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14010087 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21811 GRANADA AVE CONTRACTOR:STEPHEN&SHIRLEY PERMIT NO:14010087 GAW OWNER'S NAME: CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S:DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIALE] REMOVE WALLS,ELECTRICAL LIGHTING TO CONVERT License Class Lic.# BACK TO ORIGINAL GARAGE 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. Sq.Ft Floor Area: Valuation:$500 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:35716028.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that-the above information is PERMIT E S IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WIT�IIN 80 DA SOF 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 DAY OM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertinoagainst liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued b Date•�'�,,A granting of this permit. Additionally,the applicant understands and will comply y' with all non-point source regulations per the Cupertino Municipal Code,Section 918. ` 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) I,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. 1 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,Section 505,=3d34. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Dat S ' 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. It after making this certificate of exemption,I 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 919. Signature Date � �.� 'p ' CONSTRUCTION PERMIT APPLICATION 09*T is COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 f CUPERTINO (408)777-3228•FAX(408)777-3333•building(M-cuaertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS 2 / Rif I1 d e N A.yam q APN# p O OWNER NAMES' PHONE��• � � STREET ADDRESS 2 �f!R v ' v& c uST�)2Tn1v q54/ FAX CONTACT NAME CITY,STATE,ZIP /` FAX ZoOii i'RAAJADIA f1v� I OWNER ❑ OWNERBUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK f?F OVF ZJALLS w THE CA)e TO RC ERT wro Ohl e,AR SI' EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: H DETACH ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEINGADDED? ONO ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO P fir'` A By my signature below,I certify to each of the following: I am the property owner or authorized agLI�t;�acls,.n the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work andcate. I agree to comply with all applicable local ordinances and state laws relating to b ' g construe' n. I authorize representatives of Cupertino above-identified property for inspection purposes. Signature of Applicant/Agent: Date: f -20 SUPPLEMENIAL INFOJEMATION UIRED P Typg ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for o A* coux rER UQ DING PLAN RENTER existing building(s). Demolition permit is.required prior to issuance of building permit for new building. ❑ EXPRM PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to 0 MAJOR El SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21811 Granada Ave DATE: 01/15/2014 REVIEWED BY: MENDEZ . APN: BP#: *VALUATION: $500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION 1GENRES USE: SFD or.Duplex PERMIT TYPE: i WORK remove walls electrical lighting to convert back to original garage T SCOPE r 77 v — r • ._ , „, . Ltech.flan Check Phimb,Plan Check Elec.Plan{.'heck tkteck Pern il_hee: Plumb.Permit Fee: Elec. Permit Fee: C)fher alecrh.In•sp. Other Plumb Inst). Other Elec.Insp: blech.lnsh.1 ee.: Plumb. Inj• .Fee: Elec.Insp.l ie: NOTE:This estimate does not include fees due to other Departments(La Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelimina information available and are only 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. Select a Mise Bldg/Structure Suppl.PC Fee: O Reg. O OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: Hourly Only? ®Yes Q No $0.00 Suppl.Insp.Fee:Q Reg. .0 OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Adrn l n istrati ve_Fee: Work Without Permit? O Yes G No $0.00 0 Advanced Planning Fee: $0.00 I hours Inspections Travel Documentation Fetyr: $278.00 1STINSP Inspection,Hourly ®� Strom Motion.Feer 1BSEISMICR $0.50 0.5 hrs Admin./Clerical Fee Blda Stds Commission Fee: IBCBSC $1.00 $44.001 1ADMIN $1.50 $322.00 �� $323.50 Revised: 01/01/2014 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 eUPERTINO (408)777-3228- FAX(408)777-3333-building(a cuoertino.ora Dear Properly 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 n/ }0 rl kxvwR �E- APN BP# OWNER NAME Ln, OWNER/A�RESS�p N U DESCRIPTION OF WORK: / 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.) 