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15080198CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15080198 10200 JOHNSON AVE CUPERTINO CA 95014 (375 25 066) DE ANZA BUI DERS SAN JOSE, CA 95129 OWNER'S NAME: MATTHEW THOMAS DATE ISSUED: 03/15/2016 OWNER'S PHONE: 408-261-8820 PHONE NO: (408) 865-0222 LICENSED ED ONT ACTOR' DECLARATION BUILDING PERMIT INFO: License Class B Lie. #943227 Contractor DE ANZA BU ILDERS Date 02/28/2018 _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 (2104 SQ FT); I hereby affirm under penalty of perjury one of the following two declarations: ATTACHED GARAGE (441 SQ FT); HABITABLE BASEMENT 1. I have and will maintain a certificate of consent to self -insure for Worker's (1345 SQ FT). Compensation, as provided for by Section 3700 of the Labor Code, for the G 1)EF # 1 -ROOF TRUSSES -ISSUED 9/12/16 performance of the work for which this permit is issued. REV #1 - RETAINING WALL CALCULATIONS, MOVE WALL - r/1 have and will maintain Worker's Compensation Insurance, as provided for by ISSUED 5/18/16 '0z. Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $255000.00 permit is issued. APPLICANT CERTIFICATION certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 375 25 066 375 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said i in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applica un erstands and will comply with all non -point source regulations per t e pertino Municipal Code, Section 9.18. 180 FROM T CALLED INSPECTION. Si nature // � V Date 09/12/16 9 _ ISM : L v Date: 03/15/201 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. 1, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 09/12/16 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. 1 have will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the z. and Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Mu icipal Code, Chapter 9.12 and the permit is issued. Health & Safety Code, Section 25532(.) s Id I store or handle hazardous 3. 1 certify that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipme 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 '. Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertin` Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Se do 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit.shall _5� be deemed revoked. Owner or authorized agent: s APPLICANT CERTIFICATION Date: 09/12/16 • � 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 understands ARCHITECT'S DECI•ARATION and will comply with all non -point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 09/12/16 Professional CONSTRUCTION PERMIT APPLICATION. COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISIO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 FAX (408) 777-3333 • building (cDcupertino.org CUPERTINO ❑ NEW CONSTRUCTION ❑ ADDITION U ALTERATION / TI X1 REVISION / DEFERRED ORIGINAL PERMIT # ` S v �O v 1 "j d PROJECT ADDRESS .0Z05 I APN # 57 — Z i — C 6 OWNER NAME rfl N P 6 V V `(,1 6S7-0 E-MAIL STREET ADDRESS �G AA CITY, $TATE, ZIPFAX CONTACTN Cj PH N� /n E-MAIL \ _��Jw,3y2Ea We STRE T' j�I) CITY, STATE, ZIP y b' FAX OWNER ❑ OWNER -BUILDER ❑' OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CO CTOR NA LICENSE ER LICENSE TYPE BUS. LIC # Le- C'ev,V�_� vta w1 �`� �ZZ 1 1FS COMPANYNAMIT), V) �. (i\ FAX �� C`s i CEJ 9 � L � •v.: ST T DRE �p CITY, STATE, ZIP PH t f°��iv`CZ S�� �J:w�CO ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE IDESCRIPTION OF WORK USE I TYPE I OCC. I SQ.FT. I VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM - KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA -. ATTACH #DWELLING UNITS: IS A SECOND UNIT D YES SP:UVINI) b I UKY LJ - BEINGADDED? [-]NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES FZ2ECEIVED B'Y: r a i TOTAL VALUATION: PLANNING APPL # ❑ NO. PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO .. By my signature below, I certify to each of the f wing: I am the -properly owner or authorized agent to act on the properly owner's -behalf. I have read this application and the information I have provided 's c ect. 