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09040020 7777777777777. CITY OF CUPERTINO BUILDING DIVISION PERMIT � TQ " PERMIT NO. BUILDING ADDRESS: 22971 LONGDO RD HARPER L R Y PERMIT ISSUE DATE OWNER'S NAME: u�A DR T D D n V A TTT T1 T T r - RD j� Ai��.2CONTROL NO. PHONE: BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH a p C LICENSED CONTRACTOR'S DECLARATION fob Description U I hereby affirm that I am licensed under provisions of Chapter 9(commencing .Z, with Section 7000)of Division 3 of the Business and Professions Code,and my license is DIVIDE BONUS S ROOM W/ PARTITION WALL TO C ONC RETE w in full force and effect Z License Class_Lic•N no DateContractor 1BEDRM 6: TV/OFFICE ROOM u�. ARCHITECTS DECLARATION 1 understand my plans shall be used as public records m �yU L o f- Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractofs License Law for the co following reason.(Section 7031.5,Business and Professions Code:Any city or county K Pi which requires a permit to construct.alter,improve,demolish,or repair any swctum n"y prior to its issuance,also requires the applicant for such permit to file a signed statement ;q,Ft.Floor Area Valuation Z< that he is licensed pursuant to the provisions of the Contractor's LiccnscLaw(Chapter 9 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not men:than five hundred dollars($500). 3424001'7 . 00 0 I,as owner of the property,or my employees with wages as their sole compensation, will dothework,and thestructureisnotintendcdoroffered forsale(Sec.7044.Busoess Required Inspections and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contras or(s)licensed pursuant w the Contractor's License Law' B do P C for{his n 0 I am exempt under Owner Date RK 'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 1 have and will maintain a Certificate of Consent to self-insure for Workces Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPIION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less) I certify that in the performance ofthe rk for permit ch this peit is issued,I shall not employ any person in any manner so bcc u ct to the Wo C pensation Laws of California.Date Applicant io NOTICE TO APPLICANT:I,after making ertificate of Exemption,yoi should become subject to the Worker's Compensation provisions of the Labor Code,you must �Z forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of �i> the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name Z Lender's Address U C I certify that I have read this application and state that the above information is Li.H correct 1 agree to comply with all city and county ordinances and state laws relating to C> building construction,and hereby authorize representatives of this city to enter upon the Wsabove-mentioned property for inspection purpose Q. (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit Date _U APPLICANT UNDER TA AND WI C PLY WITH ALL N N-POINT Issued b3: SOURCE REGULATiO Re-roofs / - Signatir of Appl' Contractor D tc T of Roof ✓ AZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. 0Yes [I No If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new I;laterlals for inspection. District? 0 Yes ONO !have read the hazardous materials quimments under Chapter 6.95 of the Califor- nia Health&Safety C Sections 255(15, 533 and 25534.1 understand that if the building does not currently vc ant that it' y responsibility to nod Ute upant of the Date requirements w' usl be met prio us=of a Ccnifj tc Oc Signatur''of Applicant V All roof coverings to be Class'n"or better '\ Owner or a orized agent Datc 1SID mT71A PRO T _VE R SKEET 7� u Assessor's Parcel Number: Name of owner. Project address. 2-9. ( L cv Nfr-C�10 VJ A too= �. t Contact person. t. ��`k H ' �E� Phone. 4/0 8' -99 "�s$ r Net square footage of lot. Existing Proposed Square footage: First floor: CO©S ft cl o 1 - PtIL Second floor: t)C I 9 d Garage: -100 eff- TOTAL: 1: 9 �L ?S" f f L re there at least two 10 foot by 20 foot clear spaces inside the garage? Y Is privacy protection planting required for the project? Y On what floor(s) is work being done? 20 Ck 01'r' p,�� , na� �� IQ 00" P.