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10010025BUILDING ADDRESS: 2111.6 FREEDOM DR CONTRACTOR:-TJID-- TO B1_. PERMIIT.NO: 10010025. . �R'FEH' OWNER'S NAME -.HOMEOWNER ASSOC COMMNS OF CUPRTN DATE ISSUED: 03/01/2011 OWNER'S PHONE: 4088661247 PHONE NO: ❑ . LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COA' MERCIAL License Class Lie. # � !? -1 ADD IEILIEVATOR(25SQ), REMODEL l[ �lESTROOMS(683SQ) & � G•L ' a MAIN (FLOOR CEILING, KITCHEN(75SQ); NO RE -ROOF � Contractor V (S �b ate DOES INCLUDE D1Ei 5'd'][$UO'd'1( RAL I hereby affirm thatI am licensed under the provisions of Chapter 9 (commenciag 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: 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 Sq. Ft Floor Area: Valuation: $200000 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. APN Number: 32653034.CLUBHSE Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is EIlD PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county. ordinances and state laws relating �1(�Ifl(IQ� Ili® ���� �� PERMIT ISSUANCE ®� to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 SDA IF GM (LAST CALLEDI�YSIPIEC'1cION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Issued by: (Date: q41, granting of this permit. Additionally, the applicant understands and will comply with all non -point sour egulations per the Cupertino Municipal Code, Section 9.18: RE -ROOFS: �' Signatu Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am.exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BE'T'TER 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) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALSS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. [will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should II store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District II performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sectio s 2T, 3, and 34. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agen Date,)-/, ) permit is issued. 1 certify that in the performance of the work for which this permit is issued, l 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, l CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, l must 1 hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. I work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 1 certify that.I have read this application and state that the above information is correct. l 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point sour regu . ns per the Cupertino Municipal Code, Section Licensed Professional 9.18.. 4�mj IL J �l /3 Signature Date CITY OF CUPE.RTINO BUILDING PER BUILDING ADDRESS: 21 116 FREEDOM DR CONTRACTOR: DRAEGER O PERMIT NO: 10010025 CONSTRUCTION INC OWNER'S NAME: HOMEOWNER ASSOC COMMNS OF CUPRTN 605 COMMERCLAL ST DATE ISSUED: 03/01/2011 OWNER'S PHONE: 4058661247 SAN JOSE, CA 95112 PHONE NO: (408)536-0420 ❑ LICENSED CONTRACTOR'S DECLARATION License Class /?> Lie. .##� �, 1'^7 (6 /0 Cuntractor E)Aa e ,t°ifr' 6a � 'p— —Z3 - 'Z I hereby affirm that I %9F ► 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. BUILDING PERMIT INFO: BLDG - ELECT PLUMB MIECH RESIDENTIAL r COMMERCIAL F JOB DESCRIPTION: ADD ELEVATOR(25SQ), REMODEL RESTROOMS(683SQ) & BLAIN FLOOR CEILING, KITCIIEN(75SQ); NO RE -ROOF & DOES INCLUDE STRUCTURAL 2/23/2012 -REV# 1 REVISE ELEVATOR DETAIL -REV# 1 1SS'D 2/23/2012 I 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. 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 Sq. Ft Floor Area: Valuation: $200000 permit is issued. APPLICANT CERTIFICATION I certify that l 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 theabove 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 tate granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulaticns per the Cupertino Municipal Code, Section sienatnrek\, —&12 ❑ &VNER-aILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm tinder 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. 