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15040192I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 12 RESULTS WAY I CONTRACTOR: SC BUILDERS INC I PERMIT NO: 15040192 OWNER'S NAME: ECl TWO RESULTS LLC 1 9 10 THOMPSON PL I DATE ISSUED: 05/07/2015 OWNER'S PHONE: 6504211832 I SUNNYVALE, CA 94085 I PHONE NO: (408)328-0688 LICENSED CONTRACTOR'S DECLARATION License Class_ Li,. # Contractor — Qat Date a 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. 1 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, 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 1 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 inconsequence of the / granting of this permit. Additionally, tu applicant understands and will comply with all non -point source regulation t e upertino Municipal Code, Section 9 18. Signature Date 65 drl') Sr ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I 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. I certify that in the performance of the work for which this permit is issued, l 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 EJ COMMERCIAL E] APPLE - T.I. IST FLOOR RECONFIGURE EXISTING AREA (240 SQUARE FT) Sq. Ft Floor Area: APN Number: 35720046.00 PERMIT EXPIRES Valuation: $65000 Occupancy Type: IS NOT STARTED [IT ISSUANCE OR .ED INSPECTION. _5, 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 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 I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupe unicipal Code, Chapter 9.12 and the Health & Safety Code, Sections 2 50 and 25534. Owner or authorized agent: Date: d 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 , building(LDcuperlino.orq I I NFw (-o- z-mI ir7TOM n n 111111T n. T -T -r -TT , n PROJECTADDRESS a i�5v L� 1._f Cl APN 9 �� �• Z U � Q �� OWNER NAME �� a / , 1 i PHONE E-MAIL ?-PL =Ft �Y•^' U L�l io3� I�GE2� iNCGSLc(UQrJUP.C17 STREETADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE E-MAIL -- a2x (�S'0-L, u`1 •0117ca 4 1 G r2C7r1�i G' v �5��2�j(�CC STREET ADDRESSCI GilidTk6o� �u�C Y, STATE, ZIP �Vd4 FAX n YAu �t"gL;0 ❑ OWNER ❑ OWNER -BUDDER ❑ OWNER AGENT IRI CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENAM CONTRACTOR NAME G2EG( 'r3v2.L7� LICENSE NUMBER LICENSE TW •1 (m'1 ly la BUS. LIC # COMPANY NAME E-MAIL FAX 5 C Z•z C-5 STREET ADDRESS - 10 Tlaa<1 �s5, 'i��A ct CITY, STATE, ZIP Sia,, v q].0 Gr1 of ppb S- PHONE loSc�- (n loci `�'1 ARCMTECTIENGINEER NAME LICENSE NUMBER BUS. LIC M A—t G\ Sq �;) COMPANY NAME E-MAIL FAX oflna-�, , o Lp)n*?--3-S-,"S7\-S>con STREET ADDRESS ,.,ol%�,� 4a�,� CITY STATE, ZIP 1'P�I��,_ c� q4 ids PHONE 41s DESCRIPTION OF WORK — Ca>S i 6t -0c i N>z IS :Z76- 'ElLy Cil 4ib212� C_LVyE� 1= \M) DG AF -is CE 11_1 t3cil '2>I-S'CQ , 09 Is L(6Airi 16 tmc, OE 4/- ABc.ca���vYI�L r,o t SNCS EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES t) V Y tC. C> = h (GZ )�k - 3 USE TYPE OCC. SQ.FT. VALUATION (Sj =STG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA , 1 1 ' )44 e:) BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJ DETACH []ATTACH I k DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES BEING ADDED" NO ADDITION? ONO PRE -APPLICATION ❑YES IF YES. PROVIDE COPY OF IS THE BLDG AN ❑YES C�jIVED ON: PLANNING APPLE ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑_`� By my signature below, I certify to each of the following: I am the property Owner or authorized agent t on the property owner's behalf. I have read this application and the information I have provided is correct. I Ila e re he Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances.and state laws relating to b 'ding const ction, thorize r resentatives'of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: P'Ptj L a,3 SUPPLEMENTAL INFO _. PT AN CHECK T]PE 4v _ v{. x 2 ,_ROUTING SL1P =. New SFD or Multifamily dNvellings: Apply for demolition permit for `' i `r ❑ � n' � *`�'r t existing building(s). Demolition permit is required prior to issuance of building 4, OVER'TH1rCOiTI�TER '�.- '� c gUII,D1AG LAN.RE -IETi' F s �, r`+��s . � permit for new building.t - 14 w EXPES S4t�yI�AI N G'PIANREFIEW '•%„�''xV"iaj, _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure% form if any Hazardous Materials are being used as of this OKsTAi�nATZD �F �}� lUt { h }-�r"af"Sk'n �jY •'elae�FN„ kip' IiB ]SORICSXr J',•�y R �,w•r part project. Copy Planning Approval Letter Meeting Planning f _ of or with prior tox Building Permit .a `,ff"rn�: B i=FS TraRY SE:'ERYIJISTRICTd + submittal Of application- ,�Ryl�idpR E ti c Bld,-App_2011.doc revised 06/21/11 CITY OF CUPERTINO IY�- fiIJI .FEE F,STTMATOR - RTT11.nnvr nivrcinrr. OCCUPANCY TYPE: ADDRESS: 12 RESULTS WAY ` ' " DATE: 04/27/2015 REVIEWED BY;, PAUL PC FEE ID APN: 357 20 046 BP#: a *VALUATION: 1$65,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building IBTIPLNCK PENTAMATION USE: Permit Fee: PERMIT TYPE: 1B TI WORK APPLE - T. 1. 1 ST FLOOR RECONFIGURE EXISTING AREA 240 SQUARE FT SCOPE $0.00 OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) 1178,111-B,IV,V-B 240 $2,097.00 IBTIPLNCK $588.00 IBTIINSP Permit Fee: $588.00 Suppl. Insp. Fee.S Reg. OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 -(irr� irr Lti rrr.rt � r. l �r e: 0 E) Work Without Permit? 0 Yes (j) No $0.00 TOTALS: 240 $2,097.00 Ti;n•e l $588.00 Strong; Motion Fee: 1BSEISMICO l/,?,•1;`. l'c�Piuit l'i't' 1'1Icc. 1"htrt C'Ir,,c,k Urh('r' hl"', h?"p, .... ,.LLJ eattrnute uoes not tnctuae,Iees aue to other uepartments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School DlStrirt- ota )_ Thaca Faae n hn d n th., .. .,/:.»:,,,.....:..! .. _.:r_u- _ _ I _1. - --- FEE ITEMS (Fee Resolution 11-053 Ef' 7.%1!13) --- -- --------- --• FEE »•-» ».......- QTY/FEE -1 =11111u t.vL­ .,.. UG L VL u{LurL L !u u. MISC ITEMS Plan Check Fee: $2,097.00 Select a Misc Bldg/Structure or Element of a Building Supp!. PC Fee: O Reg. © OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $588.00 Suppl. Insp. Fee.S Reg. OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 -(irr� irr Lti rrr.rt � r. l �r e: 0 E) Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential E) Building or Structure O i Ti;n•e l Strong; Motion Fee: 1BSEISMICO $18.20 Select an Administrative Item BI da Stds Commission Fee: IBCBSC $3.00 ;B ,. 7SUEE $2,706.20 Revised: 04/01/2015