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13090154Nt 0 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 8165 HYANNISPORT DR CONTRACTOR: SAFARI VENTURES LLC PERMIT NO: 13090154 OWNER'S NAME: SAFARI VENTURES LLC 807 CLARA DR DATE ISSUED: 09/23/2013 OWNER'S PHONE: PALO ALTO, CA 94303 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL License Class Lic. # REMODEL (E) KITCHEN (149 S.F.) & (E) MASTER & HALL BATHS (126 S.F.). REPLACE 8 (E) WINDOWS, LIKE FOR Contractor Date LIKE & 3 (E) WINDOWS TO MEET EGRESS (NO I hereby affirm that I am licensed under the provisions of Chapter 9 STRUCTURAL (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 Sq. Ft Floor Area: Valuation: $33000 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 APN Number: 35611021.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR 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 DAYS ALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the a Z 3 granting of this permit. Additionally, the applicant understands and will comply Issue y: ate: / with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE- ROOFS: Signature Date 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. ❑ 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 BETTER 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 MATERIALS 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. I 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 I 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 I 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, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner Date: permit is issued. or authorized agent: _ 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I 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. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 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 source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date OWL3 �� - CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 - FAX (408) 777 -3333 - building0guoerlino.om 0�0 �5A Lj NEW CONSTRUCTION (`J1 ADDITION . U ALTERATION / Ti LI REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS B � C u a j) ry I. r 4 r`t p CITY, STATE, ZIP APN #Q - I 1 0� 1 OWNERNAME STET R) ��i TVJi�ES ��� COMPANY NAME PHONE FJeJo'�fd�'ti IVV V_ EMAIL h�IS01,FAQ(l1 mail. (ex, ,J STREET ADDRESS Q� F 1 `]_ ll�iilVS (� i ti�- D \/VV j, CITY, STATE ZIP VA Lo A 00 CA C� (13 FAX DESCRIPTION OF WORK a4? Q A tr LL R L+ m0 d A ` k IT jkQAn P_ O_ VA ,p do-` pQ w �,r �'r C C, g w i � R-� )ace r,<e w� 3 N ew o k6w (00 64 - 9Tru tv gal I S 9 V O REMOELREC CONTACT NAME bra 4�Q S PHONE 6 51D - -4 E-MAIL Y1 0-I SO In �-O Q YI I ?3 fAaW - (0,07 STREE A� CITY, STATE ZIP PAW A m C C t T 3 % � FAX ❑ OWNER OWNER- BUB.DER ❑ OwNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ©�N LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTA NGGNEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK a4? Q A tr LL R L+ m0 d A ` k IT jkQAn P_ O_ VA ,p do-` pQ w �,r �'r C C, g w i � R-� )ace r,<e w� 3 N ew o k6w (00 64 - 9Tru tv gal EXISTING USE C k� ,C G f c16 PROPOSED USE 5 OL�� CUNSTR. TYPE # Yl U USE TYPE OCC. SQ.FT. VALUATION ($) ACREAG 2, AREA FLOOR 0 AREA NETAREA SiT�fm I S 9 V O REMOELREC REMODELAREA OTHER MODELAREA 4�Q S Z IVOVo PORCH AREA DECK AREA TOTAL DECK /PORCH AREA I GARAGE AREA: DDETACH ❑ ATTACH 1 �/�,. S0,00 # DWELLING UNrfS: f BEING ADDED? ii0 ADDMON STORY ❑ O W i K4 W 5 3 3000 PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN '�%_ ES REC TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? O By my signature below, I certify to each of the following: I am the property owner or autho ' g c nth perry s behalf. I have read this V application and the information I have provided is correct. I have read the Description of Work a verify urate. I agree to comply with all applicable local ordinances and state laws relating to buil on I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Im Date: 01 1 V3 Lu 13 .BldgApp_201 Ldoc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i a Manning, runuc works, rtre, aanuary Sewer "'strict, acnuue District et, These ees are based on the relimfna information available and are on an estimate. Contact the Dept for addn'1 info, FEE ITEMS (Fee Resolution 11 -053 E, . 