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13090002CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22330 REGNART RD CONTRACTOR -TBtY--T0 BE PERMIT NO: 13090002 OET=INED OWNER'S NAM E: JOY THOMAS iMc14SaC kVA - DATE ISSUED: 11/26/2013 OWNER'S PHONE: 4082797880 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL License Class Lic. # SAN JOSE WATER CO. REPLACE EXISTING WATER STORAGE Contractor Date TANK WITH 2 NEW TANKS I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $1600000000 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: 36639006.00 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 WITHI 80 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 DA10 rROM 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 Date://,-,Q granting of this permit. Additionally, the applicant understands and will comply Issued by 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: 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 2�01, 25533, and 25534. �'_5 Section 3700 of the Labor Code, for the performance of the work for which this p �,f� % Owner or authorized agent: / Date: permit is issued. 1.�— certify that in the performance of the work for which this permit is issued, I shall N 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. Signatures _Date 11 all CONSTRUCTION PERMIT APPLICATION _Y COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 V CEJPERTINO @ (408) 777-3228 • FAX (408) 777-3333 • buildingcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS I� �j na�� (gyp APNk 366l J��oo6 OWNER NAME - 7 _Z7 �7PHONE (, �Og EMAIL�� ., �_ Y, of )2-7f w � STREET ADDRESS /-I w CITY, STATE, Z"IIPP'G✓�� FAX J .c 9 rz ( �� 7i 7d' CONTACT NAME / j /, h �r�%%S- lCi PHONE (4f� ),27 yam( r�+�v 'ZIP "a�k"Y'y 7V�Se E-MAIL Gt�c�j- i..J .ix✓l /i(i�% STREET ADDRESS i CA 1 �I 1_!� CITY, STATE, FAX -7T7 ' U e�7-�� ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 4fCJ LICENSE NUMBER LICENSE TYPE BUS. LIC 4 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHrrECTIENGINEER NAME y m�� q6e- LICENSE NUMBER C. 4 BUS. LIC 4 COMPANY NAME EMAI, FAX Q STREET ADDRESS �sGs" S- r3alcd 4w _ CITY, STATE, ZIP Sri Jose , 6 gs r Z PHONE 4�a 2-7�--7dV DESCRIPTION OF WORK Re - EXISTING USE PROPOSED USE CONSTR. TYPE I STORIES I USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA DECKAREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ATTACH :�PORCHAKEA ELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ❑ NO ADDITION? ONO PRB-APPLICATION [] YES IF YES, PROVIDE COPY OF PLANNING APPL ft NO PLANNING APPROVAL LETTER ❑ IS THE BLDG AN ❑ YES EICHLER HOME? NO ❑ ILFCEI �� OiA�� „ / 1, rr, ��/% / t�l�////i �ji�i/��0//,/ �� TOT VALU T10N: i (�i % "ii iii„ i; ,c i G ! "KA /Aj/,'r' By my signature below, I certify to each of the following: I am the property owner or authorized alent 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 con§triAction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: i Date: `/ i SUPPLEMENTAL INFORM ON REQUIRED%�yr�? _ New SFD or Multifamily dwellings; Apply for demolition Permit for existing building(s). Demolition permit is required prior to issuance of building ;� /1%; ��,�� ,i/� �� li,� %,!�%/i�l�J,i jou%/,r;��/viii✓�%r�+ permit for new building. L'6XP 5��f�,�%/rii�%%t�i�t�`L�A�`C�GP��R��Y[EW%y'�� Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. � �,/ � . � �� ,�1�'I//�/� , � /�t�✓�,/y,�i,trF�, i1,�,�,��/� ��,,�� r�,,, t�,,, Copy of Planning Approval Letter or Meeting with Planning prior to ►1CSiIER�1��J%(��//��j submittal of Building Permit application. �v,MA�t1 ju��;��1j0��/'%%��;5 ,�/,��i��r✓lei/,�a �,ii�o� �,l�,rr/GI��,/�/�i� i/i�i1��;/��uy��Ni,/��yrr��,�yrtjl��,ll �� B1dg4pp_2011.doc revised 06/21/11 .:di k -i CITY OF CUPERTINO FM -7 FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School nistrict. etc 1_ The.ce fees are based an the nreliminary information available and are anlv an estimate. Contact the Dent for addi info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) ADDRESS: 22330 regnart rd DATE: 09/03/2013 REVIEWED BY: Mendez Jim'VALUATION: APN: BP#: , 1$1,600,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: 1 0.0 PENTAMATION 1GENCOM PERMIT TYPE: WORK re lace existing water storage tank with 2 new tanks SCOPE NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School nistrict. etc 1_ The.ce fees are based an the nreliminary information available and are anlv an estimate. Contact the Dent for addi info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE 7 MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes 0 No $0.001 6 1 hours $834.00 Plan Check, Hourly 1STPLNCx Suppl. PC Fee: Q Reg. Q OT 1 0.0 firs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? ()Yes Q No $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 firs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 1t� �irrrttrat'�� f E°c: 0 0 Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 Strom Motion Fee: 1BSEISMICO $336.00 6.0 firs $834.00 Inspections 1sTINsp Inspection, Hourly Bldg Stds Commission Fee: 1BCBSC $64.00 $400.00 $1,668.00 ' ;CTL $2,068.00 Revised: 07/01/2013 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 *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:_.._....._....__.................___.........._.._..____.._. _.....w... _w..... m....0 ______. __._ �, _._ .....,.._._.. Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESSNAMEBUSINESS LICENSE # — Cabinets & Millwork X g Cement Finishing _._.. Elm ._�...�_.......,_._____w..._.._ __...�,.,_..w.....� 2.�..__. Lo es Electric Inc. p __...ww...... Excavation ._ X Fencing Chavez Fence Company 36385 Flooring /Carpeting...__..._._. _ Linoleum / Wood �...�..��.-_ Glass / Glazing ._......._.�.�_.. �.__.�.__._�.�.�...�......_....._.�.,__�_.._...M_.._._..�..�.__._._..__.�__r�....____. __��.__...._�_._._ �_....._�__.._._....._.... Heating _.. Insulation X .._ Landscaping Arborwell Professional Tree Management 25207 Lathing __......_� Masonry_ �...__._. ____.._..._.._ _.....—.__ ...._...__._...__. .. ___.__�_....._-.^ ....._._._.._..._,__. Painting /Wallpaper Paving Plastering Plumbing _.._........ Roofing .W..__... _.. _�.__�_...._..___.___.mm._..__._.�...............�..�._..�_a._._.�.. _..�...._._._.�_...... ___.. Septic Tank_.._._._.........w..._..�-__�.. _ Sheet Metal _�._........._.�.W._._......_._._...__ �._.__..__....._.._._..�...__ .__.....�...w__._.___._.._ SheetRock__.�....._.,......__�_.,...�_. _.... ____ _._._...._.�w..,..._..�._..._. .._�_._,..._._.__.... _.....__ ._.... _.�..._ Tile_w._�..-...,.-...____..._..� _.._._�. _._.. �_..........._. 5/27/15 er / Contractor Signature Date