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1506013309 X CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22871 STONEBRIDGE ST CONTRACTOR: FONG FRANK Q PERMIT NO: 15060133 TRUSTEE & ET AL OWNER'S NAME: FONG FRANK Q TRUSTEE & ET AL 22871 STONEBRIDGE ST DATE ISSUED: 06/19/2015 OWNER'S PHONE: 4082429439 CUPERTINO CA, 95014-5639 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL KITCHEN REMODEL (192 SQ FT) AND REMODEL (2) License Class Lic. # BATHROOMS (176 SQ FT). 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 Sq. Ft Floor Area: Valuation: $50000 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: 34213032.00 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 PERM�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 JALLED 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 by: Date: 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. 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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sections 25505, 25533, and 25534. / � .,ltrte Owner or authorized agent: .�-Date: s J ermit is issued. e" 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 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. _ l Signature � �"`� Date g 20 r� CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228• FAX (408) 777-3333 • building(d,)cupertino.ong 1So6 0:33 ❑ NEW CONSTRUCTION ❑ ADDITION 56 ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT 4 PROJECf ADDRESS aa��` S��nt6i .I� t '-PN ! (/ OWNERNAME Fc�AN� �5N PHONE dol;- a>ia-�►y3°1 E-JILMA �rU�k-��., ia3 �', �►h�.ro STREET ADDRESS `C14�.0 r•�{rr� �l..v� CITY, STATE, ZIP C� SIDi FAX U r gra CONTACT NAME � � �C1N PHONE 4oS --+1Z_ bqV4 E-MAIL STREET ADDRESS q.^ O Mrrr) �A D f 11v Jc CITY, STATE, IP CA g5�o\y FAX , <<�-,� OWNER El OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TEN, --NT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC k COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEFR NAME LICENSE NUI IBER BUS. LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS ` 1 AA CITY, STATE, ZIP PHONE rtt`A ` 1 DESCRIPTION OFWORKM,•�` _ COrVCt�� {►) 7 W r,r. r�. 1 \� �R 1 �l"CI'� �, DNl " ` l►1� ( U;IA4 A , N k4fA0k* VA(fAlW1�IS �.nI� w �b , b�, ��,(�,n wwj,� 6K \ EXISTIN SF CONSTR. TYPE STORIES PRO o ? USE,e, //�� I V I USE I TYPE I OCC. SQ.FT. VALUATION (S) E>aSTG NEW FLOOR, DEMO TOTAL AREA AREA AREA NET AREA BATHROOM REMODEL AREAa6 KITCHEN -OTHER REMODEL AREA /9a. REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: EIDETACH ❑ ATTACH I n DWELLING UNITS: 15 A SECOND UNrr ❑ YES SECOND STORY ❑YES BEING ADDED? .[;�WO ADDITION? 121fQ PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING ADPL R I l Nfl% PLANNING APPROVAL LETTER IS THE BLDG .4N ❑ YES� I EICHLER HOME? �'i'0 RECEI Y TOTAL VALUATION: i aZ L p O Q By my signature beloNv, I certify to each of the following: I am the property owner or authorized agent to act on 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 and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified pro rty for inspection purposes. Signature of Applicant/Agent: A �( Date: 6 /1 �� 0 C� SUPPLEMENTAL D\TFORMATION REQUI D New SFD or Multifamily dvvellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building ONTRI_711F-COIWTEWSM I LBUILDTnGPLA REXIEFy ; permit for new building.S _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C� �it F n pNGpL,�,�v fl,_cv4o _ form if any Hazardous Materials are being used as part of this project. M 9 - _ Copy ofPlanning Approval Letter or Meeting with Planning prior to Building Permit p W ,-: submittal of application. BldgApp_2011.doc revised 06/21/11 F-M-7, CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 a.' 7/1/13) ADDRESS: 22871 Stonebridge st DATE: 06/19/2015 REVIEWED BY: Sean Mech. Permit Fee: APN: BP#: 3,660135 *VALUATION: 1$50,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: _T PENTAMATION 1 R3SFDREM PERMIT TYPE: WORK Kitchen Remodel 192 s ft and remodel 2 bathrooms 176 sq ft). SCOPE 176 s.f. $645.