711113) ADDRESS: 8165 HYANNISPORT DR DATE: 09/23/2013 REVIEWED BY: MELISSA APN: 35611021 BP #: *VALUATION: 1$33,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex p 0.0 PENTAMATION 1 R3SFDREM USE: PME Plan Check: PERMIT TYPE: WORK REMODEL E KITCHEN 149 S.F. & E MASTER & HALL BATHS 126 S.F.. REPLACE 8 E SCOPE I WINDOWS, LIKE FOR LIKE & 3 (E) WINDOWS TO MEET EGRESS (NO STRUCTURAL CHANGES). NOTE: This estimate does not include fees due to other Departments (i a Manning, runuc works, rtre, aanuary Sewer "'strict, acnuue District et, These ees are based on the relimfna information available and are on an estimate. Contact the Dept for addn'1 info, FEE ITEMS (Fee Resolution 11 -053 E, . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 126 s.f. $626.00 Remodel, Bath (< =300 sf) 1REMRESBAT Suppl. PC Fee: Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 149 1 s.£ $626.00 Remodel, Kitchen (< =300 sf) 1 IREMRESKIT Permit Fee: $0.00 Suppl. Insp. Fee-ID Reg. ® OT 0.0 hrs $0.00 1 1-1 # Window /Sliding Glass Door $557.00 1WINREP Replacement PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construeiion Tax: Arlen i n ks tr°ati ve .Fee: 0 E) Work Without Permit? ® Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure 0 0 Travel Documentation Fees; Strong Motion Fee: IBSEISMICR $3.30 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $2.00 P = $5.301$1,809.00 i.. `,TOTALFEE r $1,894.30 Revised: 08/01/2013 CUPERTINO OWNER- BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255 (408) 777 -3228 - FAX (408) 777 -3333 - building(cDcupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS C a not S r� D r AF i� BPi ` S S �} OWNER NAME R'I U �VN 1l S OWNER A�QR Lj� `(1 R r`� 3SO 'Palo A,rra '7 DESCRIPTION OF WORK: TO A-* � "M l daL. P&M44d U �li� ire dI.C) l ��(Q w►Q N tAA3- W)VL6W Igoh —gruz We are providing you with an Owner - Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner - Builder. We Will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS. Please read and initial each statement below to signify you understand or verify this information.) AA1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner - Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner - Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Pr`2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 1A3. I understand as an "Owner - Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. A4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. Ah. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. PY-6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. PM. I understand under California Contractors' State License Law, an Owner - Builder who builds single - family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. W8. I understand as an Owner - Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04114110 34 a Oki. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800 - 321 -CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. Vw 10. 1 am aware of and consent to an Owner - Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide biyy all , applicable laws and requirements that govern Owner - Builders as well as employers. 1'12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner - Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the vroaertv owner's signature. , . n Property Owner's Signature: /VdM)NII--? Date: TD/ LS I ------------------------------------------------------------------------------------------------------------------------------------------ (NOTE. The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner - Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner - Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04114110 Building Department City Of Cupertino 10300 Torre Avenue La Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 C U P E RT I N O Fax: 408 - 777 -3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: 810 PERMIT # -'r&b 19,6 {'S OWNER'S NAME: SAF:f 1 V R-C-S LLC PHONE # GENERAL CONTRACTOR: BUSINESS LICENSE #. ADDRESS: 2625 !'