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Home My WebLink About1312019515 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10270 S STELLING RD CONTRACTOR: PARKWAY PERMIT NO: 13120195 CONSTRUCTION & OWNER'S NAME: CHURCH OF JESUS CHRIST OF LATT 1000 CIVIC CIR DATE ISSUED: 06/18/2014 OWNER'S PHONE: 8017128491 LEWISVILLE, TX 75067 PHONE NO: (469) 322-3768 NIn LICENSED CONTRACTOR'S DECLARATION Pi JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E �y (J / REMOVE & REPLACE (E) COMP ROOF SYSTEM, LIKE License Class Lic. # v 6 FOR ContractorDate l� ��! LIKE. VOLUNTARY SEISMIC UPGRADES FROM THE TRUSSES I hereby affirm that I am licens d under the provisions of Chapter 9 UP (INCLUDING STEEPLE). ADA BATHROOM UPGRADES (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: $365000 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: 35913105.00 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 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 180 DAYS LED 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 by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. br RF, -ROOFS: SignatureZ Date All roofs shall be inspected prior to any rooting material being installed. If a roof is I IF installed without fust 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 licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 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 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, Sections 25505, 25533, and 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, 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 (See. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 1 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (40.x) 777-3228 • FAX (408) -177-3333 • buildinaecupertino.orq ❑ NEW CONSTRUCTION ❑ ADDITION X❑ ALT ER. TION / TI ❑ REVISION,, DEFERRED ORIGINAI PERMIT # PROJECT ADDRESS APN k r �i 13—( 0 10270 Stelling Road Cu F)rtino, CA 95014 OWNER NAME PHONE:'. E-MAIL. The Church of Jesus Christ of Latter-day Saints 801 712-8491 hartline Idschurch.or STREET ADDRESS CFl Y, STA'L'E, ZIP GAX 31500 Grape St. Ste. 3-200 Lake Elsinore CA 92532-9702 CONTACT NAME PHONE E-MAIL Ron Christensen 435-225-1621 ronc apex .corn STREET ADDRESS CII Y, STATE, ZIP FAX 2720 W 7000 S Wellsville UT 84339 435-554-0525 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTPACIOR ❑ CONTRACTOR AGENT ❑ ARCHITECT 21 ENGINEER ❑ DEVELOPER ❑ TENANI CONTRAC TOR NAM E LICE\.SENUMBER LICENSE TYPE BUS.I IC=' COMPANY NAME E-MAIL PAX STREET ADDRESS CITY, STATE:, ZIP PHONE ARCHITECT/ENGINEER NAME LICI:\SE NUMBER BUS. .1C;j Ron Christensen ?4396 COMPANY NAME E-MAIL FAX Apex Design Group ronc a exd .corn 435-554-0525 STREET ADDRESS CITY, STA1 E, ZIP PHONE 2720 W 7000 S Wellsville UT 84339 435-225-1621 g DESCRIPTION OF WORK Reroof of building,Steeple replacement like for like, reroof shed, voluntary structural improvements, ADA bathroom upgrade One roof top mechanical unit replaced Aw kA41.4� I EXISTING USE PROPOSEC CSE CONSTR TYPE d S-1 CRIES A-3 A-3 T e III 1 USE TYPE OCC SQ.E I. VALUATION ($) EXIST(, NEWFLOOR DEMO TOT \1 AREA 18,274 s.f. ARIA None .AREA 420 s.f. N AIu:A18,274 s.f I BATHROOM KITCHEN OTHER REMODEL AREA REMODP. AREA REMODEL. ,RE '. 420 s.f. PORCH AREA DECK AREA TC'rAL DECK'PORCI-IAREA GARAGE AR:A DETACH ❑ ATTACH 4 DWELLING UNITS ISA SECOND UNIT ❑YES SECOND ST'U,RY ❑YES BEING ADDED? NO ADDITION? ®NO PRE -APPLICATION ❑ YES IF YES, PRC VIDE COPY OF IS THE BLDG AN ❑ YES TOTAL VALUATION_ PLANNING .APPL# NO PLANNING APPROVAL LETTER EICHLER HOME? ®NO - 365,000 By my signature below, 1 certify to e.Ich of the following: 1 am the property owner or authori a owner's behalf 1 have read this application and the information 1 have provided is correct. I have re€d the Description ofXk7ork and veri It is a • e. I agree to comply With all applicable local ordinances and state laws relating to building con r�uct xfi. I authori.