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15060028-PUB21490 MCCLELLAN RD 15060028 F/P DAVID SOUZA ET AL SCANNED BOX #596 I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21490 MCCLELLAN RD I PCO`NTRACTOR: BLACK DIAMOND I PERMIT NO: 15060028 ING OWNER'S NAME: DAVID SOUZA ET AL OWNER'S PHONE: 4082627080 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic.9 --;;7/-,-�� Contracto, eaeg 11/ Date L� 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 o7,ndcwill ion, as provided for by Section 3700 of the Labor Code, for the fcc of the work for which this permit is issued. a 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. 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 sai ity in consequence of the granting of this m.t. dditionally, the appli t nderstands and will comply with all 74 o oint sou rc regulations per th u Municipal Code, Section 9.18. Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 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. 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 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. 41550 BOSCELL RD I DATE ISSUED: 06/03/2015 FREMONT, CA 94538 1 PHONE NO: (510)770-1150 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ TO CLEAR CODE ENFORCEMENT CASE: SITE ACCESSIBILITY UPGRADES TO INCLUDE NEW SIDEWALK, CURB RAMP, LOT RESURFACING AND PAINTING, AND Sq. Ft Floor Area: I Valuation: $19500 APN Number: 36201027.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM ,LAST ,CALLED INSPECTION. Issued by: �%�✓ /%��ez Date: 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 I 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 ich emit hazardous air contaminants as defined b e Ba Area Air Qua] M ement District I will maintain compliance th the C ertino Muni ' al e, Chapter 9.12 and the Health & Safety Co ff , Section 5505, 25533`,, n 4. Owner or authorized agknt: / ate: /_C CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(d-)cupertino.orq // C%(U OL")C� ❑ NEW CONSTRUCTION ❑ ADDITION I LTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROTECT ADDRESS , APN N . OWNERNAME l� J n :E P ONE E-MAIL r+l ^ r WI I STREET ADDRESS 1 CIT TAT ZIP FAX CONTACT NAME PHO E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ElOWNER ❑ O%vNER-BUMDER ❑ o1:TIER AGENT F/ CONTRACrOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LI ENS ER LICENSETYPE BUS. LIC N + COMPANY NAME E44AIL r FAX M ell 1i —i 5 STREET ADDRESS CrTY STAT 1P PHONE Z� � 5i115i> ARCHITECT/ENGINEER NAME LICE E NUMB BUS. LIC N �rL J COMP NAME -MAIL wup STREET DRESS `'' C STAT�P PHONE DESCRIPTION OF WORK M EXISTING USE PROPOSED USE CONSTR TYPE N STORIES 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 AREA GARAGE AREA: LJ DETACH ❑ ATTACH N DWELLING=S: IS A SECOND UNIT ❑YES SECOND STORY (I YES BEINGADDED? []NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL N ❑ NO PLANNING APPROV R IS THE BLDG AN ❑ YES EICHLER HONIE? TOTAL VALUATION: a, By my signature below, o each of the lowing: I am the prope owner r authorized agent to act on the property owner's behalf. I have read this application and the inforon I have provi d is correct. I h read ttion ofWork and verify it is accurate. I agree to comply with all applicable local tcerti ordinances and state lawating to buil g constructio thoriz epres atives pertino to enter the above-iid/dentifiied property for inspection purposes. Date: C� �� Signature ofApplicant/A SUPPLEM TAL INFORMATION REQUIRED PLO CHECK k, ,_;K <;} N„ROjJTINGSLIP - - New SFD or Multifamily dwellings: Apply for demolition permit forF _ existing building(s). Demolition permit is required prior to issuance of building OVER THE-COIIhTER��,� BUII,DING PL REVIEW 3`,3.�'� , permit for new building. EXPRESS ,; c R NIZIN 'PL R Commercial Bldgs: Provide a completed Hazardous Materials Disclosure JsTAi`nD t r,uBI t w_ _ form if any Hazardous Materials are being used as part of this project ,� ❑ _ Copy of Planning Approval Letter or Meeting with Planning prior to LARGFy-x� t a FIRER submittal of Building Permit application. 4 r �sAN S RDIS�TRI - !01, 0.. ENTAI'EEALT'II .. BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO Fm-ffi FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 21490 mcclellan Dr DATE: 06/03/2015 REVIEWED BY: Sean APN: BP#: 0 & 00--?-8' 'VALUATION: 1$19,500 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE Commercial Building Civil / Religious activities in BQ zone? •, Yes � No PENTAMATION PERMIT TYPE: 1GENCOM WORK To Clear Code Enforcement Case: Site accessibility upgrades to include new sidewalk curb ramp, lot SCOPE resurfacing and painting, and signage. __. Pio:l 1 � cal; Plumh. Pernau 1 , Iaec. Permit Orhn llech. Insp. Other Plumb Ins/ Other lace. Insp. Wech. hzsl:,. Peer: P/umh. hrsp. Fey: 1:lee. Insp. Fee: 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 Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7'1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes Q No $0.00 2 hours Plan Check, Hourly $286.00 ISTPLNCK Suppl. PC Fee: Q Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $0.00 �Idrninistratil:� ic':': (� Q Work Without Permit? 0 Yes 0 No $572.00 Advanced Planning Fee: $0.00 hours Inspections $286.00 ISTINSP Inspection, Hourly Q n>el Documernla/ion Fees: Strong; Motion Fee: IBSEISMICO $5.46 Select an Administrative Item Bldg, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $578.461 $572.00 TOTAL FEE: $1,150.46 Revised: 05/07/2015 Building Department CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS PERMIT # OWNER'S NAME: 6��60CP6 PHONE # 7 O•/ jO GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCC CY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND A UBC NTRACT RS HAVE OBTAINED BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: A CITY OF CUPERTINO Date i/ 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 Owner / Contractor Signature Date