09040155 CITY OF CUPERTINO
BUILDING DIVISION PERMITONTRA OR 1NO�TION.
BUILDING ADDRESS: PERMIT NO.
20616 MC CLELLAN RD HARDEMLN MELODY & LANCE OclD407 S •
OWNER'S NAME: PERMIT ISSUE DATE
HARDEMAN MELODY & LANCE 20616 MC CLELLAN RD SANPfA'RY 4f c /2O9- CONTROL NO.
PHONE:
•
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
KTCH(14:1) &BTH(56)RMDL CI CI 0 CD
u p p LICENSED CONTRACTOR'S DECLARATION Job Description
iU P I hereby affirm that I am licensed under provisions of Chapter 9(commencing
..z,y with Section 7000)of Division 3 of the Business and Professions Code,and my license is
2<;e., in full force and effect.
sa^ License Class Contractor
3 M Date
ARCHTII;C1'S DECLARATION
I understand my plans shall be used as public records
Di°
u,H Licensed Professional
.'.O< OWNER-BUILDER DECLARATION
2<2 I hereby affirm that I am exempt from the Contractor's License Law for the
O O following reason.(Section 7031.5,Business and Professions Code:Any city or county
y
K m M which requires a permit to construct,alter,improve,demolish,or repair any structure
prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation
——< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq
xH G (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y R- that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of APN Number
Trot more than five hundred dollars($500).
0 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 Required Inspections
and Professions Code:The Contractor's 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.).
I.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 contractors)licensed pursuant to the Contractor's
License Law.
0 I am exemptunderSec. ,B&P for this reasons
Owner Y�'�' Date `Z�4'0 I
WORKER'S COMPENSATIONLARATION tt
I hereby affirm under penalty of perjury one of the following declarations:
1 I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
.tion,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 are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION 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 of the work for which this permit is issued.I shall not
employ any person in any man r so as to become subject to the Workers'Compensation
Laws of Califomi}Date
Applicant TO L r >F�a r
NOTICE APPLICANT:If,after making this Certificate of Exemption,you 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
~.c r"
[ •. 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.C.) •
W A Lender's Name
0.Z Lender's Address
O 0 I certify that I have read this application and state that the above information is
ft.H correct.I agree to comply with all city and county ordinances and state laws relating to
o building construction,and hereby authorize representatives of this city to enter upon the
i•14 above-mentioned property for inspection purposes. i
l>~ (We)agree to save,indemnify and keep harmless the City of Cupertino against .11111111111111r, 11,/,F,,,r/1 liabilities,judgments,costs and expenses which may in any way accrue against said City
V Z in consequence of the granting of this permit. Alli i'
►-r APPLICANT UNDERSTANDS AND WILL COMPLY W4 ALL NON-POINT Issued by: - ir Am liti II Date
SOURCE REGULATIONS. Or C ZS Re-roofs
•
Signature of Applicant/Contractor Dae Typeof 1:OOf
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future budding 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.
OYea T"o If a roof s installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
-mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new n iaterials for inspection.
istrict?
O Ya °
1 have read the hazardous materials requirements under Chapter6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building
does not currently have a tenant,that it is my responsibility to notify the occupant of the
requirements which must be met prior to issuance of amcate of Occupancy. Signature of Applicant Date
1-03.141--e,- Cb r �T ` —Z-`7 "•
'��' All roof coverings to be Class'fl."or better
Owner or authorizzed agent Date
COMMERCIAL/INDUSTRIAL INTERIOR
IMP O '. ENTT COVER SHEET
Assessors Parcel Number:
Name of business. c L' - -�-
Proj ect address. Z-0 C M_Q-
Contact person. t-(--& C A " '' 'hone. 4=4o "- -t- 7`3
I'ax. o v'Z-..Ste" 5 S
Current use of space. 5 ' 7.."4 s.r T3,a•—�{
Proposed use. 'v}�n..`. (C���-�- -i 1 -
Building construction type. Li) winst.b
Occupancy Group(s)
Occupancy Load.
