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12080187CITY OF CUPERTINO BUILDING PERMIT BOILIIING ADDRESS: 23500 CRISTO REY DR UNIT 421F OWNER'S NAM E: ANDREW,'. DAVID S TTEE ASSIGNEE &E OWNER'S PHONE: 6509440100 ❑ LICENSED CONTRACI'OR'S DECLARATION License Class Lie..4 Y 7 U! 3 Z Contractor15" rvu V) i, Ley L eEe9RZile. .r hereby affirm that I :un licensed under the provisions of Chapter 9 (commencing with Sec lion 7000) of Division 3 of the Itusiness & Professions Code and (hat my license is in full force and effect. hereby affirm under penally of perjury one of the following neo declarations I have and mill 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. I have and will maintain Worker's Cotimpensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANI'CERTI FIC TION I eenify 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 . indennnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may acerae against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-pom ice regulati is per the Cupertino Municipal Code, Section 9.18: Signature Date. o -l6 -r Z ❑ OWNER -BUILDER DECLARATION 1 herchy affirm that I am exempt from the Contractor's License Law for one of the following mo reasons: 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) I, as ownerof the property, am exclusively contracting with licensed contractors to construct die project(Sec.7044, Business & Professions Code), hereb%y affirm under penalty of perjure one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of die Labor Code, for the performance of tile work for which this permit is issued. I 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 permit is issued. I certify that in the performance of die work for which this permit is issued, I shall not employ any person in any manner so as to become subject to die Worker's Compensation Imes of California. If, after making this certificate of exemption. I become subject to the Worker's Compensation provisions of the Labor Code, I must fonhwith comply with such provisions or this permit shall be deemed revoked. 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 g to buildinconstruction, and hereby authorize representatives of this city to enter upon the above mentioned property fir inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and still comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date CONTRACI Oil: MISSION VALLEY PERMIT'NO: 12080187 ELECTRIC INC I'O BOX 3332 DA'Z'E ISSUED: 08/162012 FREMONf, CA 94539 PHONE NO: (51) 74Sa847 BUILDING PERNIIT INFO: BLDG r ELECT r PLUMB I— MECII r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: 421E. INSTALL LIGHTS, SWITCHCS, RECEPTACLLS, GXHAUST FANS Sq. Ft Floor Arca: I Valuation: $9000 A [IN Nu in her: 34253167.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued bv: Date: 124: ROOFS: All roofs shall be inspected prior to any rooting material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Appl Dale: ALL ROOF COVERINGS TO RE CLASS "A" OR BE ITER I IA7.ARDOIIS MATERIALS DISCLOSURE have read the hazardous materials requirements under Chapter 6.95 of the California I lealth & Safety Code. Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Ileallh & Safety Code. Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &4affty Code. Sections 25505, 25533, and 25534. Dater [ 7 CONSTRUCI'ION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of wurk's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITEICI"S DECLARATION I understand my plans shall be used as public records. Licensed Professional RESIDENTIAL, PROJECT COVER SHEET Assessor's Parcel Number: Name of owner. � IZLJ Project address. Z7 -5-0j,> , o N 1 — Y zt E Contact person. y'� 9 Phone. Fax. Sla - 7y5--ozygl Net square footage of lot.