 2 5, 533, and 25534. Owner or authorized agent: Da I hereby affirm that there is a construction lending agency "e performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Add ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (4081 777-3228 • FAX (4081777-3333 • building(5cupertino orn CUPERTINO 1 ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION (TI d REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS /O 0 p :--� L O _ _ _ u _ B) APN # vlt�o E-MAIL STREET ADDRESS 1 ©j\Q I T A O FAX Cam" 11c7v�c�o�-� (�D aVj-�3`t 1Uro�x.:� p�Ul ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DOVELOPER ❑ TENANT CONTRACTOR NAME I LICENSE NUMBER I LICENSE TYPE I BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE �Ro�t'fa-�i vet, • CONSTR. TYPE I # STORIES AREA I NEW FLOOR DEMO TOTAL ' AREA I NET AREA REMODELAREA I REMODEL AREA I REMODEL AREA DECK AREA ATTACH USE TYPE I OCC. I SQ.FT. I VALUATION (S) # DWELLING UNITS: IS A SECOND UNIT U YES SECOND STORY U YES BEING ADDED? ❑ NO ADDITION? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES - RECEIVED TO UATION: PLANNING APPL # ❑ NO PLANINING APP VAL LETTER EICHLER HOME? ❑ NO " T By my signature below, I certify to each e following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the infonnation I ha e p i d 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 ui nstruc 'on. I authorize representatives of Cupertino to enter the bove-identified property for inspection purposes. Signature of AppIicanG'Agent: Date: ��� �!►' 13 SUPPLEMENTAL FORM TION REQUIRED PLAN CHECK TYPE RIOUTING SLIP ❑ OVER-THE-COUNTER; ❑ BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ 'RESS' ❑ PLANNING PLANREI'IEli Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD ElPusuC i"ORKS ' `m 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 ❑ n7AaoR_ ❑ sanITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONTATENTAL HEALTH BldgApp_2011.doc revised 06121111 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 2 b 5 (408) 777-3228 • FAX (408) 777-3333 • building aacupertino.org 1'Jl 0 ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # LW] PROJECT ADDRESS ��7LL APN # V OWNER NAME PHONE /� _ M (�J E GClhn STREE�"f RESS � ` ` � C � T E, IP � � 11 FAX , 6 CONTACT NAME CGTC/ ((pp PHONEf f 71 E MAII.�� C� ,6, STREET ADD RFS6 �t I _ rc )� MAX(A /i 11G � `�'❑ /❑ FAX ❑ OWNER OWNER•BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICEN LIC SE TYPfz BUS. LIC #/� �S c yL ( ,�J COMPANY NAME i I 611 E M46U1 FAX /) m STREET ADDRESS %/ �,SE ZIP P . Mv 4k;A/f�jLH`` ARCHT NER M 1 LIICENSENUMBBER BUS..LIC# 1. COMP E-MAIL I FAX ST AI27aRESS �i -l� 3ya S T ��, e{ 1 V PHONE IS N �I ! DESCRIPTION OF WORK -�LA G CA EXISTINGUSE PROPOSED USE CONSTR TYPE # 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 AREA GARAGE AREA: LJDETACH [77TZ-DECK/PORCH ❑ ATTACH # DWELLINGUNrIS: IS A SECOND UNIT ❑YES SECOND STORY []YES BEING ADDED? E]NO ADDITION' []NO PRE -APPLICATION YES IFYES,PROVIDE COPY OF 1STHE BLDGAN ❑YES (tECEIVEI?BYX `� a �.