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, l 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 arxl county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon tate above mentioned property for inspection purposes. (We) agree to save indemnity 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. APN Number: 32653034.CLUBHSE I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issue y: Date: 2 -r 2 55, ,/ RE -ROOFS- All roofs shal l 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, 2.5533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should l 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. Date ONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sea 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Date V Licensed Professional CITY OF CU PIER'S INO BUILDING PERMIT I BUILDING ADDRESS: 21116 FREEDOM DR CONSTRUCT R: DRAEGER I PERMIT NO: 10010025 INC I I OWNER'S NAME: HOMEOWNER ASSOC COMMNS OF CUPRTN 1605 COMMERCIAL ST I DATE ISSUED: 03/01/2011 I OWNER'S PHONE: 4088661247 1 SAN JOSE, CA 95112 I PHONE NO: (408)536-0420 ❑ LICENSED CONTRACTOR'S yDECLARATION . ECN LARATIO License Cllas'�sy yL.iicc. # ( b1_7 lQ 6 V Contracto,A-4Mdir•(0TJ✓ &:)S,'." - Date l 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: t. 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. 2. 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. % 4%47 / APPLICANT CERTIFICATION 7 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 thl Cupertino Municipal Code, Section 9.18. Signature ^��� Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. 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) 2. 1, 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: t. 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. 2. 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. 3. 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. Date JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ ADD ELEVATOR(25SQ), REMODEL RESTROOMS(683SQ) & MAIN FLOOR CEILING, KITC14EN(75SQ): NO RE -ROOF & DOES INCLUDE STRUCTURAL Sq. Ft Floor Area: Valuation: $200000 APN Number: 32653034.CLUBHSE I Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM (LAST CALLED INSPECTION. Issued by: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, 1 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 1 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. or au orized ge CONSTRUCTION LENDING AGENCY 1 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 Add ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed Profession CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 e FAX (408) 777-3333 - building(cDcupertino.org [I NEW CONSTRUCTION I_ 15DMON D;-ttLiERATION / TI REVISION / DEFERRED ORIGINAL PERMIT # / C/ OZ� Q%' PROJECT ADDRESS ' L } R w— (901 APN 4 - F -MAIL �l / / STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME l ) 1 PHONE 2 E MAII. �DS �B I ` C.. STREET ADDRESS CITY, STATE, ZIP FAX 5,1MjJ ® .� 2— OWNER 11 OWNER -BUILDER ❑ OWNER AGENT ❑CONTRACTOR ❑CONTRACTOR AGENT �. ARCHrIECT❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LI 5 NUM1B LICENSE TYPE BUS. LIC # a COMPANY NAME G F -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHTTECT(ENGINEERNAME ICU LICENSE NUMBER BUS. LIC # COMPANYNAME, EMAIL _ FAX /rs$— C-�e+�� O STIIEETADDRESSf-V CITY, STATE, ZIP � �y�� PHONE DESCRIPTION OF WORK A&LL�1- EL-ag�OL ll /,-p caaa4�tw EXISTA40 USE lbe `! PROPOSED USE 54111 " CONSTR.TYPE V( #STO S USE TYPE oCG SQ.Fr. VALUATION (S) EXISTc NEW FLOOR AREA"21 1®Q AREA DEMO TOTAL AREA NET AREA �/4 ,9 BATHROOk REMODEL AREA ?O KITCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: LIDETAGH z,/ [3ATrACH DWELLINGUNITS: ISA SECOND UNIT ❑YES SECOND STORY ❑YES ^ rt,&40e� BEING ADDED? ®yiC ADDITION? U;UY PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN 0 � PLANNING APPL # LANNIN CNO PO APPROVAL LETTER '..... EICHLER HOME? WW- RECEIVED BY: � � TOTAL VALUAITON: -F �i � By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the pr�rperty owner's behalf. 