15090111CITY OF CUPERTINO
BUILDING PERMIT
BUILDING ADDRESS: 21310 RAINBOW DR
CONTRACTOR: ERIC KALLIO PERMIT NO: 15090111
CONTRACTOR
OWNER'S NAME: LEONG RONALD W AND DORIS L TRUSTEE
345 OLEA CT .DATE ISSUED: 09/17/2015
{rILROY, CA 95020
OWNER'S PHONE: 4089968854
PHONE NO: (408) 398-5994
LICENSED CONTRACTOR'S DECLARATION
OB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL. ❑
REMODEL MASTER BATH(106 S.F.) HALLWAY
License Class Lic. # ®�
BATH(80
SF.) KITCHEN (99 S.F.), INSTALL NEW TANKLESS
ATER HEATER, INSTALL (1) GAS LINE (140') TO BOTH
p
Contractor 191 C. L4AID b
®ate
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 followingtwo declarations
'
t. I have and will maintain a certificate of consent to self-insurefor Worker's
Sq.
S Ft Floor Area:
Valuation: $98000
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
ri PN Number: 36651010.00
Occupancy Type:
. 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.
APPLICANT CERTIFICATION
PERMIT EXPIRES IF WORK IS NOT STARTED
I certify that I have read this application and state that the above information is
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize
180 D YS FROM LAST CALLED INSP. C ION.
representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
and keep harmless City
AL"Aindemnify
bt' f )
the of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in
Issued by: Date:
consequence of the
granting of this permit. Additionally, the applicant understands and will comply with
RE -ROOFS:
all non -point ce regulat ns er the Cupertino Municipal Co e, Secti n 9.18.
` `
Signature . _ C
e Date (
All roofs shall be inspected prior to any roofing material being installed. If a roof is
inwithout first obtaining an inspection, I agree to remove all new materials for
inspection,
0 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:
t. I, as owner of the property, or my employees with wages as their sole
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.7044, Business & Professions Code)
HAZARDOUS MATERIALS DISCLOSURE
2. I, as owner of the property, am exclusively contracting with licensed contractors to
I;have read the hazardous materials requirements under Chapter 6.95 of the
construct the project (Sec.7044, Business & Professions Code).
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
I hereby affirm under penalty of perjury one of the following three declarations:
Safety :Code, Section 25532(a) should I store or handle hazardous material.
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
Additionally, should I use equipment or devices which emit hazardous air
Compensation, as provided for by Section 3700 of the Labor Code, for the
contaminants as defined by the Bay Area Air Quality Management District I will
performance of the work for which this permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
2. 1 have and will maintain Worker's Compensation insurance, as provided for by
Health &Safety Code, Sections 25505,25M, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
O r or attth i d ag r a�
' Date.
3. Lcertify 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
CONSTRUCTION LENDING AGENCY
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
Thereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
must forthwith comply with such provisions or this permit shall be deemed
Lender's Name
revoked.
Lender's Address
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
ARCHITECT'S DECLARATION
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
I:understand my plans shall be used as public records.
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Licensed Professional
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.
Signature Date
E
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21310 RAINBOW DR
CONTRACTOR: ERIC KALLIO
PERMIT NO: 15090111
CONTRACTOR
OWNER'S NAME: LEONG RONALD W AND DORIS L TRUSTEE
2345 OLEA CT
DATE ISSUED: 09/17/2015
OWNER'S PHONE: 4089968854
GILROY, CA 95020
PHONE NO: (408) 398-5994
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lic. # 5
REMODEL MASTER BATH(106 S.F.) HALLWAY BATH(80
S.F.) KITCHEN (99 S.F.), INSTALL NEW RECIRCULATION
r� ;�t
Contractor i�R kC k A-U,i D C�tP�il Date
Epter
PUMP, INSTALL (N) GAS LINE (60') TO KITCHEN STOVE;
ge�ctce_06) W ` OtiOS •� �1ke —�ror —UKP r� �e Qlat G
I hereby affirm that I am licensed under the provisions of e 9,,yN
Section 7000) Division 3 of the Business & Professions
wC v,.d U W W1 OiCLY-CUP1 wC K AU W, 9�C2
(commencing with of
�� YOCk WC-Ap�., V --e-19 lei C;2) �XV4r l d fs
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.
