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15030105CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10160 LEBANON DR CONTRACTOR: WINGON PERMIT NO: 15030105 CONSTRUCTION CO OWNER'S NAME: ANSARI SUHAIL T AND MONICA P O BOX 31983 DATE ISSUED: 06/09/2015 OWNER'S PHONE: 4082185906 OAKLAND, CA 94604 PHONE NO: (510) 228-6665 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL License Class_ Lie. #FLOOR CONSTRUCT 2 STORY SFDWL 1 ST FLOOR 2346 SQ FT; 2ND 1479 SQ FT; ATTACHED GARAGE 435 SQ -.6a Contractor �_.^ V �l� (�'Vl l.�'r t FT, PORCH 88 SQ FT i%d �Eate /C , I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions DEFERRED #I -TRUSS CALCULATIONS -ISSUED 9/25/15 Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: Sq, Ft Floor Area: Valuation: $500000 a. 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. 11 I have and will maintain Worker's Compensation Insurance, APN Number: 34214019.00 Occupancy Type: as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION PERMIT EXPIRES IF WORK IS NOT STARTED I certify that I have read this application and state that the above information is WITHIN 180 DAYS OF PERMIT ISSUANCE OR correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 180 DAYS FROM LAST CALLED INSPECTION. 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, 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. Signature Date '� ( RE -ROOFS: 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 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 ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 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 (See. 7044, Business & Professions Code) HAZARDOUS MATERIALS DISCLOSURE 2. I, as owner of the property, am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the construct the project (Sec.7044, Business & Professions Code). California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & I hereby affirm under penalty of perjury one of the following three declarations: Safety Code, Section 25532(a) should I store or handle hazardous material. 9. I have and will maintain a Certificate of Consent to self -insure for Worker's Additionally, should I use equipment or devices which emit hazardous air Compensation, as provided for by Section 3700 of the Labor Code, for the contaminants as defined by the Bay Area Air Quality Management District I will performance of the work for which this permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 2. I have and will maintain Worker's Compensation Insurance, as for by Health & Safety Code, Sections 25505, 25533, and 25534. provided Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: .11 Date: 2 a 3. 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I I hereby affirm that there is a construction lending agency for the performance of work's must forthwith comply with such provisions or this permit shall be deemed for which this permit is issued (Sec. 3097, Civ C.) Lender's Name revoked. Lender's Address APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION 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 I understand my plans shall be used as public records. upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Licensed Professional costs, and expenses which may accrue against said City in consequence of the 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. Signature Date CONSTRUCTION PERMIT APPLICATION amok COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTit�tO (`108) 777-3228 • FAX (408) 777-3333 • buildingP_Cupertln0 orgDEFERRED . ❑ NEW CONSTRUCTION ❑ ADDITION . ❑ ALTERATION / TI REVISION /DEFERRED ORIGITTAL pERMIT N PROTECT ADDRESS = r¢g Hs i APN R t ON OWNER NAME �PHONE E-MAIL STREET ADDRESS CITYI STATE, ZIP CONTACT NAME PHONE s? ®...E-MAIL r "� STREET ADDRESS _ --)13 d ,fes.- CITY, STATE, ZIP I FAX T i �✓ 9 � F 13 OR'NER 11 OWNER -BUILDER ❑ 0"AWERAGENT ❑ CONTRACTOR ❑ CONTRACT OR AGENT ❑ ARCHITECT ❑•ENGDQEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSENUh2BER Cd� j LICENSE TYPE BUS. LIC 4 COMPANY NAME FAX E-MAIL '' I t2 iH _ i STREET AD13 S CITY, STATE, ZIP _ A.x f'.,, i y 0. PIS 71Y a` AR�yITE¢'f�/ENGIII'EER NAME , $ r- y _ t I LICENSE NUMBER BUS. LIC 6' COMPANY AAm v P�F(` E-MAIL j_ y io`1.