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15040242CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21111 STEVENS CREEK BLVD CONTRACTOR: GUERRA PERMIT NO: 15040242 CONSTRUCTION GROUP OWNER'S NAME: CUPERTINO CITY OF 984 MEMOREX DR DATE ISSUED: 08/31/2015 OWN S PHONE: 408777321;5 SANTA CLARA, CA 95050 PHONE NO: (408) 279-2027 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL 11�7 1 S rk Lf License Class INSTALL NEW SPORTS COURT; INSTALL NEW COURT Lie. # LIGHTING (13) 22 FT LED TWIN AND SINGLE HEAD �^ Contractorc.�J¢,ry CO+^s 'Date 3� l FIXTURES; INSTALL WALL FACING MATERIAL ON 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: $600000 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: 32629022.00 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 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 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECT ON. indemnify and keep harmless the City of Cupertino against liabilities, judgments, r 6c costs, and expenses which may accrue agai t said City in consequence of the gid granting of this permit. Additionally, the plicant understands and will comply Issued by: Date: with all non -point so5pe7egulati ns p he Cupertino Municipal Code, Section 9.18. .fig` )) RE -ROOFS: Signature Date G g 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 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: 1, 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 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 Munici 1 Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 255 3, a 25534. Section 3700 of the Labor Code, for the performance of the work for which this f 'i 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, 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 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina()cupertino.ora C - ❑ NEW CONSTRUCTIONi ❑ ADDITION Z ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS APN # :�S k—s a OWNER NAME e� E (� ^y(� P O ' 3 ✓I' E. E IL STREET ADDRESS"— �9 ®rrf- Aa. CI ,STATE, ZIP m � �j FA �1 `i 6A / 6O®� CONTACT N � E?'PH If r / 1 —3 d- E ''mem STREET ADDRESS r /C1 rrc� ��> Cl , STATE, ZIP ( 9S ® 49--17-7-313`3 OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/E GINEER NAME LICENSE NUMBER BUS. LIC # CO Y NAME b" SS's E-MAIL FAX 7 y �y �ry (� y ® '. - 9 S `� Ss1�a/� ! A STREET ADDRESS S�.�Q-�, Z ? .SaTATEJZTP / / J9I P ® fl S e—GA Z5—7t'J DESCRIPTION DESCRIPTIO.•N�JOF WORK t o c F `CSS �� EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES 1 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 DECKIPORCH AREA GARAGE AREA: DETACH ❑ ATTACH I DWELLING UNITS: ISA�SECONDUNIT [I YES SECONDSTORY ❑YES BEINGADDED? []NO ADDITION? []NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIV$D SY TQTAL VALUATION: PLANNING APPL # [:]NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify Ito 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 constructi . I authorize representatives of Cupertino to enter the above property property for inspection purposes. Signature Applicant/Agent: �J//� of Date: SUPPLEMENTAL INFORMATfON REQUIRED ;:.pI AN CHECK TYPE ROUTING SLIP.- LIPNew ❑ THE ❑ BUILDING PLAN REYIEW NewSFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building OVER -COUNTER permit for new building. 0 EXPRESS-, = ❑ P� ANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ '%STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. CI LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ©ivrAJOR I ❑ submittal of Building Permit! application. 77 SANITARY SEWER DLSTRICT ❑ ENltI[t(iNMENTALHEALTH BldgApp_2011.doc revised 06/21/11 r� CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 21113 SCB DATE: 04/30/2015 REVIEWED BY: Sean APN: BP#: z 0 CID� ) -- *VALUATION: 1$600,000 "PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building Civil / Religious activities PENTAMATION USE: in BQ zone? 0 Yes Q No PERMIT TYPE: 1 GENCOM WORK Install new, sports court; install new court lighting 13 22 ft LED twin and single head fixtures; install SCOPE wall facing i material on retaining wall. • I . 4 a1ei:'h. Plan C:;/rec /c Plumb. Plan Chec.�k Elec. Plan Check 0.0 hrs $0.00 AAech. Perfrir fee: Phzmb. Permit Fire: Elec. Permit Fee: IEPERMIT Or're r n.t c.ar. Inst. Other- Mumh h7sp.El Other Elec. Insp. 0.0hrs $48.00 Gtech. I17sp• Fee:. Plumb. hasp. 1e•e: E/ee. Insp. Fee: "19"/u/e/ �"Clear nu/ /nautte fees aue to otner Departments y. e. Planning, Public Works, tire, Sanitary Sewer District, School District_ PIC I_ TI1P.00 IOOC nra bncnd nn ftfa nra/is»ian.n. iss£n. ..f:.,.... ..:/..bin n.,.d .. .. b... /+_._.__. .z_ n__. -- _JJ__n 2- -- FEE ITEMS (Fee Resolution /1-053 Eff '`1/131 FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (E) No $0.00 hours $286.00 Plan Check, Hourly 1STPLNCK Suppl. PC Fee: Q Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 = $208.00 Electrical IBREMPOLE Fixtures, Pole Lighting Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee:Q Reg. Q OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 Construction Tax: IBCONSTAXC $0.00 Administrative Fee: IADMIN $45.00 0 Work Without Permit? 0 Yes (j) No $0.00 Advanced .Planning Fee:., $0.00 2 hours $286.00 Inspections 1STINSP Inspection, Hourly Q 0 Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISAfCO $168.00 Select an Administrative Item Bids), Stds Commission Fee: IBCBSC $24.00 SUBTOTALS:' $333.00 $780.00 -'. '. TOTAL FEE`' $1,113.00 Revised: 04/01/2015