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14060183CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21945 LINDY LN CONTRACTOR: MARK SANTORO PERMIT NO: 14060183 OWNER'S NAME: MARK SANTORO 21951 LINDY LN DATE ISSUED: 09/26/2014 OWNER'S PHONE: 4088868300 CUPERTINO, CA 95014-4810 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL F] COMMERCIAL F] CONSTRUCT ONE STORY ADDITION (487 SQ FT); License Class Lic. # INTERIOR REMODEL (104 SQ FT); RE -ROOF (4900 SQ FT). UPGRADE Contractor Date (E) ELECTRICAL PANEL, SAME LOCATION I hereby affirm that I am licensed under the provisions of Chapter 9 REVISION #I: REMOVE AND RELOCATE WATER HEATER TO ATTIC; (commencing with Section 7000) of Division 3 of the Business & Professions GAS/WATER/SEWER REPIPE; REMOVE AND REPLACE LIGHTS AND Code and that my license is in full force and effect. OUTLETS (80). 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 Sq. Ft Floor Area: Valuation: $0 performance of the work for which this permit is issued. 1 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: 35625015.00 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 DAYS FROM LAST 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 Issued by: ��/ ` Date: granting of this permit. Additionally, the applicant understands and will comply 7l moi! with all non -point source 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 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 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). I 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 Section 3700 of the Labor Code, for the of the work for which this the Health & Safety Code, Sections 25505, 25533, and 25534. t% f performance 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 (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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(o)cuoertino.orp ❑ NEW CONSTRUCTION .. ❑ ADDITION ❑ ALTERATION / TI t6 REVISION / DEFERRED ORIGINAL PERMIT # 1tZ6L&1e_1_3 PROJECT ADDRESS ^ / / / 4C APN OViNERNAME � Sa �'!'o PHO"E / � B� `7 ° f' i — Q IO E-MAIL Rr ✓ STREET ADDRESS 2 r y L,� f C CITY, STA' �, ✓G� FAX C CONTACT NAME `GONE ✓F'' I r ^ �Oa-AIL STREET ADDRESS 2 / / A CITY, STATE, ZIPJ FAX C / T �+n OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR - ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CON'TRP.CTOR NAME a LICENSE NU?„BER LICENSETYPE BUS, LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHTIECT/ENGINEER NAME LICENSE NUMBER BUS. LIC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK T� EXISTING USE PROPOSED USE CONSTR. TYPE 4 STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA B ATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGE AREA: LJDETACH ATTACH 9 DWELLING UNITS: IS A SECOND UNrr [] YES SECOND STORY ❑ YES BEING ADDED? E]NO ADDITION? E]NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ 1'ES I'C'°7;Z'a+?" ri� Tri �% TOTAL V A ION: PLA.'NA7NG APPL ` 7JNO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO r,Y!� ✓�'"£ `� �° "`� 't' p �Iy'I, 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 bui ding construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: w Date: l` SUPPLEMENTAL INFORMATION REQUIRED t it r t ,r /` j�d r Try �V �ERT��C�iLYRTLR�"' Eu "� ✓ e t „ t � £- �iY £ t" 7 , t 'r � BUII.DIT�GT'L�ftE}TiE1V/� ��+�+� P�f New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition is required prior to issuance of building permit permit For new building• _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. I C;�„y�ll"ix�q�itapmP„ 11, +`Lr ra,:M`'rn ��"i+� w ✓ r r �Mb 'k s1 i w' �J� t7BzCav 7 m . �4n—r j��ut�,r ap ,$.�'nf'`r ^�'S `"r? °:r a'"'� , 7e Copy of Planning Approval Letter or Meeting with Planning prior to Pr I 4� 3 dr' ��r � 9 �' ? s t iN 30 a" s N mr ;'�+1"v'"m ,• <; � s. 6 "h ar r A �ITARYSE submittal of Building Permit application., .w .i 4 "tKK - E �YRotT�7ETtr HEALT BldgApp_201 1. doc revised 06/21/11 CITY OF CUPERTINO FM_7 FEE ESTIMATOR - BUILDING DIVISION 11" h,. ��/ �; r 7�� - �. Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check 0.0 hrs $0.00 Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: IEPERMIT rrrl. , °< ca, "n"p Other Plumb Insp. 0.0 hrs $48.00 Other Elea Insp. 0.0 hrs $48.00 Alco,A' ! I,; /'Voc.h'Ji l�x NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etc.). These fees are based on the oreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution I.1-053 Eff 71'13) ADDRESS: 21945 Lindy Lane DATE: 03/12/2015 REVIEWED BY: Sean MISC ITEMS rr APN: BP#: 14060183 *VALUATION: Iso '"PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: I PENTAMATION 1 RPSS PERMIT TYPE: WORK Revision #1: Remove and replace water heater to attic; water re i e as re i e sewer re i e SCOPE remove and replace lights and outlets (80). 11" h,. ��/ �; r 7�� - �. Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check 0.0 hrs $0.00 Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: IEPERMIT rrrl. , °< ca, "n"p Other Plumb Insp. 0.0 hrs $48.00 Other Elea Insp. 0.0 hrs $48.00 Alco,A' ! I,; /'Voc.h'Ji l�x NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District etc.). These fees are based on the oreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution I.1-053 Eff 71'13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # $25.00 Plumbing IPRSEWER I Sewer, Sanitary Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 1 1# $29.00 Plumbing 1 1PRWHEATR I Water Heater Permit Fee: $0.00 Suppl. Insp. Fee.0 Reg. Q OTFo-o-T hrs $0.00 =# Plumbing $72.00 IPGASRES Piping, Gas <=4 Outlets PME Unit Fee: $0.00 PME Permit Fee: $96.00 = # Electrical $348.00 IBREARECEP Recep/Switch/Outlets "r,fL�rrJ°tdr: �cr� drex: Administrative Fee: /ADMIN $45.001 # $14.00 Plumbing IPRREPIPE Re -Pipe Interior 0 0 Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 i Travel Documentation Fee: ITRA VDOC $48.00 Strony4 Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: ' $189.00 $488.00 TOTAL F)E; $677.00 Revised: 02/14/2015 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95024-3255 Telephone: 408-777-3228 Fax: 408-777-3333 TOP ADDRESS: Z! IJL L)jjjy C ,, PERMIT # l p OWNER'S NAME: 1-4, c rK 5'j lI PHONE # t -/o S -kd; e(- Y306 GENERAL CONTRACTOR: m 14 G- c i Idtr BUSINESS LICENSE # ADDRESS: Z-5-1" p� ,� V,,/(, g w°1 s"�— CITY/ZIPCODE: S,jfo-,�r-i *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: Owner / Contractor Signature F- S- -/S-- 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 Rocky - Tile Owner / Contractor Signature F- S- -/S-- Date ALTERNATE MATERIALS AND METHODS / MODIFICATION FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 •FAX (408) 777-3333 • building(a cupertino.org CUPERTINO ❑ REQUEST FOR MODIFICATION OF CODE (CBC 104.10) REQUEST FOR ALTERNATE MATERIAL, DESIGN OR METHOD OF CONSTRUCTION (CBC 104.11, CFC 1.11.2.4) To apply for this request, complete sections 1, 2, & 3 ink ortype) SITE/j } /y ADDRESS (,/l "l V L( �0 �� APN GU lG DATE 1Owner........%i Address.... .....L Email.............................................................. 1' l ...................... 7................................ �� .._ N................ Phone.......................................... PC #:Lj-),J,, ... Permit #:................................ PLN #:................ .,.............. Dept./Div. --... p/ 171.. Job Status: �� r Type: ....... ................ Stories: ................. .......... Occupancy:.......................... Floor Area: ............................. Occ. Load:............ Use of Bldg:c�l�� ............. 5 5 G �l 5 � Applicant .... .�.................r.................Title .....................vLr .CJ. Y� , �7 S V" v Address......�......1�......hl...` L� ...............V...............-0-� .............. �b��Sl —���i c Email....................................................................... Phor e...... ..................................... 2 REQUEST: For code modifications, please state the applicable code requirement and the extent of relief desired. For alternate requests, state the type of system proposed and design methods. Submit plans if necessary to illustrate request. Additional sheets or data may be attached. © T,1 L, 0 '12X- ;T Attach additional sheets if necessary. GU lG C tJ L� A , fifi PP (10 (( qpy r,„ q�✓� vz � 3 JUSTIFICATION/FINDINGS OF EQUIVALENCY: For code modifications, applicant shall demonstrate that special, individual reasons exist that make compliance with the strict letter of the ordinance impractical and that equivalency is provided. For alternate requests, applicant shall demonstrate suitability, strength, effectiveness, fire resistance, durability, sat and sanitation that is equivalent to the code for a similar use. Code Sectioq(s ©� 7`2 CAS `` (y, ` G' f , 7• �✓ Attach additional sheets if necessary. GU lG C tJ L� A , fifi PP (10 (( qpy r,„ q�✓� vz � / ".We; BuildingOfficial: .................................................................................. Print:................................................................................... Date:................................... FireMarshal: ........................................................................................ Print: ...................................... ............................................ Date: ................................. .' Petitioner's ( "r nature: Position:. .wayt.... Date:. 'I Reviewed ....Si ...................................Date:..( i .. The Request is: ❑ GRANTED ❑ DENIED I De L Comments: CONDITIONS OF APPROVAL: No. of Items:......... .................... Fee Due: $................................. Date Paid: ................................. Receipt No,: .............................. Processed by: ............................ BuildingOfficial: .................................................................................. Print:................................................................................... Date:................................... FireMarshal: ........................................................................................ Print: ...................................... ............................................ Date: ................................. .' DEPARTMENT ACTION: After determination, copies to: 1) applicant, 2) permit file A11form 2014.doc revised 01/15/14 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building a(�cupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SIE ADDRESS A 6P# 2-1 11 ild-/ � / � ilyO U OWNER NAME1 ` ,N ER ADDRESS DESCRIPTION OF WORK: We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer' under state and federal law. 109- 6. 1 understand if I am considered an "employer' under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. �7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04114110 9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. ZY-10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. 'eve 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. _LW12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS. Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: -6--/ ----------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Al2,� Date: �--i- l el OwnerBuilderForm 2010.doc revised 04/14/10 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 21945 LINDY LN � DATE: 09/24/2014 REVIEWED BY: MELISSA UNITS APN: 356 25 015 1 BP#: 14060183 *VALUATION: I$o *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: Amps PENTAMATION 1 REAP2 PERMIT TYPE: WORK ADD PANEL UPGRADE TO PERMIT APPLICATION SCOPE APPLIANCE / EQUIP TYPE FEE ID h.' QTY UNITS BP FEES Elec. Permit Fee: IEPERAET Services 1 ERT<200 Other Elec. Insp. 6-6 $48.00 1 hrs 200 Amps $48 PME Unit Fee: $48.00 PME Permit Fee: $48.00 Administrative Fee: JADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 TOTALS: Travel Documentation Fee: I TR,4 VDOC $48.00 Strong Motion Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the prelimina _ information available and are only an estimate. Contact the Dept or addn 7 in o. FEE ITEMS (Fee Resolution 11-053 Eff. 711113) FEE h.' Elec. Plan Check 0.0 1 hrs $0,00 Elec. Permit Fee: IEPERAET Other Elec. Insp. 6-6 $48.00 1 hrs PME Plan Check: $0.00 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the prelimina _ information available and are only an estimate. Contact the Dept or addn 7 in o. FEE ITEMS (Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: $48.00 PME Permit Fee: $48.00 Administrative Fee: JADMIN $45.00 Work Without Permit? 