�'�> �;� FAX STREET ADDRESS / ;,s CITY, STATE: ZI PHONE - e CAP` DESCRIPTION OF WORK - 'l\ ' I V /. j - USE TYPE ( OCC. I SQ.FT. I` VALUATION (S) EXLSTG NEW FLOOR DET10 TOTAL 1 AREA AREA AREA INET AREA BATHROOM KITCHEN REMODEL AREA REMODEL AREA MODEL AREA ❑ ATTACH m DWELLING UNITS: IS A SECOND UNIT __0__y-ES ­_J SECOND STORY )]YES BEING ADDED? ❑ NO ADDITION? []NO PRE -APPLICATION [] ITS IF YES, PROVIDE COPY OF I IS THE BLDG AN ❑YES C£IVEDB �` ' - } PLANNMNGAPPLR ❑NO PLANNINGAPPROVALLETTER EICHLERHOME? NO - 3 TOT ALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. fhave read this application and the information I have provijed is correct. I have read the Description of Work and verify it is accurate. I agree tocomply with all applicable local ordinances and state laws relating to buildin' construction. I authorize representatives -of Cupertino to enter the above -i e Pfled property for inspection purposes. Signature ofAppiicant/Agent: f Date: Ti, I— SUPPLEMENTAL (SMA TION REQUIRED PIA3�CHECITSPE 2 WON 320i3TiNGSLiP�i�x _ New SFD or Multifamily d-wellings: Apply for demolition permit for 2.te OAR�HE-GOUhTER�Bi7IIDLVGPLT7REV>Lj;r existing building(s). Demolition permit is required prior to issuance ofbuilding ONE__ _ P 4 P g� permit for new buildingso Boo ff C3 Exl'RESS PzAi,�,m�Ahrx> ysEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous .Materials are being used as part ofthis project. . v—, %�gg ��P x �� Copy of Planning Approval Leiter or Meeting with Planningrior to su bmittal of Building Permit application. p.�`Ox�x ssC BldgXpp 2011.doc revised 06121/11 CITY OF CUPERTINO � 30105 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10160 LEBANON DR. DATE: 09/08/2015 REVIEWED BY: PAUL APN: 342 14 019 BP#: 15030105 *VALUATION: $0 PERMIT TYPE: Building Permit PLAN CHECK TYPE: PRIMARY Addition USE: SFD or Duplex PENTAMATION WORK Deferred #1 - SCOPE 1GENRES ✓--� ----� •� ��••�-• Afe ch. Pkai Check Phimb, Now C hc?ck 1.tec. Plan Chve C il'Ch. Permit fee: Plum 3. Peivni; Fee: Elec. Permit Fee: Other Akch. f syr. hrs $0,00 Other Plumbbap. oil -el, l:lBC. !r"ZSjJ. ;i%Czcla. h7,rp. Fee: Plump. Imp. Fee: fit�>c. Insp, Fee: Suppl. Insp. Fee:(E) Reg. 0 OT0,0 hrs -F— '--'gca F—'-ccccco Ic.:e. rcurcnarag, ruauc warxs, rlre, ,3anuary Sewer District, School District. etc.). Thew fooe aro A—.4 n sG r,, _ ___ ___ ____ . ___.._,.., FEE ITEMS (Fee Resolution 11-053 Eff 711113) �,,,„, ,,,,, wvwocuucc FEE u eu ucc QTY/FEE vcu un e�eencuae. t-unracr ine"e r or aaan'l in o, MISC ITEMS Plan Check Fee: $0.00 1 # Deferred Submittal $286.00 1DEFSUBM Suppl, PC Fee: (F) Reg. 0 OT]0.0 hrs $0,00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:(E) Reg. 0 OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C ons'truclion Tax: Adh7inistrative Fee: Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential G Building or Structure A Trmel Docuinenlation Tees: Strom Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 $0.00 $286.00 r $286.00 Revised: 07/02/2015 14 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10160 LEBANON DR CONTRACTOR: WINGON PERMIT NO: 15030105 CONSTRUCTION CO OWNER'S NAME: ANSARI SUHAIL T AND MONICA P O BOX 31983 DATE ISSUED: 06/09/2015 OWNER'S PHONE: 4082185906 OAKLAND, CA 94604 PHONE NO: (510) 228-6665 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CONSTRUCT 2 STORY SFDWL 1ST FLOOR 2346 SQ FT; 2ND License Class Lic. FLOOR 1479 SQ FT; ATTACHED GARAGE 435 SQ FT, Contractor 4k�I+I � UIJ � Date 7� Cij %C f' / PORCH 88 SQ FT I hereby affirm that I am licensed under the provisions ofChapter 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: $500000 erformance 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: 34214019.00 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 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 WS FROM LAST CALLED INSPEYYON. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the G4/�� - granting of this permit. Additionally, the applicant understands and will comply Issued by:46" Date: with all non -point source regulations per a Cupertino Municipal Code, Section 9.18. �^ RE -ROOFS: Signature Date d 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. 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, Sectio is 25 5, 25533,nd 25534. Section 3700 of the Labor Code, for the performance of the work for which this 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 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 918. Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION i 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 GUPERTIN0 (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org 9NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 10r`60 1 r 9- r` 6 kI - APN # 0 CJ`s O V a V !E-MAIL OWNER NAME tL �l PHONE 0�-28- o STREET ADDRESS I3 FLICKE9 WA CITY, STATE, ZIP FAX SUN YV LC C,4ge-oB CONTACT NAME� l.16 P 013 E MAII ru_; yA ' O Y 0O- Cz l /' STREET ADDRESS CITY; TATE, FAXKTLf- - OZIPP �I ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT 19- ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 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 Sr CITY ST TE, ZIP X05 PH NE v� 5 `� 08 - _01-87,15 DESCRB?TION OF WORK 2 ' S1r 0 M& I o - To off_ EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES 1 �4 IJ USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA NEW FLOOR AREA DEMOI' AREA TOTAL NET AREA J t BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORC DECK AREA TOTAL DECKIPORC14 AREA GARAGE AREA: DETACH []ATTACH r U ( Q # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES 11 19 BEING ADDED? []NO ADDITION? [-]NO PRE -APPLICATION RYES P VIDE COPY OF IS THE BLDG AN ❑ YES REC�IV�D t .,,� TOTAL VALd T VALUATION: PLANNING APPL # ❑ NO T APPROVAL LETTER EICHLER HOME? 5tNO ' ,may' } XBY �. - J 7 S fie 1� By my signature below, 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 build' h tion. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: /� -7 SUPPLEMENTA ATION REQUIRED' „t„RT AN CHECK „, ROUTING_'SLIP _ New SFD or Multifamily dwellings: Apply for demolition penmit for � existing building(s). Demolition permit is required prior to issuance of building OVER'�'HE-COUNTER i BUIL ING PL.� REVIEW t permit for new building &©° ” ti b ' r� a• EXP,Rh`SS + ,a , t L.ANNING PJ..A}�:REVIER � a _ Conumercial Bldgs: Provide a completed Hazardous Materials Disclosure sTANpARD voRxs " oM A form if any Hazardous Materials are being used as part of this project. °s❑ I�A.R(�E °r``� z� �'�izp �K �` AE �i::'a.,e . ° e j :'"b � Copy of Planning Approval Letter or Meeting with Planning prior to =s PSA 'f _ submittal of Building Permit application. ❑ MAJOR s # �)ERD�STRICT �r BldgApp_201126C revised 06/21/11 CITY OF CUPERTINO WW Ti F.F. Ti.QTTMATnR—RTTHMING DIVISION OCCUPANCY TYPE: ADDRESS: 10160 lebanon dr DATE: 03/17/2015 REVIEWED BY: MELISSA PC FEE ID APN: BPS: j -5 '`VALUATION: 1$500,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY USE: SFD or Duplex 2nd Unit? 0 Yes '' No I PENTAMATION 1 R3SFDW PERMIT TYPE: i WORK construct 2 story sfdwl 1 st floor 2346 sq ft; 2nd floor 1479 sq ft; attached garage 435 sq ftporch 88 s SCOPE ft OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID Otdrer rilech. Irsn.F-1 _L_ CONSTR. s.f. idecl2. Irup. 1+'ee: Phinib. linw. Fee: Elec. Insp. Fee: Suppl. PC Fee: Q Reg. Q OT 0.0 hrs R-3 (Custom) II-B,III-B,IV,V-B 4,349 $3,303.92 IR3PLNCK $3,732.72 IR3INSP Suppl. Insp. Fee -.(F) Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 TOTALS: F-4349 $3,303.92�` # new Construction Tax: IBCONSTAXR units $3,732 72 "s us. $: fA""t, Administrative Fee: G wf F....d. �;2 ^a �' ��" 5�; �, s i � �11i,< �� �LIY �; i� . �I�.�'� 3tSi ry�� fi�N'K�L'��.4�W73 '� k" M�{ r n���� ��jvyq� aF d`i'�Y .G., y (���(H3 i,d.�'�'1 '� ��� aha � k�'�F-•"i.i, � 4.,..A 4��i `�.� 13,E -� 'F� �A : E�a`ksXx i9eclr, t'lran Cheek I'IturtL. Plctn C'laeck Elec, Phan Check L1ecl;. Permit Fete: Plumb. Permit Fee: Elec. Permit Fee: Otdrer rilech. Irsn.F-1 _L_ Other Plumb Insp.Lj Other Elec. Insp. idecl2. Irup. 1+'ee: Phinib. linw. Fee: Elec. Insp. Fee: Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 I NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fare, Sanitary Sewer District, Schoo ___ r -- --- 6....,,4 __ rb., availahlo- and are only an estimate. Contact the Dept for addn'l Info. 'Uturtut, fa"Z. lLL GJG — .,G uuu cu v....... .rr...». ...—.......__-- ----- - -- - -- ------ FEE ITEMS (Fee Resolution 11-053 Ef. 711/13) FEE QT -1 MISC ITEMS Plan Check Fee: $3,303.92 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $3,732.72 Suppl. Insp. Fee -.(F) Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 # new Construction Tax: IBCONSTAXR units $ 670.76 0 Administrative Fee: G Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: IPLLONGR $608.86 Select a Non -Residential Building or Structure 0 I Travel Doc•urnentalion Fees: A Strong Motion Fee: IBSEISMICR $65.00 Select an Administrative Item BldgStds Commission Fee: IBCBSC $20.00 SiTBTOTA)�LS! $8 401.26 $0.00 �TOTALFEE`� 8,401.26 ,'``` -•-`-;r t ";n ` ;.