'I have read this application and the information I have provided is correct I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local tifed ordinances and state laws relating tobrlilding con c ' . I authorize representatives of Cupertino to enter the above-idenproperty for inspection purposes. �5 Signature of Appllcant/Agent / � Date: i p SUPPLEMENTAL INFORIIATI UII2ED PLAN CHECK TYPE ROUTING ROUTING SLIP 9 BULLDiNG REVIEW New SFD or Multifamily dwellings: Appl or demolition permit for existing building(s). Demolition permit is required prior to issuance of building _mi oL 9 VER-1'SE-CorJNTER PLAN pert for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLICWORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ Fm vErr _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ sANITARY SEWER Dismucr submittal of Building Permit application. ❑ ENVIItONMENTAL HEALTH, BldgApp_2011.doc revised 06/21/11 (I 11 GIF (I I" I I". 111(D) era, AIDII)I I I(I►NI'll:M(I►II)I:I. CITY OF c U!'f l'; O I"I:I'lM l I AI"I"I.I( •1 I I31 I GRM C�C:1 (--> o,;�L APN # 3 A (0,5 4 1--W f) Date: Is a 2 nd unit being added? Yes ❑ leo ® yes, please ffillll out the permit application for 2ndIlIl,i,. Building Address: l t l V f� �A M I>�—, C AJOn 0 ui-e Mailing Address (if different from building address): H Owner's Name: p me ©tv A5rX6 Q ®� Phone # : R- Contractor: Phone #: Fax #: Contractor License #: Cupertino Business License #: Contact:" V-L6+� W 1 t, I 1' Q ,e7 Phone #: -;i– �� Building Permit Info: Bldg. Elect. Plumb. [9— Mech. ❑ Hill is de ❑ Job Description: /� 11;� 014wl- dition-What is being added?(Be Specific): Apleva-t%-- What iis, being remodeled (not including addition)? I I Remodel Includes Re -Roof: Yes ❑ No ffT� If yes list number of squares Remodel Includes Structural: Yes a—No ❑ Do you have the pre -application planning approval? Yes R`o ❑ If yes, please provide a copy of your j?Ranning approval letter. Planners name: Square Footage) Addition: 7,17,_ I�orch: Deck: Garage: Detached Attached 7s" s- we3 Remodel: Kitchen 1.— Bath Li` Other o�— Type of Construction (Usage Class): Occupancy Type: 1-A, 1-13 ❑ II/III/V-A ❑ 11/111 B, IV -HT, V -B Valuati,�n: Please check this box if the project is a second -stony addition ❑ ]Project Size: Express ❑ Standard E�arge ❑ Major ❑ Please complete relevant portion of the Green Building Checklist & attach it to the application or if appllicahlle, Green ]wilding ]Points Achieved: include in plan set & the sheet index. ***]For Office Use Only*** Over -the -Counter ❑ Revised 07/06/09 CITY OF CUPIERTINO FEE ESTIMATOR - BIIILDNNG DIVISION ADDRESS: 21116 freedom dr. I DATE: 02/23/2012 1 REVIEWED BY: bob s. MAPN: BP#: 10691002 *VALUATION: $0 *PERMIT TYPE: Building Permit PLAN CHECK TVPEE: Alteration / Repair PRIMARY SFD or Duplex 1PENTAMATION 1GENRES USE: PERMIT TYPE: WORK I revise elevator detail. �+Zr]Td NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These ees are based on the prefinina _ information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Jesolut'ion 11-05; Elf. 7/7/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: hourly Only? (D Yes 0 No $0.00 hours Plan Check, Hourly $130.00 ISTPLNCK Suppl. PC Fee: f: Reg. Q OT L0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppt. Insp. Fee -.0 Reg. Q OT Elhrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 LJ ) Work Without Permit? Yes 0 No $0.00 Advanced Plannin, Fec,: $0.00 Select a. Non -Residential Building or Structure G Strong Motion I've: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0,00 $130.00 TOTAL 1FEE: $130.00 Revised: 1/19/2012 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 JOB ADDRESS: SUBCONTRACTOR WON ME BUSRN ESS LECENSE # I am not using any subcontractors:2—I—IJ Signature Date Please check applicable subcontractors and complete the following information: n WE Owner/ Contractor Signature Date SUBCONTRACTOR BUSENESS NAME BUSRN ESS LECENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Pleating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile n WE Owner/ Contractor Signature Date