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08100121CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 21871 DOLORES AVE (LOT2) I CONTRACTOR: TBD - TO BE DETERMINED I PERMIT NO: 08100121 OWNER'S NAME: ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. #1 Contractor Date DATE ISSUED:07/29/2009 PHONE NO: BUILDING PERMIT INFO: BLDG r ELECT F PLUMB r MECH F RESIDENTIAL F COMMERCIAL r I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:NEW 2 STORY SFDWL W/ATTCH (commencing with Section 7000) of Division 3 of the Business & Professions GARAGE(514.5SQ)& PORCH Code and that my license is in full force and effect. 77' LOT 2 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. 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. Signature Date OWNER -BUILDER DECLARATION 1 hereby affirm that 1 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 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. 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. 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. 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 - . -7—Z + Licensed Professional I CITY OF CUPERTINO BUILDING PERMIT I IBUILDING ADDRESS: 21871 DOLORES AVE I CONSTRUCTION E & RIGHT I PERMIT NO: 08100121 OWNER'S NAME: CUPERTINO, CA 95015 PHONE NO: (408)861-0928 ❑ LICENSED CONTRACTOR'S DECLARATION I" F BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. 4 j- r r MEC11 RESIDENTIAL COMMERCIAL Contractor Date 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: 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. APPLICANT CERTIFICATION I certify that I 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. Date OWNER -BUILDER DECLARATION I hereby affirm that 1 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). 1 hereby affirm under penalty of perjury one of the following three 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. 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 91R JOB DESCRIPTION: NEW 2 STORY SFDWL W/ATTCH GARAGE(514.5SQ)& PORCH 77' LOT 2.V I S. 1 Q tU Sq. Ft Floor Area: I Valuation: $700000 APN Number: 35714081.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: 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. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & 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 Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, / 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional Signature, Z a • • CUPERTINO April 8, 2009 Suejane Han 770 Allen Court Palo alto, CA 94303 Building Department CITY OF CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3228 • FAX: (408) 777-3333 SUBJECT: Permit application extension Dear Suejane: Your permit application #08100121 for 21871 Delores Ave (lotp has been extended the maximum 6 months till 10/20/2009. This is a one-time only extension. Your permit for the new house will need to be approved, paid for and issued no later than 10/20/2009. If the permit is not issued by 10/20/2009 then you will need to pay all new fees. You need to continue with the plan checking process for both permits for 21871 & 21881 Delores Avenue. Even though you still have Public Works issues, you need to keep the plan check process going so the other departments will be approved. Do not let these sit without any activity on them. Your permit application #09010037 for 21881 Delores Avenue will expire 7/09/2009. Mike Chewgot the comments on 2/11/2009. We still have not received a resubmittal. I talked to Mike 4/08/2009 and he indicated that you were concerned about the P submittal supplemental fees. This fee is $122.00 compared to $2800.00 if you let the permit application expire.. There will be no extension for 21881 Delores if the plan check process has not been ongoing. If you have any questions or concerns, please contact me at 408-777-3246. Sincerely, Susan Winslow City of Cupertino, Building Department Cc: Mike Chen H.M.C. Associates, LLP 12280 Saratoga/Sunnyvale Rd Saratoga, CA 95070 Susan Winslow To: hmikechen@aol.com Subject: 21871 & 21881 Delores Ave Attachments: 21871 & 21881 DELORES AVE2.doc Hi Mike, I am attaching a letter regarding the extension for 21871 Delores and the resubmittals for 21881 Delores Ave. I have sent this letter to the owner and also mailed you a copy. Sincerely, Susan Winslow 0 • Dear Sir or :Madam: April 3, 2009 � APR o 3 Zoos This letter is to request the extension of plan review for property at 21871 Dolores Ave., Cupertino. The plan was submitted on Oct. 20, 2008. The comments were received on Nov 11, 2008. One of comments is to submit the plan of adjacent neighbor 21881 Dolores Ave., Cupertino. It normally takes 2 to 3 months for architect and structure engineer to complete a new building design. We managed to submit the plan of 21881 Dolores rive on Jan. 9, 2009. The comments are received on Feb. 13, 2009. We consolidated the feedback on 21871 and 21881, and submitted the revised public works plan on :March 3, 2009. The comments were received on March 19, 2009. One of comments is to obtain arborist report to design sidewalk. We paid the fee to City on :March 26, 2008. I was told it takes about 2 weeks to complete the report. In the past few months, we work hard on the projects. One biggest challenge was to submit the adjacent neighbor's plan that takes many months to make a good design. Also we still cannot resolve the public works issues. According to the first comments on 21871 Dolores, we ought to submit public works and other plans at the same time at resubmittal. These issues caused unexpected delay on 21871 Dolores Ave. plan resubmittal. Please approve the extension of plan review on 21871 Dolores Ave. If you have any questions, please contact me at 408-4645030. Your assistance is highly appreciated. 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