` 'mea :.r ,'u,- u, x.+. », "9k..w.,.x.,�,: ft..,:".v Revised: 02/14/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15030105 10160 LEBANON DR CUPERTINO CA 95014 (342 14 019) WINGON CONSTRUCTION PO BOX 31983 OAKLAND CA 94604 OWNER'S NAME: ANSARI SUHAIL T AND MONICA DATE ISSUED: 06/09/2015 OWNER'S PHONE: 4082185906 PHONE NO: 5107868838 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class @ Lic. #949206 Contractor WINGON CONSTRUCTION Date 06/30/2016 —BLDG —ELECT _ PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH RESIDENTIAL COMMERCLAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: CONSTRUCT 2 STORY SFDWL 1 ST FLOOR 2346 SQ FT; 2ND I hereby affirm under penalty of perjury one of the following two declarations: FLOOR 1479 SQ FT; ATTACHED GARAGE 435 SQ FT, PORCH t. I have and will maintain a certificate of consent to self -insure for Worker's 88 SQ FT Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. REV #I - REVISED FAMILY ROOM, POWDER ROOM, MASTER I have and will maintain Worker's Compensation Insurance, as provided for by BATHROOM; ENLARGED SKYLIGHT ABOVE KITCHEN; REVISED ( Section 3700 of the Labor Code, for the performance of the work for which this MASTER BEDROOM AND MIDDLE BEDROOM WINDOWS; ADD permit is issued. NEW APPLICANT CF,RTIFICATION FURNACE. ISSUED 11-12-15 1 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 DEFERRED #I -TRUSS CALCULATIONS - ISSUED 9/25/15 and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for DEFERRED #2 - SITE LANDSCAPE - ISSUED 5/10/2016 inspection purposes. (We) agree to save indemnify and keep harmless the — -- City of Cupertino against liabilities, judgments, costs, and expenses which Sq. Ft Floor Area: Valuation: $500000.00 may accrue against said City in consequence of the 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. APN Number: Occupancy Type: 342 14019 Signature C pate 05/10/2016 DECLARATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR I hereby affirm that I am exempt from the Contractor's License Law for one of the 180 DAYS FROM LAST CALLED INSPECTION. following two reasons: t. 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 Issued by: PAUL O' SULLIVAN sale (Sec.7044, Business & Professions Code) Date: 06/09/2015 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). RE -ROOFS: I hereby affirm under penalty of perjury one of the following three declarations: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I have and will maintain a Certificate of Consent to self -insure for Worker's installed without first obtaining an inspection, I agree to remove all new materials for Compensation, as provided for by Section 3700 of the Labor Code, for the inspection. performance of the work for which this permit is issued. 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by Signature of Applicant: Section 3700 of the Labor Code, for the performance of the work for which this Date: 05/10/2016 permit is issued. 3. 1 certify that in the performance of the work for which this permit is issued, I ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of Cahfomia. If, after making this certificate of HAZARDOUS MATERIALS DISCLOSURE exemption, I become subject to the Worker's Compensation provisions of the I have read the hazardous materials requirements under Chapter 6.95 of the Labor Code, I must forthwith comply with such provisions or this permit shall California Health & Safety Code, Sections 25505, 25533, and 25534. I will be deemed revoked. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the APPLICANT CERTIFICATION Health & Safety Code, Section 25532(a) should I store or handle hazardous I certify that I have read this application and state that the above Information is material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I correct. I agree to comply with all city and county ordinances and state laws will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and relating to building construction, and hereby authorize representatives of this city the Health At Safety Code, Sections 25505, 25533, and 25534. 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, costs, and expenses which may accrue against said City in Owner or authorized agent: consequence of the granting of this permit. Additionally, the applicant understands Date: 05/10/2016 and will comply with all non -point source regulations per the Cupertino Municipal CON TL�JION LENDING AGENCY Code, Section 9.18. 