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10030132 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21559 EDWARD WAY CONTRACTOR:BLACK DIAMOND PERMIT NO: 10030132 DESIGNS NER'S NAME: SKLAR DONALD 3481 DEL NORTE DR DATE ISSUED:03/22/2010 OWNER'S PHONE: 4082558998 SAN JOSE,CA 95132 PHONE NO:(408)272-5959 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C�'�+�'r�� c# / T / G� � d MECH r— RESIDENTIAL I— COMMERCIAL Contractorg4,i� Z t&n.r ,(2_Date A4 pc I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMODEL KITCHEN,NEW CABINETS,COUNTER TOPS, (commencing with Section 7000)of Division 3 of the Business&Professions SINK, Code and that my license is in full force and effect. GARBAGE DISPOSAL,NEW OUTLETS,GFI,NEW FURNACE, NEW WATER HEATER,TILE FLOORS ALL DUE TO FIRE 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 permit is issued. Sq.Ft Floor Area: Valuation:$18000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:35619004.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. 1 ? ature "gate v ZZ Zo/ Issued Date: ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. 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. Owner or authorized age APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) the above mentioned property for inspection purposes.(We)agree to save Lender's Name inify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address 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. ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signatu Date_ Licensed Professional CITY OF CUPERTINO 9 ITEMS OF 9 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN 35619004 . 00 DATE ISSUED. . . . . . . : 03/22/2010 RECEIPT #. . . . . . . . . BS000010000 REFERENCE ID # . . . : 10030132 SITE ADDRESS . . . . . : 21559 EDWARD WAY SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER SKLAR DONALD ADDRESS 21559 EDWARD WAY CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4764 RECEIVED FROM . . . . : D & M SKLAR CONTRACTOR . . . . . . . : MUELLER, CRAIG D LIC # 18104 COMPANY BLACK DIAMOND DESIGNS ADDRESS 3481 DEL NORTE DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95132 TELEPHONE . . . . . . . . : (408) 272-5959 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 18, 000 . 00 1 . 00 0 . 00 1 . 00 0. 00 1BSEISMICR VALUATION 18, 000 . 00 1. 80 0 . 00 1 . 80 0 . 00 1EPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1MPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1MRRAA UNITS 1 .00 63 . 00 0 . 00 63 . 00 0 . 00 1PPERMITFE FLAT RATE 1 . 00 42 . 00 0 .00 42 . 00 0. 00 1PRWHEATR UNITS 1 . 00 25 . 00 0 . 00 25 . 00 0 . 00 1REMRESKIT SQ FEET 300 . 00 570 . 00 0 . 00 570 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 828 . 80 0 .00 828 . 80 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 828 . 80 #4267 --------------- TOTAL RECEIPT 828 .80 CITY OF CUPERTINO ` ADDITION/REMODEL CUPEkT1NO PERMIT APPLICATION FORM APN # 2 J Date: 0 o z/--, C C-) HAr-e-k *Z_Z_' "Z_0/C1 Is a 2"dunit being added? Yes No [:1If yes, please fill out the permit application for 2"dunit. Building Address: _ n Z SS� e GJri r C-4 Mailing Address (if different from building addre s): Owner's Name:: Phone# Contractor: Phone#: ?o Svc wr/ Fax #: Contractor License#: '7 -7 Cupertino Business License#: Contact: Phone#: - Fax #: BuildingPermit Info: Bldg. / Elect. Plumb. ®-- Mech. "-- Hillside ❑ Job Description: Addition-What is being added?(Be Specific): What is being remodeled (not including addition)? ��fete ��`,, ��h«-►Pfs Cove , S/ 5�:��'� G-ar 6G�r 27�5 's/�►,�� OVe-v1 '>c?G -f o Remodel Includes Re-Roof. Yes ❑ No [ dyes list number of squares Remodel Includes Structural: Yes ❑ No \ Do you have the pre-application planning approval? Yes ❑ No ❑ If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen 'OoV Bath Other Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ IUIII/V-A ❑ II/Ill B, IV-HT, V-B EZ,--"' t--'-3 Valuation: ($,poa, a© Please check this box if the project is a second-story addition ❑ Project Size: Express ❑`Standard ❑ Large ❑ Major❑ Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, Green Building Points Achieved: include in plan set& the sheet index. ***For Office Use Only*** Over-the-Counter ❑ Revised 07/06/09 CITY OF CUPERTINO ADDITION/REMODEL CITY Of FEE SCHEDULE CUPEi�TINO :Quantity Fee ID Fee