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 t uildin c ction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: L,6 SUPPLEMENTAL INFORIXATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit 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 Permit application. B19gApp 2011.doc revised 06121111 RsV� CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15080198 10200 JOHNSON AVE CUPERTINO CA 95014 (375 25 066) DE ANZA BUILDERS SAN JOSE, CA 95129 OWNER'S NAME: MATTHEW THOMAS DATE ISSUED: 03/15/2016 OWNER'S PHONE: 408-261-3820 PHONE NO: (408)865-0222 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #943227 Contractor DE ANZA BUILDERS Date 02/28/2018 _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 (2104 SQ FT); I hereby affirm under penalty of perjury one of the following two declarations: ATTACHED GARAGE (441 �Q FT); HABITABLE BASEMENT 1. I have and will maintain a certificate of consent to self -insure for Worker's (1345 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. REV #1 - RETAINING WALL CALCULATIONS, MOVE WALL f , 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 Sq. Ft Floor Area: Valuations $255000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 37525 066 375 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 aga'abilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against sid Ci in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the appli ant un erstands and will comply with all non -point source regulations per the C pertino Municipal Code, Section 9.18. 180 DAYS FROM LAST C LED INS CTION. Signaturec> i Date 5/18/20.16 Issued by: ALEX VALLELUNGA Date: 03/15/2016 OWNER -BUILDER DECLARATION c I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons; 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. 1, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code), Date: 5/18/2016 1 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 performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 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 by California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will Section 3700 of the Labor Code, for the performance of the work for which this maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued, Health & Safety Code, Section 25532(a) s Id 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 equipm nt r 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 Are Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupe M nicipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sectionj 25$05, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall c be deemed revoked, --Owner or_authorized-agent: APPLICANT CERTIFICATION Date: 5/18/2016-- NSR T E D A EN Y 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 understands ARC'HITECT'S DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal I understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 5/18/2016 professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - building c(,,cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION n ALTERAITON i TI 0 RFVIS10N ! DFFFRRED F -16V I B ooh o ORrGMTAT R RAffIT II PROJECTADDRESS k0Z® ® ATN# OWNERNAME 9n� ` 11•tir►'t�^'C�.1� t �''m_Ov.A'4.`j P L - C24" VC? � Hoe, V'Y/� .Viaia++R-0 U19A, V'C'htA STREET ADDRESS',�. CITY, STATE, Z FAX CONTACT NAME�A ` V,6 'CO o^• P � TGs a�'S i 11�` �Ct� >�l �►�" � e%e l �•Ofa STREET ADDRESSyk rte' (:ffY,STATE, ZIP FAXEl OWNER ❑ OWNER -BUILDER 0 OWNER AGENT VNICONPRACTOR © CON'I'RACTORAGENT ❑ ARCHITECT ❑ ENGMER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME N1\`1L..e> l�wv-tw—�-O`� LICENSE NUMBER LICENSE TYPE C3 BUS. LIC # COMPANY NAME O � /� r C1, rs `.Je. f� �°ZG � �D S�, tee. 1N�` L (,�/C1J�'e-�TJC71�6C9� FAX STREET ADDRESS CITY, STATE,. ZIP ARCH[TECUENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANYNAME E-MAIL. FAX STREET ADDRESS CITY, STA TB,ZIP _ PHONE.. _.... DESCRIPTION OF WORK f t j - V to �`, EXISTING USE. _ PROPOSED. USE _ CONSTR. TYPE # STORIES _NEWFLOOR USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG DEMO TOTAL AREA AREA - AREA NET AREA BATHROOM - KITCHEN - :OTHER REMODELAREA REMODELAREA REMODEL AREA PORCHAREA DECKAREA TOTAL DECKIPORCHAREA GARAGE AREA: []DETACH E]ATTACH #DWELLINGUNITS: IS. A SECONDUNrr []YES sECONDSTORY []YES BEINGADDED? [:]NO ADDITION? []NO PRE -APPLICATION n YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVE i] � ' � TOTAL VALUATION: PLANNINGAPPL# ONO PLANNING APPROVAL LETTER EICHLERHOME? []NO _ By my Signature below, I certify to each of tAe, fo owing: I am the property owner or authorized age t to act on the property owner's behalf. I have read this application and the information I have provid d' i correct. I have read the Description of Work and verify itis accurate. I agree to comply with all applicable local ordinances and state laws relating to b ding o ction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: ,r Date: SUPPLEMENTA_ INFO TION REQUIRED PLAN CHECK TYPE Rou TING SLIP © OVER TH GG -COUNTER El HEILDINGPF ANREVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing 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 Q STANDARD © PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. iz LARGE 0 IGIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to MAJOR ❑ SANrrARYSEwERDISTRLCT submittal of Building Permit application. El ENVLRONmENTALHEALTH BZdgApp_2011.doc revised 06121/11 1i^• CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10200 JOHNSON AVE CUPERTINO CA 95014 (375 25 066) OWNER'S NAME: MATTHEW THOMAS OWNER'S PHONE: 408-261-8820 LICENSED CONTRACTOR'S DECLARATION License Class B Lic. #943227 Contractor DE ANZA BUILDERS Date 02/28/2018 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. hereby affirm under penalty of perjury one of the following two declarations: 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 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 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 rela ' g to building construction, and hereby authorize representatives of i city to enter upon the above mentioned property for inspection purpose . We) agree to save indemnify and keep harmless the City of Cupertino ag i t liabilities, judgments, costs, and expenses which may accrue againsta City in consequence of the granting of this permit. Additionally, the appl c nt understands and will comply with all non -point source regulations p r the Cupertino Municipal Code, Section 9.18. Date 03/15/2016 hereby affirm that I am exempt from the Contractor's License Law for one of the 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) I, 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 followingthree declarations: 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 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. 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 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 03/15/2016 CONTRACTOR: PERMIT NO: 15080198 DE ANZA BUILDERS SAN JOSE, CA 95129 DATE ISSUED: 03/15/2016 PHONE NO: (408) 499-8391 BUILDING PERMIT INFO: —BLDG —ELECT —PLUMB MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: CONSTRUCT TWO STORY RESIDENCE (2104 SQ FT); ATTACHED GARAGE (441 SQ FT); HABITABLE BASEMENT (1345 SQ FT). Sq. Ft Floor Area: I, I Valuation: $255000.00 APN Number: Occupancy Type: 375 25 066 Is PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED sued by; ALEX VALLELUNGA Date: 03/15/2016 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roofis installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Date: 03/15/ 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. I 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.' equip e t or devices which emit hazardous air contaminants as defined by the Bay A ea it Quality Management District I will maintain compliance with the Cupertino unicipal'Code, Chapter 9.12 and the Health & Safety Code, Sect, ns 5505, 25533, and 25534. Owner or authonzea agent: Date: 03/15%2016 I hereby affirm thafthere 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO 91 NFW (YINCTRTTC`TTnM CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 building (ja�cupertino.org F-1 AnnITTON F-1 AT.TFR ATTON / TT F-1 RFVTRT0N / r)F..FF.RRFTT ORTCTTNAT. PER MIT # PROJECT ADDRESS 10200 JOHNSON DRIVE APN# 375-25-066 OWNERNAME MATHEW THOMAS PHONE 408-261-8820E-� matsthomasusa@gmail.c STREET ADDRESS 10200 JOHNSON DRIVE CITY, STATE, ZIP CUPERTINO, CA 95014 FAX CONTACT NAME KYLE CHAN, ARCHITECT PHONE 510-396-9731 E-MAIL kyle@kylechan.com STREETADDREss5205 PROSPECT ROAD #135-120 CITY,sTATE, ZIP SAN JOSE, CA 95129 FAX ❑ OWNER ❑ OWNER -BUILDER 13 OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT t 'ARCHITECT 11 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME T B. D. LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEERNAME KYLE CHAN, AIA LICENSE NUMBER C-31616 BUS. LIC# COMPANYNAME KYLE CHAN ARCHITECT E-MAIL kyle@kylechan.com FAX STREET ADDRESS 5205 PROSPECT ROAD #135-120 CITY,STATE,zIP SAN JOSE, CA 95129 PHONE DESCRIPTION OF WORK 1, DEMOLISH EXISTING RESIDENTIALBUILDING. 2. PROPOSED A NEW 2 -STORY BUILDIN WITH A BASEMENT. 3. NEW (N) KITCHEN (218 SF). 4. NEW (N) BATHROOMS: BASEMENT: 41 SF 1ST FLOOR: 51 SF, 2ND FLOOR: 95 SF, 5. INSTALL (N) 200AMP ELECTRICAL SERVICE. 