�e representatives of Cupertino to en 0r e above -identified property for inspection purposes. Signature of ApplicandAgent: Date:��t 6/UI3 _ SLIPPLEMENTAL INFORMATION REQUIRE'D PLAN CHECK TYPE ROUTING SLIP ❑ OVER -THE -Cot LATER ❑ BCILDING 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. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a Completed Hazardous Malerials Disclosure V STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials ,Ire being used as part of this pr.lject. ❑ ❑ LARGE FIRE DEPT Copy of Planning Approval Letter or Meeting with Planting prior to 1:1 E-1 DISTRICT submittal Of Building Perm it app,ICatlOn. MAJOR 54N1T\RV SEWER ❑ ENVIRONMENTAL HEALTH Bldg9P1, 2011.doc revised 06/21'11 CITY OF CUPERTINO Fm -7, FEE ESTIMATOR - BUILDING DIVISION 1AADDRESS: 10270 STELLING RD DATE: 12/23/2013 REVIEWED BY: MELISSA PC FEE ID APN: 359 13 105 BP#: 3�020/ *VALUATION: 1$365,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: IATIPLNCK PENTAMATION 1ATI PERMIT TYPE: WORK REMOVE & REPLACE E COMP ROOF SYSTEM LIKE FOR LIKE. VOLUNTARY SEISMIC SCOPE UPGRADES FROM THE TRUSSES LIP. ADA BATHROOM UPGRADES & UPDATE 2 DRINKING p OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID A (Tenant Improvements) II-B,III-B,IV,V-B 430 $2,366.00 IATIPLNCK $575.00 IATIINSP ..lust FFV' $575.00 Suppl. Insp. Fee:Q Reg. O OT0,0 hrs $0.00 1 # Mechanical $139.00 IBCAIRHA Air -Handling (<=10K cfm) PME Unit Fee: $0.00 PME Permit Fee: $47.00 Work Without Permit? O Yes O No $0.00 TOTALS: 430 $2,366.00 Travel Documentation Fee: ITRA VDOC $575.00 Strong Motion Fee: IBSEISMICO MEGH, HOURLY O Yes ; d No PLUMB, HOURLY O Yes Q No ELEC, HOURLY O Yes Q No Mech. Plan Check 0.0 hrs $0.00 Plan Check Fee: Hourly Only? 0 Yes Q No $2,366.00 Mech. Permit Fee: IMPERMIT Suppl. PC Fee: Q Reg. O OT 0.0 Other Mech. Insp.Ehrs $47.00 �;,.;:zr ..., �.� 'lh: , �..� _ _ Itis;.El 11(.rit rs. ;. ","c / i. mh. rlEl_ t.. , .. ..lust FFV' NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta). These tees are based on the Dreliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 L' ..' 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $2,366.00 5 hours Plan Check, Hourly $695.00 /STPLNCK Suppl. PC Fee: Q Reg. O OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 118,3001 s.f. Re -roof $1,427.00 IREROOFCOM Permit Fee: Hourly Only? 0 Yes Q No $575.00 Suppl. Insp. Fee:Q Reg. O OT0,0 hrs $0.00 1 # Mechanical $139.00 IBCAIRHA Air -Handling (<=10K cfm) PME Unit Fee: $0.00 PME Permit Fee: $47.00 Work Without Permit? O Yes O No $0.00 Advanced Planning Fee: $0.00 5 hours Inspections 0 $695.00 ISTINSP Inspection, Hourly Travel Documentation Fee: ITRA VDOC $47.00 Strong Motion Fee: IBSEISMICO $76.65 Select an Administrative Item Bldy, Stds Commission Fee: IBCBSC $15.00 SUBTOTALS: $3,126.65 $2,956.00 TOTALFEE:: $6,082.65 Revised: 10/01/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U PE RTI N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: d ie % PERMIT # 131,20lq5 OWNER'S NAME: u, PHONE # a6f- 71,X - I GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: L.e&A -(/ r ll TY 7506-7 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(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 ?) Z'" C > Owner / Contractor Signature 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 ?) Z'" C > Owner / Contractor Signature Date CONSTRUCTION PERMIT APPLICAT[ON COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina(c)cuoertino.ora ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI -?S REVISIOND FERRED ORIGINAL PER -MIT n l 3120! �5 PROTECT ADDRESS / n � ! /I APN 4 —t63 � OWNER",A"' S P �tOI K I E -MA L of v O� 4 STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NP ,E PHO. E A4 'K? l - V CL vek 6rr STREET ADDRe rS CITY, STATE, ZIP F.AX 0-AWER ❑ 0 '�"ti-BUD-DER R AGE?.1' cCh RACTOR ❑ COI17RR CTOR AGEIN ❑ ARC---'r-CT ❑ E-NGWEER ❑ DF�ELOPER ❑ TENANT CO? TRACTOR NAM - jl LICENSE NUMBER LICENSE TYPE BUS. LIC T wYCOK,COw COMP.AI.'YNAME E-A4AIL I F.tX !