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14060193 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 14060193 10645 CORDOVA RD CUPERTINO CA 95014 (342 22 099) KELLY CONSTRUCTION INC MOUNTAIN VIEW, CA 94040 OWNER'S NAME: DATE ISSUED: 10/09/2015 OWNER'S PHONE: ( PHONE NO: (650) 965-9052 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #63330 Contractor KELLY CONSTRUCTION INC Date 04/30/2018 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: **LOT C**, CONSTRUCT 3 STORY HILLSIDE SFDWL (2712 SQ FT): I hereby affirm under penalty of perjury one of the following two declarations: GARAGE (441 SQ FT); AND PORCH (75 SQ FT); RETAINING 1. I have and will maintain a certificate of consent to self-insure for Worker's WALL(S) ATTACHED/NEAR FOUNDATION (SEE PLN SHT S8.1). Compensation, as provided for by Section 3700 of the Labor Code, for the REV #1 - NECESSARY CHANGES DUE TO GRADING (PIERS, performance of the work for which this permit is issued. RETAINING WALLS); MINOR FLOOR. PLAN CHANGES. IS SUED 6-1- 2. I have and will maintain Worker's Compensation Insurance, as provided for by 16. Section 3700 of the Labor Code, for the performance of the work for which this REV #2 - MINOR REVISIONS TO FOUNDATION PLANS/DETAILS TO permit is issued. REFLECT SITE CONDITIONS. ISSUED 9-13-16 APPLICANT CERTIFICATION REV #3 - MINOR REVISIONS TO CIVIL PLAN FOR SITE certify that I have read this application and state that the above CONDITIONS. ISSUED 9/30/2016 information is correct. I agree to comply with all city and county ordinances REV #4 - RECONFIGURE SIDE AND REAR PATIOS, INCLUDING .and state laws relating to building construction, and hereby authorize RETAINING WALLS AND STAIR LOCATIONS; RECONFIGURE representatives of this city to enter upon the above mentioned property for BEDROOM #2 TO CREATE FORMAL LIVING AREA, ADD (N) inspection purposes. (We) agree to save indemnify and keep harmless the WINDOWS, CHANGE ELECTRICAL AND SHEAR WALL; CHANGE City of Cupertino against liabilities, judgments, costs, and expenses which WINDOW SIZE AT 1 ST FLOOR BEDROOM AND NEW WINDOW 2ND may accrue against said City in consequence of the granting of this permit. FLOOR; RECONFIGURE KITCHEN LAYOUT; CHANGE CEILING AT Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. FORMAL DINING ROOM FROM VAULTED TO FLAT AND NEW LIGHTING LAYOUT. REV #5 - REVISED SITE WORK TO CREATE PATIOS AND STAIRS Signature Date 1/14/19 WITH CONSTRUCTION OF RETAINING WALLS (252 LF TOTAL)- ISSUED 1/14/19 OWNER- I hereby affirm that I am exempt from the Contractor's License Law for one of the DEF #1 - ROOF TRUSS CALCULATIONS. ISSUED 8/17/2017 following two reasons: 1. 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 Sq. Ft Floor Area: Valuation: $500000.00 sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). APN Number: Occupancy Type: I hereby affirm under penalty of perjury one of the following three declarations: 342 22 099 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. PERMIT EXPIRES IF WORK IS NOT STARTED 2. I have and will maintain Worker's Compensation Insurance, as provided for by WITHIN 180 DAYS OF PERMIT ISSUANCE OR Section 3700 of the Labor Code, for the performance of the work for which this 180 DAYS FROM LAST CALLED INSPECTION. permit is issued. 3. 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 Issued by: Le�acX Worker's Compensation laws of California. If, after making this certificate of Date: 10/09/2015 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 RE-ROOFS: be deemed revoked. All roofs shall be inspected prior to any roofing material being installed. If a roof is APPLICANT CERTIFICATION installed without first obtaining an inspection, I agree to remove all new materials for certify that I have read this application and state that the above information is inspection. 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 Signature of Applicant: to enter upon the above mentioned property for inspection purposes. (We) agree Date: 1/14/19 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the Signature Date 1/14/19 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 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 Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code Sections 25505, 25533, and 25534. Owner or authorized agent: Date: 1/14/19 CONSTRUCTION LENDING AGENC hereby affirm that there is a construction lending agency or the performance of work's for which this permit is issued (Sec. 3097, Civ C ) Lender's Name Lender's Address ARCHITECT'S DECLARATION understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 14060193 10645 CORDOVA RD CUPERTINO CA 95014 (342 22 099) KELLY CONSTRUCTION INC MOUNTAIN VIEW, CA 94040 OWNER'S NAME: OWNER'S PHONE: ( LICENSED CONTRACTOR'S DECLARATION License Class GENERAL BUILDING CONTRACTOR Lic. #633307 Contractor KELLY CONSTRUCTION INC Date 04/30/2018 hereby affirm that I am licensed under the provisions of Chapter 9 (commencing ith Section 7000) of Division 3 of the Business & Professions Code and that my cense 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' Woiker'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 (relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agreelttrsaye 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 sourceMplations per the Cupertino Municipal Code, Section 9.18. Date 8/17/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: r. 