10120124COVER SHEET
10120124-D
7662 SHADOW H I LL LN
PERMIT # &Z 2 0 IL J DATE -.Z
PROJECT AA A A/ af+er
ADDRESS 7 K 6 '� (l`'c
APPLICANT OWNER A -r r -.r
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ISSUED B - DATE /✓�� / TOTAL FEES
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COMM. SQ. FG (NEVI) T.I. SQ.FT.
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REQD. PAID
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ISSUED B - DATE /✓�� / TOTAL FEES
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CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7662 SHADOWHILL LN
CONTRACTOR: NICE & RIGHT
PERMIT NO: 10120124
CONSTRUCTION INC
OWNER'S NAME: NANCY CHEN
P O BOX 2285
DATE ISSUED: 06/15/2011
OWNER'S PHONE: 4089963896
CUPERTINO, CA 95015
PHONE NO: (408)361-0928
❑ LICENSED CONTRACTOR'S DECLARATION
F r r—
License Class Lic.#
BUILDING PERMIT INFO: BLDG ELECT PLUMB
MECH RESIDENTIAL COMMERCIAL
r
Contractor Date
I hereby affirm that I am licensed under t e provisions oC Chapter 9
JOB DESCRIPTION: ADD ONE STORY ADDITION & ENLARGE MASTER
(commencing with Section 7000) of Division 3 of the Business & Professions
SUITES(BATH, BATH &ADD BEDROOM
Code and that my license is in full force and effect.
N4(470SQFT);REMODEL PART OF MASTER SUITE
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.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Sq. Ft Floor Area:
Valuation: $75000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 36224022.00
Occupancy Type:
APPLICANT CERTIFICATION
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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
Issued by: Date: (�
.1 IV
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one Of
All roofs shall be inspected prior to any roofing material berg installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
1, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
[ have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(x) should I store or handle hazardous material.
permit is issued.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Health & Safety Code, Sections 25505, 25533, and 25534.
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
Owner or authorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked.
Ce.Q �Ct�1ir%GoN Date:
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
1 certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
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
ARCHITECT'S DECLARATION
9.18•
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7662 SHADOWHILL LN
CONTRACTOR: NANCY CHEN
PERMIT NO: 10120124
OWNER'S NAME: NANCY CHEN
7662 SHADOWHILL LN
DATE ISSUED: 06/15/2011
OWNER'S PHONE: 4089963896
CUPERTINO, CA 95014
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
f— f—
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. #
MECH RESIDENTIAL J_ COMMERCIAL
Contractor Date
1 hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: ADD ONE STORY ADDITION & ENLARGE MASTER
(commencing with Section 7000) of Division 3 of the Business & Professions
SUITES(BATH, BATH #2 & ADD BEDROOM
Code and that my license is in full force and effect.
#4(470SQFT);REMODEL PART OF MASTER SUITE
1 hereby affirm under penalty of perjury one of the following two declarations:
1 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.
1 have and will maintain Worker's Compensation Insurance, as provided for by
Sq. Ft Floor Area:
Valuation: $75000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 36224022.00
Occupancy Type:
APPLICANT CERTIFICATION
I certify that 1 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
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Issued by. Date:
Signature Date
OWNER -BUILDER DECLARATION
RE -ROOFS:
1 hereby affirm that I am exempt from the Contractor's License Law for one or
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
1, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
[ have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, l shall
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
Health & Safety Code, Sections 25505, 25533, and 25534.
Compensation laws of California. If, after making this certificate of exemption, 1
become subject to the Worker's Compensation provisions of the Labor Code, 1 must
Ow4i e^r or authorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked.Y • 6
T —f Date: �2
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that 1 have read this application and state that the above information is
1 hereby affirm that there is a construction lending agency for the performance of wrk's
correct. 1 agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
1 understand my plans shall be used as public records.
`� 6 ��
Signature` Date
Licensed Professional
CUPERTINO
CITY OF CUPERTINO
ADDITION/REMODEL
FEE SCHEDULE
APN#
Date:
'3G2-24.-0az
Is a 2° unit being added? Yes ❑ No M If yes, please fill out the permit application for 2° unit.
Is this a 2°d story Addition? Yes ❑ No JZ
Is this house an Eichler? Yes ❑ No I. If yes, needs Planning approval.
