14080209-D PUB7547 DE LA FARGE DR
14080209
F
DAVID HASS
SCANNED BOX # 688
It
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7547 DE LA FARGE DR
CONTRACTOR-
PERMIT NO: 14080209
ON
ig
OWNER'S NAME: DAVID HASS
DATE ISSUED: 10/03/2014
OWNER'S PHONE: 4087308877
PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
CONSTRUCT ONE STORY ADDITION (92 SQ FT);
M A,
INTERIOR
REMODEL OF RESIDENCE AND GARAGE (2013 SQ FT);
? �
v11_0 ctor
�-•.ram-�-
REROOF - SHAKE TO COMPOSITION SHINGLES (2013 SQ
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,
crcby affirm under penalty of perjury one of the following two declarations:
ave and will maintain a certificate of consent to self -insure for Worker's
to
mpensation, as provided for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $200000
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: 35926027.00
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 D YS 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
granting of this permit. Additionally, the applicant understands and will comply
Issued by: te:
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
h r? c A a
'.:�� �,.'� ,s_:�Y��• r-- p..
RE -ROOFS:
�-I �+rtc[tttY .,, .
d Dais -
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
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 1 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 2550 , 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
p
Owner or ant iz 'agr_
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
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
s
COMMUNITY DEVELOPNIENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building@cupertino.org
❑ NEW CONSTRUCTION LJ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED
6`6
O�GINAL PERMIT #
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PROJECT ADDRESS 75 f I r _7 Pef 0 r
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APN # 3iO -7
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OWNER NAME
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E-MAIL
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STREET ADDRESS
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CITY, STATE, ZIP
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CONTACT NAME ,
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT G ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
s
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECTIENGINEER NAME ` H n l G
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LICENSE NUMBER 7 7
BUS. LIC #
COMPANY NAME
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E-MAIL
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FAX
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STREET ADDRESS
12 3� aakvL"edCA 4 303
CITY, STATE, ZIP
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PHONE
0-887
DESCRIPTION OF WORK f ✓S r C i- r
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EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
p 1 3
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USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA 2 D 3 Y
i
AREA
AREA '7 r 0 3 S
G
NET AREA2, f^_
I
_tZ
BATHROOM
REMODEL AREA .Z
KITCHEN
REMODEL AREA ZOO
OTHER
REMODEL AREA `
(a %,
Z
�1 �.0
— I c
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: D TACH
�, TTACH
I
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
BEING ADDED? V6
SECOND STORY ❑ YES
ADDITION?
1
PNO
vY❑
0
PRE -APPLICATION ❑ YFS IF YES, PROVIDE COPY OF
PLANNING APPL N 0 PLANNING APPROVAL LETTER
IS THE BLDG AN YES
EICHLER HOME? LYRO
RECEIVED B
' r f
TOTAL VALUATION:iiii1111���----
-
0 , oO O
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act erty 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 buildi ns t' I authorize representatives of Cupertino to enter the above- entl ted property for inspection purposes.
Signature of Applicant/Agent: e!i Date: '7�x40
SUPPLEMENTAL INFORMATION REQUIRED
y. `rinry caECK rYrE ,=
iavrnvc SLIP'
New SFD or Multifamily dwellings: Apply for demolition permit for
❑ OVER T#iE COUNTER
BUILDINGPLA?V RE�'TEW
is required prior to issuance of buildin
g gO P 4 P g���---,,,%%%���;
existing buildin s . Demolition pen
permit for new building.
❑= XPRESS P
LANNINGPLAIV xi vlEw
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
" STANDARD ,` �b:
PUBLIC WORKS
_
form if any Hazardous Materials are being used as part of this project.
❑
a
`
Copy of Planning Approval Letter or Meeting with Planning prior to
LARGE ' �'�
❑
FIREDEP��
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submittal of Building Permit application.
MAJOR ;
•
SAIVl�r WERIIISTRICT°
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❑ ,ENS IRONMENT.AL HEALTI a „ -
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BldgApp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
igADDRESS:
7547 de la farge dr
DATE: 08/20/2014
REVIEWED BY: Mendez
APN:
BP#:
*VALUATION: 1$200,000
*PERMIT TYPE: , Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
USE: SFD or Duplex
2nd Unit? 0Yes `' No
OTC? 0 Yes ONo
PENTAMATION
PERMIT TYPE: 1 R3SFDADD
WORK
interior remodel to include 2127 sq ft add 92 sq ft to rear of sfdwl new water heater
SCOPE
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-BjV,v-B
0
$0.00
$0.00
TOTALS:
0
$0.00
$0.00
MECH, HOURLY O"Yes 0'No
. PLUMB,'HOURLY 'O'Yes O No
ELEC, HOURLY,' . O Yes' (E)No,
Nfech, Non Check
Plumb, Plan Check 0.0 hrs $0.00
Elec..PI«n Check
;tfech. Pernii! Fee:
Plumb. Permit Fee: IPPERMIT
F'Iec. Pierre it Fee:
Orhrr iifixh. 1nsp.
Other Plumb Insp. 0.0 hrs $48.00
Orher Elec. Insp.
�11ach. 112sp. Fee:
I Phanb, lush. Fce:
I Elec. Insp. hee:
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 6reliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 ff. 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? O Yes ) No
$0.00
2� hours Plan Check, Hourly
y 6V. PLNCK
Suppl. PC Fee: Q Reg. O OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
2,127 s.f. Remodel, Other
$5,456.00 1 IREMRES2
Permit Fee:
$0.00
Suppl. Insp. Fee: D Reg. O OT
0.0
hrs
$0.00
0 # Plumbing
$29.00 IPRWHEATR Water Heater
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
(,,,011 ruction .T(I..°
Administrative Fee:
0
Work Without Permit? O Yes No
$0.00)
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure O
i
Travel Documentation Fee: ITR4VDOC
$48.00
Strong Motion Fee: 1BSEISMICR
$26.00
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$8.00
SUBTOTALS: `
$130.00
$5,771.00 ;' ' T,O.TAL FEE:
lionao
Revised: 0711012014