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15010054CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 866 BETTE AVE CONTRACTOR: GLOBUS BUILDER INC PERMIT NO: 15010054 OWNER'S NAME: DING HUI AND CUI LI 6350 LAUREL CANYON BLVD STE 400 DATE ISSUED: 03/18/2015 OWNER'S PHONE: 6503538655 N HOLLYWOOD, CA 91606 PHONE NO: (818) 760-7100 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lic. #_ ��� 953 SQ FT ADDITION TO FRONT AND REAR OF SFDWL TO INCLUDE (3) BEDROOMS W/ BATHROOMS; REMODEL 576 l� Contractor. Date ©� ' / 0 ''045— SQ FT THROUGH OUT I hereby affir am licensed under the provisions of Chapter 9 REV # 2 - REVISE SHEARWALL TO FRONT ELEVATION - (commencing with Section 7000) of Division 3 of the Business & Professions ISSUED 7/16/15 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. I.have and will maintain Worker's Compensation Insurance, Sq. Ft Floor Area: Valuation: $200000 as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 36924047.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction, and hereby authorize representatives of this city to enter WITHIN 180 D F PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino liabilities, 180 POF ear ED INSPECTION. against judgments, costs, and expenses which may accrue against said City in consequence of — — " granting of this permit. Additionally, the applicant understands and will comply y: -- Date:!�— with all non -point source regulations pe he Cupertino Municipal Code, Section 9.18. - OOFS: Signature Date d�6 _2__111)All roofs shall be in ct or to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for ❑ OWNER -BUILDER DECLARATION inspection. I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 I hereby affirm under penalty of perjury one of the following three California Health & Safety Code, Sections 25505, 25533, and 25534. I will declarations: maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the I have and will maintain a Certificate of Consent to self -insure for Worker's Health & Safety Code, Section 25532(a) should I store or handle hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the material. Additionally, should I use equipment or devices which emit hazardous performance of the work for which this permit is issued. air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupe'no Municipal e, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections ;W5,25533, an 534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. _ ) Owner or authorized agent: Date: 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 forthwith comply with such provisions or this be deemed I hereby affirm that there is a construction lending agency for the performance of for permit shall revoked. work's which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address APPLICANT CERTIFICATION 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 granting of this permit. Additionally, the applicant understands and will comply I understand my plans shall be used as public records. with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date r CUPERTINO• ❑ NEW CONSTRUC CONSTRUCTION PERMIT APPLICATION � COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION. 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building cDcupertino ora ❑ ADDITPON. ❑ ALTERATION / TI ® O DEFERRED ORIGINAL L V PROJECTADDRESS _ PERivIII APN OWNER NAME e •• L 1 11 LIONE n l�L�r` � � STREET ADDRESS t 610 Lee_ Qr' CITY, STATE, ZIP j J ' / / +� 1_ II �Jl/ 15 I FAX CONTACT NAME STREET ADDRESS 4-O PHONE E-A4AII CITY, STATE, Zip FAX OA'IgR ❑. OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ CONTRACTOR NAME. U AT LICENSE NUMBER 611-380 LICENSE TYPE TENANT BUS. LIC Rj COIvfPANY NAME m DNABLLING UNITS: IS A SECOND UNIT El YES SECOND STO RY ❑ YES E-MAIL ® 1— Lfi i I �f Qj6r' -0 FAX � lJZL& STREETADDRESr,� AoWF,yp (` CITY, STATE, ZIP+/ �9 ,�a_� �%�r/ �r'�/`�vL�"� 9/�yF' p [/ PHONE $8 2GU'�97�= PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG ANYES PLANNDSGAPPL: ❑NO PLANNING APPROVAL LETTER I EICHLERHOAIE? �NO��'_= �l� TOTAL ARCHrrECT/ENGIN,EERNAME