� Q.al 390 CITY /ZIPCODE: " �', ° CA- T4 30 *Our municipal code requires "all businesses working in the city to'have a City of Cupertino; business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCTEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A- CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V 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 `- 2320)3 Owner/ ontractor Signature Date r C\'y"X-Iho Ch q 0 SCOVE OF WORD — 2 spa K tvvov4 -ou h'0 Q ITY D�VELO�F&D TMENT (V'C9 � 14UGDIVISI®NO APPROVED This set of plans and specifications MUST be kept at the N �1tJ Nod io�'9�gtion. It is unlawful to make any c anges or alterations on same, or to deviate f S ourv" Q W •i therefrom, without approval from the Building Official. 1 The stamping of this plan and specifications SHALL NOT be held to permit or to be an approval of the violation of any visions or State Law. C�j)ATE 23113 PERMIT N0. �verni�a Go_ gavo GR kot o G o ?,0l0 C� 1 NDt 5HEF-T 2 3 Co i r�1 " jW Bv1dh vt Cowl . 2.010 CPS Rest ae �,ol do I EE ,� Oder Zoi o CA �►nQr �id.� z� 0 SCOVE OF WORD — 2 spa K tvvov4 -ou h'0 Q ITY D�VELO�F&D TMENT (V'C9 � 14UGDIVISI®NO APPROVED This set of plans and specifications MUST be kept at the N �1tJ Nod io�'9�gtion. It is unlawful to make any c anges or alterations on same, or to deviate f S ourv" Q W •i therefrom, without approval from the Building Official. 1 The stamping of this plan and specifications SHALL NOT be held to permit or to be an approval of the violation of any visions or State Law. C�j)ATE 23113 PERMIT N0. �verni�a Go_ gavo GR kot o G o ?,0l0 C� 1 NDt 5HEF-T 2 3 Co i r�1 " jW Bv1dh vt Cowl . 2.010 CPS Rest ae �,ol do I ,� Oder Zoi o CA �►nQr �id.� 1 Gat'v Mal �TOLKAI f KihIC►pod CWV R 4& H A LL Q AT 14 ROOM - F,?Ct ST six o�115k, EXI s°ri G Q�pC %�ti cF W 1 N 00 W W w ww" 1 w 1 "t1iDko - New - Pot, STt-v UN 9,AL (�`3 WrlND4�VS F LAD C)K PLA0 A SK '* r- C SEP 213 2013 4 c?" g r"5 Moohni s of N �)C�1 ST 1 N G� [3 REMODEL: nom...._._.., , � RQ�OSE� . , .n F. 6 Al L I I :, 2� L ►Ke. � r W U Z Q CL 0 0 w 0 O U 51 tY tD O 70 0 N w > w a w L 'Iry S CfJ. OF WOE. si oy, , Vft ,V I , 1Z)'1 LET, 1N1 N W 0 W N-1- N FLAID R - 1L6 - Vvl�1 tj t- RND �-ttl PFR -- gT LE P(ST b pJ F- 20 - P(H? CIRCUIT FOR S V P Pi-y • ® 9 bs H- c- m%tspor-V Pr- M ASTE K. bhT.� Roots IREM'0 PF-L- �Xi 2► Qnx hQ TEIAVEREb ► o„x ►�o�� yyiNOorJ ' L-,)(-e, 90LAce *wDo w 0� uj ca, m i � a • q 3 W � W of ---- vr,I S' Icy' S' I" �/ SCALE (2 - - REMOVE �l REPLACE VANITY W\)jjTERlOP i s1 NK skOW r va1vt RJR 50.55 sF _ oV� A R� VLAV -M'I LIFT W•l wbow, S�wEk W WALL �, R M FUPoR �LE wi RAN �flN p�R �iRflY�l�Nfr 2 fiFG.i Pr's" Li 667 toNE ZO -INMP OR C\Jll FAR SVQ PLY SIG5 Dr wiN cove 5'x 2'. j0rr Gps N9 S SGflLE ��2 ` V AQEh= SF KiTCffEN RF�OD�L� ,z ��, �w )6 STI i1 J U J t v Li fie- No �ra -ml�5. Cl+oa.KTs o r. red Cv'ta ° - �;�pliah�� -s' . 8165 ,a- �Y�nn�s tot pr F G= . �!'x K 1T C HF N R E M O D'��.--X- \)e��� s ON S\ Pro TOseA - -SCOPE OF WORK �' GP�`/.�VT RE�tAI�S rt�E S�r�1E — R E w'► RE u R R Cabe A S CA 9.1 NETS A0D WuNTER' es NEW u�HTl�(r' PElz D �AW,i Cr 0 < o v 4Q- X • W1NJbD 5 — RmRce"CNT C LI K U Ke) No cl�av�ge. iV\ alme_r,s�o „s ► �� IO,X� CTe�,peccc� F.P. �' t0 "xco 510 0 "X LJ �i 1 Sox 11811 U S,Xzj lO"► 2, )O X ► 10,1 . c � V �O ko� Q o z QGIX3" Jou (sill hei�w = 31) 3 NEW V�IiN�ows NOW- Sj-R\jCTA4�L To be, replaced . r NEW WI UDOW y'lo..x 3 ' 8" srE F-� /"-I W"N3 Liv'iNG- Y�avM sl u P G A?,R GE C, 51 t,(- ?�a,a ro0� bwTw Di N,,N(r PoR CL 7 n c I ov, hM m &A -*2 J\ 1 G , L. 2 cXis'riN(r K).Tcie,t o o �e.� 1 WiNDOW s ► It V x Z: 4 �o i7e replacedt by z hew W i ti3Dfl W S ��►o'`x 3 %61 N S EE U- Lev A-r t oN n VVI Exi5Ti�� c�n��ge SOOER 14' 10" x COW To be, replaced . r NEW WI UDOW y'lo..x 3 ' 8" srE F-� /"-I W"N3 Liv'iNG- Y�avM sl u P G A?,R GE C, 51 t,(- ?�a,a ro0� bwTw Di N,,N(r PoR CL 7 n c I ov, hM m &A -*2 J\ 1 G , L. 2 cXis'riN(r K).Tcie,t o o �e.� 1 WiNDOW s ► It V x Z: 4 �o i7e replacedt by z hew W i ti3Dfl W S ��►o'`x 3 %61 N S EE U- Lev A-r t oN n 7V ELEvkfi)nN � - CXI STI N& Go NDitoN I Uv � N �OUJs # .I 1 # 2 � Rt )D e 0Ti GA L-5) PRO POSED AIEW WIoDOW FOR SOTH-) IL 4 10" 3' 8" Building Departnent cool p i=OR REVtEWE ReV1ewed BY 710 �l.E VR'(lON (�) E)OST NG C,()mMTVW SL \pf,�, flovR, 3' \Nlwt>ow 43 FROpOsEb MEW vi l o bow 4' ! 