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15080223CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15080223 20840 CHERRYLAND DR CUPERTINO CA 95014 (359 20 03 1) OWNER/BUILDER OWNER'S NAME: CHERRYLAND LLC DATE ISSUED: 03/03/2016 OWNER'S PHONE: 408-568-0616 PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor OWNER/BUILDER Date 03/03/2016 —BLDG —ELECT —PLUMB MECH RESIDENTIAL COMMERCIAL 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. JOB DESCRIPTION: CONSTRUCT TWO STORY RESIDENCE (2069 SQ FT), I hereby affirm under penalty of perjury one of the following two declarations: ATTACHED GARAGE (459 SQ FT), COVERED PORCHES (308 1. I have and will maintain a certificate of consent to self -insure for Worker's 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. z 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 Sq. Ft Floor Area: Valuation: $435000.00 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 APN Number: Occupancy Type: ordinances and state laws relating to building construction, and hereby 359 20 031 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 PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION. Code, Section 9.18. Issued by: MELISSA NAMES Signature Date 03/03/2016 Date: 03/03/2016 OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1. I, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: z I, as owner of the property, am exclusively contracting with licensed Date: 03/03/2016 contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the z I have and will maintain Worker's Compensation Insurance, as provided for California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will by Section 3700 of the Labor Code, for the performance of the work for which maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the this permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous 3. I certify that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Worker's Compensation laws of California. If, after making this certificate of the Health & Safety Code, Sections 25505, 25533, and 25534. 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 Owner or authorized agent: be deemed revoked. Date: 03/03/2016 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant ARCHITECT'S DECLARATION understands and will comply with all non -point source regulations per the I understand my plans shall be used as public records. Cupertino Municipal Code, Section 9.18. Licensed Professional Signature Date 03/03/2016 14 CITYWCUPERTINTORUILDT G ERM1 IT UII.Lr t* I: SS: COMACT€ Rz. 'kFRKff N Isosttz2 ; OW CS3MMIMDR CMMMN0 CIti:95014 (35r120 €231)[24840 CHMYLAOND C WNERIBM73F,It R MIF i3, CIA 93014-2958 (35920 042) 4i 4 2i R"SIVA it z [tIttY3 I i} f C DATE %SSUM 033103/2016 OWNER'S PHONE. 449,4644034 PiiONENt€: BUILDING PERAUTINFO: License Class Lit. Contractor DANEEfBi =EH pate BLDG_ EMCT ®I'LTJ14� lterrby aftirrm that I Strt ltcensr i ttndor I}ibr i{t'aaYisfons Ckf Chaptor (CaP.3lneraettl —bMC1I,,, RE8MENTI.AL.„„COASMRCLAL with 5ectl6u 7400) ti 01vision 3 sof the Bnsimast & Proleselm s Code and t)ret my, license Is in full foree and effect. JOB 1D&SCRIPTIOM I hereby of rA under penalty nfperlury cafe otthe follolwing tw da orations:rAmi, MNSTRUCT TWO STORY RUSTDENCJ� (266 Q �; ia. inti E (�3 9 Std �: covE poke S (3()8 1, 1 have and wilt maintain a a rycataof conRont to sol insmifQiWorker's: () }• CQanpctasatteo3, ashided for by Soction,3700 of tate Labor Crxio, torr the ;{ EV * I - (919/16) • ADDWC TNLAUNDRY kM, AkDD 2ND SCKTN perforrnance: of fhe work for] hichfids perrolt is Issubd. 'mi T Rf3C2m # 2 w f S`SI) Mo -1 S 2. 1 kava and will S inWn Workees Compensation insurance, as provided for by Woa 3700 of theI.aitbx Circ, far tho perfom=*z ofthework far which this pc rntt is issntxl. Sq. FtFlourla rm, VAi tlow $435000,Lt4 ,At'tai rr�.i4'F`l'F'R7'Itf�c°A"t1it� t certly that [have read this appticatfor) and state that the altcve APN INumbat`t , oempAncy Typo, information is ourrect. I agree to comply vAth agi city and county ordinances wW $lata laws relating to bukring construction, end hereby au it ei 359 24 representatives of this city to anter upon the above mentioned property for gitspactiort purposes. Vie) agree to save indernnify and keep flanniess the I Clfy of Cuperreinu against liabilities, judgmen% costs. and expenses Wbloh FERMT EXPIRES IF WORK IS NOS'TARUL ,$ may accrue agalnsf said City In consequence of the Vranfng of this penult: the applicant understanda,and sill comply with al wort saint WITHIN $D DAYS Ci Ir ' �ISSUANCEOR source rt gi€laWe per" upertraa Municipal Code, Sargon 9,18. 