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15060009 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22422 WALNUT CIR SOUTH CONTRACTOR:MICHAELS PERMIT NO: 15060009 CONSTRUCTION OWNER'S NAME: SIMSARIAN JAMES R TRUSTEE&ET AL 707 LINCOLN AVE DATE ISSUED:06/02/2015 OWNER'S PHONE: 4083953556 SAN JOSE,CA 95126 PHONE NO:(408)2924999 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL Ej wi (DUPLEX)REPLACE 13 WINDOWS&2 PATIO DOORS, License Class 71�"` Lic.# S LIKE FOR LIKE(ALL TO MEET EGRESS&BE TEMPERED Contractor �L��C °�` N Date I WHERE I hereby affirm that I am licensed under the provisions of Chapter 9 REQUIRED BY CODE) (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. Sq.Ft Floor Area: Valuation:$9380 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:35703036.00 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 / IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 18 IT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 L ED 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 Issue Da e. granting of this permit. Additionally,t e applicant understands and will comply with all non-point so rce regulations er t pertino Municipal Code,Section 9 18. RE-ROOFS: Signature �_ Date r7.4-/JawAll 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 evices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Ba Area Air uality anagement District I performance of the work for which this permit is issued. will maintain compliance with the ertino nicip ode,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti s 05 3,an 5534. Section 3700 of the Labor Code,for the performance of the work for which this t . s Owner or authorized agent: DateL / 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 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 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 o GUPERTINO (408)777-3228• FAX(408)777-3333•building ED-cupertino.orp J ElNEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI q❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS ��(L / � A ,_ /_. 7� APN 9 —O ,3 - 036 O ,33Q OWNER NAMEPIP& z 4 v�J J / E-MAIL STREET ADDRESS � Qr rVl �� CITY, STATE,ZIP G�5 (1,.4 70,,f FAX CONTACT NAME �sE,PHON `O��72- STREET ADDRESS 7a;? /C°������, CITY,STATE,ZIP J y�7s��F FAX OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEA/ LICENSE NUMBER LICE YP BUS.LIC �t�c� 6a �v �,fZF'9� a� COMPANY NAME E-MAIL FAX STREET ADDRESS J�� CITY,STATE,ZIP5.� PHONE !, ARCHITECT/ENGTS'EER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP /PHONE DESCRIPTION OF WORK 2- ./J.Vt L �y ® f� �(G�� �(�G� 4(14,6 EXIST NG USE PROPOSED USE - CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR, DEMO TOTAL AREA AREA AREA NET AREA BATHROOM. KITCHEN.. OTHER. REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH k 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 `REC i- rit - _ VALUATION: PLANNING APPL� ❑NO PLANNING APPROVAL LETTER EICHLER HOME? -By my signature below,I certify to each of the follows g: Ia the property Terorautho agetoapp]ication and the information I have tided' co ect, e read the Description o ork and v ate. I agree to comply with all applicable local ordinances and state lays relating to i s cti authorize representatives of Cupertin enter the above-ideritifie prty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEME AL ttORI` REQUIRED = x • ' �.L�NCHECK,TITE�1� { ROUTII�GSLIP �' � New SED or Multifamily dwellings: Apply for demolition permit for ,� OVEFtTHE-COUNTER ' C��BUbDINGPLANREYIEW existing building(s). Demolition permit is required prior to issuance of building - permit for new building. ExPx�ss � � pLnlfivc PTArrxEVlEw _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ©STANDARD ' �� ❑ PUBLTwoxxs form if any Hazardous Materials are being used as part of this project. _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. © MoRsAnTPAI;YrsEREiiDISTRICT '� �. r � .'� ��h.. 4 3 rte.* •: BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 22422 WALNUT CIRCLE S DATE: 06/02/2015 REVIEWED BY: MELISSA APN: 357 03 036 BP#: "VALUATION: 1$9,380 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY SFD or Du lex PENTAMATION 1 GENRES USE: p PERMIT TYPE: woRK DUPLEX REPLACE 13 WINDOWS & 2 PATIO DOORS LIKE FOR LIKE ALL TO MEET EGRESS & SCOPE BE TEMPERED WHERE REQUIRED BY CODE) 211 ,Meeh. Plan Check Plumb. Plan<"hee• Elec.Plan Check iWech. Permil Fee: Plumb, Permit Fee: Elec. Permit Fee: C)tlrer il,fech. Irisp. other Plumb Insp. E]_L__ 01ber ls'lec.hula. L-1 #aeciz h1s1).Fee: Phunh. 111"p. Fee: lilec°.Imp'.Fee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These fees are based on the prelimina information available and are only an estimate. Contact the Dept-for addn'l info. FEE ITEMS (Tee Resolution 11-053 Eff' 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 15 1 # Window/Sliding Glass Door Suppl.PC Fee: (j) Reg. 0 OT 0.0 hr's $0.00 $574.00 1WINREP Replacement PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee.-(F) Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: ,1(bninislrative Fee: 0 Work Without Permit? 0 Yes No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential G Building or Structure 0 Travel Doeb rnentraliori Fees: � Strong Motion Fee: IBSEISMICR $1.22 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SiJBTOTALS: $2.22 $574.00 TOTAL FEE: $576.22 Revised: 05/07/2015 �✓ fJN�f ,�Gpp(:; /�te , �U•v �i GJl/-��`ll�J Il�?��i�CJ� % Co,%1,:IUNITY DEVELOP( LENT DEPARTMENT 2— vv � ��t����,��'7�S���� �� BUILDING DIVISION - CUPERTINO APPROVED This ,et of plans and specifications MUST be kepi C. to during constr.,ction. It is unlawful to Gvl•�� �,�0y, ���Sr��yu��,v� � changes or alterations on same, or to deviate J therefrom,without approval from the Building Cfficial. i he Stampin ian and spe ations SHALL N"I i ,o permit or to ppro f the v ole J]b,�clA) b �•�Sb 6+�`�u PERMIT# I it-tT j pJ+" a COP F F PLOT PLANS CH ED BY 4P0 3`i3� �rti�.SG ^, DATE b �� PLANNING DE T CUPERTINO �r o 0 JAN 0 2015 8igg �' `�-