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15070043CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19800 VALLCO PKWY CONTRACTOR: LAYTON PERMIT NO: 15070043 CONSTRUCTION OWNER'S NAME: CUPERTINO PROPERTY DEVELOP LLC 9090 S SANDY PKWY DATE ISSUED: 07/07/2015 OWNER'S PHONE: 4083431088 SANDY, UT 84070 PHONE NO: (949) 429 -6740 M- NE LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ RE- STRIPING PER EXISTING APPROVED PLANS /SPACES. n �y License Class A 9'6 Lic. #_ �9� 23 D NO Contractor, 6,CDA 5-r-r MgA...._Date _? 7 / — PARKING CHANGES 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: $1000 rformance of the work for which this permit is issued. 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: 31620108.19800 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 O + T 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 ED INSPECT . 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 ued Date: �C with all non -poin urce regulatio er the Cupertino Municipal Code, Sec n 9.18. r RE- ROOFS: Signature Date J 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. 13 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). 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 1 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 deTned by the ay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with a Cu ertino Municipal Code, Chapter 9.I2 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, ons 25 05, 2553 , an 25534. Owner or authorized agent: Date: 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. Signature Date �c�4.3y�s • CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building (a�_cuoertino.orq 1700 4 - I ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION / DEFFF.RED ORIGINAL PROJECT ADDRESS S glnio APN 4 I — / L' 1 O ^ VNO OWNERNANM PHONE f o 3 t,3 f6W E -MhIL cqperr� Do v 7 STREET ADDRESS CITY, S T£, ZIP ^ ^ FAX COMACT NAME PHONE 6 /3 3 E -MA:L PAY7hD STREET ADDRESS �K CITY, STATE, ZIP FAX X01VNER ❑ OWNER- BUILDER ❑ OWINTER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMB /, LICENSETYP BUS. L1C k 33�6 2- CO14PANY NAME E•M.A1L j FAX ( G✓ STREET ADDRESS (J� iLICE CITY, STA I:FIP Imo' (�+(- �J C'P ARCHITECT/ENGINEER NAME NSE NUMBER�N BUS. LIC R COMPANY NAME E -MP.IL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK Pay- eK ; -34� ry, A9prVV" P l /"s &OL'i ✓- EXIS i-ING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) ExLSTG NEW FLOOR AREA AREA LTA DE1140 AREA TOTAL NET AREA - O BATHRDOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ❑ ATTACH �DWELLAGUNTI'S: ISASEGONDuNrr YES SECOND STORY ❑YES BEING ADDED? NO ADDITION? - ` TOTAL, VALUATIO. PRE - APPLICATION ❑ YES IF YES. PROVIDE COPY OF PLANNUNGAPPL° ❑NO PLANNING APPROVAL LETTER IS THE BL ❑ YES EICHLE HOME? ❑NO �O� By my signature below, I certify to each of the owing: I am the pro erty owner or authoriz _ nt to act on the property owner's behalf. I have read tGGGChiiss application and the information I have pr . is orrect. I have ad the escription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bui ding bonss a rize r resentatives'of Cupertino to enter the above-icVntifiel prropperty fo inspection purposes. S i dnature of Appl icant/Agent: Date: )0 RE ED SUPPLEMENT I ORMATION UIR Q = PIAI� CE(ECFZTYPE,__ ` �? _ iON iTZ�GS_ LIP New SFD or Multifamily d«,ellings: Apply for demolition permit for O�- ER.TE(F�COiIhTER r Aa �. BUII.DL�GPL4ISTREVIE�V existing building(s). Demolition permit is required prior to issuance of building r_ L, permit for new building. [7 ExPr> ss iR OTPLAIQALM1GPLANREPIEw _ Commercial B1dQs: Provide a completed Hazardous Materials Disclosure Elm sT4n�nRD �w uaiRORxs_ form if any Hazardous Materials are being used as part of this project. t _ Copy of Planning Approval Letter or Meeting with Planning prior to��s MA�'O �� 'r` � � '' ��SAIsTTARYSEFi'Ei2DISTRICT��. submittal of Building Permit application. B1dgApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION I& ADDRESS: 19800 VALLCO PKWY DATE: 07/07/2015 REVIEWED BY: MELISSA APN: 316 20 108 BP #: Q 3 VALUATION: j$1,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY USE Commercial Building Civil / Religious activities in BQ zone? Yes � No PENTAMATION 1 GENCOM PERMIT TYPE: WORK RE- STRIPING PER EXISTING APPROVED PLANS /SPACES. NO PARKING CHANGES SCOPE NOTE. This estimate does not include fees due to other Departments (Le. Planning, Publie Works, Fire, Sanitary Sewer District, Sehool 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 -0.53 Eff.' 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes 0 No $0.00 1 hours $143.00 Plan Check, Hourly ISTTPLNCx Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee:E) Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $0.00 Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select allon- Residential Building or Structure 0 Strong Motion Fee: IBSEISMICO $0.50 1.0 hrs $143.00 Inspections ISTINSP Inspection, Hourly Bldy Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $286.00 TOTAL FEE: $287.50 Revised: 07/02/2015