(k �I� `PHOh STREET ADDRESS ' t C TY, STATE, ZIP 1F ,f 11066 e ARC=lCTNGIIALER NA -MIF LICENSE NUMBER BUS. LIC R COMPANY N.AA;E E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP' PHONE DESCRIPTION OF WORK ` � 4�v- he le e EX'_S1ANGUSE PROPOSED USE CONSTR nPE '' STORDSS USETYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: Lj DETACH ❑ ATTACH s DWELLING UNITS: ISA SECOND UNIT ❑ YES SECOND STORY ❑YEs BEING ADDED? ❑ No ADDITION? NO —PRE•r',PPL3C-i7I0N—[�1'-ES--ff-Y-rS-PAOIIDELOPLOF _ISSIaE BJrDG AN rl '- E R e .: _ . ;- OT.AL VALUATION. O PLAGAPPROVAL LETTER PLA'.T'1NGAPPL: ❑NI.NLN EICHLERHOME? ❑NO - - - By my signature below, I certify to each of the following: I am the property owner or authorized _ nt to ac on the property owmer'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 law's relating to building c tio• - thorize representatives of Cupertino to enter the above-identifie pro erj' for inspectio urposes. S i gnature of Appl icant/Agent: SUPPLEMENTAL I\TFOR_A4ATI0'\T REQLIRED #x Cz-... oti RTxE couI�TER s-,^�v`�"cFa i. BuabTl.crL�': uAM-1-5 Newdwellings: r t 1\e�� SFD or l6ultifamily dwellings: Appl} for demolition permit for existing building(s). Demolition permit is required prior to issuance of bulldmg OR a �� x3 permit for new building. g%-`4FJ� tEATERs' I'tNth Hazardous Disclosure iLam � --N -j _ Commercial Bldgs: Provide a completed Materials sq form if any Hazardous Materials are being used as part of this projert. WN, Copy of Planning Approval Letter or Meeting with Planning prior to � T � _ s 3f. 70R ' r� NNW - � AR3I'�RI SER_ DISTF.TNN �- submittal submittal of B uildina Permit application.�<� .x�-a'��.��= Bld.-App_2011.doc revised 06/21/11 CITY OF CUPERTINO Fr -,m7 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10270 S STELLLING RD FEE DATE: 09/04/2014 REVIEWED BY: MELISSA APN: 35913105 BP#: Plan Check Fee: "VALUATION: Iso 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE: Suppl. PC Fee: ) Reg. 0 OT 0.0 PENTAMATION 1GENCOM PERMIT TYPE: 19 WORK 9/4/14 - DEF # 1 FOR STEEPLE $0.00 SCOPE NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Di.ctrirt_ etr_)_ The.ce fpi v are ha.ced on the nreliminary information availahle and are only an estimate_ Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution I1-053 bff. 7%11/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # $286.00 Deferred Submittal IDEFSUBAf Suppl. PC Fee: ) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 (F) Work Without Permit? ® Yes (F) No $0.00 Advanced ?lannin1,Fee: $0.00 Select a Non -Residential Building or Structure Q i Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee. $0.00 SUBTOTALS: $0.00 $286.001 TOTAL FEE: 1 $286.00 Revised: 08/20/2014 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10270 S STELLING RD CONTRACTOR: PARKWAY PERMIT NO: 13120195 CONSTRUCTION & OWNER'S NAME: CHURCH OF JESUS CHRIST OF LATT 1000 CIVIC CIR DATE ISSUED: 06/18/2014 OWNER'S PHONE: 8017128491 LEWISVILLE, TX 75067 PHONE NO: (469) 322-3768 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL 0 REMOVE & REPLACE (E) COMP ROOF SYSTEM, LIKE License Class IS Lic. # FOR LIKE. VOLUNTARY SEISMIC UPGRADES FROM THE Contractor /1Date __ TRUSSES I hereby affirm that I am li ensed under the provisions of Chapter 9 UP (INCLUDING STEEPLE). ADA BATHROOM UPGRADES (commencing with Section 7000) of Division 3 of the Business & Professions & Code and that my license is in full force and effect. %, !