Square footage of remodeled area. `" '-?. ",. ��` �'e-�'� .S---(c=. Gt ovrt.4
Is the building equipped with: Fire sprinkles? y.-' teall1 Fire alarm system? Y
Number of floors in the bidding? `rt-Aoor(s) is work being done?
Brief description .of work' ��`""�'cQ
tO7ni
Code editions:2008 CBC -N)2008 CFC. -N)2008 CMC N)
2008 CPC -N)2008 NEC 1N)
Effective 1/1/08
Are there any chemicals/hazardous materials to be stc red at site? Y -
If above answer is yes,provide a list of materials and quantities.
If job is involves food service,provide 3 extra plan sc is for Health Department review.
Commercial Plan Review Process Work BookPage-10-revised 1/1/08
,
ii_EsiOENTIAL KITCHEN LIGHTING ��VO S E T WE-5R
Date
Project Title _L - INTERIOR ALTERI\TIO \
At least 50%of the total rated wattage of permanently installed himinaires in the kitchen must be in luminaires that are high
•acy luminaires as defined in Table 150-C. Luminaires that are not high efficacy must be switched separately.
Kitchen Lighting Schedule. Provide the following information for all luminaires to be installed in kitchens.
5 ,'„ 1 High EfYicac ? . Watts x stantity = High Efficacy Watts or Other Watts
Yes_, No a _ x = or
-
_ Yes n No o x = or
Yes❑ No x = or
Yes❑ No❑ x = or
Yes No x = Or
Total: A: B: .
COMPLIES IF A >B Yes No o
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TERMINATION OF ALL ENVIRONMENTAL AIR DUCTS SH?LL! 1'BE A MIN. OF 3'
FROM ANY OPEN'G INTO THE BLDG. PER UMC SECT. 504.6 :\1,,,E.'
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FOR DRYERS & COOKING UNITS , THE CONDUCTOR WIRES W/ AN INSULATED 10 J
NEUTRAL & FOUR-PRONG OUTLET ARE REQ'D. ;-, KIT.
THE ITCH ARE LIMITED TO li)(31(;54-
TWO SMALL APPLIANCE BRANCH CIRCUITS FOR
SUPPLYING WALL & COUNTER SPACE OUTLETS ONLY. NO OUTSIDE PLUG, RANGE I O G
3,x4.5 I I 3'-5"
HOOD DISPOSAL DISHWASHERS DINING ROOM OR MICROWAVES. I ISLAND. I k
A DEDICATED 20-AMP CIRCUIT TO SERVE THE REQ'D BATHROOM OUTLETS. I II �
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-FAULT CIRCUIT-INTERRUPTER PROTECTION AT BEDROOM. WHERE ,5'cmc ouNT� D/0
BRANCH CIRCUITS THAT SUPPLY 125-VOLTS, SHGLE-PHAS 15 & LUORSC. LIGHT
20-AMPER OUTLETS.
'
ALL SMOKE DETECTORS SHALL BE INSTALLED PI=.R NFP -..7
REQUIREMENTS. --
ALL SWITCHES ARE TO BE OF THE GROUNDED -TYPE AS PER E
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Brief description of work.
Code editions:2008 CBC -N)2008 CFC -N)2008 CMC Q }N)
2008 CPC -N)2008 NEC
Effective 1/1/08
Are there any chemicals/hazardous materials to be stc red at site? Y -
If above answer is yes,provide a list of materials and quantities.
If job is involves food service,provide 3 extra plan sets for Health Department review.
Commercial Plan Review Process Work BookPage-10-revised 1/1/08
i ES ENTLAT., KITCHEN LIGHTING WORKS ET WS-5R
Project Title - INTERI0R ALTERATION M Date
At least 50%of the total rated wattage of permanently installed luainaires in the kitchen must be in luminaires that are high
'acy luminaires as defined in Table 150-C. Luminaires that are not high efficacy must be switched separately.
Kitchen Lighting Schedule. Provide the following information fo-all luminaires to be installed in kitchens.