LICENSE2 WMER By my signature below, I certify to each of the following: I amt property owner or authorized a ent to act o roe —�? application and the information I have provide -is correct. I ,e read the Description ' ra ofWork ander e. I agree to complyawit ali app ordinances and state lauds relating to building onstruction authorize representatives'ofCupertino to enter the / BUS. LIC R COMPANY NAME Date L ` r SUPPLEMENTAL rF ON RE RED SFD E-MAIL -- 20 existing building(s). Demolition permit is required prior to issuance building °vEii TBEFco T R (_l� $ Dm�cPL r> of permit for new building. FAX STF.EET ADDRESS Disclosure form if any Hazardous Materials are being CITY, STATE, ZIP used as part of this project. PHONE DESCRIPTION OF WORK M tX15TB1G USE PROPOSED USE I CONSTR TYPE STORIES USE TYPE ( OCC. I SQ.FT, VALUATION (S) AREA NEW FLOOR DEMO TOTAL _ AREA AREA AREA I.'E1' AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA I this :bte local B1dg,4pp_2011.doc revised 06/21/11 U AT m DNABLLING UNITS: IS A SECOND UNIT El YES SECOND STO RY ❑ YES BEING ADDED? El NO ADDITION? E] NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG ANYES PLANNDSGAPPL: ❑NO PLANNING APPROVAL LETTER I EICHLERHOAIE? �NO��'_= EIM '"-� TOTAL VALL By my signature below, I certify to each of the following: I amt property owner or authorized a ent to act o roe —�? application and the information I have provide -is correct. I ,e read the Description ' ra ofWork ander e. I agree to complyawit ali app ordinances and state lauds relating to building onstruction authorize representatives'ofCupertino to enter the / above -identified rope r`y for' spection SignatureofApplicant/Agent: Date L ` r SUPPLEMENTAL rF ON RE RED SFD PZ�N�CHEC�iT1PE l F _zou1 LR —New or Multifamily du' us: Apply for demolition permit forM 20 existing building(s). Demolition permit is required prior to issuance building °vEii TBEFco T R (_l� $ Dm�cPL r> of permit for new building. y s�F _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being �� Y PT3BIF40RTCS ' used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. oa x . this :bte local B1dg,4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 866 BETTE AVE DATE: 07/16/2015 REVIEWED BY: MELISSA APN: 369 24 047 BP#: 15010054 VALUATION: Iso %PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair URSEIMARY SFD or Duplex PENTAMATION PERMIT TYPE: 1 GENRES WORK REVISE SHEARWALL TO FRONT ELEVATION - ISSUED 7/16/15 , SCOPE r Akeh. Alun Check Plumb. Plan Chcwk Elec. Plan Check ;1.Iech. Penni[ Fee: Plumb. Permit Fee: 1 lec. Permit Fee: ofber ;i tech. Inset. Other Numb Inst. L_E3 Other Eke. Insp. 1 aUech. Ins)). Fee: Phtmb. h;sp. Fee: l:'lec. Insp. /tie: PME Plan Check: $0.00 ossucJ." uuc w ucner uepurunenis V. e. rtanning, Yadilc WorKS, Pire, Sanitary Sewer Uist et, School District etc L Thoco foo. neo /nand — #I.- . l: .:. - .:., f__. _ �_z • - - --------_. FEE ITEMS (Fee Resolution 11-053 Lff 711/13) _._ ....» .. ».„......� FEE QTY/FEE ..... u,. a,uiuuc& ine "e c or aaan-i info. MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 L—__ J hours $143.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: (D Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes (D No $0.00 Suppl. Insp. Fee:Q Reg. C) OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C:oristrzu'tion Tax: Acbninistrative Fee: G Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential E) Building or Structure 0 Traijc l Documentalii,n Fees: Strom Motion Fee: $0.00 1.0 hrs $143.00 Inspections ISTINSPInspection, Hourly Bld& Stds Commission Fee: $0.00 _ sUBToTALs $0.00 $286.00 _ TOTAL $286.00 Revised: 07/02/2015 M' CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 866 BETTE AVE CONTRACTOR: GLOBUS BUILDER INC PERMIT NO: 15010054 OWNER'S NAME: DING HUI AND CUI LI 6350 LAUREL CANYON BLVD STE 400 DATE ISSUED: 03/18/2015 OWNER'S PHONE: 6503538655 N HOLLYWOOD, CA 91606 PHONE NO: (818) 760-7100 `� L ENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL 953 SQ FT ADDITION TO FRONT AND REAR OF SFDWL TO License Class Lie. # 9/ ��® INCLUDE (3) BEDROOMS W/ BATHROOMS; REMODEL 576 Contractor Date S , SQ FT THROUGH OUT REV # 1 - ALTER/SWAP LOCATION OF WINDOWS/DOORS I hereby affirm th am licensed under the provisions of Chapter 9 & RELOCATE LAUNDRY RM & GARAGE ACCESS & ADD (commencing w' Section 7000) of Division 3 of the Business &Professions Code and that my license is in full force and effect. (N) ELECTRICAL FIREPLACE -ISSUED 4/7/15 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: $200000 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 permit is issued. APN Number 36924047.00 Occupancy Type: 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 to building construction, and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR 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 granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per pertino 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. 13 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons:ALL I, as owner of the property, or my employees with wages as their sole compensation, ROOF COVERINGS TO BE CLASS "A" OR SETTER 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 I hereby affirm under penalty of perjurjy one of the following three California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: I 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 Compensation, for by Section material. Additionally, should I use equipment or devices 'ch emit hazardous as provided 3700 of the Labor Code, for the nagement District I air contaminants as defined by the Bay Area Air Qur252534. performance of the work for which this permit is issued. will maintain compliance with the Cuperti o Muni ode.Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25 , 25533 Section 3700 of the Labor Code, for the performance of the work for which this Owner permit is issued. or authorized agent: Date: I certify that in the performance of the work for which this permit is issued, I shall �CTIONNDING 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 CONST 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. P ( ) 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 •FAX (408) 777-3333 • buil ding(aD-cupertino ora ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION / DEFERRED ORIGINAL PERMIT # PROJECf ADDRESS a p�� Q (/ �0.9 / OWNER NAME % 7 PHONE { E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME r PHONE / 23 6 S_O 3 ��� SS E-MAIL C STREET ADDRESS/'/ I j CITY, STATE, ZIP �. LFAX 1 Fj (/ L-P�� Mvw, '✓L 1/) J9 OWNER ❑ OWNER -BUILDER ❑ O'AWERAGENr ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LIC ENSE NUMBER ' aI L�� LICENSE TYPE //J BUS. LIC # COMPANY NAME /� E-MAIL �—( W� �l/Lt1'®bfiYp vl 1/✓G> . GaDn FAX DL,..,, BRESStiv ARCHITECT/ENGINEERNAME '• J` (/(J4 yt✓l 1 � CITY, STA�Fp LICENSENUMBERI/ ` 7- PHONE BUS. LIC # COMPANY NAME E-MAIL62 Y( I"LSriC aOGZl�9t , Cif73'l� FAX STREET ADDRESS ONO CITY, STATE, ZIP ! / PHONN6 () 265-9iW NO DESCRIPTION OF WORK � p �I^ 06W577 12 V F Arr5 n� ��.� /�y C (J �J vVS9• e I am the property owner propertyr As application and the information I have provided is correct. I have read he Description ption oftWork ordinances and state laws relating touiing const ' kr OW -ro M05t 4 1 sal:rn P,LANCHECfZTYPE � � 3��-.,,i � y�t� l �$OUTINGSLI��� 3 _ New SFD or Multifamily dwellings' Apply for demolition permit for i� EXISTING USE PROPOSED USE CONSTR TYPE #STORIES ^1✓XPRESS 'M NEW FLOOR DEMO USE TYPEEMST OCC. TOTAL SQ.FT. VALUATION ($) q s AREA AREA AREA AREA NET AREA £PUaLTcwolixs 'its, kYPU. part project. BATHROOM REMODELAREA KITCHEN REMODEL AREA OTHER REMODEL AREA i ❑.LARGRtyrx❑�"II2R��Px 4h r ATTACH # DWELLING UNITS: IS A SECON�DTO�N 11 SECOND STORY ❑YES BEING ADDADDITION? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN 0 YES PLANNING APPL # 0 N PLANNING APPROVAL LETTER EICHLERHOME? - VALUATI0 NO ;: L Iftlot-si . By my signature below, I certify to each of the following: I am the property owner propertyr As application and the information I have provided is correct. I have read he Description ption oftWork ordinances and state laws relating touiing const ' nd verifyit iso accurate. agree oecomplybehalf. all applicable local ruc I authorize representatives of Cupertino to enter the above-identiifie ro r r p pe�rly�n�ec' purposes. Signature of Applicant/Agent: Date: 4-1 SUPPLEMENTAL INFORMATION REQUIRED S 4 1 sal:rn P,LANCHECfZTYPE � � 3��-.,,i � y�t� l �$OUTINGSLI��� 3 _ New SFD or Multifamily dwellings' Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building OVER �H)rCOUNTER r YLANREVIEW J' permit for new building. ^1✓XPRESS 'M MNNINGYiANi2EVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure q s form if any Hazardous Materials are being used as of this �' Y r y f 4� R'k Y� t .{ £PUaLTcwolixs 'its, kYPU. part project. - � Copy of Planning Approval Letter Meeting i ❑.LARGRtyrx❑�"II2R��Px 4h r _ or with Planning prior to submittal of Building Permit application. BldgApp_2011.doe revised 06/21/11 CITY OF CUPERTINO WN FF.F FC'PTMAmnD DTTTT T\Tl�7r T\7i 7T[VTA1r 1A ----- -- ADDRESS: 866 BETTE AVE Liiv Ll♦11Jl DATE: 04/07/2015 Vl\ REVIEWED BY: MELISSA APN: 369 24 047 BP#: 15010054 *VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY SFD or Duplex PENTAMATION PERMIT TYPE: 1 GENRE WORK REV # 1 -ALTER/SWAP LOCATION OF WINDOWS/DOORS & RELOCATE LAUNDRY RM & SCOPE GARAGE ACCESS & ADD (N) ELECTRICAL FIREPLACE - ISSUED 4/7/15 l9ech. Plan Check Phimb. Plan Check I leu..Plan ChFEI',c. /ruh. 1'ernril Fee: Plumb. Permit Fee: Permit Fee: Chher a/cc•h. ,idech.Ins��.1 e: 01her Plumb Irup. Plumb. hisp. Fee: Other Elec. insp. 1 lec. 1nsEi. Ince: uuca nut District.etc.). fonc ..rn h Invinuecoin,„ ;ees Uue to orner vepartments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School FEE ITEMS (Fee Resolution 11-053 L' f.' 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (D No $0.00 hours Plan Check, Hourly $286.00 ISTPLNCK Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:(2) Reg. 0 OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax:T-T Administrative Fee: 0 1 1 G Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential G Building or Structure 0 i Trm,el Doeuinenlalion Fees: Strong Motion Fee: $0.00 Select an Administrative Item Bldp, Stds Commission Fee: $0.00 SUBTOTALSc_ $0.00 $286.00 - TOTAL FEE $286.00 Revised: 02/14/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 866 BETTE AVE CONTRACTOR: GLOBUS BUILDER INC PERMIT NO: 15010054 OWNER'S NAME: DING HUI AND CUI LI 6350 LAUREL CANYON BLVD STE 400 DATE ISSUED: 03/18/2015 OWNER'S PHONE: 6503538655 N HOLLYWOOD, CA 91606 PHONE NO: (818) 760-7100 JOB DESCRIPTION: RESIDENTIAL F] COMMERCIAL LICENSED CONTRACTOR'S DECLARATION 3953 License Class Lic. # /J (� SQ FT ADDITION TO FRONT AND REAR OF SFDWL TO INCLUDE (3) BEDROOMS W/ BATHROOMS; REMODEL 576 Contractor C IIII)IX Date SQ I hereby affirm that I am licensed under the provisions of Chapter 9 FT THROUGH OUT (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. have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area: Valuation: $200000 Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 36924047.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction, and hereby authorize representatives of this city to enter WITBE N 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, 180 DAYS F LED INSPECTION. costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will compl ate: with all non -point source regul 'ons per the Cupertino Municipal Code, Section ]!� 9.18, Signature Date RE -ROOFS: All roofs shall a 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 ElOWNER-BUILDERDECLARATION inspection. I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 I hereby affirm under penalty of perjury one of the following three California Health & Safety Code, Sections 25505, 25533, and 25534. I will declarations: maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the I have and will maintain a Certificate of Consent to self -insure for Worker's Health & Safety Code, Section 25532(a) should I store or handle hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the material. Additionally, should I use equipment or devices which emit hazardous 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, 253, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: Date:- 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 Lender's Address APPLICANT CERTIFICATION 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building aacupertino.org El NEW CONSTRUCTION ADDITION ❑ ALTERATION/ Ti I—I REVISION / DEFERRED l60" A ORTOT F.RMTTB PROJECT ADDRESS / 1� - B !