� y„�,' TOTALV ATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? �NO „ sf� 3- By my signature below, I certify to each of the following: I am the property owner or authorized agent t the property owner's behalf. I have read this application and the information I have provided is correcthave read the Description of Work and verify it is accurate. I agree to omply with all applicable local ordinances and state laws relating to bu* ingctruc J author' a representatives of Cupertino to enter the abov i ntif p pe for inspection purposes. Signature of Applicant/Agent:�!/�% !s! Date:z, SUPPLEMENTAL INFOM3tTION REQUIRED;Pinricfficir� e ���i>�,csi>p" �t RO,� . C'�I�OVERTHFCDUNTER � BUIi,D1NGP�ARRE � �,�' _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. P Materials Disclosure Commercial Bldgs: Provide a completed Hazardous form if any Hazardous Materials are being used as part of this project. t �0``"FIREDEP�' _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. �JIIATOR q� �. YSEWER IS�I ❑ENVIRONMENT HEALTH enr B1dgApp_2011.doc revised 0612]/] 1 t CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 YPERTINO NEW CONSTRUC' (408) 777-3228 • FAX (408) 777-3333 • buildingna.cupertino.org \ 'ION ADDITInN I I ALTFRATION /TI I I RF.VT.g1nN / DF.FFRRF.D 0RinrNAL. PERMIT* PROJECT ADDRESS /4'W �-r� l` /� �tI - ` C.�L/ � I . `�s UvL 1 OWNER NAME P (� , �'I �! - - _ o fl/,C E-MAIL STREETADDRESS `1✓�� CITY, STATE, ZIP C FAX CONTACT NAME sTVgeVsS. or�� 1OW'N6ER ❑ OWNER -BUDDER ❑ OWNER AGENT CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT C@ A 77 OIt,IVAt��a�rP I Q Q . / P _ L ENeIR&I I LICENSE TYPE BUS. LIC 9 14 i GSy /�pJ va JkGIIIJEERNaI�OA"y C�.�i MefNSIT RE, BU Ilj LA DESCRIPTION OF WORK �� 1 j � � i � � �� ` 4 9G-`� ( \✓� l-ii���� �'�/Y���l,/'V1.VV\ \3. �'��✓'�i Gi'^:'S{i .�'sti���i�S.L�'� V=nTI G U RO O ED US CONSTF- ` , � � ! �d TYPE * � "" j � STORIES 1 - USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA 2- q BATHROOM REMODEL AREA \ �� sv KITCHEN REMODEL AREA I iv OTHER REMODELAREA PORCH AREA N41% � DECK AREA ORCAREA TOV3JN,� :��' DiiiETACH ❑ ATTACH k DWELI�,IL) [.ITS: [< �� IS A SECOND UNIT ❑� S BEING ADDED? � "O SECOND STORY ❑ ADDrrION? PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF PLANNING APPL k ❑ NO PLANNING APPROVAL LETTER ISTHEBLDGAN ❑YES ETCH LER HOME? VNO RECEIVEIABY- " ,, . L . !E r, .,.'� TOTAL VALUATION: L �2� L)00, By my signature below, I certify to ac I f e following: I am the property owner or authorized ag t to act on the property owner's behalf. I have read this application and the information I h e p vi d 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 tp bui i� c nstru idn I authorize representatives of Cupertino to enter the ab��de tel property for inspection purposes. @l Signature of Applicant/Agent: Date: ,��-� SUPPLEMENT ORM 'ION REQUIRED PLAN CHECKTYPE .. :;.%ROUTING SLIP ❑ OVERTH&COUNTF.R ;: ❑ BUILDING jPLAN REVIEW New SFD or Multifamily wellings: Apply for demolition permit for — existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ 1CXPRCSS ❑ PLANNIIVGPLAN REVICW, _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD:--.-.':.......:: ❑ PUBLrCavoRICS form if any Hazardous Materials are being used as part of this project. El` LARGE . . ❑ . FIRE DILPT `:: :. . _ Copy of Planning Approval Letter or Meeting with Planning prior to Tom''TOR; `..: : ; . '::.' : ;, SANITARY SEWER DISTRICT ❑ '...:. submittal Of Building Permit application. .' .