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15060028 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21490 MCCLELLAN RD CONTRACTOR:BLACK DIAMOND PERMIT NO: 15060028 PAVING OWNER'S NAME: DAVID SOUZA ET AL 41550 BOSCELL RD DATE ISSUED:06/03/2015 OWNER'S PHONE: 4082627080 FREMONT,CA 94538 PHONE NO:(510)770-1150 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E] TO CLEAR CODE ENFORCEMENT CASE: SITE License Class 14 Lie.# ACCESSIBILITY UPGRADES TO INCLUDE NEW �j � SIDEWALK, Contractor��i11��}� e�eJGC Date �� CURB RAMP,LOT RESURFACING AND PAINTING,AND I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's r ion,as provided for by Section 3700 of the Labor Code,for the e of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$19500 will maintain Worker's Compensation Insurance,as provided for by00 of the Labor Code,for the performance of the work for which this APN Number:36201027 00 Occupancy Type: sued. APPLICANT CERTIFICATION 1 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 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, •/ costs,and expenses which may accrue against sai ity in consequence of the Issued b ��H�✓ ��/ Date 3 granting of this rt. dditionally,the appli t nderstands and will comply y' ' with all no oint sourc regulations per th up i Municipal Code,Section 9 18. tura'` // ROOFS: Signa Date �� J All roofs shall be inspected prior to anyny 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) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(x)should I store or handle hazardous 1 have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices ich emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined b e Ba Area Air Qu M ement District I performance of the work for which this permit is issued. will maintain compliance th the C ertino Muni ' al e,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Co ut: Section 5505,25533, n 4. j Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized ag ate: ✓�J 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 4�DD� (408)777-3228• FAX(408)777-3333•building a-)cuperdno.org CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION *TERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS ` APN# - /'� . OWNER NAME PHONE 1, E-MAIL + ,�f STREET ADDRESS j /�,� CIT , TAT ZIP � 11 657 � FAX r-� ." 1 CONTACT NAME ` �: PHO E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ElNTI OER ElOwNER-BUILDER 11OWNER AGENT E/CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LI ENS NUM ER LICENSE TYPE BUS.LIC# U �1; f `! CO ANY NAME E-AQAIL f � FAX f-km el STREET ADDRESS CITY STAT ,ZIP PHONE ARCHITECT/ENGINEER NAME LICEN E NUMB BUS.LIC# V3 i �NAMEy�r > . t COM�eV i t��?� 1l YL�✓ E-MAIL FAX STREET DRESS ` CI ,STATEyZIP PHONE DESCRIPTION OF WORK • !v1%'VM(y y" ' EXISTING USE PROPOSED USE CONSTRTYPE #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: LJDErACH ❑ATTACH P DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YFS BEING ADDED? NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF Is THE BLDG AN ❑YES v�RECEIVE:'BYE ;'.,�r,°r, � ?NO,'�5 ��3, TOTAL VALUATION: PLANNING APPL� IJ NO' PLANNW G APPROV R EICHLER HOME? �"x�f - '�� f,;}`y,, .Ixi By my signature below,I certi o each of the lowing: I am the grope owner r authorized agent to act on the property owner's behalf. I have read this application and the inform on I have provi d is correct. I h read t e tion of Work and verify itis accurate. I agree to comply with all applicable local ordinances and state law relating to buil g constructio thoriz epres atives pertino to enter the above-i/den'tified property for inspection purposes. Signature of Applicant/Ag Date: SUPPLEMLXTL INFORMATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for as OVERJHT<�`�OUIvTpEt 'k FBUII.�DING & ° u ' PL .+- existing building(s). Demolition permit is required prior to issuance of building 5 � s IYMY � p , y say tk permit for new building EZPxEss�` ry�" #� PiaNnu�GYL RE�(Fw �• Tk�S?20.f t "T v-lfi,�•3S S "Yi.';N�' S+ '14fRf.u^x$'`il,f i € 5� tisV+ �t # PUBLTGWORFCS _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure iRys�r�vvD4jr a� y,nN form if any Hazardous Materials are being used as part of this project. i�inn t� f24ag 14 -05 JREPT t° I �6 � E r t Copy of Planning Approval Letter or Meeting with Planning prior to sub_mittal of Building Permit application. ti � yrr �aix �< -...aGh✓<.. w 3.R Qs N -J"..r. BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION WAPN: DRESS: 21490 mcclellan Dr DATE: 06/03/2015 REVIEWED BY: Sean BP#- ��(� �- 'VALUATION: $19,500 PERMIT TYPE. Building Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY Civil/Religious activities PENTAMATION 1 GENCOM USE: Commercial Building in BQ zone? 0 Yes �No I PERMIT TYPE: WORK To Clear Code Enforcement Case: Site accessibility upgrades to include new sidewalk curb ramp, lot SCOPE resurfacing and painting, and signage. � ! t "w � "'g `V"F., p4 } 4+Y,FF..:< ti I�SC ( r ., ,,F�,(A VfK Y R.t S".Ti7a (i,.`�._ Ih r7R �:] (^ 1 3 t'?4 t3 •F 1 ll' h ; 3 F:!•"�'4A'C'C. Y Y k +� h c >.,.,t....,.. f •.�-i :�fii�t 'uhf s �"�tx a� `.`; -v7 i��.� t4 r � rs�„.. .. _:5:.. ,v. ”, tr.�;.. Lfc'c:/r. I'lem Check 1'/ru:;h. 1'lun(7x ck lilrc. Pion 171eck aleck. l'crr?til t c;e: !'l1�nzG. Perrrli;!r:: h;lec. Yerrrlir Fee: 17t11r;r;ilrr/r. Insp, Other Phrmb ln.v), Other L.;ec•. h7q.). Lj ;1-lech. lru/'. Fee: 1'!!1114. 111sp. Fc'e: 1>Ic:c.Insp. I''ee: 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 (Fee Resolution 11-053 Ej. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes (E) No $0.00 F hours Plan Check,Hourly Suppl.PC Fee: Q Reg. Q OT 0.0 hrs $0.00 .00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: Hourly Only? Q Yes 0 No $0.00 Suppl.Insp.Fee-.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $0.00 .ldwinis•tralive Fae: 0 Work Without Permit? (F) Yes Q No $572.00 E Advanced Plannin&Fee: $0.00 hours Inspections E) Travel Uaculnewaliorl Fees: $286.00 ISTINSP Inspection,Hourly 0� Strong Motion Fee: IBSEISMICO $5.46 Select an Administrative Item Bldg�Stds Commission Fee JBCBSC $1.00 . 007 .,af t:.hTM $1,150.4 k .c 8.46 $T $57 5 ?L ,k U Revised: 05/07/2015