10100051CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7373 FALLENLEAF LN
CONTRACTOR: KIRK KOSLOWSKI
PERMIT NO: 10100051
OWNER'S NAME:
SAN JOSE, CA 95113
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
f— r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic. N
MECH r RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: TO CLEAR CODE VIOLATION: PHASE 1- REPAIR
(commencing with Section 7000) of Division 3 of the Business & Professions
EXTERIOR EXIT BALCONY. DEMOLISH STORAGE ROOM AND
Code and that my license is in full force and effect.
EXIT STAIRWAY. ADD TWO NEW EXIST
I 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.
I have and will maintain Worker's Compensation Insurance, as provided for by
Sq. Ft Floor Area:
Valuation: $50000
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 35927025.00
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.
Issued by`f Date
Signature Date
NER-BUILDER DECLARATION
RE -ROOFS:
ger
Iy affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. If a roof is
towing two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
Iner 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
1 hereby affirm under penalty of perjury one of the following three
declarations:
l 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
1 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 d med by the Bay Area Air Quality Management District 1 will
I certify that in the performance of the work for which this permit is issued, I shall
maintain complia 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 S fety de, 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
ge7[1�
forthwith comply with such provisions or this permit shall be deem re e .
Date:
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
Treby
I certify that [ have read this application and state that the above nfo ation is
that there is aconstruction lending agency for the performance of wrk's
correct. 1 agree to comply with all city and county ordinances d s e laws relating
permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives f t ' city to enter
Lender's Name
upon the above mentioned property for inspection purposes. agree to save
indemnify and keep harmless the City of Cupertino against liabi ities, judgments,
Lender's Address
costs, and expenses which y accrue against said City in consequence of the
granting of this permit. dd tionally, the applicant understands and will comply
with all non -poi sour re ulations per the Cupertino Municipal C e, Section
ARCHITECT'S DECLARATION
9.18. (
I understand my plans shall be used as public records.
SignatureDate ` p 1 l(
Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT - alb" I
BUILDING ADDRESS: 7373 FALLENLEAF LN I CONTRACTOR: TEAMWRKX DP►T6 O: 10100051
OWNER'S NAME:
1 SAN JOSE, CA 95112 I PHONE NO: (408) 287-2700 I
LICENSED CONTRACTOR'S DECLARATION
License Class G' Lic. # 5M- 1*460
Contractor aet w, a 0y %X Date q — I V% 1 1
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:
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.
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.
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
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 will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date -le hr
❑ OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury 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 the Labor Code, for the
performance of the 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 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, I
become subject to the Worker's Compensation provisions of the.Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
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
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 will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18,
BUILDING PERMIT INFO: BLDG ELECT PLUMB
r r
MECH RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: TO CLEAR CODE VIOLATION: PHASE 1 - REPAIR
EXTERIOR EXIT BALCONY. DEMOLISH STORAGE ROOM AND
EXIT STAIRWAY. ADD TWO NEW EXIST
8/10/2011- DEF# 1 - DEFERRED STAIRCASE WITH CALCULATIONS-
8/18/2011 DEF# 1 ISS'D
Sq. Ft Floor Area: I Valuation: $50000
APN Number: 35927025.00 I Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS F M LAST CALLED INSPECTION.
Issued by: 71_6 Date:
RE -ROOFS:
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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should 1 store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 25505, 25533, and 25534.
Qwner or authorized agen/ Date: —
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
Signature Date
CITY OF CUPERTINO BUILDING PCRW
BUILDING ADDRESS: 7373 FALLENLEAF LN
OWNER'S NAME:
0/LICENSED CONTRACTOR'S DECLARATION
License Class Lie. # s41440
Contractor'[-t.'dwv,Wry-X C x,%5k- Date t0 - `F- h
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.
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
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
1 certify that 1 have read this application and state that the above information is
correct. 1 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,
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
9.18.
CONTRACTOR: TEAMWRKX
1691 OLD BAYSHORE HWY
SAN JOSE, CA 95112
:10100051
DATE ISSUED:03/17/2011
PHONE NO: (408) 287-2700
BUILDING PERMIT INFO: BLDG F ELECT F PLUMB r
MECH r— RESIDENTIAL i COMMERCIAL
JOB DESCRIPTION: TO CLEAR CODE VIOLATION: PHASE I - REPAIR
EXTERIOR EXIT BALCONY. DEMOLISH STORAGE ROOM AND
EXIT STAIRWAY. ADD TWO NEW EXIST
101412011- REV#1 - REVISE ELECTRICAL SERVICE, ADD NEW LIGHTS, REVISE
STAIRS, ADD CAIN RAIL GUARD-REV#1 ISS'D 10/4/2011
Sq. Ft Floor Area: I Valuation: $50000
APN Number: 35927025.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Signatu/lililiL� Date / `� �� Issued by:
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury 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 the Labor Code, for the
performance of the 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 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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
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
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 will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date:
RE -ROOFS:
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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(s) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.I2 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
or authorized agePt:
,,- C_/l/
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
Signature Date
I understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
Fm�ff FEE ESTIMATOR — BUILDING DIVISION
DATE:
REVIEWED BY:
JimADDRESS:
APN:
BP#:
'VALUATION: $50,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi -Family g Dwellin
USE:
Buildina is
>3 Stories 0 Yes 0 No
PENTAMATION 1GENRES
PERMIT TYPE:
WORK
SCOPE
-. l.y„j1-�_:�._„�=.Z'!C'�iiit �.-"`S CY"'i•T-J f 1 -rl -:.- (- -ii- ].?-:,'•'i:[:�: -\- J .{,r.\" A: •I,):� «(. S. (.�-:5.:'��s l,.i:? [ -1, i ..t. /. ) l'.: 3'
. S, :�, r4.. ..fir Jr i �-.r,.. ,>..r.. .;,� .-S/� .-l-. r: (` ,� � �! 5> r.',{Sr ''7.. •.rr- k g "rsi.r.-.�}�e -] .�.:., ..rt.,
1 i ?�r>a .� .'II,•1. .r. .� s:.S..rr: :�[ !•:_.: 5 .�•h• _✓ SS
r p i;a'ai •r • � rr:. -,i --.!•'I=..:5,: . c- .SJ 3 .•�?,:ice., n--
r S- yy
} � S;1)s�.,N..[r..S.�S,.2L:t`,�Ir£.::.,.,...:-:ss�,,,.,ir:,c�..%.�:.:rr.�..t��.,�n;�:.•.��.:'�•...