0 Yes 0 No $0.00 Travel Documentation Fee: I TR,4 VDOC $48.00 Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $189.00 $0.00 TOTAL FEE- $189.00 Revised: 08/20/2014 CONSTRUCTION PERMIT APPLICATION O\ COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTtNO (408) 777-3228 • FAX (408) 777-3333 • building a(�cupertino.org \ [I NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS, /. - ' APN N 3 5b /� ` h OWNER NAME A s a1, PHONE V o d 96 E-MAIL C,.. f.7 i -� STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME x+-14 r w PHONE `- 1, 6- E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX OWNER WNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME / ^ LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, "ZIP PHONE ARCHITECT/ENGINEER NAME / M , LICENSE NUMBER BUS. LIC # COMPANY NAME E -MA ce FAX STREET ADDRESS CITY, STATE, ZIP RNE q0 DESCRIPTION OF WORK L/ (�� f ft' / e rd C /'-��j� e- r D 0 EXISTING USE PROPOSED USE CONST -TYPE #STORIES V L USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG[� AREA 2�� i NEW FLOOR AREA p DEMO AREA TOTAL NET AREA Q b BATT-IROOM KITCHEN OTHER REMODEL ARE!: REMODEL AREA REMODEL AREA / 01 PORCH ,AREA DECK AREA TOTAL DECK/PORCH AREA GARAGEAREA DETACH ❑ ATTACH # DWELLTNG U`1ITS. ISA SECOND UNIT ❑ YES SECOND STORY ❑YES 1 BEING ADDED? 5rO ADDITION? WO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN El YES TOTAL VALUATION: PLANNINGAPPL# gNO PLANNING APPROVAL LETTER EICHLER HOME? WO / 4ednt!,;��Fo�oertv By my signature below, I certify to each of the following: I am the property owner or authorizner's behalf. I haav[e read this application and the information I have provided is correct. I have read the Description of Work and verify it s accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent ,f�i Date: 6—' O —I y SUPPLEMENTAL INFORMATION REQUIRED PLAN CTIECK TYPE ROUTING SLIP El OVER TIIF C0VNTER 0 BUJI DING 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 neva building. El EXPRESS Q PLANNINU PLAN REVI,V\k' Commercial Bldgs; Provide a completed Hazardous Materials Disclosure E STANDARD C7 PUBLIC WORNS form if any Hazardous Materials are being used as part of this project. LARGE FIRE uRFT _ Copy of Planning Approval Letter or Meeting with Planning prior to 'U MAJOR � SAe�`ITARYS�SVERDISTHICT submittal of Building Permit application. P.NitIROJVMFNTNI,HEA'LTH BidgApp_20/1.doc revised 06/2//l CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 21945 I_INDY LNDATE: TYPE OF CONSTR. 07/02/2014 REVIEWED BY: MELISSA APN: 356 25 015 BP#: V �� -VALUATION: 1$150,000 *PERMIT TYPE: Building Permit II-B,111-B,IV,V-B PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: $1,284.00 2nd Unit? 0 Yes •- No OTC. 0 Yes (j) No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK ADD 487 S.F. TO CREATE N MASTER BEDROOM SUITE. REMODEL 104 S.F. OF E GREAT SCOPE ROOM & RE -ROOF 49SQ'S (E) ROOF $0.00 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (s.f.) PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 487 $1,579.00 IADDPLCK $1,284.00 IADDINSP Permit Fee: $1,284.00 Suppl. Insp. Fee -0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 . ['cc 0 E) Work Without Permit? Yes (j) No $0.00 TOTALS: 487 $1,579.00 $1,284.00 Strong Motion Fee: IBSEISMICR MECH, HOURLY 0 Yes G No PLUMB, HOURLY Q Yes G No li ELEC HOURLY 0 Yes lF No MISC ITEMS Plan Check Fee: $1,579.00 ----------- Suppl. PC Fee: Q Reg. C) OT 0.0 El $0.00 PME Plan Check: J'� 4,900 s.f. Re -roof $784.00 IREROOFRES Permit Fee: NOTE: This estimate does not include fees due to other Departments (Le. 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 . 711113 FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,579.00 104 s.f. Remodel, Other $418.00 IREMRESOTH Suppl. PC Fee: Q Reg. C) OT 0.0 hrs $0.00 PME Plan Check: $0.00 4,900 s.f. Re -roof $784.00 IREROOFRES Permit Fee: $1,284.00 Suppl. Insp. Fee -0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 . ['cc 0 E) Work Without Permit? Yes (j) No $0.00 Advanced Planning Fee: IPLLONGR $68.18 Select a Non -Residential G Building or Structure Strong Motion Fee: IBSEISMICR $15.00 Select an Administrative Item 1 Bldg Stds Commission Fee.. IBCBSC $6.001 SUBTOTALS: $2,952.181$1,202.001 TOTAL FEE: $4,154.18 Revised: 07/01/2014 40 M CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21945 LINDY LN CONTRACTOR: MARK SANTORO PERMIT NO: 14060183 OWN'ER'S NAME: MARK SANTORO 21951 LINDY LN DATE ISSUED: 09/26/2014 OWNER'S PHONE: 4088868300 CUPERTINO, CA 95014-4810 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL CONSTRUCT ONE STORY ADDITION (487 SQ FT); License ClassLic. II INTERIOR REMODEL (104 SQ FT); RE -ROOF (4900 SQ FT). UPGRADE Contractor Date (E) ELECTRICAL PANEL, SAME LOCATION 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. 