180, DAYS FROM LAST CALLED INSPECTION ignature tate am i Issued by; Date; f1 4} 16 I hereby affirm that I Am exempt from the Contractaea tcense Lain for one cif the following two reasons: its d35���I 5: ,Ali: Sss?sa7lbetmpwlaliddrjr, aaPpbmginsic7led.il"axofts a. 1, as owner of the propeM, or my ciuploye stztb w� as tlreix se 3e:: €ststalled.tvititant first obteipingeft luspeciito, I agree to mmovo alt now rr3 l iisls for wtqperpati^ awili do the Work and the strudw-e is not intended or offraed forsraspetAten sale (Soo 7044, Business & Prafesslons Cade) Lasawn�'ofdazi-p crnse7mlusivolyconfractutgwlts.li czS SignatumofAppli atw. coub tors to construct tho prcct(Scc.7W� Bp ioess& Professioru: codc), IOkte. I hereby of ut under penally atpedryu�ry� perre of tine f011ovdog three ded1grations: 3, I have and will Maintain a i attificats Q{c'onsont to sel-721im {Qtwbrw@ AL LRt?OF CO"MINDS TO BE �S "A„ OR BETTER cost smsatiott, as providrd forby Section 3700 Qf Hae Labor Cbdt,for the p-rforautmoffbewarkfarwhwhthis permit islssued. ttMARDs3CiSidA E gA Ifi tis I ttsva and wtgl tnaintfm iorku's Compctssation Itasmatteo, as provided for by I have reed the bazardous maierfafs requframcnfs ander Mapter Cr.95 of the Smd6n 37!04 of thelzbor Code,.fcr the perfennance of the work for yrbicb Lfnis California Healti & Safety Cade Sections 25505, 25533, and 25534. Twill Permit is issued.,: Ma in conapilaraco With thG.Cupordno Municipal Code, Chaxrtcr 9.32 Ansi tit s, low thatin the petiattnitnco of the work far whi6 this portant is iastacd, I ilcalth & Safely Code, Section 25$32(9) should, .I store or hxnttle hazardous fait not employ teak peY$t n m a»yarnaez SQ s5 to become 8r3ti'Z t toTlrb airmaterial. Addliionsilfy, $taQi3irf 13194 eq¢lpt3aent QS dslces �%iltCtS $intt atxrsrrdous utaxttlatonts ss defined by rite iiagAr°ear#tri)sasiltl` IYlans�erttant District I Wcaimes Compensation> -lases ol'Cstifantia. it; uftcr-n3ak thisc cn"tiicatc of will wftt maintsin complionco with tine Cnperttoo 1 unicipal Code, chapt& 9.12 and exemptioa, l boOOMe subject to tils 3r0rkeras-P013p0matJOA.Iar OVisions Of the tree gooich &Safety Critic, Sptil ars 2 irS 25533, and 2$ 4, laibor Code, I must forthwith "Iy with orlon provisions or (bis permit shall s deensed isvoicod. t5wwtter a utttorized agent: I cortify that i have read th€s application and state that, the above Informalic n is Correct, l agree to cetntply whit tltl city and ctnrzay ordinances and sate laws STRt i hereby a;ilrm that there is a construction.landing agency for the perfoi manoe relating to tltiildino constmotion; and hereby authorize representatives of this city 1Work fist which nils p$ririitiS Issued (Sec, 3,097, Civ } Lender's Name to easter arrxrta the above meta#ionad Itrtaperty far Instottan.purpQs. (4�Ve) agfee` tri save trtdtumi€y arrakeep harmless the City of Cupertino against inabilities, l srtdar � dress )ustt3raterats, costs, and expenses vtttida msy accrue against said City, in oonsequenoe of the granting ofthis pars it AddMonally, the applcant, understands a"= rsIAt3,4 am§ Ml.cornply with all non -point source regulatttons,per the Cupertino is unic€pal .AxR€TF F0 l undersiant� mjr pgane si3 I be used es puitilc rsctirds: Corrie, Section 0-18. f l r3n.1d tgaiaturu Exrcfesstra)tat V Q-0 CUPERTIN Oa El NEW CONSTRUCT PROJECT ADDRESS ONVNERNAT E CONTACT NAME, STREET ADDRESS CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISI 10300 TORRE AVENUE • CUPERTIN,O, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • build ing(cDcupertino.org ❑ ADDITION ❑- ALTERATION /TI REVISION / DEFERRED ORIGINAL PERMIT #�v ode! a 3vA��' APNn Z r� PHONE E-MAIL CITY, STATE QIP FAX PHONE �® �® � �„-- . � � E-MAIL CITY, STATE, ZIPS 13 r. FAX ❑ OWNER ❑ OWNER -BUILDER - ❑ OV,TATERAGENT L7 CONTRACTOR ❑CONTTRACTORAGENT ❑ ARCHITECT ❑ ENGATEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC Y COMPANY NAME E-1,4AIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/EINIGINEER NAME LICENSE NUT IBER BUS. LIC r COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF PORK USE TYPE OCC. I SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL - AREA AREA AREA. NET AREA BATHROOM YTCHEN - OTHER - REMODEI. AREA I REMODEL AREA - REMODEL AREA BEING ADDED? ❑ NO ADDITION? ❑NO PRE -APPLICATION E]Y ES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES TOTAL VALUATION: PLA KINGAPPL# ❑NO PLANKINIG APPROVAL LETTER EICHLERHOME? ❑NO -, Y 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 building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent:rf ,— cam@ Date:` SUPPLEMENTAL IRIFORMA4-10N REQUIRED Nein SFD or Multifamily dwellings: Apply for demolition pennit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 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 Pen -nit application. BldgApp_7011.doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15080223 20840 CHERRYLAND DR CUPERTINO CA 95014 (359 20 03 1) OWNER/BUILDER OWNER'S NAME: CHERRYLAND LLC DATE ISSUED: 03/03/2016 OWNER'S PHONE: 408-568-0616 PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor OWNER/BUILDER Date 03/03/2016 —BLDG _ELECT PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH — RESIDENTIAL _ COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: CONSTRUCT TWO STORY RESIDENCE (2069 SQ FT); I hereby affirm under penalty of perjury one of the following two declarations: ATTACHED GARAGE (459 SQ FT); COVERED PORCHES (308 1. I have and will maintain acertificate of consent to self -insure for Worker's 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, 2. 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. Sq. Ft Floor Area: Valuation: $435000.00 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 APN Number: Occupancy Type: ordinances and state laws relating to building construction, and hereby 359 20 031 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 PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal 180 DAYS FROM LLED INSPECTION. Code, Section 9.18. Issued by: ME S Signature Date 03/03/2016 Date: 03/03/2016 OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for r. I, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: A as owner of the property, am exclusively contracting with licensed Date: 03/03/2016 contractors to construct the project(Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER r. 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance, as provided for California Health & Safety Code, Sections 25505, 25533, and 25534.. I will by Section 3700 of the Labor Code, for the performance of the work for which maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the this permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous 3 I certify that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipment or devices which emit hazardous J • 77 shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Worker's Compensation laws of California. If, after making this certificate of the Health & Safety Code, Sections 25505, 25533, and 25534. 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 Owner or authorized agent:/7� be deemed revoked. Date: 03/03/2016 C APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state taws of work's for which this permit is issued (Sec, 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant ARCHITECT'S DECLARATION understands and will comply with all non -point source regulations per the I understand my plans shall be used as public records. Cupertino Municipal Code, Section 9.18. Licensed k::7���Da�teO03&03/2016 Professional Signature LIN CONSTRUCTION PERMIT APPLICATION [1 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 3 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(ftupertino.org r NEW CONSTRUCTION U ADDITION U ALTERATION / Ti U REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESSo � ,� APN #-204,L) 07 J OWNERNAME j. ,,Gf9`��YGA % PHONE EMAIL STREET ADDRESS * � � � CITY, STATE, ZIP l.U'f+ .. _ FAX CONTACT NAMEa` �, � PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OwNERBuiLDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENTCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE CHIT VENGINEERNAME U,— LICENSE NUMBER �i V F,� BUS. LIC# COMPANY NAME '+� ti E-MAIL /R t �L� g FAX STREET ADDRESS NN� CITY, STATE, ZIPPHO �t Z ��ad DESCRIPTION OF WORK W EXISTING USE PROPOSED USE CONSTR. TYPE I # STORIES t^� —, '2— � / � -� USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG i, f NEW FLOOR DEMO �V TOTAL ' AREA L1 i orJ AREA � -? AREA L .,o Jn NETAREA�y f ( +;a] f� f 34101000 0e00,+, BATHROOM V KITCHEN OTHER ,/J V REMODEL AREA REMODEL AREA j REMODEL AREAL PORCH AREA DECK AREA TOTAL DECKNORCH AREA GARAGE AREA: DETACH TACH 0 © p0U # DWELLNG UNITS: IS A SECOND UNIT ❑ YTS SECOND STORY ❑ YES BEING ADDED? y�j O ADDITION? 0 - 000 PRE -APPLICATION U4ES IF YES, PROVIDE COPY OF IS THE BLDG AN ElYES RECE EDB + : TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? \^u� - r N: ..: 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 building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: ld 14 --- Date: A I- ! U `i SUPPLEMENTAL INFORMATION REQUIRED ;PLANGHECI�TIF atllirrlNG it ' New SFD or Multifamily dwellings: Apply for demolition permit for [j OVER TIIE-COI)1�TERi7r[ Dr15kI Pr AN RE VIEA existing building(s). Demolition permit is required prior to issuance of building permit for new building. CI EXPRESS PLANBLA1SitEEw NING x Commercial Bldgs: Provide a completed Hazardous Materials Disclosure °� sTANDARv O PIi$LrC�v©itrs _ form if any Hazardous Materials are being used as part of this project. ❑ a;.LARGE '� EIRE DEPT` Copy of Planning Approval Letter or Meeting with Planning prior to LD", MJOR ' SANTTARYSE4��ERDTSTRICT submittal of Building Permit application. ,, x D ENVIRONMENTAi HEALTH; BldgApp_2011.doc revised 06121111 CITY OF CUPERTIlVO FEE ESTIMATOR — BITILDING DIVISION _T_ ADDRESS: 20840 CHERRYLAND RD A DATE: 08131/2015 REVIEWED BY: SEAN APN: BP#: *VALUATION: 1$435,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: 2nd Unit? •' Yes No PENTAMATION 1 R3SFDW PERMIT TYPE: WORK CONSTRUCT TWO STORY RESIDENCE 2069 SQ FT • ATTACHED GARAGE 459 SQ FT SCOPE COVERED PORCHES (308 SQ FT). TYPE OF FLR AREA OCCUPANCY TYPE: CONSTR. s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 2,836 $3,046.44 IR3PLNCK $2,964.52 IR3INSP I TOTALS: 2,836 <il$3,046 44,,I _ $2,964.52 lleeh..Plran Check. I himb. Plan (7heek Flee, Plata Check wech..Permit Free Phimb. Permit Fee: T:lec. Perwit Fire: __LOther flee'. Insp, Other Plumb hiep. Other flee. Irtsp. ; �'G"/t. IIZ p. �`ee: Phiii2}7. /YtSp). 1`(?f': �_`.�lea li?b�?. i`;'BG. '.. NOTE: This estimate does not include fees due to other Departments (Le. Plannine, 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 1.1-053 Eff. 7/LQ FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,046.44 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $2,964.52 Suppl. Insp. Fee: Reg. OOT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1-1 # new units$684.98 cinfinisfra ive Fee: 0 Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: IPLLONGR $397.04 Select a Non -Residential Building or Structure A Trav eI.Do c urn enIalion Fee.: Strong Motion Fee: IBSEISMICR $56.55 Select an Administrative Item Bldg- Stds Commission Fee: IBCBSC $18.00 $7,167.53 $0.00 $7,167.53 Revised: 07/62/2015.. City of Cupertino Pemit renewal Date: April 10, 2017 Building Address: 20840 Cherryland Drive, Cupertino Permit No: 15080223 Owner Name: Cherryland LLC/ Suejane Han Owner address: 20846 Dunbar Drive, Cupertino The building completion has been delayed. A lot of outside improvement on the private street need be done. The heavy rains has impacted the work schedule for the last few months. The estimated building completion date is the end of July 2017. Owner Cherryland LLC/ Suejane Han CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building na cupertino. or4 — Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITEADDR SS - AP BP# .a OWNEP, NAME ;:.: L OWNER ADDRESS- DDRES -DESCRIPTIO DESCRIPTIOOF WORK: FA We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) IfiT'11�1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Bull r" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. �. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 5?L/k I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. SJR H. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5�K I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. 50111. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. �. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 51�. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 . I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. � 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. _ rt 1.1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. 2. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the in or ation l have -provided on this form. Licensed contractors are regulated bylaws designed to protect the. public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint... Your only remedy against unlicensed Contractors maybe in civil court. It is also important for you -to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you -obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: - ----------- --------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBurlderForm 2010.doc revised 04114110 Cupertino Union School District 10301 Vista Drive, Cupertino, CA 95014 Tel (408) 252-3000 • Fax (408) 865-0326 10997 Developer Impact Fee Compliance The Cupertino Union School District has adopted Resolution Nos. 1403, 1404, and 141501, imposing developer impact fee pursuant to Government Code 53080. Building Permit Request The City of ' i� has received a request for a Building Permit described as follows: ��Iesiclential Development Project Commercial/Industrial Development Project Name of Developer/Owner C,ka� y -1A ( ouyn_ L Lf_ _ + Project Address. Z O Description: Square Footage: 1,I () % jLot/Parcel #: ? �a Z �'-C�-S Permit #: I 0?30 2 Z-3 Date: I t ) -3 ') I I �- — Square footage will be verified by the city prior to Representative-._____. of a building permit; fees may be adjusted accordingly. - -- Important Notice: Bring this form and payment to 10301 Vista Drive, Property Office. Cupertino Union School District gives no credit for total demolition of existing square footage area, which makes way for new construction as mandated in the Government Code Sections 53080, 53080.6 and 65995. SCHOOL DISTRICT DEVELOPER IMPACT FEE CERTIFICATE OF COMPLIANCE The authorized representative of the Cupertino Union School District has reviewed the City of (f&f r'_Jer IA1C) Building Permit Request described above and hereby certifies that the developer or authorized representative has met the requirements of the District's Developer Impact Fee requirements. Dated: 3 f. Certificate not valid without District seal, initial, and date. By: ✓'� -� Authorized `representative Cupertino Union School District Fee: $ 4,17 9. 3 �a Check No.: Ar Facilities Planning - White City - Yellow Requestor - Pink Accounting - Gold FREMONT UNION HIGH SCHOOL DISTRICT 589 WEST FREMONT AVENUE SUNNYVALE, CALIFORNIA 94087 408-522-2200 Developer Impact Fee Compliance Building permits will not be issued without a completed Certificate of Compliance Building Permit Application The City of�091/ has received a request for a Building Permit described as follows: _ New Residential Development _ Residential Addition (501) sq. ft. or more Commercial Development Name of Owner/ Developer: - �- I I-A_k� Project Address: Lot/Parcel # Square Footage: Description: Permit / PlanCheck# 450K, i` 7 ?_. _? 1 Date: ?u' By: City Building Inspector Square footage verified by the city prior to issuance of a building permit; fees may be adjusted accordingly. F CG4C1 Lr- ICIIICIItQIY DI: JII II.I SCHOOL DISTRICT DEVELOPER IMPACT FEE CERTIFICATE OF COMPLIANCE The authorized representative of the Fremont Union High School District has reviewed the City of l + i!J V �- o o Building Permit Request described above and hereby certifies that the developer or authorized representative has met the requirements of the District's Developer Impact Fee requirements. Dated: - i. By: Certificate not valid without District Seal, Initial, and Date Distribution: Facilities Planning —White City — Yellow Fremont Union High School District Authorized Representative Fee $ .? "7 -r , 4a l:. Requestor — Pink Accounting — Gold Dev. Impact Fee Compliance (Rev. 11/22/05) [12/08 — 1000]