/ eferred #2- replacement of handicap handrails deferred #2- replacement of I hereby affirm under penalty of perjury one of the followin to<s:handicap handrails I have and will maintain a certificate of consent to self-i rker's Compensation, as provided for by Section 3700 oft Code, for the Area: Valuation: $365000 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insur ed for b Section 3700 of the Labor Code, for the performance o work for which this APN Number: 35913105.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that 1 have read this application and state that the above information is PERMIT EXPIRE ORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN I AYS F 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 DAY RO AST 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 Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. � � `````�� RE-ROOFS: Signature ., , Date f /JI Z/11/ All roofs shall be inspected prior to any roofing material being installed. If a roof is 17 installed without first obtaining an inspection, l 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 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 1 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 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505 2 Section 3700 of the Labor Code, for the performance of the work for which this Lj� Owner or authorized agent- Date: r�—'1 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 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 l 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 [a COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building aacupertino.orq ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI_ REVISION EFERRE ORIGINAL PERMIT # PROJECT ADDRESS � APN # i02 -3b c-, :54PIA4 kkxel OWNER NAME PHONE E-MAIL STREET ADDRESS CITY, TATE, ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC k 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 DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE # 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 AREATOTAL DECKIPORCH AREA GARAGE AREA: DETACH []ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? []NO ,V PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY' TOTAL VALUATION: PLANNING APDL# NO PLANNING APPROVAL LETTER EICHLER HOME? E3 NO 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 constru'.ilk uthorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: �/ F"1 SUP MENTAL INFORM ION REQUIRED ri uv CHECK cimE .:. ROUTING SLIP'. _ New SFD or Multifamily dwellings: Apply for demolition permit forovEx TxE cooivTER ❑ BUILDnvG PLAN REVIEW., existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ "PLAN NTING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTANna❑ PUBLIC WORK tn ' 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 t0 ❑. MAJOR �' ❑ SANITARY $EWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 1. doc revised 06'21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10270 stelling rd DATE: REVIEWED BY: Mendez APN: BP#: 'VALUATION: 1$15,250 °PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: 1 # $286.00 PENTAMATION 1GENCOM PERMIT TYPE: WORK deferred #2- replacement of handicap handrails SCOPE 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 addh 7 info. FEE ITEMS (Fee Resolution II -055 Ff: 71,13 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # $286.00 Deferred Submittal IDEFSUBM Suppl. PC Fee: (j) Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT T0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 (D Work Without Permit? 