F -T }►T High Efficacy? . Wads x Qtantity = High Effica Watts or Other Watts
Yes-_ • No ❑ -- x = or
Pest No a _ x = or
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Total: A: • B: •
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TERMINATION OF ALL ENVIRONMENTAL AIR DUCTS SHALL BE A MIN. OF 3' £ cI_, -
FROM ANY OPEN'G INTO THE BLDG. PER UMC SECT. 504.6 I •1 QG
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FOR THE KITCHEN ARE LIMITED TO - I�CJ�
TWO SMALL APPLIANCE BRANCH CIRCUITS _ •
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BRANCH CIRCUITS THAT SUPPLY 125-VOLTS, SI OGLE-PHAS 15 & 'WORK. UGHT
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adjustment to fit job conditions. has been paid or job order placed. i
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CITY OF (CUPERTINO
a., ADDITION/REMODEL
CCUPERJINO FEE SCHEDULE
APN # cq i b 4)Li 0 _ v v Date:
Buildin Address: b
- c. i c, OW 12-sA-41.
Mailing Address (if different from building address):
6
Owner's Name: l Phone# :
L.1A -tc.G -i ALL--�-o�� G,-- 4-05 -- Lt- — ci`) 0
HOA: (Exterior work only) Yes ❑ Noy
If yes, provide letter from HOA
Contractor: Phone#:4os'
€& Fax#: - j5S�-5 S9s
Contractor License#: Qc9 ,/ 0 , -
Cupertino Business License#:
Contact: �. Phone#:�aK— 44/c/ ^���
�Pc! Q4-C Fax #:
Building Permit Info:
Bldg. 1 Elect. 0 Plumb. V Mech. 5j Hillside ❑
Job Description:
Addition-What is being added?(Be Specific):
What is being remodeled (not including addition;?
A
Remodel Includes Re-Roof: Yes ❑ No [] If yes list number of squares
Remodel Includes Structural: Yes ❑ No []
Do you have the pre-application planning approval? Yes ❑ No 0\
If yes, please provide a copy of your planning approval letter. Planners name:
Square Footage: /
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen )W I Bath S Other
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B [ S /- w 4 L
Valuation:4I2o0O, 00 Please check this box if the project is a
X second-story addition ❑
Project Size: Express lii. Standard ❑ Large ❑ Major❑
Please complete relevant portion of the Green Building
IChecklist& attach it to the application or if appl:.cable, Green Building Points Achieved:
include in plan set & the sheet index.
***For Office Use Only***
Over-the-Counter ❑ Revised 02/05/09
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Df scription Fee Permit Type
Sq Ft Group
DECKS 1R3SFDADD OR
1R3SFDREM
1DECKWOOD Deck(Wood)-Each B
(Each)
1 DECKRAIL Deck Railing-Each B
(Each)
GARAGES 1R3SFDADD OR
DETACHED 1R3SFDREM
1 GARDTW<=1 K Wood Frame up to B
1,000 S (each)
1 GARDTM<=1 K Masonry up to 1,000 SF B
(each)
BCONSTAXR Construction Tax Res
(new detached garage)
PATIO'S OPEN 1R3SFDADD OR
1R3SFDREM
1PATIOWOOD Wood Frame up to 300 B
SF
1PATIOMETAL Metal Frame up to 300 B
SF
1PATIOOTHER Other Frame up to 300 B
SF
PATIO'S CLOSED 1R3SFDADD OR
& SUN ROOMS 1R3SFDREM
1 PATIOENCLW Enclosed Wood up to B
300 SF
1PATIOENCLM Enclosed Metal up to B
300 SF
1 PATIOENCLO Other Enclosed Patio up B
to 300 SF
1 COVPORCH Porch Covered-Each B
(Each)
REMODELS 1R3SFDREM -
1REMRESKIT • Kitchen Remodel up to B (Deduct "$"for ea plan
�'`` 300 SF check)
1REMRESBAT Bath R model up to 300 B "
SF
1 REMREOTH Other Remodel up to 300 B "
SF
•
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Sq Ft Group
1MECPLNCK Stand Aione Mechanical M
Pln Ck (hourly
1PLMPLNCK Stand ALone Plumbing P
Pln Ck (hourly)
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commis sion Fee
1 BSEISMICRE Seismic Residential B
1TRAVDOC Travel Documentation B
1BUSLIC Business License B
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