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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