1 hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Signature Date 05/10/2016 Lender's Address CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10160 LEBANON DR OWNER'S NAME: ANSARI SUHAIL T AND MONICA OWNER'S PHONE: 4082185906 LICENSED CONTRACTOR'S DECLARATION License Class Lic.# (�'I t �" iti v► Contractor IN 1 hereby affirm th 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 performance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance, as provided for by ection 3700 of the Labor Code, for the performance of the work for which this 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 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, costs, and expenses which may accrue against said City in consequence of the 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. / Date ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three 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, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 1 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, costs, and expenses which may accrue against said City in consequence of the 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. Date CONTRACTOR: WINGON I PERMIT NO: 15030105 DATE ISSUED: 06/09/2015 OAKLAND, CA 94604 1 PHONE NO: (510) 228-6665 JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] CONSTRUCT 2 STORY SFDWL IST FLOOR 2346 SQ FT; 2ND FLOOR 1479 SQ FT; ATTACHED GARAGE 435 SQ FT, PORCH88 SQ FT REV 0 - REVISED FAMILY ROOM, POWDER ROOM, MASTER BATHROOM; ENLARGED SKYLIGHT ABOVE KITCHEN; REVISED MASTER BEDROOM AND MIDDLE BEDROOM WINDOWS; ADD NEW FURNACE. Sq. Ft Floor Area: I Valuation: $500000 APN Number: 34214019.00 1 Occupancy Type: PERMIT EXPIRES I.F WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should 1 store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, ti 25505, 25533, and 25534. Owner or authorized age Dater f ✓t CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Ad ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed Professi CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 'Ii;, ;, (408) 777-3228 • FAX (408) 777-3333 • building(d)cugeriino.org °" a ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI '�c REVISION /DEFERRED ORIGINAL PERMIT R P'5050105 PROJECT ADDRESS 1 O Q I O / APN 4 n — O (` OWNERNAI,fE / `� PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME` , G j PHONE E-MAIL LG A [�OO' CO STREET ADDRESS G� CITY, 2-Atl Z3 �O C FAXL El OWNEl OWNER -BUILDER ElOWNER AGENT 1:1 CONTRACTOR CONTRACTOR CONTRACTOR AGENT A ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONIRACTORNAME I 6(�6 LICENSENUMBER LICENSE TYPE BUS. LIC B COMPANY NAME �O y E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE (- 4150 -$lei-872 ARCHITECT/ENGINEFR NAME C LICENSE NUMBER BUS. LIC 9 T[ c O /IV)-rx COM,PAN1Y NAME E-MAIL FAX S rREET ADDRESS CITY, STATE, ZIP PHOT rE DESCRIPTION OF WORK ` _ 1 ' ` �— 5 Tb "A 0-A0— � f — Q H S (O O L -T1 E)7STING USE PROPOSED USE CONSTR TYPE 4 STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NFEW FLOOR DEMO TOTAL AREA I AREA AREA NFT AREA '- BATHROOM KITCHEN OTHER REMODELAREA RE1.10DEL .AREA REMODEL AREA lr� 10"�Gn PORCH ARE,1 DECK AREA TOTAL DEGVPORCH AREA GARAGE AREA: DETACH ❑ ATTACH 9 D WELLING UNFITS: IS ASECOND UNIT E] YES SECOND STORY ❑YES BEING ADDED? El NO ADDITION? ❑NO PRE•.LP?LrCATION ❑YES IF YES, PROVIDE COPY of IS THE BLDG AN ❑ YES°C 'J�^"ova � ✓ �' f TOTAL, VALUATION: PLANN4NGP -PPL. ❑NO PLANNFING APPROVAL LETTER EICHLER HOME? ❑NO �' r ', r By my signature below, I certify to each ofthe following: I am the property owner or authorized aeent 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 buil 'ng construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicandAgent: Date: 0 SUPPLEMENTAL n\TFORMATION REQUIRED w ..yPtiAN},C> cic ? ) 1!'IiovriresLlr 6°,, ,,, ❑ ❑ New SFD or Multifamily dwFellings: Apply for demolition permit for OBER THE CQV,NTER (+r z EtULLDLNG L4NREVTER !+Ir existing building(s). Demolition permit is required prior to issuance ofbuilding(�y' J ����rr�r *f t I permit for new buildinag. ❑' Ertl Z� Y❑c>� fayr s6 �� ,t f g Hazardous Materials Disclosure Commercial Bldgs: Provide a ( aror� Fir at i rr�`a`' ❑� s i r shy r r r completed sTn.,n�Az�n <<�rt��. r uB,i,I�woRh ��ra , � � � form if any Hazardous D4aterials are being used as part of this project. ❑ � n � �FLRk,DEP'�"�"rr" Copy of Planning Approval Letter or Meeting with Planning prior to L4RGD �k�y mr ��s ��� e `hx�C ❑y P i bI n,r�aa � xI'; �� � �Y Permit application. rgde'I ' ,!