15040184CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10359 GLENVIEW AVE
CONTRACTOR: LNB CONSTRUCTION, PERMIT NO: 15040184
INC
OWNER'S NAME:
861 SEQUOIA AVE DATE ISSUED: 08/26/2015
OWNER'S PHONE:
MILLBRAE, CA 94030 PHONE NO: (415)585-3884
LICENSED CONTRACTOR'S DECLARATION
1�91
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E]
QQ�
CONSTRUCT ONE STORY ADDITION (260 SQ FT);
License Class Lic. # { Vv— 9-v
CONVERT
Contractor ��S, rte, Iy� T"UNPERMITTED
ate
ENCLOSED BACK PORCH (134 S.F.) TO
-I
CREATE (N) MASTER BATHICLOSET; KITCHEN
I hereby affirm that I am licensed under the provisions of Chapter 9
REMODEL
(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: $100000
performance of the work for which this permit is issued.
I e 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: 36911026.00
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
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 DYS FROM LAST CALLED INSPE TION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses w mayitioacc against said City in consequence of the
(I�
granting of this permi . Addn y, It applicant understands and will comply
Issued by:
with all non-point so ice ulati ns er the Cupertino Municipal Co e, Section
9.18.
2� !�
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
❑ OWNER-BUITWR DECLARATION
inspection.
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)
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 th ay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino nicipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sectio 2 O5, 2$ ,and 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 DING 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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
Cl9PEEtTIIalO (408) 777-3228 o FAX (408) 777-3333 o buildinp@cupeitno.org
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PRGJECr ADDRESS I d 3 7 y F- 71777 Ave
APN # 3 �] -11- b Z
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❑ OWNER ❑ OWNER BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACroRAGENT ❑ ARCHTTECr ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
c
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
ARCHITECT/ENGINEER NAME L� y i
LICENSE NUMBER
BUS. LIC #
COMPANY NAME p �1 g�1
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STREET ADDRESS
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DESCRIPTION OF WORK / PO ! 6vi Ig ry T -i- biyO WP VVevi Nvev $Qi --f% • -X1S 1 lN� p2AA'Lj 11N�
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EXLSTINGUSE
PROPOSEDUSE CONST&TYP
#STORIES
USB TYPE OCC.
SQ.FT.
VALUATION($)
E3MTG
i�
DEMO
TOTAL
AREA
AFA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER -
REMODELAREA
REMODELAREA
RELIODELAREA
AREA DECK AREA
TOTALDECR/PORCHAREA
GARAGE AREA: DETACH
f
ATTACH
ISASECONDUNIT ❑YES
SECONDSTORY ❑YES
BEINGADDED? ❑NO
ADDITION? ❑NO
PLICATION ❑YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
TOT LV LUANN:
[4DWE1,,'uNGuNrrs:
NGAPPL# ❑NO PLANNING APPROVAL LETTER
EICHLERHOME?VV�v
CC��//1/
signature below, IY to each of thefollowing: I am the property owner or autho " ag on the owner's behalf I have read this
tion and the information I have provided is correct I have read the Description of Work and verify itisa . Iagree to comply with all applicable local
nces and state laws relating to building construction. I authorize representatives of Cupertino to enter a aboveidentified property for inspection purposes.
-
Signature
ure of Applicant/Agent: Date: `�/?� 7 o 13
PIAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ HUILDING PLAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for
Q building(s). Demolition permit is required prior to issuance of building
permit for new building.
EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
El MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONDIENTALHEALTH
B1dgApp 2011.doc revised 06121/11
I . I-OtA
CITE' OF CUPERTINO
_.,:. FFF F T1MA'l 0'R — RITIT.DING DIVISION
OCCUPANCY TYPE:
ADDRESS: 10359 Glenview Ave
DATE: 07/16/2015
REVIEWED BY: Sean
PC FEE ID
APN:
BP#:
*VALUATION:
1$100,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
USE: SFD or Duplex
2nd Unit? 0Yes Q No
OTC? 0 Yes No
PENTAMATION
PERMIT TYPE: 1 R3SFDADD
i
WORK
CONSTRUCT ONE STORY ADDITION 260 SQ FT); CONVERT UNPERMITTED ENCLOSED BACK
SCOPE
PORCH (134 S.F.) TO CREATE (N) MASTER BATH/CLOSET; KITCHEN REMODEL (270 SQ FT);
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
394
$1,626.00
1ADDPLCK
$1,323.00
IADDINSP
$0.00
270 s.f.
$645.00
Remodel, Kitchen (<=300 sf)
IREMRESKIT
Permit Fee:
$1,323.00
Suppl. Insp. Feer Reg. Q OT
0.0 hrs
$0.00
= # Window / Sliding Glass Door
$431.00T, w11vnEP Replacement
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
Construction Tax:
TOTALS:
394
$1,626.00
�,a �,, �;
$1,323-00
0
G
Mech. P1071 P1aaa Check
Mech. Permit Fee:
Other Mech. Insp.
Mech. hasp. Fee:
Plumb. Plan Check
Plumb. Permit Fee:
Other Plumb hasp.
Plumb. Insp. Fee:
Elec. Plan Check 10.0 1 hrs $0.00
Elec. Permit Fee: lEPERMIT
Other Elec. Insp. ! 0.0 1 hrs 1 $48.00
Dec. hasp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Fublzc Works, etre, aantrary newer uisrracr, .3cnuu1
Cnntnrt the Dont for addn'l into.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13)
FEE
QTY/I
MISC ITEMS
Plan Check Fee:
$1,626.00
E20Eamps
$48.00
Electrical
IBELEC200 Services
Suppl. PC Fee: (F) Reg. OT
0.0 hrs
$0.00
PME Plan Check:
$0.00
270 s.f.
$645.00
Remodel, Kitchen (<=300 sf)
IREMRESKIT
Permit Fee:
$1,323.00
Suppl. Insp. Feer Reg. Q OT
0.0 hrs
$0.00
= # Window / Sliding Glass Door
$431.00T, w11vnEP Replacement
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
Construction Tax:
Administrative Fee:
0
G
Work Without Permit? 0 Yes (DNo
$0.00
Advanced Planning Fee: 1PLLOIVGR
$55.16
Select a Non -Residential
Building or Structure
E)
Travel Documentation Fee: ITR.4VDOC
$48.00
Strong Motion Fee: IBSEISMICR
$13.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$4.00
`CJBTOfiY.S
$3,117.16
$1,124.00
`]COT'AL FEE'
$4,241.16
Kevisea: unurtzu-io