6. ATTACHED GARA EXISTING USE RESIDENTIAL PROPOSED USE CONSTR. RESIDENTIAL TYPE V -B # STORIES 2 W1 BASE MEIT TYPE OCC. SQ.FT. - VALUATION (S) EXISTGNEW AREA 1,439 SF FLOOR AREA 2,451 SF DEMO AREA. TOTAL NETAREA3,890 SF ___, $20,000_ BATHROOM- REMODELAREA 152 SF - KITCHEN. REMODELAREA 132 SF OTHER REMODELAREA1,806 SF - ; $15,000 PORCH AREA DECK AREA - TOTAL DECK/PORCH AREA GARAGE AREA: DETACH 441 SF ATTACx� _,I` $200,000 64 SF NONE 64 SF GARAGE # DWELLING UNITS: 1 IS A SECOND UNIT YES BEING ADDED? �NO SECOND STORY YES ADDITION? ❑ � �NO -13 441 SF $20,000 PRE -APPLICATION YES IF YES, PROVIDE COPY OF IS THE BLDG AN �. YES EICHLERHOME? NO CEIVED B Y - `` TOTAL VALUATION: PLANNING ADPL# NO PLANNING APPROVAL LETTER ❑ $d'255.,000 R2015-09 Y y signature f3 g property agent the property owner's behalf. I have read this B li linformat t on I have provided iislcorrn t. I have read the Description o Work and verify a PP p'fy � s accurate. I agree to comply with all applicable local application and the ordinances and state laws relating to building co c . I tho ' e representatives of Cupertino to enter the abovep-id ntified for inspection purposes. Iroperty Signature of Applicant/Agent: Date: D 2 SUPPLEMENTAL INFORMATION REQUIRED PLAN CtcE TYKE RaG sI� _ New SFD or Multifamily dwellings: Apply for demolition permit forD R, lcoimlTE� BI7TLnnvG Pls REvIEw existing building(s). Demolition permit is required prior to issuance of building I permit for new building. d ExPI2Ess €r PL NIviP GPLAAPII+EVIkW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sTvn Pundc wo'A'K& 4 _ form if any Hazardous Materials are being used as part of this project. LaxG> FIRE Dir _ Copy of Planning Approval Letter or Meeting with Planning prior to 1vIAaoR sANVF SEwERDISTRICT submittal of Building Permit application. Eh ENVIRONTVWNTAL HEALTH BldgApp_2011.doc revised 06/21/11 T1 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ' ADDRESS: 10200 JOHNSON DR DATE: 08/27/2015 APN: BP#: REVIEWED BY: SEAN *VALUATION: 1$255,000 xPERNIIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY USE: SFD or Duplex 2nd Unit? Yes •� No PENTAMATION PERMIT TYPE: 1 R3SFDW WORK CONSTRUCT TWO STORY RESIDENCE 2104 SQ FT); ATTACHED GARAGE 441 SQ FT); SCOPE BASEMENT (1345 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,111-B,IV,V-B 3,890 ✓3,252.54 IR3PLNCK f 3,440.82 IR31NSP Allech. hiq). l=ee: Plumb. Inst. F,e: l lec_ Insp, Fee: 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1 #new units $684.98 Adi? inistrative'Fee: 0 Work Without Permit? 0 Yes (j) No $0.00 TOTALS: 3,890 $3,252.54 = _ $3,440.82 S210 t � 6 n _ >_ L= QTY/FEE MISC ITEMS Plan Check Fee: ilech. Plan t'heck Plurrrh. 1'lran f `heck Elec..Plan Check F;Perrrlit Fez: Plumb, dyer mh Fee: 'i Elec. Perinit Fee: Other J11f ch. Insp. Other Plumb J. -up. ' Other Eke. lnv,. Allech. hiq). l=ee: Plumb. Inst. F,e: l lec_ Insp, Fee: NOTE: T his estimate does not include fees due to otiler Lepartments (Le. rlanning, runic nvorKs, care, aunuary .zewe—Istrwil ocnuut n;..s,.I - - mU,...,. r ,... -.- x,...,,a -N ih. /mY.H"h%o and nr& n"hy an O.WimatO_ 1"antact. the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,252.54 Select a Misc Bldg/Structure or Element of a Building, Suppl. PC Fee: Q Reg. Q OT0.0hrs $0.00 PME Plan Check: $0.00 Permit Feer $3,440.82 Suppl. Insp. Feer Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1 #new units $684.98 Adi? inistrative'Fee: 0 Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee. 1PLLONGR $544.60 Select a Non -Residential Building or Structure 0 'I'rtn �'Z Documentation urnc nt�tlican 1j'c �'s: Strong Motion Fee: IBSE-ismcR 'l $33.15 Select an Administrative Item Bldg Std s Commission. Fee: IBCBSC ✓ $11.00 . - ST 67.091 $7,91 0.00 y r u TcAF $7,967.09 Revised: 07/02/2015 ►' CUPERTINO Owner Name Address I WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 408) 777-322 FAX (408) 777 A PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION Please refer to the attached California Civil Code Sections 1101.1-1101.8 which are part of this Certification form. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form Owner' Signature: anliL, Date: /a —45"- % y YNo Go to Question 2. 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Sign below and skip the rest of the form Owner' Signature: ❑ No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 110 1. 1 through 1101.8 do not apply, Owner' Signature: No Go to Question 4. Date: Sign below and skip the rest of the form. Date: / —S`- j 11 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the fonn. Owner' Signature: Date: ,W Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached. My property is a single-family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non-compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). ❑ My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). ❑ My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. SB4072014.doc revised 03118114 On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). 