> .; . ❑ r, NVIRONMENTAL IrGAL'I`II %21 B1dgApp_2011.doc remised 06121111 CONSTRUCTION PERMIT APPLICATION � COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION QL� 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255�/ (408) 777-3228 • FAXr (408) 777-3333 ' building(5cuoetno.org \ �� ,TON f-1 AT)T)TTION I AI.TF.RAT1nN/TT X RF.VTSTC) 1T)FTd FERRFn nRIC;TNAT..PF.RMTTV PROJECT ADDRESS OWNER NAME PM C �•I �j, .G► [ ly�l.PHONEE-I,1AIL � T / ' ►� STREET ADDRESS ✓� CITY, STATE, ZIPC ! /+ h FAX CONTACT NAME � 4 � Z/LIL.�i,¢ �n�® Q -7 ST[,E5f epC 5S.S, `� Cti( � L� C ✓✓ Ci �iY � � ` t ` ram i k OWNER ❑ OWNIERR--BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGFNT ❑ ARcHrrECT ❑ ENG,-gaR ❑ DEVELOPER ❑ TENANT IC'* LE 1i � LICENSE TYPE T BUS. LIC R 1�dYl.'L ®AWL � ` r-5 1"1�r�RERS ` L4A1�✓E �� ®' .. � F'\.2s� JL4t �% . �} [ C� �l , �2iCP&T GIjJEERAiiat �Sa R�I BU d�iV71`1T1Gi �. �/`Jl vF 1 'tc'Y.3�lr\e-- 1-V C VA e3� STATEMP DESCRIPTION OF WORK �� ` �✓� � � ��� � � ��\ 1 � �3�'\ E TS�I G• �RO O� D UPS CONS7R TYPE � m STORIES USE TYPE OCC. SQ.FT. VALUATION (i) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA 9A 2- BATHROOM REMODEL AREA (j KITCHEN ` REMODEL AREA 1 OTHER REMODEL AREA tjk PORCH AREA A i DECK AREA TOTAL DL-CI:/PORCH AREA � G E AREA:: E D.-FACH P. ❑ATTACH ar DWEL��S: IS A SECOND UNIT ❑�S BEING ADDED? �- 0 SECOND STORY S ADDITION? 0 PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL R NO PLANNING AP ROYAL LETTER ❑ IS THE BLDG AN ❑ YES EICHLER HOME? u[�NO : RECEIVED.. BY. -' . - `` �: '::.: � , / ` � �., L TOTAL VALUATION: � �ZV W O By my sin nature below, I certify to Ifac I f le fol lowing: I am the property o%Ngier or authorized agent to act on the property owner's behalf. I !lave read this application and the information I hate p vl d is corr t. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state lays relating bui i� c s cti n. uth iz r resentatives of Cupertino to enter the above-identifie property for inspection purposes. �' �s ��VI Signature ofApplicant/ARenC Date: ` SUPPLEMENT IeW10 °ION REQUIRED : ' LAN c cICTYri i xouT>Tic si iP New SFD or Multifamily wellings: Apply for demolition permit for o\R-TcOLTArrx : ❑ BU[LDLNG PLAA RD\ IL1\'. ' existing building(s). Demolition permit is required prior to issuance of building pem)itfor rewbuilding. ❑:rXritrss:°-;.:.:,:`:>'.'.:::.:'`:.'.rlaanpvGrialyitEtw.::'.::,'....: _Commercial Bldg s: Provide a completed Hazardous Materials Disclosure El.. SraNnAxD ` ' PUBLICRORIGS P form if anv Hazardous Materials are being used as part of this project. :.❑ L ...❑ ..D.. LARGE= Copy ofPannin Approvall Letter Meeting with Planning prior t0 gAPP ':: ''' SANITARY DISTRICT hZATOR;;?.; ',:: ;;•::` . ,SCFYCR,. s ,, ... submittal ofBuildina Permits application. � PP ❑`; NVIRONAiENTAL ITEALTIi ►mac AR Bldg,4pp_2 011. doc revised 06121/11 CITY OF CUPERTINO 6 FM_7 FEE ESTIMATOR - BUILDING DIVISION 1AADDRESS: (/ 0 3 .3. B N DATE: 09/25/2013 REVIEWED BY: larrys APN: BP#: 3 Z© J E 3 'VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY Multi -Family Dwelling USE: 1 Buildina is >3 Stories ® Yes Q No PENTAMATION 1 R2 PERMIT TYPE: WORK defered submittal of truss calculations _40 SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-2 (Apartment) II-B,III-B,IV,V-B 0 $0.00 $0.00 TOTALS: 0 $0.00 $0.00 il:':(C'%.r T) t .l_:.., .. IC: filS'; t. NOTE: This estimate does not include fees due to other Departments (i.e. 