r.SS:si-.Sx�•.�i1�1�{i'z':�Sif1.r�]J�.L.a..�rilrn[zx...:,i1.}�-[.:S):-:. ��i�:Zi:7.•.i Ji1=. ,.Yr. :�i>'.a.� :ielYT.i...Cil.f.]. i.,.z1.Ik::[.�.:C�`r
,l,fcdi. Plan Check
pfull1b. PFuo Check
r7ec. Pl'mf Cheek
Pe'.#".pfii 1'f'!'.'
1111mh. Pe--rrnil r%4(';
l[.li%e permit Fec':
O�hcr Mech. Insp.
<�.117,' .1' (.r(!t.'.o it ::;rk.
0/lre: Lh'r. /nsp.
llech. Insp. F,X:
I'ri:[„6. 1r:.1;i. Fe'..:
Flee. /nsp" l'cc:
NOTE. These fees are based on the areliminary information available and are onlv an estimate. Contact the Dent for addn7 info.
FEE ITEMS (Fee Resolution 09-051 Eff. 7/1/10)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: 1SUPPKFEE
$0.00
2 # Stairs
$507.00 ]STAIRS (Specify # of Flights of Stairs)
Suppl. PC Fee: 0 Reg. 0 OT
2.0
hrs
$252.00
PME Plan Check:
$0.00
999 s.f. Remodel, Other
$569.00 IRE'MRESOTH
Permit Fee:
$0.00
Suppl. Insp. Fee{' Reg. 0 OT
0.0
I hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax
Acoustical Fee: 0 Yes 0 No
$0.00
0
Work Without Permit? 0 Yes 0 No
$0.00
Planning Fee:
$0.00
Select a Non -Residential 0
Building or Structure
Truvel Docz-unentufion Fees:
Strong Motion Fee: 1BSEISMICR
$5.00
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$2.00
•\. ); it err Ln. Fs;•.:.) 1�.v .._Y,r }�.{lh.Ci�:��(F," �Ii1•-./r
k
$259.00
t<!'i, i.%.� :i.`: ',cif: 'S]'z
$11 076.00 ,::-:. ;�;-,,;;� �,::�':<z`` ! • s'.
1
I
3
Revised:9/29/2010
WOW
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 7373 fallenleaf
DATE: 10/04/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION:
$500
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi-FamilyDwelling
USE: g
Building is
>3 Stories 0 Yes (F) No
PENTAMATION 1GENRES
TPERMIT TYPE:
WORK
revise electrical service add new lights, revise stairs add Gain rail quard.
SCOPE
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the nrelinsnary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 L . 7i7/IIZ
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Misc Bldg/Structure
...................... .
or Element of a Building
Suppl. PC Fee: Q Reg. Q OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee-0 Reg.
Q OT
O.Q
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Q
0
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
Strong Motion Fee:
IBSEISMICR
$0.50
1 # Revision
$652.00 IREVRESADD Addition
Bldg Stds Commission Fee: IBCBSC
$1.00
:: $ 'fir:
�,..
$1.5f}
$652.00 : . ':':.`:::,., f.`
653.50
Revised: 10/01 /2011
��� CITY OF CUPERTINO
I��iil FEE ESTIMATOR - BUILDING DIVISION
iaADDRESS:
7373 fallen leaf In.
DATE: 08/10/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION: Iso
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Du lex
USE: p
2nd Unit? Yes No
OTC? 0 Yes 0 No
PENTAMATION 1 DSR3
PERMIT TYPE:
WORK
deferred staircase with calculations.
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
Deferred Submittal (R-3)
II-B,III-B,IV,V-B
0
$0.00
$0.00
TOTALS:
0
$0.00
........
$0.00
NOTE: These feet are hated on the nrelindnary information avaHahle and are nniv an estimate. Contact the Dent for addn 7 info.
FEE ITEMS (Fee Resolution 11-053 F.. 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes O No
$0.00
0 hours Plan Check, Hourly
$390.00 ISTPLNCK
Suppl. PC Fee: (F) Reg. 0 OT
I0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:0 Reg. 0 OT
FO.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Acoustical Fee: 0 Yes 0 No
$0.00
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
4._
Strong Motion Fee:
$0.00
Select an Administrative Item
Bldg Stds Commission Fee:
$0.00
........................: . :: S$::C1;i
0.00
390.00 :: >;:'::.:..::::i4�:
390.00
Revised: 07/04/2011