1/We, the owner(s) of this property, certify under penalty of perjury that non-compliant plumbing fixtures have been replaced with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8, the current California Plumbing Code and California Green Building, Standards Code, and manufacturer's installation requirements, and that the water -conserving plumbing fix e comply,wit th is as indicated in the table below. Owner's (or Owner Agent's) Signature: Date: Upon completing and signing this Certificate, please return it to the Building Division in order to final your permit. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB407 2014. doc revised 03118/14 Non -Compliant Water -Conserving Plumbing Fixture —Plumbing Fixturel (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usage/Flow Rate Fixture Type Water Usage 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 /Flow Rate 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 Single -Family Multi -Family Commercial Residential Residential Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite, average flush volume of two reduced flushes and one full flush Urinals Exceed 1.0 0.5 gallons/flush Gallons/flush Showerheads Exceed 2.5 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of gallons per minute U.S. EPA WaterSense Specification for Showerheads (A hand-held shower is considered a showerhead.) For multiple showerheads serving one shower, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. Faucets — Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 Lavatory per minute minute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets 0.8 gallons per minute @ per minute @ 60 psi; 20 psi minimum 0.8 gallons per minute @ 20 psi In common and public use areas: 0.5 gallons per minute @ 60 psi 1.8 gallons per minute 60 psi Faucets — Exceed 2.2 gallons 1.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60 Kitchen per minute 60 psi @ 60 psi psi Faucets May temporarily increase May temporarily up to 2.2 gallons per increase up to 2.2 minute @ 60 psi, and must gallons per minute @ default to maximum 60 psi, and must 1.8 gallons per minute @ default to maximum 60 psi 1.8 gallons per minute Where faucets meeting @ 60 psi the above are unavailable, Where faucets meeting aerators or other means the above are may be used to achieve unavailable, aerators or reduction. other means may be used to achieve reduction. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB407 2014. doc revised 03118/14 ' 1\S- P.) /0(70-r- CALGREEN SIGNATURE-DECLARATIONS • Project Name: 10200 JOHNSON AVE • Project Address: 10200 JOHNSON AVE,CUPERTINO,CA 95014 1 '' Project Description: 2 STORY NEW RESIDENCE 10-r-1,7 B6 SECTION 1 —DESIGN VERIFICATION . Complete all lines of Section 1—"Design Verification"and submit the completed checklist(Columns 1 and 2)with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalOreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented into the • ,project in accordance with the requirements set forth in the 2013 California Green Building Standards Code as adopted the City of Cupertino. • . g 3, 1 Owners Signature Date° ' ! MATHEW THOMAS ;` 'Owner's a ase Print). • 8/3/2015 , I Design essional'a Signature Pate II KYLE CHAN . I ,Design Pro- ,,Y' ame (Please Print) • Ar .,../.......,1 ,8/3/2015 i,I ', -Signature of License;Pro = responsible for CalGreen compliance Date I ALI ZAMANI,A ••e NSTRUCTION AND REMODELING 408-441-0967 i G Name of License Pr.r ,+onal responsible for CaiGreen compliance(Please Print) Phone • ` alis_construction@yahoo.com i. Email Address for License Professional responsible for CalGreen compliance ' SECTION 2—IMPLEMENTATION VERIFICATION' 1 Complete,sign and submit the competed checklist',including column 3,'together with all original signatures on Section '.2 to the Building Department prior to Building Department final inspection., ;, ' I have Inspected the work and have received sufficient documentation to verify and certify that the pr`oject identified above was constru to 'n cordance with this Green Budding Checklistand inaccordance with the,requirements'of ' i I the 2013 Cali Building Standards Code as adopted by the City of Cupertino. I 10/13/2017 . Signature of Livens rofesslonal responsible for CalGreen compliance at KYLE;;C AN 66 - 44-3111 Name of License Professional responsible for CaiGreen compliance(Please Print) Phone 1 KYLE,@KYLECHAN.COM i Email Address for License Professional responsible for CalGreen compliance L I i Psgc¢,crf5; , CalGree,,'2014.dacrevised11/13/14 . I