-• Existiniz Proposed Square footage: First floor: Second floor Garage: -- TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage / N ASG 16 212 Is privacy protection planting required for the project? Y> Build it Green Total Points E:;;� On what floor(s) is work being done? Brief de ption of work. I Ns7-), 674 ) L E g1jj�Z -c P-- LAHP �F�P�P-c-sCXt7AJST'F-�+F% Code editions: 2007 CBC N)2007 CFC N)2007 CMC 2007 CPC (Y - N)2007 NEC N\ Effective 1/1/08 COMMUNITy NG DIVISIONECUPERTNONT E� AppROVED This set of Plans and specifications alt is unlawfulto meake any pt at the lob site during construo changes or alterationsapproval from nthe Bud e, or to deviate without app Building Official. therefrom, ons SHALL NOT CUPERTINO The stamping of this plan and specifi lof t e violation Building Department held to permit or to beOan approval Ordinance or State Law. of any provisions of any nY� bl�^ l nr'9 F i BY DATE —�� �t d Q ^ REVIEWED FOR CODE COMPLIANCE PERMIT NO. V _ _ 4 j Plan Review Process Work Book Page -8-Revised 8/05/08 ss Balcony_i ifio' ! I I I I!! I!I!I!I ,!111+I p I I I I I I!! I I I I -•-,-laT a - t Fre ce I i I 1T'Bot 0or$' IIII©11111!111:11111 II IIIIIIII IIIIIIIIII111111. 111111111 IIIIIIII o 1 1 1 I ! gDi�I' 11IIIIIIIIillllll: ill ! I IB�0�t�Sr14 I I i I I I I i 1 I I I I I I I ! i _ 63")<-1.5'. I I Steakfas—edroom 1 ©! 1 919'TIx 7 i l l l l l l! I� —• I �- 1� I I I I I I I I i I I I I I ill I Kitcheri�j I' ! I I IT 1 I I I I I I 7y;� i �, I i 1 1? -I I I I I I I 12 l DoClosets '2 x TO 1! 1 I _ CCiUse ; ! Batconyu- _ I I 6' x d5A—. Ras' age; -i I I s = I Sets = �T 1 1 1 1 1 1 I-6-2 �T �-4�1 x IIIIIII I I I I I I I Ilill V III ©- =, � ©—°ry-Foyr I I I 1 1EnteI I I I I�a - I I Klose !I 1 1 1 1 1 1 �-- ©IO' l ipl —9XQ�!I r I I 3'0. x 9'fi' I iI I. •I 6I I I I I I Tl I I I! I l i l l! I I I I I I 15Tx �' �i� �•i I__�� I IIII!lill�_0. 1 I 1 ! � ; I ! !! ' II I '' IIIIIII!!III•!i OI IIIIIIIIII l! 171 i! II ! I I I 1 1 Bedroom I I i I i! I I I I L I IIIIIII11111 I 114'4t x111;'9'1 i! I I I I I' i��I17 V I I I©I I 1 1 I 7,71 1 1 -yl1 1 —11 1I I Ipi I I I I I & Emergency Response System p Electrical Outlet U Cable Television Outlet V Telephone Outlet ❑ = 1 foot Model G INTERIOR LIVING SPACE 3 1,260 Square feet (r� Two Bedrooms • Two Baths Floor plmu mereprzttnmuve. AcrJ mmsue aand lOYMI moy vary. BALCONY SPACE 210 Square Feet AT RANCHO SAN ANTONIO CUPERTINO ❑ NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255. (408) 777-3228 • FAX (408) 7�77-3333 • buildingQcuoettino orc ' I-1 ADDMON 'rI IrFuannNiTt F-1 / Q 0 P 0,f •-.... vN••u., � V1LLVll�Hl CLtU}lll ri PROJECT ADDRESS AFF A z35'oa c Isra�- �'tn. �N„- OWNER NAME �2Lj /1_//V� 1 •%/I. I1� LS / Ql I PHONE -9YY'�%loD E4&km STREET ADDRESS Sa-a C¢IS 17—c CrrY. STATE. ZIP '; G�7E,2-'f I ,� a-C.p 9Sool FAX CONTACT NAMEPHONE lrE¢PJ Pi N i Slo-3o Y- 7-7- 3; E-MAIL_ tmo. VI l�[r STREET ADDRESS CITY, STATE, IIP FAX ci ❑ OwmSR ❑OWNER-dUQ-DER ❑ OWNER AGENT q+ GONiWROR ❑ CONTRACroRwGENr ❑ ,= G, ❑ FNGLN�R ❑ DEVE.OPa ❑ T4JwNr CONTRACTOR NAME r Sro.-J P�r_r Ero-ciRrc lP.ac LICENSE NUWBEA 7v/3Z LICENSE TYPE I C-10 HUS. LIC A COMPANY NAMEI E-MAIL FAX SIO_ -7 S-_OZ�� ADD 55C7Y,STATF, IIP o. X 3332 0Er.0n1 i CR Q YS 3 PHONE /o-7 5 -MY ARCHEPECT/ENGINEER NAME - LICENSE NUMBER BUS LICA COMPANY NAME SMAC FAX STREET ADDRESS I CTIY, STATE, ZIP I PHONE DESCRIPTION OF WOR% -7 Zy _ 16 Lr 11- Lam. L SES HT I VS7pl LJ�Z> �}E4i L<Nos Z CI4 AtA; r , EXISTING USE ROPOSED USE CONSTATYPE 11 ISTORIES USE I TI -PE OCC SQFT. I VALUATION (S) EGSrG NEW FLOOR DEMO TOTAL AREA ARTA AREA N`_T.LQ&\ N '^J / its 1 c J 7 RATHROOM REOTT+=3 REM0011wNE,1 REMODEL AREA R'�tOD'3. AR.:w PORCH AREA OECx AREA TOTEDEC�R�A�GARAGE ARFA: DETAATT4 DWELLaNG UNIS: LS A SECON SECOND STORY ❑YES BEING ADD ADDTTIOM - ONO - PRE-APPLIGnON ❑YFS ffYES PROVIDE COPY OF PLVNNIJG APPLA ❑NO PLANNING APPROVAL LETTER IS THE BLDG wN ❑YFS EICHLER HOME' 0 N RECEMED BY: TOTAL VALUATION: By my signature below, I certify to each of the fallowing. I am the prooerr/ owner