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 a.' 7/1/13) rlfech. Plan Check Numb. Plan Check Elec..Plan Check Mech. Permit Fee: Plumb. Permit Fee _L_ Elee. Permit Fee: Other 11eeh. Insp. Insp.Li Other lslec. Insp. 14ech. Insp. Fee Islec. Insp, Fe(� NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 a.' 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 192 1 s.£ $645.00 Remodel, Kitchen (<=300 sf) 1REMRESKIT Suppl. PC Fee: E) Reg. OT0.0 hrs $0.00 PME Plan Check: $0.00 176 s.f. $645.00 Remodel, Bath (<=300 sf) IREMRESBAT Permit Fee: __T0_0 $0.00 Suppl. Insp. FeeQ Reg. Q OT hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C: onsb-uction Tax: -1 �:ltnitti.cttctti�=`. E) Work Without Permit? Yes (F) No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure ©A Strong Motion Fee: IBSEISMICR $6.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $2.00 SUBTOTALS: $8.50 $1,290.00 TOTAL FEE.T $1,298.50 Revised: 05/07/2015 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(d)cupertino.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 '71 4�0 S'TONE J3 IDGC t C /I 9d 0154(•'(L� APN BP#C_ OWNER NAME 19A.v/< N OWNERADDRESS t9,9Z o Mt7kk1 Pe-, C U e C P 7 -,A10 DESCRIPTION OF WORK:7-CAI6A-1 /C &/k1p p& 7-4J O &,4 7A1 e0 0 A/s XEPIAC OX/6 D n n 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.) VY -1. 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. J ' 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. X 3. 1 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. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. a 5. 1 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. )`� 6. 1 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. 0,2 d- d'-7. 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. 8. 1 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 04/14/10 k 9. 1 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. 37'1 0. 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 by all applicable laws and requirements that govern Owner -Builders as well as employers. 0 _,�' 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information l 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.) 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 owners signature. Property Owner's Signature: Date: 6 1.2 c rJr - -------------------------------------------------------------------------------------------------------------------------------------------- (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: Address of Authorized Agent: Tel No 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 04/14/10 ADDITIONAL CODE REQUIRMENTS Energy code mandatory lighting measures: 1. All permanently installed high efficacy luminaires shall be switched separately from low efficacy luminaires. (I50(k)(7)) 2. Permanently installed lighting in Kitchens shall be high efficacy luminaires. Up to 50% of the - wattage of permanently installed lighting in kitchens may be in lights that are not high efficacy. (150(k)(8)) 3. - Permanently installed luminaires in bathrooms, garages, laundry rooms and utility rooms shall be high efficacy luminaires OR are controlled by an occupant sensor(s) certified to comply with Section - 119 that does not turn on automatically or have an always on option. (150(k)(10)) - Plumbing plan notes: 4. Water closets shall -have an average water consumption of not more than 1.28 gallons per flush. (CPC 403.2) 5. Shower heads shall have a water flow not to exceed 2.0 gallons per minute @ 80 psi. (CPC 408.2) 6. Faucets in kitchens, wet bars, lavatories, laundry sinks, etc shall have a water flow not to exceed 1.8 gallons per minute @ 60 psi. (CPC 403.6) 7. Shower stalls shall have a clear interior finish area of 7.1 sq. ft. and be able to accommodate a minimum 30 inch circle at the threshold level. These clearances shall be maintained up to a height of 70 inches above shower drain. (CPC 408.6) 8. Shower compartments and walls above bathtubs with installed shower