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15030083OR CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21825 LOMITA AVE CONTRACTOR: K & M DEVELOPMENT PERMIT NO: 15030083 INC OWNER'S NAME: 21815 LOMITA AVE LLC 20874 HANFORD DR DATE ISSUED: 07/02/2015 OWNER'S PHONE: 4083905127 CUPERTINO, CA 95014 PHONE NO: (408) 390-5127 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ S1-4CONSTRUCT TWO STORY RESIDENCE (3891 SQ FT); License Class .0 Lic. H %�� GARAGE rC `/��%?>��C (454 SQ FT); COVERED PORCH (205 SQ FT). Contractor ate ADDRESS CHANGED FROM 21815 LOMITA. I hereby affirm that I am licensed under the provisions o Ch ter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 1 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: $700000 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 APN Number: 35716061.21825 Occupancy Type: permit is issued. APPLICANT CERTI FICATION 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 FROM LAST CALLED 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 Issued b �� ZAP—G% Date: � �� granting of this permit. Additionally, the applicant understands and will comply Y with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Z 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 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 HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will 1 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(x) should 1 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 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and 1 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 permit is issued. Owner or authorized a Date: Z 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 L ING 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 teNEW CONSTRUCIION ;'�03 odd 3 CONSTRUCTIONIAPPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 . buildi!Lg -tggp arfiirara.ol ❑ ADDITION ❑ ALTERATION i TI [:1REVISIOVEFERRED ORIGINAL PERMIT PROJECT ADDRESS Z/WJ M //�A V /��,„ %j / /t APN b _' / _I I �a / A C��• OWNER NAA1E �O �pS/�1/✓!/� �• S�Z NE �,p ['• E `G('I�l' a fiJaiIca / QP 9 STREETADDRESS zoo �//�.,ifQ•� .�2 . CITY, STATE, ZIP FA.' cum i� coq CONTACT NAME / N PHO 'E / - -• Z E-\1Al Ir STREETADDRESS 6 1 � CITY. STATE- _IP O O, FA3 ` Z -� J ❑ oN\'F.R ❑ O%kN'ER-BUILDER OWNER AGENT ❑ COIFMACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGIN'MR ❑ DEN -ELOPER ❑ TENAA'\T CONTRACTOR NAME LICENS NUMBER LICENSE TYPE BUS LIC k C AME rMa,�`�%a F'.46gp. 753 97d STREET1I1)DR 'SSCITY, O� , STATE. ZIP ja�� i.,� S�oi y PH NE �� d'• 390. S/Z ARCHITECT'ENGI EE N, N[E LICE -SE NIUMBh R L+ BUS. LIC U CONfPANY NAME f E-MAIL FAx We C?jf STREET S ..� CITY, STATE, P O PHONE J DESCRIPTION OF w ORK EXISTING USE f {MEW PROPOSED USECONSTR S� ' Y`'W/ TYPE V_6 !l STORIES USE TYPE OCC. SQ.FL. VALUATIO'v is) ExISTG AREA FLOOR DENIOv AREA 3 AREA TOTAL ,ETAREA /� [� 3 F 3 BATHROOM REMODELAREA KITCHEN REMODELAREA OTHER REMODELAREA � o �/(� \ ! �/ L PORCH AREA 'vS" DECK AREA _ TOTAL DECKPORCH AREA GARAGE AREA: DETACH r .�ATT�H _.. _ _. v� VI -3 A, DWELLING UNITS ISA SECOND UNIT ❑ YES SECOND ORY ❑YES BEING ADDED? �N0 ADDITION". AND PRE -APPLICATION YES IF YES, PRO\qDE COPY OF IS THE BLDG AN ❑ N'FS RECEIVE Y: TOTAL VALUATION' y PL IiNING APPL NO PLANNING APPROVAL LEITER EICHLER HOAIF,? NO /oa .x)o By my signature below, 1 certify to each of the following: I am the property owner or authorized agent to act on the property ossner's behalf. I have read this application and the information I have provided is correctthe read the Description of Work and verih' it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building o ction. uthonze representatives of Cupertino to enter the above -identified property_ for inspection purposes. Signature of Applicant/Agent '.'.`.wW_, � Date. SUPPLEMENTAL tTtR=ATZNREQUI PLAN CRECK TYPE ROtFRNG SLIP _ New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER BUTLDaVG PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C STANDARD IQ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. / ❑ URGE FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR SANITARY SEWER DISI'RI(T submittal of Building Permit application. ENVIRONMENTAL HEALT)I BidgApp_2011.doe revised 06"?1'11 CITY OF CUPERTINO IY"/�JI FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 21 omita Ave DATE: 03/12/2015 REVIEWED BY: Sean PC FEE ID APN: BP#; 15030OF-3 *VALUATION: 1$700,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex 2nd Unit? 0 Yes G No USE: PENTAIVIATION 1 R3SFDW PERMIT TYPE: WORK Construct two story residence (3891 sq ft Gara e 454 sq ft , Covered Porch 205 sq ft). SCOPE PME Plan Check: OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 4,550 $3,319.38 /R3PLNCK $3,854.58 IR3INSP $0.00 PME Plan Check: $0.00 Permit Fee: $3,854.58 Suppl. Insp. Fee -.0 Reg. 0 OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 4,550 $3,319.38 Construction Tax: IBCONsmn $3,854.58 N newunits NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt otr )_ Thoco fooc aro hacod nn tho nroliminary infnrmn/inn avadahlo and oro nnly an octimnfo_ Cnntarl tho Dont for add" 'I info_ FEE ITEMS (Fee Resolution I1-053 ETf 7%1:'13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,319.38 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $3,854.58 Suppl. Insp. Fee -.0 Reg. 0 OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONsmn 1 N newunits $670.76 1 . 