❑rz,ili,l0ird�f � �, ,, M I� nt v `^�r�E ©An AI2]SCI2 ITFZICT o I submittal ofBuilding S X' -x. 2 , Try, 0nxo5`�IEnTAr HEaiix BIdgApp_2011.doc revised 06121111 9%�� CITY OF CUPERTINO -71 FEE ESTIMATOR - BUILDING DIVISION r ADDRESS: 10160 LEBANON DR DATE: 10/05/2015 REVIEWED BY: PHUONG APN: 342-14-019 BP#: *VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Suppl. PC Fee: Q Reg. Q OT PENTAMATION FURN/AC PERMIT TYPE: A WORK REV #1 REVISED FAMILY ROOM POWDER ROOM MASTER BATHROOM ENLARGED SCOPE SKYLIGHT ABOVE KITCHEN, REVISED MASTER BEDROOM AND MIDDLE BEDROOM WINDOW Mech. Plan Check 10.0 1 hrs $0.00 Mech. Permit Fee: IMPERMIT Other Mech. Insp.0.0 hrs $48.00 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School DiclrirG olr_ L Thoco foot aro havod nn Iho nroliminary infnrmadnn availahlo and aro nnly an owimNo_ Cnnlarl Iho non/ for addn'1 inf)_ FEE ITEMS (Fee Resolution 11-053 Eft 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 # $143,00 Mechanical IMFR=<100 I Furnace, Forced -Air Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -.0 Reg. Q OT F. 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 i__tJlt �I'F'f Ii'II IF /LT.I. Administrative Fee: IADMIN $45.00 Q Work Without Permit? O Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G) A Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: $0.00 F 1-1 # $859.00 Revisions IREVSFDWL7SFDWL Bldg Stds Commission Fee: $0.00 SUBTOTALS: $141.00 $1,002.00 TOTAL FEE -1 $1,143.00 Revised: 0710212015 I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10160 LEBANON DR CONTRACTOR: WINGON CONSTRUCTION CO PERMIT NO: 15030105 OWNER'S NAME: ANSARI SUHAIL T AND MONICA I P O BOX 31983 1 DATE ISSUED: 06/09/2015 OWNER'S PHONE: 4082185906 1 OAKLAND, CA 94604 1 PHONE NO: (510) 228-6665 1 LICENSED CONTRACTOR'S DECLARATION License Class �Lic. # / �/i� 6 / Contractor (t tl C a n� (,".te 11qC. 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: t. 1 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, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. l 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, costs, and expenses which may accrue against said City in consequence of the 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. Signature �7/ -) Date ( t— ❑ OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three declarations: 1. 1 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. 2. 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 permit is issued. a. 1 certify that in the performance of the work for which this permit is issued, 1 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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, costs, and expenses which may accrue against said City in consequence of the 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. Signature Date JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ CONSTRUCT 2 STORY SFDW L IST FLOOR 2346 SQ FT; 2ND FLOOR 1479 SQ FT; ATTACHED GARAGE 435 SQ FT, PORCH 88 SQ FT DEFERRED #I - TRUSS CALCULATIONS - ISSUED 9/25/15 Sq. Ft Floor Area: I Valuation: $500000 APN Number: 34214019.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAY&01*ERMIT ISSUANCE OR 180 DAY RCF1 8'I CALLED INSPECTION. Date: 2� RE -ROOFS: All roots 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should 1 store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: `/-/ � 1_� 2 O ( Ir � CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional V CUPERTINO CONSTRUCTION PERMIT APPLICATION CONil\'UNITY DEVELOPPJiENIT DEPAR T MiENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPER T INO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildino(a�cuDertino.org ❑ NEW CONST RUCTION ❑ °.DDITION ❑ s TER.4T10N / T I ❑ REVISION / DEFERR.ED PRorECT.4DDPEss C ANI; 2- !4— O% l MV.11"ERN.4i,4E UI A -f\) ) l' PiIONE E-NG4IL STRFET ADDRESS I CITY, STATE, ZEP TA -X CONTACT XAME PHONY✓ . r LC - �Z��5 E -l? 4iL K�<<�29y/rura, �z M STREETADDRESS `� iC yL� S -r��l CITY STATE , ZIP �'3S FAX — ❑ Oti'?�ER ❑ OU?--R-SUIL.DER ❑ O'J,',KER AC+ .'T ❑ CONJ TR.a.CTOR ❑ COX -TRACTOR AGENT ❑ ARCHITECT ❑ EN'02�H-R ❑ DE\ELOPER ❑ _.�!