0 Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G Strong, Motion Fee: IBSEISMICO $4.27 Select an Administrative Item B1di4St& Commission Fee: IBCBSC $1.00 SUBTOTALS: $5.27 $286.00 TOTAL FEE: $291.27 Revised: 10/01/2014 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10270 S STELLING RD CONTRACTOR: PARKWAY PERMIT NO: 13120195 CONSTRUCTION & OWNER'S NAME: CHURCH OF JESUS CHRIST OF LATT 1000 CIVIC CIR DATE ISSUED: 06/18/2014 OWNER'S PHONE: 8017128491 LEWISVILLE, TX 75067 PHONE NO: (469) 322-3768 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] !l(� REMOVE & REPLACE (E) COMP ROOF SYSTEM, LIKE Class ass Lie. # 7 / FOR Ti[/ J23/1LIKE. VOLUNTARY SEISMIC UPGRADES FROM THE Contractor Date S TRUSSES I hereby affirm that 1 a licensed under the provisions of Chapter 9 UP (INCLUDING STEEPLE). ADA BATHROOM UPGRADES (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: 9/4/14 - DEF # 1 FOR S EEPLE- ISSD 9/23/2014 1 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 q. Ft Floor Area: Valuation: $365000 performance of the work for which this permit is issued. Q�G [` 1 have and will maintain Worker's Compensation Insurance, as prov. Section 3700 of the Labor Code, for the performance of the work for ich this A umber: 35913105.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION OPS I certify that I have read this application and state that the above information is PERMIT Ey IF WORK IS NOT STARTED correct. 1 agree to comply with all city and county ordinances and state laws relating WITH'O DAYS F 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 IgO DA RO T CALLED INSPE TI N. 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 Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section ROOFS: 9.18. � � Signature � Date Z All roofs shall be inspected prior to anyny 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 Signature of Applicant: Date: 1 hereby affirm that 1 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, wil I do the work, and the structure is not intended or offered for sale (See.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 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.I2 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 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, Sections 25 25533, and 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, [ 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 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 e'�'s.rsaf • CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3235 Telephone: -108-777-1228 Fax: -I08-777 >333 J( )13 :ADDRESS: I PERMIT # / 3 OWNER'S NAME:�LA 1 PIIONF -71 f GENERALCONTRACTOR: BUSINESS L1CFNSI'2) ADDRESS:. *our municipal code requires all businesses %%orking in the cite to have a Cite of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUP:1\CY INSPECTIO\(S) WILL BE SCIIEDULED UNTIL Tllf' GENERAL CO\TRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPF,RTINO BUSINESS LICENSE, am not usin- am subcontractors: — Signature Please check applicable subcontractors and complete the following information: Date ✓ SUBCONTR=ACTOR BUSINESS NAME BUSINESS LICE\'SI: # Cabinets &- 11ilk%ork Cement Finishing Electrical Excavation NA, Fencing Floori112 `Carpeting Linoleum:` Wood Glass % Glazing, heating,,, llrltintsAl.*_ �" �`�5 Insulation __�� tj �LI Landscaping f V Lathing Al% Masonry o Painting /Wallpaper Paving F Plasteringe�3 Plumbing .. VKYQC(p�CZ� Roofing Ali �es�c e,� &,o :N. 5ob� Z�3 1 Septic Tank _ Sheet 'Meta! 1-3.5� Sheet Rock j"cpj TI.T T k! TE& -�'j? �'nr3 �f501 j Fs -AM;, E:r,,r-dt (S - vV/1Y ,;C ZQ