Sq. Ft Floor Area:
Valuation: $98000
have andwill 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: 36651010.00
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 DA=LASTED 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
by:Date:
granting of this permit. Additionally, the applicant understands and will complyIssued
with all non -pointsource regulations per the Cupertino Municipal Code, Section
9.18.
'
�'�
RE -ROOFS:
Signature Date
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without fust 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
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)
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, 25505, 5533, and 5534.
Section 3700 of the Labor Code, for the performance of the work for which this
JSecis
Owner or authorized agenDate:
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
CONSTRUCTION LENDING AGENCY
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
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
withall non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
im
ADDRESS: 21310 Rainbow Dr
DATE: 11/16/2015
REVIEWED BY: Phuong
APN: 365-51-010
BP#:
'VALUATION: J$98,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
rO.O
PENTAMATION 1R3SFDREM
PERMIT TYPE: 19
WORK
REMODEL MASTER BATH 106 S.F. HALLWAY BATH 80 S.F. KITCHEN 99 S.F.),INSTALL NEW
SCOPE I
RECIRCULATION PUMP, INSTALL (N) GAS LINE (60') TO KITCHEN STOVE; REPLACE (10) p
Vech. flan C hz, w Plumb. Plan Check 0.0 hrs $0.00
Plumb. Permit Fee: IPPERMIT
Other Plumb Insp. 1 0.0 1 hrs 1 $48.00 .
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 ha.ced an the nreliminary information availahle and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff: 7"11'132
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1-8 67 s.f.
$645.00
Remodel, Bath (<=300 sf)
IREMRESBA7'
Suppl. PC Fee: (F) Reg. OT
rO.O
hrs
$0.00
PME Plan Check:
$0.00
= s. f.
$645.00
Remodel, Kitchen (<=300 sf)
IREMRESKIT
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0 OT
0 0
hrs
$0.00
14 #
$
Window / Sliding Glass Door
1WINREP Replacement
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
0 # Plumbing
$72.00 IPGASRES Piping, Gas <=4 Outlets
�.^ir,s '=`"
Administrative Fee: (ADMIN
$45.00
Q
E)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
i
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$12.74
Select an Administrative Item
LLj
Bldg Stds Commission Fee: 1BCBSC
$4.00
SUBTOTALS:
$157.741$1,936.00
TOTAL FEE:
$2;gg37-4
Revised: 10/01/2015
CUPERTINO
CONSTRUCTION PERMIT APPLICATION 15N0111
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building ancupertino.ora
❑ NEW CONSTRUCTION n ADDTTTow F1 e T TFD E TMM I TT n nit gtr t,. r
- _ - - - - - --• . — _...-.. • . •�.. , u
.. . --N I i�r nic�cL viC.LC711VA1.. Yt;KMl l ;r
PROJECT ADDRESS
� APN n
ER NAME B
D MgIL + i
STREET ADDRES CITY TAT
.a FAX
CONTACTPON
� E-MAIL
STREE ADD
TATE, Z
FAX
E
O�['NER ❑. O'%TiER-BUILDER ❑ OR'NcRAGENT 1KCONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT O'ENGLNEER ❑ DEVELOPER ❑ TENANT
CO�TRp` TOR ANE j LI5 4B
is
LIC E
BUS. LIC i
COMPANY NAME
FAX
STREET ADDRESS -(2a
STATE, ZIP
PHONE
F
A P CHITECT/ENGINEER NAME LICENSE NUMBEP
_
BUS. LIC #
COMPANY NAME
E MP IL
FAX
STREET ADDRESS
CITY, STATE, ZIP
I
PHONE
DESCRIPTION UFWORK
l
s
�
idm
EXIS GUSE
PROPOSED USE
CONSTR TYPE #STORIES
USE TYPE OCC. SQ.FT.
ALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
-_
BATHROOMg
REMODEL AREA Ii
KITCHEN OTHER
REMODEL AREA REMODEL AREA
FOR AREA
DECK AREA I
TOTAL DECK/PORCH AREA
GARAGE AREA: El DETACH
-
I
[]ATTACH
I
N DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑YES
BEING ADDED? No
ADDITION? []NOPRE-APPLICATION
❑ IBS IF YES, PROVIDE COPY OF
15 THE BLDG AN ❑ YES
I;1VED B-�'- -
-YEN -M.
T VALUATION'
PLANNINGAPPL: ❑NO PLANNING APPROVAL LEITER I
EICHLERHOME? I-] NO
- - gr
w
By my signature below, I certify to each of the following: I am the property owner or autho zed agent to act on the property owner's behalf. nave 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 Iocal
ordinances and state laws relating u1 'ng conscti . I auth ize representatives -of Cupertino to enter the above-iflentifiid property for inspection purposes.
S ignature of A.pplicantlAgent:
Date:
SUPPLEMENTAL INFORMATION REQUIRED
2oIiTRtGST----
= =RESI
.-
`�
NTew SFD or Multifamily d-wellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
OSERTHCOUNT�R
BUIIDL�GPLANItE4�EF
permit for new building.EI�Ess�R
AGE Nlyvj
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure�STANDARD�
FRXR
E
form if any Hazardous Materials are being used as part of this project.
] -
Copy of Planning Approval Letter or Meeting with Planning prior tom
Building Permit
LxG
t17flRSIiT21R
DEPT
SE�iR�ISTRIC
submittal of application.
EL
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E3L�ntOI�MEIlT4�HEAI;THe
Bldgt4pp_2011.doc revised 06/21111
CITY OF CUPERTINO 15 Q 1 1 1
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 21310 Rainbow Dr. DATE: 09/17/2015 REVIEWED BY: PAUL
APN: 366 51 010 BP#; *VALUATION: $98,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIUSE: SFD or Duplex ___TPP 1 R3SFDREM
PERNIIT TYPE:
WORK Remodel Master Bath 106 S.f. Hallway Bath 80 S.f. Kitchen 99 S.f. Install new tankless water
SCOPE heater, Install (N) gas line (140') to both tankless water heater and to kitchen stove.
NOTE: This estimate does not include fees due to other Departments (e. e. Planning, Public Works, Fire, Sanitary Sewer District, School
Distract, etc.. These fees are based on the vreliminar information available and are on1v an estimate Contact the Dent fnr addn'l infn
FEE ITEMS (Fee Resolution 11-053 E f 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
186 s.f.
$645.00
Remodel, Bath (<=300 sf)
IREMRESBAT
Suppl. PC Fee: C) Reg. 0 OT
0.0
I hrs
$0.00
PME Plan Check:
$0.00
FWs.f
$645.00
Remodel, Kitchen (<=300 sf)
1 IREMRESKIT I /
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0 OT
FO-0-1hrs
$0.00
# Plumbing
$29.00 IPRWHEATR • Water Heater
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
# Plumbing
$72.00 1PGASRES Piping, Gas <=4 Outlets
Construction Ra:
Administrative Fee: 1ADMIN
$45.00
"�
Work Without Permit? O Yes No
$0.00
Advanced Planning Fee.
$0.00
Select a Non -Residential
Building or Structure
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$12.74
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$4.00
SC7BT0AIiS
$157.741$1,391.00
.z ''�
$1,548.74
Revised: 07/02/2015
Building Department
City Of Cupertino
10300 -Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C O P E RT I N O Fax: 408-777-3333
13, <�> CONTRACTOR] SUBCONTRACTOR LIST
JOB ADDRESS: - PERMIT # C
OWNER'S NAME: PHONE #, r
GENERAL CONTRACTOR: Ve,�, ESS LICENSE #
ADDRESS; 1 C9J F 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 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 Date
Please check applicable subcontractors and complete the following information:
V
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood,
Glass / Glazing
Pleating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile q- G
fit, -^� �
-0 .G_ -
.; 4
/ Contractor Signature
D e