or authorized .vent m act on rhe orppc. owner's be I Gave rad this application and the informazion I have pro ed is correct I have ;rad rhe Description of Work and verify it is accurate. I agree m comply with all applicable local ordinances end state laws relating b ' consuucion. I author= mpr-xntatives of Cupertino m enter the above-identir!cd for propertyinspection purposes. Signature ofApplieandAgenn I'DNate: (Y 'l6 -/ ? . SUPPLEirtENTALINFOREVAI"iONREQ ED • ' PLLN CHECK ROUTING SLED _ New SFD or Multifamily dwellings: Apply for demolition permit for ��� existing building(s). Demolition permit is reauircd prior Lo issuance of building CS ovER-rt�rovnTER aan.Dme PUN aevmv permit for new building. 0 EXPRESS ❑ PL.LYYLNG PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC form if any Hazardous Materials are being used as part of this project. WORKS 0 uxeE ❑ FINE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to - submittal of Building Permit application. `WOR Cl SAYTTARYSEWER DISTRICT ❑' ENVI tON:Im.NTAL —ALTO Bldg 1pp_ZOl 1.doc revised O&TYII 11 J 4H3 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION dADDRESS: 23500 cristo rey dr. #421-E DATE: 08/16/2012 REVIEWED BY: bobs. \ APN: BP#: I *VALUATION: $9,000 *PERiMiTTYPE: Building Permit PLAN CIiF,CK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Plumb. Permit Fee: PENTAI\'IA9'ION 1RMAP8 PER�IITTI'PE: A WORK install lights, switches rece taces exhaust fans. SCOPE Other Plumb Insp. NOTE: This euitnate does not includejeev due to other Departments (i.e. Planning. Public /forks. Fire, Sanitary Sewer District. School District. etc.). These lees are based on the nrelintinam information available and are on6, an ee'tinmte. Contact the Dent for addn'I info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/1l) FEE QTY/FEE MISC ITEMS Mech. Plan Check 0.0 hrs $0.00 Plumb. Plan Check Elec. Plan Check 1 0.0 1 hrs $0.00 Mech. Permit Fee: IMPERAM" Plumb. Permit Fee: Elec. Permit Fee: IEPERAHT Other Mech. Insp. 0.0 hrs $45.00 Other Plumb Insp. Other Flec. Insp. 0.0 its $45.00 ,llech. /asp. Fee., Permit Fee: Plumb. hep. Fre: Flee. /aye. Fee: 0_0 NOTE: This euitnate does not includejeev due to other Departments (i.e. Planning. Public /forks. Fire, Sanitary Sewer District. School District. etc.). These lees are based on the nrelintinam information available and are on6, an ee'tinmte. Contact the Dent for addn'I info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/1l) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F__27 # $46.00 Mechanical 1BREA111ENF Ventilation Fan Suppl. PC Fee:' I) Reg. 10 OT 0.0 hrs $0.00 PME Plan Check: $0.00 6 $45.00 Electrical 1 /BREA-iRECFP Recep/Switch/Outlets Permit Fee: $0.00 Suppl. Insp. Fee -.0 Reg. Q OT 0_0 hrs $0.00 37 $152.00 Electrical IBREAfFIAT Fixtures, Lighting PML' Unit Fee: $0.00 PME Permit Fee: $90.00 Constrnrli(in Tar: Administrative Fee: 1ADMIN $42.00 O G Work Without Permit? 0 Yes Q) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) Travel Documentation Fee: ITRA VDOC $45.00 Strong Motion Fee: 1BSEISAHCR $0.90 Select an Administrative Item I3Idtt Sids Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $178.90 $243.001 TOTAL FEE: $421.90 Revised: 07/01/2012 Building Department City Of Cupertino 1(1 M Torre Xvemie Cunertino. CA 95014-3255 CUPERTINO Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: Z 3-5-00 C)ZiS TJ ZE OWNER'S NAME: PERMIT # lz-d6/ (f -7 PHONE# S!O-3o -9Zz3 GENERAL CONTRACTOR: iS5jo..i VA Ei.re:1—aAG BUSINESS LICENSE # ADDRESS:37z- idr CITY/ZIPCODE:Fr-�cMoaT- CA -9 SSG -von mumcipai cune requires all ousmesses 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 ANDA L S CONTR CTORS BUSINESS LICENSE. HAVE OBTAINED A CITYOF CUPERTINO 1 am not using any subcontractors: Cp Ignature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAIVE 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