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15030084 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21815 LOMITA AVE CONTRACTOR:K&M DEVELOPMENT PERMIT NO: 15030084 INC OWNER'S NAME: 21815 LOMITA AVE LLC 20874 HANFORD DR DATE ISSUED:07/02/20I5 OWNER'S PHONE: 4083905127 CUPERTINO,CA 95014 PHONE NO:(408)390-5127 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL � COMMERCIAL � CONSTRUCT(N)TWO STORY RESIDENCE(3889 SQ FT); License Class � Lic.# �`7`� �J� GARAGE(454 SQ FT); COVERED PORCH(448 SQ FT). Contractor ��/c�Z✓L7��/f��v��ate 7 Z %� I hereby aftirm that I am licensed under the provisions 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:$700000 ave 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:35716061.00 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 �,ITHIN 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,judgmenu, cosu,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: ure Date �� i� All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection,1 agree to remove all new materials for inspection. ❑ OW - UI 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 ficensed 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 a�rm 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 Z permit is issued. Owner or authorized Date: J'S 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 Califomia. lf,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 keen 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.Addi[ionally,the applicant understands and will comply with alf non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date � �� a� � ' CONSTRUCTION PERMIT APPLICATiON �.�� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DlVISION �� 10300 TORRE AVENUE•CUPERTINO, CA 950143255 = 3 C U F��r�� (408) 777-3228•FAX(40$) 777-3333•buiidinq;�cu ertino.or NEVV CONSTRUCTION ❑ ADDITION ❑ ALTERATION i T! ❑ REVISION E �D ORIGINAL PERMIT# PRO)ECT ADDRESS ��` � �` L � � � APN� ��, G�C S 6 OWIVER NAt�tE PHON-E E-hiAIL �9�2 � ��✓C .Qco . 3So.siz ��.��e�� c� �•/• ti STRE��DRFSS 'l� !�� a CITY. S�TE,ZI� /�J `-.! /�O� F�`O• ��/ � ' rr � CONTACT NAME ,}�/ � PHOtiE �` b � E-!�i � v - aK e . STREET ADDRESS CITI', 7'ATE, ZIP F.�1.� s� v6" p oI -a =-: 15' ❑OWNER ❑ OWNER-BLRLDFR O��?JER AGENT ❑ COh'1RACTOR ❑CONTR.4CTOR AGEh7 ❑ ARCHiTECT ❑ENGINEER ❑ DE�'ELOPER �TENANT CO�qCTOR NA� �w_ r� LiCENS NU B �� LICENSE 7'YPE BUS.LIC tt i 7 ��v COM11 A�Y'N: tE E-AtAIL FAX �'ML��✓ G i�a � G� �.�wM ��F Z.�3 7B S�ADDRES L�ry � �? . GTl'.STAT�IP/,� G� �� P/ E — � r7 f.i,O�,� 0. S�Z ARCHITECT'E?vGl EER N.a'rtE L[CENSE NUt�4BER � BUS.LI # b ,` .. �f� COMPANY NAbfE E-RtAIL , � FA.' , n - Zt2-7� SIREET ADDRES `• � CITY,STATE,ZIP / PHQNE /' � �� DESCRIPTION OF 1k'ORK ` b �' v . E\1STQJG USE PROPOSED USE CONSTR.TtPE #STORIES s Z USE TYPE OCC. SQ.FT. \'AL.UATION(5) . " Ea'ISTG NEW FIAOR DEMO TOTAL -7 �J 9/ AREA AREA AREA NETAREA ��sl� �/ �4/ �L�� C J BATHROOM KITCHEN OTHER /// REMODEL AREA REMODEL AREA REMODEL AREA � /�� '�/�2 � �� V J PORCH AAEq DECK:�REA TOTAL DECf:.�PORCH AREA GAR.4GE AREA: DETACH / /, S • � 5 aTTACH �C/�� v � ��ll �DWELLLtiG I�NITS: IS A SECOIVD UNIT ❑YES SEC ND STOR1 ❑1"ES 1 BE�iGADDED.' QNO ADDITION? �O �.. PRE•AFPLICATION YES IF 1'ES,PROVIDE COPY OP IS Tf�BIAG AN� �YES RECEIVED • � TOTAl.