Building Address:
i,(--Gz s (-FA
Mailing Address (if different from building address):
Owner's Name:
Phone #
s r,_\c� c CG,e�
Contractor:
Phone #:
`r•
Fax/e-mail:
Cupertino Business License: State Contractor License #:
Contact:
Phone #: (-toe_-) 4(?6-" _V1 8�
T�� qF) v (.C--,3 rrL—t_,-- Qe5r
Fax /e-mail: c-< &P-) q4E--?S�q
Landscape Ordinance Compliance: d o -e rC) W a l• r a tM
Landscape area in sq. ft. (includes all irrigated areas): J -Y--k S=am
If 2,500 sq. ft. or less, compliance with the Landscape Water -Efficiency Checklist is required.
If more than 2,500 sq. ft., a complete Landscape Project Submittal is required.
Compliance Method: ❑ Plant Type ❑ Water Budget
Building Permit Info: Bldg. Elect. Z Plumbing Mechanical C] Hillside Q
Project Size: Counter ❑ Express ❑ Standard ❑ Large ❑ Major ❑
Job Description:
Addition -What is being added?(Be Specific): ILI -2
What is being remodeled (not including addition)?
�?,n�a d�-¢-1 � �r� U-1 � rte- 1�r►��
Remodel Includes Re -Roo. Yes ❑ NoIf yes list number of squares
Remodel Includes Structural: Yes ❑ No
Do you have the pre -application planning approval? Yes X No [ (ZA
If yes, please provide a copy of your planning approval letter. Planners name: r3 les `
S ootage:
Additi .!70 Porch: Deck: Garage: Detached Attached
Remodel: Kitchen Bath Other_ [-Apt
Type of Construction (Usage Class):
Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV -HT, V -B
Valuation: Q'�3
Please complete relevant portion of the Green Building
Checklist & attach it to the application or if applicable,
Green Building Points Achieve
include in plan set & the sheet index.
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: 26�a'
Ln PERMIT # 2
OWNER'S NAME:
PHONE #lf
GENERAL CONTRACTOR7.&5>
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:
Owner / Contractor Signature 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 Rock
Tile
Owner / Contractor Signature Date
1
�Vim OWNER -BUILDER DISCLOSURE FORM
CUPERTINO
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building(alcupertino.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:
SITE ADDRESS
'766-24hadcohi'll &n.
APN
BP#
OW ER NAME
OWNER 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.)
I - t-' 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 homeowners 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.
L ' 2. 1 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.
'� L - 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.
�L'4. I 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. v
L6. I 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.
q U -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.
I -L8. I 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.
OwnerBuilderFonn 2010.doc revised 04/14/10
'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.Gsib.ca.gov for more information about licensed
contractors.
�,(, '10. I 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.
�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.
L- �-12. 1 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: 4 / I S-1 "l /
---------------------------------------------------------------------------------------------------------------------------------------------
(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
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 pennit is issued to verify the property owner's
signature.
Property Owner's Signature: Date:
OwnelBuilderForm 2010. doc revised 04/14/10
FM-7
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
OCCUPANCY TYPE:
ADDRESS: 7662 shadowhill In.
DATE: 12/17/2010
REVIEWED BY: bobs.
PC FEE ID
APN:
BP#:
*VALUATION: 1$75,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex
USE:
OVER THE
COUNTER. 0 Yes 0 No
PENTAMATION 1 R3SFDADD
PERMIT TYPE:
WORK
LkL. Intp, Fre:
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,111-B,IV,V-B
470
$1,438.00
IADDPLCK
$1,169.00
IADDINSP
LkL. Intp, Fre:
PME Plan Check:
$0.00
ams
$42.00 1
lectric 1—= -nom lP
Electrical----
00 Services
Permit Fee:
Permit
$1,169.00
Suppl. Insp. Fee49 Reg.
0 OT
0.0
1 hrs
$0.00
s
'?'00
PME Unit Fee:
$0.00
PME Permit Fee:
TOTALS:
470
$1,438.00
1
1 $1,169.00
MECH, HOURLY 0 Yes (E) No
PLUMB, HOURLY 0 Yes Q No
ELEC, HOURLY 0 Yes Q No
<b cdy. Plan C'he(k
MISC ITEMS
Elec. Plan Check 0.0 1 hrs $0.00
,yl --i, Permit Fee:
Phw . Penn„ F'cc.
Elec. Permit Fee: IEPERMIT
Other Ak'ch. Insp.
01hur Pblr nh Insp
Other Elec. Insp. 0.0 J hrs $42.00
',I- (h. hash. Fce:
ah. fnv).