-NT CONT�ACTOR XA-MEA^ j LICENSE N�FLI,2ER LICEXSE T-1?E BUS. LIC ��/ l �f �� COI,rIPA XY NA! iE f E_I. F IL FAX 11 9J "PSTk UL(") D �-1 STREET ADDRESS CITY, STATE, Z'.P PHONE FRCI 17ECT,LKGL =ER ?:AME LIC NSEN.'U14BER _ 3LS. LlC ' CCIVLFA NY NAMIF- E-l✓i4II FAX STREET ADDRESS CITY, STATE, ZIP n_SCRPTIO OF,','C:<-Kr' •� ( 1 AN EXISTr\G USE USE CONc7R.1'PE =STORIES �ROPOSED l:'SE TY -PE OCC. SQ.FT. \'?1UAT10'; (S) EXISTG NEW FLOOR I DEMO TOTAL ,-P-7A AREA ASc=A Y-ITCFFN' OT ER R=MODELAP.EA REVIODEL AREA RE1140DELARE.4 PORCH .=. i.EA DECK.-RE, TOT ?-L C:.CKPCRC:-1 hRE.h G=.r'..hGE ARcP.: U DETACH ❑ATTACH D\;'ELLTG LTITS; ISA SECOND USIT ❑ 1'ES SECOND STORY ❑ YES EEL\G S-DDED9 ED No ADDITION' []'NO --- , )ON ❑ —c iF 1-S, ?? cv't z CO?)' C. IS THE SLDG.�,N ❑ `.2S \-EJ 31': .' TOTA1. \'.=, A T 10'\ h ❑,�O ?LA?�T )TG AP?ROA% I-LEiiER EICHLER HONTE' ❑';O �I� �, �"'""j'. ;� By my si=ztu're belo\V, I cemfy to each of the follow Ing: I Ena i�, ' o e --y e\Vn( agent to act on the Pro ' o\Vner's behalf. 1 hz e rez ?Dplicz:±cn al:d the info:n-:Etion I hEve provided is co-ect. I have read the Dcscriptio-n of Wo -k anal ve-u'y it is accura;e e. I E_ to comply •x;-, l all EPpliczb'.e local o-�inances zed stz:e !av s-e'atir.g :o cul ci-� cc-_ t;on. I zutl Drize rep: ese_�tzti\ es of CuPe:; oto enter [ e above-idwtti 'e p:'ope, y. for ;nspeci on Y emeses. Si_nar:re o[ P.ppiicznd.�.genr-. Date: S I SU P PL—EN 4` �T,IL lNFOR- AT ON RE UIRED Q j, PL4\ Ci ECI TYPE- ROIUTINGSLir' ❑- -\TER' D ire',;' AFD o; 1\i'�ai:E-tlly d•aellirgs: ,�rp,y , r e:,,o!;:;cn �er�;�t =or eaistin? b'�ilcir.c(s). Dtmol;z:cm pc=- t is :' c_ir d p,:Or :G iSSl,a ce o." _ _ OVERT E -COL °L'ILDING PLAN REV'IES' rG l' ?1 G';' bti711i 1:1o• ❑ E\PRESS U LNG _ CO =1. "C;7_I1 c: ?. o _ t 3CG" :L c. 0 -- a _ Gt S'\'_ _.._._,'. __. ST._\;,. nD J PUBLIC t\.0 S 70j-,--,lli anv HaZ21dOL'S [\Aa:eT.-a!S =-e Lft_S�d as DE:C: a".:S p: Oj OCi. 1J LARGE ❑ FIF.EDEP7 Cody of P'.a:L :n2 .A.p. Io; al Lel:er or8 pric_ ;0 —H 41-IJOR ,. FDc. \IT.'.R]'SE\\'ERDISTRICT qubnliral of Buaci_o Permit aoplicanon. y 1 ❑' EN\7RO\>;ENTALr+EALTH rr_ ,��� CITY OF CUPERTINO �'�1/JI FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 10160 lebanon dr FLR AREA s.f. DATE: 03/17/2015 REVIEWED BY: MELISSA BP FEES APN: BP#: 15,03 S `VALUATION: 1$500,000 rPERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex 72nd USE: Unit? Yes No PENTAMATION 1 R3SFD PERMIT TYPE: A WORK construct 2 story sfdwl 1 st floor 2346 sq ft; 2nd floor 1479 sq ft; attached garage 435 sq ft porch 88 s SCOPE ft Permit Fee: $3,732.72 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,IVN-B 4,349 $3,303.92 /R3PLNCK $3,732.72 IR3INSP $0.00 PME Plan Check: F7 Permit Fee: $3,732.72 Suppl. Insp. Fee. -0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 4,349 $3,303.92 _ $3,732.72 1 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 an the nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (lee Resolution 11-053 Eff 71/!13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,303.92 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT0.0 hrs $0.00 PME Plan Check: F7 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 an the nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (lee Resolution 11-053 Eff 71/!13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,303.92 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $3,732.72 Suppl. Insp. Fee. -0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 1BCONSTAXR 1 # new units $670.76 (D Work Without Permit? Yes Q No $0.00 Advanced Planning Fee: IPLLONGR $608.86 Select a Non -Residential Building or Structure 0 i Strong Motion Fee: [BSEISMICR $65.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $20.00 SUBTOTALS: $8,401.26 $0.00 TOTAL FEE: 1 $8,401.26 Revised: 02/14/2015 ,�,��,�,��� CITY OF CUPERTINO 15o30i s W—W 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 Dictrirt_ otr_ )_ Th~ fees are hacod an the nreliminary infnrrnatinn availahle and are nnly an estimate. Cnnlacl the hent fnr addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef/: 711113) ADDRESS: 10160 LEBANON DR. DATE: 09/08/2015 REVIEWED BY: PAUL APN: 342 14 019 BP#: 15030105 VALUATION: Iso °PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex 0.0 PENTAMATION 1GENRE USE: III PERMIT TYPE: WORK Deferred #1 - Truss Calculations°� ° , ° RSCOPE E. . ��� ���� NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt_ otr_ )_ Th~ fees are hacod an the nreliminary infnrrnatinn availahle and are nnly an estimate. Cnnlacl the hent fnr addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef/: 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # $286.00 Deferred Submittal IDEFSUBM Suppl. PC Fee: 0 Reg. O OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C ollsiruction Tux.