heads shall be finished with a smooth, nonabsorbent surface to a height not less than 72 inches (6 ft). (CRC R307.2) 9. The maximum hot water temperature discharging from the bathtub, shower and whirlpool bathtub filler shall be limited to 120 degrees Fahrenheit. The water heater thermostat shall not be considered a control for meeting this provision. (CPC 409.4 & 408.3) 10. A 30 -inch clear width for water closet compartment and 24 inch clearance in front of water closet. (CPC 402.5) Electrical Plan Notes: 11. The installation of smoke alarms in all of the following areas shall be provided: (CRC R314.3) a. On the ceiling or wall outside of each separate sleeping area in the immediate vicinity of bedrooms. b. In each room used for sleeping purposes. 12. The installation of carbon monoxide alarms in the following areas shall be provided: (CRC R315.1) a. Approved carbon monoxide alarms shall be installed outside of each separate sleeping area in the immediate vicinity of the bedrooms and on every level including basements in dwelling units that have fuel -fired appliances or attached garages. 13. A minimum of two 20 amp small appliance branch circuits shall be provided for all receptacle outlets in the kitchen, dining room, pantry, or other similar areas. (CEC 210.11(C)(1)) 14. At least one 20 amp branch circuit shall be provided to supply bathroom receptacle outlets. Such circuits shall have no other outlets. (CEC 210.1l(C)(3)) 15. In every dwelling unit, fixed appliances such as food waste grinders, dishwashers, washing machines, dryers, laundry tray locations, built-in refrigerators or freezers, furnaces, AC units, built-in heaters or r' any other fixed appliance with a motor of/4 h.p. or larger shall be on a separate 20 amp. branch circuit. 16. All receptacles in bathrooms, garages, accessory buildings, outdoors, crawl spaces, unfinished basements, kitchens (where receptacles serve counter top surfaces), laundry, utility, wet bar sinks (within 6 feet of the edge of the sink), shall have ground -fault circuit interrupter (GFCI) protection. (CEC 210.8(A)) 17. In all areas specified in 210.52, all non-locking type 125 -volt, 15- and 20- ampere receptacles shall be listed tamper-resistant receptacles. (CEC 406.12) ResKitBathPo1icy_M4.doc revised 01/15/14 TITLE 24 COMPLIANCE LIGHTING 1. ALL NEW PERMANENTLY INSTALLED LIGHT FORURESTO BE HIGH -EFFICACY LED LIGHTS CERTIFIED BY THE CALIFORNIA ENERGY COMMISSION. LEGEND OF SYMBOLS EXISTING WALL TO REMAIN 7' NEW PARTITION WALL O 77jr' PATCH WALL DEN BEDROOM 2 BATH 2 MASTER BEDROOM I R C 7 JUN 19 2015 BY: LIVING ROOM I IO ❑ L� MASTER BATH CO 1 ,1UNITY DEVELOPMENT DEPARTMENT UILDING DIVISION - CUPERTINO APPROVED 7T:-Ll s t of plans and specifications N11JST be kept at the i during construction. It is unlawful to make any F_ —1 changes or alterations on same, or to deviate KITCHEN they om, without approval from the Building Official. F `-�- _ The amping of this plan and specifications SHALL NOT DINING ROOM ENTRY GARAGE be d to permit or to be an approval of the violation of a y provisions of any City 0 dinance or State Law. BY s DA (y •/ 9 •l'S BREAKFAST — E 1 I T# Al ROOM — i EXISTING PLAN scALE: vTr = 1'-D' DEMOLITION NOTES 1. ALL WORK SHALL BE IN ACCORDANCE WITH THE CALIFORNIA BUILDING CODE AND ALL REQUIREMENTS OF OTHER APPLICABLE CODES AND REGULATIONS. 2. ALL ELEVATIONS, DIMENSIONS, MATERIALS AND OTHER CUP- 3uildir)91)C0Lrtrrnt 1; JUN 19 2015 BUILDING DEPARTMENT - BUILDING DEPARTMENT 08.18.15 TSANG/FONG HOUSE CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22871 STONEBRIDGE ST CONTRACTOR: FONG FRANK Q PERMIT NO: 15060133 TRUSTEE & ET AL OWNER'S NAME: FONG FRANK Q'TRUSTEE & ET AL 22871 STONEBRIDGE ST DATE ISSUED: 06/19/2015 OWNER'S PHONE: 4082429439 CUPERTINO, CA 95014-5639 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E] KITCHEN REMODEL (192 SQ FT) AND REMODEL (2) License Class Lic. # BATHROOMS (176 SQ FT). REV # 1 - REPLACE (E) PANEL, SAME LOCATION & NO Contractor Date CHANGE IN AMPS — ISSUED 8/5/15 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 Sq. Ft Floor Area: Valuation: $50000 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: 34213032.00 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 IT 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 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 granting of this permit. Additionally, the applicant understands and will comply Issued Date: 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) I, 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. 