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 Deptfor addn'1 info. FEE ITEMS (Fee Resolution 11-053 Er: 7i1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? ® Yes Q No $0.00 1 # $0.00 Deferred Submittal Suppl. PC Fee: (F) Reg. () OTTO-07 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee-0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTitXR 0 # unitsnew $0.00 Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fee: $0.00 0 hours $417.00 Plan Check, Hourly ISTPLNCK I 1)r,; tf�.;�c; rca;=�>rr �'f�.,. Stron. Motion Fee: $0.00 = hrs $417.00 Inspections ISTINSP Inspection, Hourly Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $834.00 TOTAL FEE: $834.00 Revised: 08/01 /2013 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION Wjui ADDRESS: 20030 SCB- BUILDING B DATE: 02/27/2013 REVIEWED BY: MENDEZ beAPN: f BP#: *VALUATION: 1$2,320,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY Muiti-Family Dwelling USE: Building is >3 Stories Q Yes Q No PENTAMATION 1 R2 PERMIT TYPE: WORK BUILDING B- CONSTRUCT 17 MFDWL UNITS SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (S.f. PC FEES PC FEE ID BP FEES BP FEE ID R-2 (Apartment) II-A,III-A,V-A 19,840 $8,068.21 IR2PLNCK $11,912.91 IR2INSP TOTALS: 19,840 $8,068.21 $11,912.91 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School hictrirt_ vtr_ L Thoce foot aro hated an the nreliminary information availahle and are only an estimate. Contact the Dent far addn'l into. FEE ITEMS (Fee Resolution 11-053 E,f' 711112 FEE QTY/FEE MISC ITEMS Plan Check Fee: $8,068.21 Select a Misc Bldg/Structure I or Element of a Building Suppl. PC Fee: (F) Reg. () OT 0.0 hrs $0.00T PME Plan Check: $0.00 Permit Fee: $11,912.91 Suppl. Insp. Fee:Q Reg. Q OT T0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1 units # new $629.29 f' 0 0 Work Without Permit? 0 Yes (2) No $0.00 Advanced Planning Fee: IPLLONGC $5,356.80 Select a Non-Residential Building or Structure i Strong Motion Fee: IBSEISMICO $487.20 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC 1 $93.00 SUBTOTALS: 26,547.41 $0.00 TOTAL FEE: $26,547.41 Revised: 01 /01 /2013 Building Department City Of Cupertino 10300 Tone Avenue 5 61d j'LZq- Cupertino, CA 95014-3255 / 7D 7 3 Telephone: 408-777-3228 C U PE RTI N O l�/ Fax: 408-777-3333 /CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: ; � .. 1 1, '\ PERMIT # OWNER'S NAME: i °�; " °i i �_ Fes_-� F PHONE # GENERAL CONTRACTOR: ' r } x' l.; �. {� i' BUSINESS LICENSE # ADDRESS: „.:�';r j:=�, F,lr ?�x.; CITY/ZIPCODE: C"i.ii' t-r_> i�!LfGz *Our municipal code requires all businesses working in the city to have a City of Cupertino business Iicense. NO BUILDING FINAL OR FINAL OCCUPANCY 1NSPECTION(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: Signature Please check applicable subcontractors and complete the following information: Date 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 ;`. � � •'`-. -fie, �- ,r Date '` pwner / Contractor Signature