��L.U�TION: PLA;�INING APPL� ?+O PLANNING APPRO\'AL L6TTER EICHLER HOA�. NO � -�^,s� � - ��s By my signature betow,I certify to each of the foliowing: I am the propem�o�mer or authorized agent to act on the propertv owmer's behaif. I have reud this application and the information I have provided is rrect. I ve read the Description of Work and�•erify it is accurate. i agree to comply with all applicable local ordinances and state laws relating to buildin o ction. I�uthorize representatives of CupeRino to enter the above-identitied pro for inspection purposes. Signature of ApplicandAgent: `�� \ Date: �r�Z�� SUPPLEMENTAL INFORMATION REQUIRE �x cx��c�c z�eE ROU['II�iG SLiP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER BUlLDIIVG PLAN RE�7EW existing building(s). Demolition permit is required prior to issuance of building permit for ne�i�building. � �.�xxEss PL4\?1ING PLAN RE�'IEW Commcrcial Bldgs: Provide a completed Hazazdous Materials Disclosure �STANDARD Pvs[.tc wox[cs form if any Hazardous Materials are heing used as part of this project. �G� �D�p,�, Copy of Planning Approvat Letter or Meeting with Planning prior to � �aR �SANITARY SEWER DISTRICT submittal of Building Permit application. EPIVIROhAtEhTAL HEAL7'H Bldg.4pp_2011.doc re►�ised 06 21'I1 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 21815 Lomita Ave DATE: 03/12/2015 REVIEWED BY: Sean APN: BP#: ��03�� 'VALUATION: $700,000 rPERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex 2nd Unit? Yes •- No PENTAMATION 1 R3SFDW USE: PERMIT TYPE: WORK Construct two sto residence 3889 s ft � Gara e 454 s ft � Covered Porch 448 s ft . SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA pC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. R-3 (Custom) II-B,III-B,IV,V-B 4,791 $3,334.84 IR3PLNCK $3,976.44 IR3INSP TOTALS: 4,791 $3,334.84 $3,976.44 iie� �'--rr;;C ��r�c,d� i'(�rtuh 1' +�i l�/��x�i; F,ir��. Nl�u�C`f:��ck lji'<.';i. �'t>I';lt;!f-�;'i'' I'tt.r�/?. tr't'i-if7;/1'a'i:: /'.��it'r� 1'i'r-Iirl/!'Cc'. (1�Ircr 1�/ec�1�r. Ir�s,r� O�;;er 1'l�rrr.�ll lr,:s,r� O�l��r/:�lrrc l�zs�. ';'.�::�li. I>>,�>_ /��.��;� 7'Iz�rul�. l;u��z /•�c.:_ l.,i��c. �tas�?, r�<��: NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etG . These ees are based on the relimina in ormation available and are onl an estimat� Contact the De t or addn'l in o. FEE ITEMS (Fee Resolution 11-053 Ef. 7.%1;'13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,334.84 Select a Misc Bldg/Structure Suppl. PC Fee: Q Reg. Q OT 0.0 �'S $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $3,976.44 Suppl. Insp. Fee:Q Reg. Q OT Q,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 #neW Construction Tax: IBCONSTAXR 1 units $670.76 �'i�f�t2inr.5�ti��atil�a f•��>e: � Work Without Permit? � Yes � No $0.00 � Advanced Plannin�Fee: 1PLLONGR $670.74 Select a Non-Residential � Building or Structure � 7rt��=� 1)nrr.�rit<rs7��:zlir,rr T��r��.�: � Stron�Motion Fee: IBSEISMICR $91.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $28.00 SUBTOTALS: $8,771.78 $0.00 TOTAL FEE: $8,771.78 Revised: 02/14/2015