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13060083 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20605 VALLEY GREEN DR CONTRACTOR:XL CONSTRUCTION PERMIT NO: 13060083 OWNER'S NAME: BERG FAMILY PARTNERS,L.P. 851 BUCKEYE CT DATE ISSUED:08/12/2013 OWNER'S PHONE: 4089961010 MILPITAS,CA 95035 PHONE NO:(408)240-6000 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL[] License Class C-2 Lic.# 6 y l4 d VOLUNTARY SIESMIC STRENGHTENING-ROOF ANCHORS Contractor XL C w3)ry C,6-)/-) Date/kw 2 ?a/3 **SEE NOTES- -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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$40000 ave 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:32610046.20605 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 WITHIN80 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 F M LAST CALLED INSP CTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the �/ 3 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. gn � /� I7�7� any roofing Signature ,i / �---�-"A" Date v 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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 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. f�? 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,1 CONSTRUCTION LENDING AGENCX become subject to the Worker's Compensation provisions of the Labor Code,I must 1.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 1 have read this application and state thatthe 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 rr1�� CONSTRUCTION PERMIT APPLICATION V 12 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUP:ERTINO (408)777-3228• FAX(408)777-3333• building(a-cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION RrALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS 0 60s, VAGI f ]� /�R E c# OR APN# OWNERNAMEAPPIF- 1 PHONE E-MAIL STREET ADDRESS I TNFIAOTE L JOP CITY, STATE,ZIPCUPE1?*ffiJ,0 FAX CONTACT NAME bR LAir m PHONEyve_O 73_.?1,� E-MAIL ��w)�X_��ST 40 M STREET ADDRESS 9-TI '01'aw Cr Clw��STATEr�s0i 7s�� FAX p-2 - /OO ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME gkYA/V r- / w,�/ LICENSE NUMBER P7 q90 LICENSE TYPE}� / q BUS.LIC# COMPANY NAME L o1V S („f/''VWLT'p N E-MAIL�� V a L•O FAX G T LCo/US a � STREET ADDRESS f ' L)(, r�� `,r CITY,STATE,ZIPf4I,.P/rQ ,C_0� PHONE( 9J,,7iiu_d,oa ARCHIT ��Nyo �A *f&&i4'4, C 4'�' T- LICENSE NUMBER n BUS.LIC 7q qShe COMPANYNAME 5 ]y /� •N E-MAIL FAX STREET ADDRESS'qq G El CAlwNo REAL C�s ATE,ZIrO ` E) ePHONE DESCRIPTION OF WORK RF J ' H,i cor v r e o C� t EXISTING USE PROPOSED USE CONSTR TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(3) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NEC AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ❑ATTACH ftDWELLING UNITS: IS ASECOND UN IT ❑YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OFIS THE BLDG AN ❑YES RF_qWlrD BY: TOTAL VALUATION:J7 PLANNING APDL N ❑NO PLANNING APPROVAL LETTER EICHLER HOME? []NO - l__ r _ ')O OOO f By my signature below,I certify to each of the following: I am the property 0-TIP-11r aut zed ag,6 to act on the.prpperty owner's behalf. I have read this application and the information I have provided is correct. I have read the Description ork and ve6t,y.it'is_acfurate. 1 agree to comply with all applicable local ordinances and state laws relating to building construction. I honze representatives of Cupertino to ental the above-identified property for inspection purposes. Signature of ApplicanUAgent: "`" Date: SUPPLEMENTAL FORMATION REQUIRED PIAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER NOBUILDING PLAN REVIEW 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 Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS 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 to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. Cl ENVIRONMENTAL HEALTH BldgApp_2011.doe revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20605 VALLEY GREEN DR DATE: 06/10/2013 REVIEWED BY: MELISSA [jai APN: 326 10 046 BP#: 0 W'T *VALUATION: 1$40,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1 B TI USE: PERMIT TYPE: WORK VOLUNTARY SUPPORTS PLATES BOLTS PURLINS FOR FUTURE STRUCTURAL SUPPORT SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. B (Tenant Improvements) II-B,111-B,IV,V-B 400 $1,954.90 IBTIPLNCK $610.57 IBTIINSP TOTALS: 400 $1,954.90 $610.57 MECH,HOURLY Q Yes (j) No PLUMB,HOURLY 0 Yes Q No ELEC,HOURLY Q Yes Q No �h. Permit Fee Plumb. Permit Fee: F,lec. Permit F�^e: Other Alfech.Insp, Other Plumb Insp. U; c'r F.lec.Insp. ET 11ech.Imp. Fv(.. Plumb. Insp.Fee: Elec.Insp. f ce: NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District etc). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 Eft' 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,954.90 Select a Misc Bldg/Structure Suppl. PC Fee: (j) Reg. 0 OT FO.0 T hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $610.57 Suppl. Insp. Fee.e Reg. Q OT Q.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fe e: Work Without Permit? 0 Yes (F) No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential 0 Travel Documentation Fees: I Building or Structure 0 Strong Motion Fee: IBSEISMICO $8.40 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: 1 $2,575.871 $0.00 TOTAI. FEE: $2,575.87 Revised: 04/29/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS:-2,40, oS D PERMIT# Q o8 3 OWNER'S NAME: -, PHONE# GENERAL CONTRACTOZY. BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: "Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork ) Cement Finishing , Electrical Excavation Fencing Flooring / Carpeting Linoleum/Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting I Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal p Owner/Contractor Signature Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 C U P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST TOB ADDRESS:204$Sr LLS QEEN DR PERMIT# `sj(D4 O03 OWNER'S NAME: P PHONE # GENERAL CONTRACTOR: XL G*Aa R Vt v/J BUSINESS LICENSE# ADDRESS: Sgi CrCITY"ZIPCODE: sy-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 Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork oor— My 2#3 99 0 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 t ---_ - �9—/Q Owner/Contractor Signature Date