LkL. Intp, Fre:
NOTE. These fees are based on the Preliminary information available and are onlv an estimate. Contact the Dent for addn 7 info.
FEE ITEMS (!'ee Resolution 09-051 E . 7/1/10)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$1,438.00
140 s.f. Remodel, Other
$380.00 IREMRESOTH
Suppl. PC Fee: 0 Reg. 0 OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
ams
$42.00 1
lectric 1—= -nom lP
Electrical----
00 Services
Permit Fee:
Permit
$1,169.00
Suppl. Insp. Fee49 Reg.
0 OT
0.0
1 hrs
$0.00
s
'?'00
PME Unit Fee:
$0.00
PME Permit Fee:
$42.00
Construction Tax -FT
Acoustical Fee:
0 Yes E) No
$0.00
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Planning Fee:
PLLONGRNGR
$61.10
Q
0
Travel Documentation Fee: ITRA VDOC
$42.00
Stronp, Motion Fee:
IBSEISMICR
$7.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$3.00
SUBTOTALS:
$2,762.60
$422.00
TOTAL FEE:
1 $3,184.60
Revised: 12/07/2010
PLAN REVIEW EXPIRATION NOTICE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buifdingecupertino.org
CUPERTINO
May 11, 2011
NANCY CHEN
7662 SHADOWHILL LN
CUPERTINO CA, 95014
SUBJECT: PLAN REVIEW EXPIRATION NOTICE
Site Address: 7662 SHADOWHILL LN
Building Permit Application #: 10120124
Expiration Date: 6/15/2011
This letter is sent to inform you that you have a pending construction permit application that will be
expiring at the date shown above. As a courtesy, the Building Department makes every effort prior
to the expiration of a construction permit application to notify the applicant of the impending
expiration.
Per the California Building Code Section 105.3.2, this notification letter is issued as a reminder
that the construction permit application for the specified project will expire on the date shown
unless the following action is taken within 30 days of the date of this letter:
A. A building permit application is approved and the building permit is paid for and issued prior to
the expiration date specified; or
B. A request for an extension is submitted in writing with a justifiable cause demonstrated to the
Building Official prior to the expiration date of the application. Each extension, if granted, will
be for a period of not more than 90 days. Extension requests shall be hand delivered to the
building department or e-mailed to suew@cupertino.org. A $39.00 fee shall apply to all
extension requests, payable to the City of Cupertino at the time the request is made.
If a plan review application expires, the renewal of the application will NOT be granted unless
the construction plans comply with the 2010 California Codes and any new local regulations that
came into effect from the date of the original application. Additional plan review (and associated
fees) will be required to verify d6mpliance with these new regulations.
The plans will become null and void 30 days after the date of this letter if a building permit is not
secured or an extension is not granted. You will have 10 business days after that date to pickup
your documents or they will be recycled. At that point the permit application will then be voided
in the Permit System and all documents pertaining to the permit application will be recycled.
Sincerely,
Susan Winslow, Administrative Clerk
408.777.3246, suewQcupertino.org
Building Department, City of Cupertino
PlanReviewEzpirationNotice.doc revised 02/23/10
Special Inspection and Testing
- Construction Observation • Engineering Consultants
CAPEX ENGINEERING ING
--- R 0. Box 14198, Fremont, CA 94539 • Tel: (510) 668.1815 • Fax: (510) 490-8690
E-mail: capexinc888@gmail.com
SPECIAL INSPECTORS DAILY REPORT IPM -
PROJECT NAME: C! O 7/ ''S c'a i_ 1 �� 1 . PROJECT #:
PROJECTADDRESS:
PERMIT #: �0 %Z OIZ 4—
INSPECTOR:. '''�L ` I. D.#G'—a ��4' CONTINUOUS PERIODIC
SPECIAL INSPECTION PERFORMED:
DESCRIBE INSPECTIONS MADE INCLUDING LOCATIONS:
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7 yam!! CAd
7—
L I ST
~LIST TESTS MADE:
LIST ITEMS REQUIRING CORRECTION
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LIST
t
LIST CHANGES TO APPROVED PLANS AUTHORIZED BYARCHITECT OR ENGINEER:
1
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' j Y
COMMENTS: /,v( Cl/I
e)
NOTE - USE REVERSE SIDE FOR ADDITIONAL SPACE FOR ANY ITEM
To the best of my knowledge work inspected was in accordance with the Building Department approved
design drawings, specifications & applicable workmanship provisions of the CBC except as noted above.
SIGNED: DATE: �' ��