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 Sq. Ft Floor Area: Valuation: $0 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: 35625015.00 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 DAYS FROM LXX ,;,:SLED 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 with all non -point source regulations per the Cupertino Municipal Code, Section» 9. l 8. RE -ROOFS: Signature Date 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. 10 OWNER -BUILDER DECLARATION Signature of Applicant: Date: I 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 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). 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(x) 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 theerformance of the work for which this p a ^ t] Owner or authorized agent: _ l �iM � Date: 1 permit is issued. f 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, 1 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 CupertinoMunicipal Code, Section Licensed Professional 9.18. Signature_ Date X 16 y CITY OF CUPERTINO F"Eff FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE; ADDRESS: 21945 LINDY LN DATE: 07/02/2014 REVIEWED BY: MELISSA PC FEE ID APN: 356 25 015 BP#: (q O`f�-� "VALUATION: 1$150,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? 0 Yes G No OTC. 0 Yes 0 No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK ADD 487 S.F. TO CREATE N MASTER BEDROOM SUITE. REMODEL 104 S.F. OF E GREAT SCOPE ROOM & RE -ROOF 49SQ'S (E) ROOF OCCUPANCY TYPE; TYPE OF CONSTR. FLR AREA (s.f.) PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) 11-B,111-B,IV,V-B 487 $1,579.00 IADDPLCK $1,284.00 IADDINSP $0.00 PME Plan Check: $0.00 4,900 s.f. $784.00 Re -roof IREROOFRES Permit Fee: $1,284.00 Suppl. Insp. Fee.0 Reg. ® OT F0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 487 $1,579.00 $1,284.00 MECH, HOURLY 0 Yes 0 No PLUMB, DOURLY C) Yes (F) No ELEC HOURLY 0 Yes E No MISC ITEMS P Plan Check Fee: / EKI s.f. $418.00 Remodel, Other IREMRESOTH E 7__ Suppl. PC Fee: Q Reg. C) OT FO.O h_rs $0.00 NOTE: This estimate does not include fees due to other Departments (Le. 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 addn7 into. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,579.00 EKI s.f. $418.00 Remodel, Other IREMRESOTH Suppl. PC Fee: Q Reg. C) OT FO.O h_rs $0.00 PME Plan Check: $0.00 4,900 s.f. $784.00 Re -roof IREROOFRES Permit Fee: $1,284.00 Suppl. Insp. Fee.0 Reg. ® OT F0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 X 0 G Work Without Permit? C) Yes Q) No $0.00 Advanced Planning Fee: IPLLONGR $68.18 Select a Non -Residential Building or Structure E) 0 Strong Motion Fee: IBSEISMICR $15.00 Select an Administrative Item Bldg Stds Commission Fee:_ IBCBSC $6.00 SUB'T'OTALS; $2,952.181$1,202.00 TOTALFEE.F $4,154.18 Revised: 07/01/2014 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 21945 Lindy Ln DATE: 06/02/2014 REVIEWED BY: A. Salvador PC FEE ID APN: 356-25-015 BP#: TBDZVO&OV631 "VALUATION: Iso PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? Yes No OTC. ® Yes (F)No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK Permit Fee: SCOPE Suppl. Insp. Fee:Q Reg. Q OT OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (s. r.) PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,WN-B 487 $1,579.00 IADDPLCK $1,284.00 IADDINSP Permit Fee: $1,284.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 0 Work Without Permit? © Yes No $0.00 TOTALS: 487 $1,579.00 $1,284.00 stroll",NjQjinn Fee: MECH, HOURLY 0 Yes ) No PLUMB, HOURLY 0 Yes 0 No ELEC, HOURLY Q Yes Q No 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 ITEMSL< Rcsoiwi ri ll. 055 /, f.%'l.'1�3i. FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,579.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,284.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 0 Work Without Permit? © Yes No $0.00 Ad% nct:d 1'lanninp Foe: IPLLONGR $68.18 Select Non -Residential G Building or Structure 0 stroll",NjQjinn Fee: $0.00 Select an Administrative Item MGI-. StClw $0.001 SUBTOTALS: $2,931.181 $0.00 TOTAL FEE: 1 $2,931.18 Revised: 04101/2014