/- A V� APN # � , I � ' `Z— � OWNER NAME /' 9 PHONE 6 5-0 q 6 C�rL -E-MAI-LJ' L o ` 6 8� y6vw- STREET ADDRESS ��• CITY, STATE, ZIP j I /� FAX 1 A � a/ CONTACT NAME . � Y1, S� PHON 9s ®-26S 8416 E-MAIL I'Ya,-Q( 2OLD afflave[ It% STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT N ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAM 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 1� EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES I USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA rI r SSS///LLLv�J BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA �l PORC117R7 DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YESRECEIVED BY; - - TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO -• j p �'� By my signature below, T certify to each of the following: I am the property owner or authorized agen o _act the pro rty 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 accur agree to comply with all applicable local ordinances and state laws relating to building I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. 4.0nruction. Signature of Applicant/Agent:c Date: ` / SUPPLEMENTAL INFORMATION REQUIRED Q PLAN CHECK TYPE ROUTING SLIP ❑ OVER -THE COUNTER EL4*UILDING ' PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building.❑ - =ANDARID INN, Pr—AN REVIEW — Commercial Bldgs: Provide a completed Hazardous Materials Disclosure IcwoRlcs. -' form if any Hazardous Materials are being used as part of this project. ❑ –T LARGE FI Copy of Planning Approval Letter or Meeting with Planning prior to ❑ SEWER DISTRICT submittal of Building Permit application. MAJOR SANITARY ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FM -7 FEE ESTIMATOR - RTTTT.n-F1Vt_' ilrVrCrnAT OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. • X Vl\ im ADDRESS: 866 bette ave R-3 (Custom) DATE: 01/08/2015 REVIEWED BY: Mendez APN: BP#: 1-56 $1,666.00 "'VALUATION: 1$200,000 PERMIT TYPE: Building Permit PLAN CHECK TY E: Addition PRIMARY SFD or Duplex USE: 2nd Unit? f Yes 0 No PENTAMATION Suppl. Insp. Fee:O Reg. 0 OTC? 0 Yes 0 No PERMIT TYPE: 1 R3SFDADD WORK 1953 so ft addition to front and rear of sfdwl; remodel 576 so ft through out SCOPE PME Unit Fee: $0.00 PME Permit Fee: OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 953 $2,654:00 IR3PLNCK $1,666.00 IR3INSP L k"(% ins p, Fee: $0.00 Permit Fee: $1,666.00 Suppl. Insp. Fee:O Reg. 0 OTO.p hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 953 $2,654.00 1 $1,666.00 MECH, HOURLY 0 Yes G -No PLUMB, HOURLY Q Yes 0 No ELEC, HOURLY Q Yes 0 No NE"n ( _f:eck 1'1111,7b Nnor Ch"( -f. A'h'car IJC'i N%i. Fee:1'1 ,:?d(>. /'ei T7i'(i hdd: F ec. 1 e md,, 1;v;... t 3tl1rT ,;11:>ii`i IF21.'�.El ' rti•tNCit. 1i2.4'l?. l',Ir:: /3r17ant". 117")). Fee: L k"(% ins p, Fee: $0.00 -1 L...,LLJ estimate; Ltuca not inctuae jees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the nrelim;nnr„ ;"fnrM"f;n„ -------I FEE ITEMS (Fee Resolution 11-053 Eft' 7/1113) ------------------ FEE » ..... v QTY/FEE v... w.. . ...La. — a.V/L[lLL[ L/LG LG L u, (LULL/L L LIL V. MISC ITEMS Plan Check Fee: $2,654.00 EKI s.f. $503.00 Remodel, Other /REMRESOTH Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,666.00 Suppl. Insp. Fee:O Reg. 0 OTO.p hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Tux: TT :1(]f 12ilfl3ti �7tlit•' 1''t:" - Q Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: IPLLONGR $133.42 Select a Non -Residential) Building or Structure 0 d Strong Motion Fee: IBSEISMICR $26.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $8.00 SUBTOTALS: $4,487.42 $503.00. TOTAL FEE..$4,9:90..42 Revised: 01/06/2015