1- I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Bu Ider"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. 2. 1 understand building permits are not required to be signed by property owners unless they are responsible for th construction and are not hiring a licensed Contractor to assume this responsibility. 3. 1 understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may pr tect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. K4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license lers on permits and contracts. II5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the I 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. &-6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and fe eral 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. 7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family r sidential 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. 8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for Tan financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction de ects in the workmanship or materials. Oi+,neBuilderFonn 2010.doC revised 04/14/10 �e€ ,r 9. 1 understand I may obtain more information regarding my obligations as an "employer"from the Internal R venue 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.cslb.ca.gov for more information about licensed contractors. 4th 10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I e 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 by all applicable laws and requirements that govern Owner-Builders as well as employers. 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the in ormation 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 property owner's si nature Property Owner's Signature: Date: ! + /S `f --------------------------------------------------------------------------------------------------------------------------------------------- (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: 0w77e7Bteilde7Fo7-7772010.doc revised 04114110 Jan 13, 2014 I am applying for a permit to remove the room inside my garage. The house is located at 21811 Granada Ave, Cupertino, CA 95015. The house was built in the 1940's. One of the previous owners before me had made a room in the garage. I would like to re-covert it back to a normal garage space. All I will be doing is to remove all the walls that are forming the room. I will not be adding anything new. There will be no structural changes or reconfiguration of anything. I am just returning the space into the original garage space. I will remove the walls that are forming the room and anything else so to make the space back to the original garage. The drawings below show more details. Fig 1 shows my garage as it is now. Fig 2 shows my garage after the walls are removed. Fig 3 is an FYI to show the garage in relation to the rest of the house. 1 /J/-L qL96 kFn�avF EV�2y7{��N� L�t.SE THAT .Da Nor &Z:LON!' To -THF Cp1RA4',g . rale -�rx* MpCf: : �GfcTi2iC�4L L/may t,�4 r G�rvNVII1t4 ✓�S! =6C?Pf1�^TDEPARTNIENT BUILDING DIVISION-CU ERTINO o1I pians and specifict,jt-,r:s MUST he kElpt at the construct,�n. it is uniavt/`t,l to r —1 G;iy n,,,vvithou't approval l i rotil die Buiicfln� ti ii 'j p lr� ofthis Nan an c rt�I n fie- ions sF ,"it Psrnnit or to >i ,�_ roe !of t;-:,.%, r,,V!ions of any C,rdy ,;,diriance or fzzta i._ O,, FFICE COP ,v. f YLII'1' IY�Ai�� CFIECKED BY o_ ry�� CUPERTINO DAVE } 130iiding Department EPT. LANNI JAN N i G 2014 D_ ATE REVIEWED FOR CODE COMPLIANCE p BLDG. DEPT. Reviewed By: ¢ � �, .iS ` u J Drive way 18 Garage door Z � 2.5 S O11.5 c ------- ' -•---T-------------------- -------------------------- u, 1 1 Ln( 1 1 ----------------- I ?1✓ 11� 1) remove all walls and W doors as indicated by 2 dash lines. r 16.5 9 OC 1 CIOGf � w � i N --------------------------------- ---- ' W 1 I �y 3.5 1 I i5 ---� 5.5� ^1 1 CHECKED Fig 1. Garage before room removal �rATE p ANN DEPT. Drive way 18 Garage door DATE BLDG. EPT. CUPERTMO ooa�ent 19' Rl,�ildin�k �� 19 .-A CODE FUR CODE COMPI-1ANCe. REVIEW Reviewed By- 61 8' Fig 2. Garage after room removal G 0 ----------------- Street Granada Ave ___________________ --------- 1_-----kA e) 1 Drive way �.J O �v Garage Kitchen 00 N v Bath Bath Q v Bedroom PLOT PLAl\-5 CHECKED BY Bedroom Living room PLANK UEPT. DATE BLUG .DEPT.-- Bedroom Family room Bath IB '" �Gp�GU , Fig 3.Layout of the entire house