- (ci r`r�r, lr cr rf t' ;`(T' O E) Work Without Permit? O Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) 0 i 7rrc, ,cl Stronp_ Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $286.00 TOTAL FEE, $286.00 Revised: 07/02/2015 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: PERMIT # r -St -0 ;0 tt OWNER'S NAME:421 ? f PHONE # (_Zl a)(� -- GENERAL CONTRACTOR: BUSINESS LICENSE # 3' ADDRESS: I f " CITY/ZIPCODE: ewe *Our municipal code requires all businesses working 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: er / Contractor Signature .......... Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving ............... ............... Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile er / Contractor Signature .......... Date 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 • building(cDcupertino.orq 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: http://www.cupertino.or,/index.aspx?pa,,;e=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 95014 building(«,cupertino.or 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 q BLDG PERMIT #:,� DATE. SITE J ADDRESS: 01 6 D L� fan C�j r �✓L d OWNER'S NAME: ��� 1I �n I P ONE #: 0 FAX #: MAILING ADDRESS (if different from site address): CONTRACTOR:1 J��� �� �t `� T &H PHONE #: �r FAX #: CONTACT: PHONE#: FAX #: I request the City to release my utilities prior to obtaining a final inspection approval for the building. 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 City has issued a certificate of occupancy for the building. ,. � Qrl � Owner:........................... ... ...............................Print:_ U k.. Date:......... ........../...L.P... .. �Eal — - Utilih;Releasel-orm__2011.doc revised 0S/'09/11 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildingCo�cuDertino.org F EF RD ❑ NEW CONSTRUCTION ❑ ADDITION . ❑ ALTERATION / TI JKJ REVISION / DEFERRED OP IGITAL PERMIT n PROJECT ADDRESS , L,2ba,i&n n�A.PNI 9 O[q . OWNER NAME ATiS(--" - , PHONE �.. .� ,`.._,�I, E-MAIL STREET ADDRESS' yw CITY, STATE, ZIP / C..t�^�,� a � PHONE 0 E-MAIL CONTACT NAME y, STREET ADDRESS CITY, STATE, ZIP FAX ❑ OIA NFR ❑ OWNER -BUILDER ❑ 01l'NER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER / LICENSE TYPE BUS. LIC N Z0 COMPANY NAME E-MAIL FAX Efi� 1 m S STREET AD S Ve CITY, STATE, ZIPj� P ONE (g L Cit, 0 / D 0 AR41-5TEnENGINEER NA -ME r _ ^ /• LICENSE NUMBER r ("')i r BUS, LIC 4 v �1 FAX COMPANY NAME E-MAIL - [ STREET ADDRESS jam. TJ i CITY, STATE, ZI J PHONE DESCRIPTION OF WORK CAfIAI Ell9EXISTING US � PROPOSED USE CONSTR TYPE 4 STORIES ,l 1 USE TYPE OCC. SQ.FT. DN (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 ATrA CH DWELLING UMITS: 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 ❑ YES PLANNING APPL: ❑ NO PLANNENG APPROVAL LETTER EICHLER HOME? NO CEI VF1p$} t ?" "„ r' TOT, ALUATION: ❑ �, By my signature below, I certify to each of the following: I am the property owner or authorized went to act on the property oHmer's behalf. have read this application and the information I have provi ed is correct. I have read the Description of Work and verify it is accurate. I agree tocomply with all applicable local ordinances and state laws relating to buildin' construction. I authorize representatives 'of Cupertino to enter the abboTieritified property for inspection purposes. I S ignature of Applicant/Agent: Date: SUPPLEMENTAL INTF UTATION REQUIRED 1.VS x E „'as .?Ianci cx ., New SFD or Multifamily dwellings: Apply for demolition permit for rL�f O}-&RTHE-C'OUhTERy"Iusy r "��BUII,T�i[sGPL=1NRLVIER' � existing building(s). Demolition permit is required prior to issuance of building r f permit for new building. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure _ form if any Hazardous Materials are beingO used as part of this project. Copy of Planning Approval Letter or Meeting with Planning to �ipfvirl µ��II ya %T�b�ad a1r gay��k��rii _ prior " SAhfS'1RY i P,IZllISTR7CP SEF € r; submittal ofBui]dingPermit application. +aa I�iIJt^ f�ar"ys +�,� eJ�+yr^rr��`�,x",'` I��,u BldgaApp_1011.doc revised 06/11/11