� �C_ JJgLL IN fagOr I(301 Brief description of work. �h Code editions:2008 CBC -N)2008 CFC �'/.N)2008 CMC (Y-N) 2008 CPC -N)2008 NEC N) wJ_ Effective 1/1/08 yl ✓ - Plan Review Process Work Book Page-B-Revised 1/1/08 Flood 4-o f3oNo+ fr ` Zvic ry ,7 2 (� rU - r ¢ ui E- W Z N ¢Ln Z z LLJ I� N umiT� 12,4 ,0*ice 40 U UtCTIz ®V TACT Z 4-F,060 E Q o p l,oc,0p' JNO IJ T I Y¢ N stoic m LL 17 v-L.F r LLJ mw -TO kvmcij uj z "AaEO, ¢Z Ln z z c� o . - r I v 1S`IDNTI PZOCT �C)' ER SHEET P r Assessor's Parcel Number: Ic..`� Name of owner. Project address. 2-9 -7 ( L-0 ry C,c�,0 L-u N P, Contact person. �. ONe—PCO, Phone. /-/0$,_ Fa,,. 44 —2 .��Z Net square footage of lot. Existing Proposed Square footage: First floor: o®S ff;� r,0 � � I E Second floor: _ o c `An d pTr Garage: TOTAL: re there at least two 10 foot by 20 foot clear spaces inside the garage? Y Is privacy protection planting required for the project? Y On what floor(s) is work being done? *2r Cl- _ icy � �� �� ��� � C�3�b1 u S �00�1 Brief description of work. �h� P�2 p� n"��� fta o S(fc-r1et c P-L OLD Code editions:2008 CBC -N)2008 CFC ' N)2008 CMC (Y-N) 2008 CPC 9-N)2008NEC -N) Y Effective 1/1/08 m cn cn - O �G Plan Review Process Work Book Page-B-Revised 1/1/08 pjok S F►.00� +o Q©H0.�. « �' w"nelo&JS -2 f� ■■� vj,.ry p 0 w S,7 2' VP feu r T N H W Z N V) tA Q Z LU �2/r 42Yq F94AF140 �+�vsSt z ®ver 4-60,0E12, CC LU • N Fi�r�0.LJ m taL OTL e L.61 w Q �WW w J J a U_ z z N o . V t� CITY OF C UPERTINO CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM d96q(X)2 o APN # 4 0 / 7-� Date: `�, ' / Z 1 Building Address: 2, 21 --7 ' L or\j 00 Mailing Address (if different from building address): Owner's Name: L E A W PIN RA'Ic y4Q, Phone#: 3 ( Ise HOA: (Exterior work only) Yes ❑ No ❑ t — q ©g jo _ S 3 (6/1) If yes, provide letter from HOA Contractor: E [_ I Phone: Fax: Contractor License#: N Cupertino Business License#: N Contact: Phone: Fax: Residential Commercial ❑ Job Description: �! l� �. FQO�i 3©N �.jS iR om � � r � N 0I _ 3F-DP_ooM RC Building Permit Info: Bldg ❑ Elect ❑- Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT,V-:3 Valuation: 1 -30 O Square Footage: Project Size: Express [R*' Standard ❑ Large 1:1 Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it to the application or if applicabl,:, include in plan set& the sheet index. IPoints Achieved: For help, contact Build it Green at www.builditgr.en.or Revised 02/05/09 an, CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPERTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Apr lications (up to 400 sf) B additional stucco application 1 WINREP Replace=it windows/sliding glass B door (ea 8 windows) 1 WINMEWSTR New Window-structural shear B wall/masonry (includes plan ck fee) 1 EPERMITFEE Electrical F ermit Fee E 1MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alor e Electric Pln Ck (hourly) E 1 MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P I STPLNCK-(3 Hr Min Standard Flan Check (when no E/M/P) B when not over counter) hourly-staid alone 1 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT / TYPES 1BSEISMICR Seismic R.-sidential B 1BSEISMICO Seismic CDmmercial B r 1TRAVDOC Travel &:documentation B / 1 BUSLIC Business License B ,Q,412-TM- U ` of5 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 :,UPEkTIN0 Buildin De artment JOB ADDRESS: 2�� � p o�>>ti PERMIT # v ��-Z OWNER'S NAME: Ov' p4�- _ PHONE # ' - d7 GENERAL CONTRACTOR: rJ E L.3,-Mflj FAX # I am not using any subcontractors: Si,nature Date Please check applicable subcontractors and comn:)lete 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Avner/Co ct Signa Date OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (?arent,spouse or child) will perform: A. All the work authorized by this permit B. A portion of the wo3-k C. _ None of the work If B or C is checked,complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. All of the work B. — A portion of the work (complete section below) Contractor --TAddress/City Phone # State License # FT�ykpe of work to ..1..-.._...7 3 _ I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understanc.that I may be an employer(see reverse side). A Certificate of Insurance covering workers' con tpensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City . Phone Number Type of work to be erformed ........................................................................ I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information(reverse ' e). Property Owner's Signature: Date: Job Address: 7 ^> >�– Permit# Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department.