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 22`555334. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: 2v 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 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. C Csr Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building Acugertino.orra F-1 NTAW rnm,,TRTTrTTom F-1 AI)nTTTOW F-1 AT.TF.RATTON / TI Wr REVISION/ DEFERRED ORIGINAL PERMIT # l S0 (�d r 3 J PROJECT ADDRESS2`. p / - i 2 i T O APN # -3 l CGl C�Ti Cl , C� OWNER NAME P O 4Eqg 24�z E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME D &A -J , r , V 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 6 J D(:-: T6(,_ DESCRIPTIOt'yCjF}+}�J / S C Fe n -'' 70 C// T9 CN L /-7,fN€ L EXISTING USE PROPOSED USE CONSTR. TYPE I # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH I []ATTACH I # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY [3YES BEING ADDED? []NO ADDITION? N PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF ISTHE YES CEI TOTALVALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? E] NO By my signature below, I certify to each of the following: I am the property owner or authorized o act on the property per's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. ee to comply with all applicable local ordinances and state laws relating to building oTpnstmction. I authorize representatives of Cupertino to enter the abov ptifie4 property' for inspection purposes. Date: Signature of Applicant/Agent: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER uILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior td issuance of building permit for new building. ❑ EXPRESS ❑ 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 ❑ ❑ submittal of Building Permit application. MAJOR SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.d6c revised 06121111 CITY OF CUPERTINO 19 M-1 FEE ESTIMATOR - BUILDING DIVISION 191 ADDRESS: 22871 STONEBRIDGE ST DATE: 08/05/2015 REVIEWED BY: MELISSA UNITS APN: 34213 032 BP#: 15060133 *VALUATION: Iso °PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: Amps PENTAMATION 1 REAP2 I PERMIT TYPE: WORK REV # 1 - REPLACE E PANEL SAME LOCATION & NO CHANGE IN AMPS SCOPE :1111/. 11'1sp Piet' APPLIANCE / EQUIP TYPE �;ech. Plan FEE ID i'hamb. Plan (.'heckF-F QTY UNITS BP FEES Elec. Permit Fee: IEPERMIT Services 1 ERT<200 Other Elec. Insp. 0.0hr�$4 100 Amps $48 :1111/. 11'1sp Piet' PME Unit Fee: $48.00 PME Permit Fee: $48.00 Administrative Fee: (ADMIN $45.00 Work Without Permit? Yes 0 No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $48.00 Strom Motion Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the Dreliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Efj.' 7/1/13, Check i'hamb. Plan (.'heckF-F Elec. Plan Check 0.0 hrs $0.00 14ech. fermi/ 1,ec: Plumb. Petnzit Fee: Elec. Permit Fee: IEPERMIT «zhc r .i{dec/t..Insl). `),her Plumb hzsl::?.Li Other Elec. Insp. 0.0hr�$4 PME Plan Check: $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the Dreliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Efj.' 7/1/13, FEE QTY/FEE MISC ITEMS 'kart Check.Fee: P(.-" (. Fee PME Plan Check: $0.00 :1111/. 11'1sp Piet' PME Unit Fee: $48.00 PME Permit Fee: $48.00 Administrative Fee: (ADMIN $45.00 Work Without Permit? Yes 0 No $0.00 Travel Documentation Fee: ITRA VDOC $48.00 Strom Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: 1 $189.00 $0.00 TOTAL FEE: 1 $189.00 Revised: 07/02/2015