0'1 yJ - _ �3uildin9 DP�e D�pL1��'GE REV1EwEU �.pC {CUD ` F,e \jie�ed BY .. 11 C- Q.InhYS �4 rl- rJ r ' FLeo rV R P LA ti q f PL ►j ?.taro o 1 o 5 M o C- D.= P- I 1 ® Q lou- � 3 f P• 1� cL C L_ a Liv�►NG j�avM y Q1 Ni NCr RAOM O �e,��2 � <� •O • K-IT 00 00 41J.. ARR GE r-\ rl i N 0 I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 8165 HYANNISPORT DR I CONTRACTOR: CALIFORNIA SUPERIOR I PERMIT NO: 13090154 I OWNER'S NAME: SAFARI VENTURES LLC I CONTRACTOR INC -2625 MIDDLEFIELD RDI DATE ISSUED: 09/23/2013 I OWNER'S PHONE: I #350, PALO ALTO, CA 94306 l PHONE. NO: 650- 787 -8486 I IN LICENSED CONTRACTOR'S DECLARATION Q License Class Lic. # " P 91 7 Contractor t� It��1w f~ J vOQri or 1IN~ Date �0� 3 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 following4wo'declnrations: 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. / Signature Date 1 '614,113 ❑ 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) 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: - 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, Signature Date BUILDING PERMIT INFO: BLDG T— ELECT r PLUMB i MECH f— RESIDENTIAL r— COMMERCIAL , JOB DESCRIPTION: REMODEL (E) KITCHEN (149 S.F.) & (E) MASTER & HALL BATHS (126 S.F.). REPLACE 8 (E) WINDOWS, LIKE FOR LIKE & 3 (E) WINDOWS TO MEET EGRESS (NO STRUCTURAL Sq. Ft Floor Area: I Valuation: $33000 APN Number: 35611021.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DA ISSUANCE OR 180 D LLED INSPECTION. i Issued b Date: Ca�� 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: 10j W13 ALL ROOF COVERINGS TO BE CLASS "A" OR BET'T'ER HAZARDOUS MATERIALS DISCLOSURE I 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 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. Owner or authorized agent: 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 Add ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional Ca lifornia Superior Contractor, Inc XICET[SE # 987909 2625 MIDDLEFIELD ROAD # 350, PALO ALTO CA 94306 650.787.8486 (PHONE) ACCEPTANCE OF RESPONSIBILITY NEW PERMIT RESPONSIBLE October 25th, 2013 CITY OF CUPERTINO BUILDING DEPARTMENT Dear Sir or Madam, We accept to take the responsibility as the General Contractor for the permit # 13090154 issued on 9/23/2013; we accept to be the Contractor of Record for that permit. Very Truly Yours, CALIFORNIA SUPERIOR CONTRACTOR, INC Nelson Koen President Safari Ventures, LLC 807 Q ARA DRIVE, PALO ALTO, CA 94303 650.996.0635 (PHONE) TRANSFER OF RESPONSIBILITY CHANGE OF PERMIT RESPONSIBLE October 25th, 2013 CITY OF CUPERTINO BUILDING DEPARTMENT Dear Sir or Madam, We, as the current responsible and Owner - Builder for the Permit ## 13090154 issued on 9/23/2013 for the property at 8165 Hyannisport Dr, Cupertino release the responsibility and transfer it to the General Contractor "California Superior Contractor, Inc" who has accepted to take that responsibility and accepted to be the Contractor of Record for that Building Permit Very Truly Yours, SAFARI VENTURES, LLC Sally Ruben CFO "W Building Department :{ City Of Cupertino 10300 Torre Avenue pertino, CA 95014 -3255 elephone: 408- 777 -3228 Fax: 408-777-3333 r ter. JOB ADDRESS: S a hni S r`� TEAR Ix# $l `S OWNER'SNAME: saAR1 VE RES LLC I PHONE #1 �. 53 — GENERAL CONTRACTOR: $LTSINESS T I,S- 5" ADDRESS: 2625 V%koWJAd Q.at 3 CITY /ZIl'CO : �:_ � � C& 8430 *Our municipal code requires "all businesses working-in the city to hAV. "" Crt u NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION($) 1-TLI &B ] GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OWTf , s BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the.foll-o cformati V SUBCONTRACTOR BUSINESS NA1VIE , Cabinets & Millwork `T�►�(S j i' Cement Finishing » r Electrical A6" R Lecyll C, Excavation Fencing Flooring / Carpeting, Linoleum / Wood- Glass f Glazing Cq 4fotilfl ` SUPER30R 'C _:� Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper `� --tF' GA 0 F-W.A Paving Plastering Plumbing Roofing �y Septic Tank f :. Sheet Metal x Sheet Rock Tile >4 Owner / ontractor. Signature R !!business license. EIEDULED UNTIL THE CITY OF CUPERTINO Date 08INESS LICENSE # y Date