Description Fee Group Permit Type S 1R3SFDADD ADDITIONS 1PLLONGRNGR Long Range PL Planning/Residential 1R3INSP Dwellings Inspections B 1R3PLNCK Dwellings plan check B 1R3REPINSP Dwellings Repeat B Inspection 1R3REPPLNC Dwellings Repeat Plan B Check 1R3HINSP Dwellings Hillside B inspection 1 R3HPLNCK Dwellings Hillside plan B check 1R3HREINSP Dwellings Hillside B Repeat Inspection 1R3HREPLNC Dwellings Hillside B Re eat Plan Check 1R3ALTINSP Dwellings Alternate B Materials Inspection 1R3ALTPLNC Dwellings Alternate B Materials Plan Check 1PCESS Cesspool P 1PPRSEWG Ea. Private Sewage P Disposal System 1PRSEWER Sewers P 1BPSPRINK Lawn Sprinkler/Backflow P 1BPWSVCS Main Water Service P 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1REROOFRES Residential Re-roof Each B 100 SF CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft DECKS 1R3SFDADD OR 1R3SFDREM 1 DECKWOOD 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 SF (each) 1 GARDTM<=1 K Masonry up to 1,000 SF B (each) 1BCONSTAXR Construction Tax Res (new detached garage) PATIO'S OPEN 1R3SFDADD OR 1R3SFDREM 1 PATIOWOOD Wood Frame up to 300 B SF 1PATIOMETAL Metal Frame up to 300 B SF 1 PATIOOTHER Other Frame up to 300 SF B PATIO'S CLOSED 1R3SFDADD OR & SUN ROOMS 1R3SFDREM 1PATIOENCLW Enclosed Wood up to 300 B SF 1PATIOENCLM Enclosed Metal up to 300 B SF 1PATIOENCLO Other Enclosed Patio up B to 300 SF 1 COVPORCH Porch Covered-Each B (Each) REMODELS 1R3SFDREM 1 REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan 300 SF check 1 REMRESBAT Bath Remodel 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 Group Permit Type Sq Ft 1REMRES2 Remodel Residential B Greater than 1000 sq ft 1REMRES3 Remodel Residential B Greater than 2500 sq ft. 1REROOFRES Residential Re-roof Each B 100 SF REMODEL PLNCK ISTPLNCK (1-3 for Standard Plan Check B NOT FOR OVER THE remodel) COUNTER PLAN CKS. WINDOW/SLIDING 1R3SFDREM GLASS DOOR 1 WINREP Replacement windows B (ea 8 windows) 1 WINNEWNSTR New Window (non- B structural) 1WINMEWSTR New Window (Structural B Shear Wall/Masonry) 1 WINBAYSTR Bay Window (Structural) B SKYLIGHTS 1R3SFDREM 1 SKYL<10 SF Skylight less than 10 sf B 1SKYL>10SF Skylight greater than 10 B sf or structural 1STAIRS Stairs-first flight/ea addt'1 B 1EPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M 1PPERMITFEE Plumbing Permit Fee P IELCPLNCK Stand Alone Electric Pln E Ck (hourly) CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft 1MECPLNCK Stand Alone Mechanical M Pln Ck (hourly 1PLMPLNCK Stand Alone Plumbing P Pln Ck (hourly) 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B f 1 TRAVDOC Travel & Documentation B / 1 BUSLIC Business License B RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number: Name of owner. 5 K I Project address. Contact person. �e� Phone. -Z Fax. J Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: /17 Garage: TOTAL: I AM I WITH THE CIT OF Are there at least two 10 foot by 20 foot clear spaces inside the garage?— . �ur+tRTINC)cz,t,t�ANU OADIWA J(_;ES 5;:- DATE-1-3. Is privacy protection planting required for the project? SIGN This set of plans and specification,,MUST uild it Green Total Points be kept on the lob at all times am;.t unlawful to make any changes or alt,.r itions on same without written permission from On what floor(s) is work being done? the Building Department. City of Cupertino. The stamping of this plan and specifications LL T Brief description of work. / jeco . el a permit r Vd yG� P ` _Q 0. n ity()rdinanc or State taw Code editions:2007 CBC -N)2007 CFC 6(P-N)2007 CMC 4f—>N) 2007 CPC N)2007 NEC N) Effective 1/1/08 'Ag M1{ E� Plan Review Process Work Book Page-8-Revised 8/05/08 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 CUPERTINO CONTRACTOR/ SUBCONTRACTOR LIST Z1�S c.Jc?�r t�Jc� PERMIT JOB ADDRESS: NAME: 'may« � PHONE# Z0g�(a OWNER'S �g a BUSINESS LICENSE# GENERAL CONTRACTOR: � cs _ S CITY/ZIPCODE: ADDRESS: *Our municipal code requires all businesses working in the city to have a City of Cupertino business IicenTIL THE NO BUILDING FINAL OR FINAL OCCUPANCYIHAVE OBTAINED AN(S) WILL BE IICITY OF CUPERTINO GENERAL CONTRACTOR AND ALL SUBCONTRACTORS BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: %/ SUBCONTRACTOR BUSINESS NAME 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 Date Owner/Contractor Signature