0 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: IPLLONGR $637.00 Select a Non -Residential Building or Structure 0 0 i 1r/' I-r,rr Fcc Strong Motion Fee. IBSEISMICR $91.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $28.00 SUBTOTALS: $8,600.72 $0.00' TOTAL FETF $8,600.72 Revised: 02/14/2015 V/ Building Department City Of Cupertino 10300 Torre Avenue 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: Z/ Z,5 4 v--6 PERMIT # 15 0 3 o0 OWNER'S NAME: 2IXI-51d L PHONE # _S/Z GENERAL CONTRACTOR:/ypZrvl P AC BUSINESS LICENSE # 2'2-2,,e .14 ADDRESS: Zo S yid ,�� --VCITY/ZIPCODE: S *Our municipal code requires all businesses worMng in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED 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: -✓ SUBCONTRACTOR BUSINESS NAME BUSYNESS LICENSE # Cabinets &Millwork Ca✓s �✓ a/ s✓G 3 313 Cement Finishing oma./ -34 3D Electrical f G 2 Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation an! 33 Landscaping�L Lathing Masonry Painting / Wallpaper �., 1 7�/•r ,. �6/ Paving Plastering Plumbing lyL/•✓t///n1C v' ✓ Zo �� Roofing 71 Septic Tank Sheet Metal Sheet Rock /—�yL.r i 'Vez�,✓/dLG �� Tile Owner. -Contractor Signature Date V CUPERTINO Building Department CITY OF CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3228 • FAX: (408) 777-7606 OFFICIAL NOTIFICATION OF NEW/ADDRESS CHANGE TO: All Agencies FROM: City of Cupertino DATE: April 10, 2015 CORREC,TION LETTER RE: New/Change of Address APN #356 16 061 —(357-16-061) Please note the following new address: 21815 Lomita Ave is being demolished and 2 new houses are being built. 21815 Lomita Ave will remain on Lot B. 21825 Lomita Ave will be the new address for lot A. See attached map. The new address will take effect 30 days from the date of this letter. Please update your records accordingly. If you have any questions, please call me at (408) 777-3246. Sincerely, Susan Winslow Administrative Clerk Cupertino Building Dept 408-777-3246 or suew@cupertino.org C t Building Department CITY OF CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3228 • FAX: (408) 777-7606 OFFICIAL NOTIFICATION OF NEW/ADDRESS CHANGE TO: All Agencies FROM: City of Cupertino DATE: April 06, 2015 RE: New/Change of Address APN #356-16-061 Please note the following new address: 21815 Lomita Ave is being demolished and 2 new houses are being built. 21815 Lomita Ave will remain on Lot B. 21825 Lomita Ave will be the new address for lot A. See attached map. The new address will take effect 30 days from the date of this letter. Please update your records accordingly. If you have any questions, please call me at (408) 777-3246. Sincerely, Susan Winslow Administrative Clerk Cupertino Building Dept 408-777-3246 or suew@cupertino.org CUPERTINO PURPOSE UTILITY RELEASE REQUEST FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • build nQ _cupertino,oM For residential single family or duplex construction, there are cases where gas and electric utilities are requested to be released prior to the issuance of the certificate of occupancy. Upon approval from the building inspector, the City of Cupertino is allowing both utilities to be released prior to the final sign -off of the building. INSTRUCTIONS 1. Download this form at: htti)://www.cupertino.org/index.aspx?page=297, 2. Complete the form and obtain signatures from both the owner of the property and the primary contractor. 3, Fax, E -Mail, Mail or hand deliver the original signed form to: City of Cupertino Building Division Attn: Utility Release Request Form 408-777-3228 office 10300 Torre Ave. 408-777-3333 fax Cupertino, CA 950I4 buildinefa,cupertino.org 4. Schedule a Gas Meter Release inspection (#403) and/or Electric Meter Release inspection (#404). Please note, a Gas Test inspection (#506) is required prior to or at the same time of the Gas Meter Release inspection. BUILDING INFORMATION (Please complete the following information): APN DLDG7 PERMIT �S DATE: SITE ADD ESS: Zi6PZs OWNER'S NAME:PHONEM �� 2yr'a. S'/2 FAX MAILINaADD E S (if different from site address): !/ '-Z r C� C TR CT R: PHONE t#: . / - G�f /'� �'�� FAX A CONTA T: PHONE M FAX #: I request the City to release my utilities prior to obtaining a final inspection approval for the bullding. I fully understand the occupants of the building cannot move Into the residence until they receive all of the required final sign -offs and the Clty has issued a certificate of occupancy for the building. % Owner... ........ ........ ... ........................ Print.......'��0 �7H�......��'��.......... Date:. ��/1....�,. Contractor:.....,, Print:../.7.!�7?�' ------ ------ Uri1ityRc1easeForm_Z011.doc revised OS/09/11