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) z. 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 penaltyof perjury one of the following three declarations: 1. I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for 8y Section 3700 of the Labor Code, for the performance of theMork for which this permit is issued. z. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the1abor Code; for the performance of the work for which this permit is issued. 3. I certify that in the performance, of the work for which this permit is issued, I shall,not employ any person is any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become;subj.ect to the Worker's Compensation provisions of the Labor Code, I must forthwitl 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 19.18. Signature Date 8/17/2017 DATE ISSUED: 10/09/2015 PHONE NO: (650) 965-9052 PERMIT INFO: BLDG —ELECT —PLUMB MECH _ RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: **LOT C** CONSTRUCT 3 STORY HILLSIDE SFDWL (2712 SQ FT): GARAGE (441 SQ FT); AND PORCH (75 SQ FT); RETAINING WALL(S) ATTACHED/NEAR FOUNDATION (SEE PLN SHT S8.1). REV # 1 - NECESSARY CHANGES DUE TO GRADING (PIERS, RETAINING WALLS); MINOR FLOOR PLAN CHANGES. ISSUED 6-1- 16. REV #2 - 9/1/2016 MINOR REVISIONS TO FOUNDATION PLANS/DETAILS TO REFLECT SITE CONDITIONS. ISSUED 9-13-16 REV #3 - 9/1/2016 MINOR REVISIONS TO CIVIL PLAN FOR SITE CONDITIONS. ISSUED 9/30/2016 REV #4 - RECONFIGURE SIDE AND REAR PATIOS, INCLUDING RETAINING WALLS AND STAIR LOCATIONS; RECONFIGURE BEDROOM #2 TO CREATE FORMAL LIVING AREA, ADD (N) WINDOWS, CHANGE ELECTRICAL AND SHEAR WALL; CHANGE WINDOW SIZE AT 1ST FLOOR BEDROOM AND NEW WINDOW 2ND FLOOR; RECONFIGURE KITCHEN LAYOUT; CHANGE CEILING AT FORMAL DINING ROOM FROM VAULTED TO FLAT AND NEW LIGHTING LAYOUT. jib""MEMO Sq. Ft Floor Area: I Valuation: $500000.00 APN Number: Occupancy Type: 134222099 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. by: Legac 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: v / Date: 8 201 ALL ROOF uA11 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) shouldI 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 Cupertino Municipal Code, Chapter 9.12 and CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10645 CORDOVA RD CONTRACTOR: OGRADY BRIAN J AND PERMIT NO: 14060193 THERESA M OWNER'S NAME: 853 CAMPBELL AVE DATE ISSUED: 10/09/2015 OWNER'S PHONE: LOS ALTOS, CA 94024 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ **LOT C** CONSTRUCT 3 STORY HILLSIDE SFDWL (2712 License Class Lic. # SQ FT): GARAGE (441 SQ FT); AND PORCH (75 SQ FT); RETAINING WALL(S) ATTACHED/NEAR FOUNDATION (SEE Contractor Date 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 Sq. Ft Floor Area: Valuation: $500000 Compensation, as provided for by Section 3700 of the Labor Code, for the APN Number: 34222099.00 Occupancy Type: 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. PERMIT EXPIRES IF WORK IS NOT STARTED APPLICANT CERTIFICATION T certify that I have read this application and state that the above information is a e: l d 1r' 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. RE -ROOFS: Signature Date 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. 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 t. 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 as owner of the property, am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the construct the project (Sec.7044, Business & Professions Code). California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & I hereby affirm under penalty of perjury one of the following three declarations: Safety Code, Section 25532(a) should I store or handle hazardous material. 1. I have and will maintain a Certificate of Consent to self -insure for Worker's Additionally, should I use equipment or devices which emit hazardous air Compensation, as provided for by Section 3700 of the Labor Code, for the contaminants as defined by the Bay Area Air Quality Management District I will performance of the work for which this permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. 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 Ow c1 C f C rtify that in the performance of the work for which this permit is issued, I shall of 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 I hereby affirm that there is a construction lending agency for the performance of work's must forthwith comply with such provisions or this permit shall be deemed for which this permit is issued (Sec. 3097, Civ C.) Lender's Name revoked. Lender's Address APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION correct. I agree to comply with all city and county ordinances and state laws relating I understand my plans shall be used as public records. to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save Licensed Professional 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 '(i r I certify that in the performance of the work for which this permit is issued, I I have read the hazardous materials requirements under Chapter 6.95 of the shall not employ any person in any manner so as to become subject to the California Health & Safety Code, Sections 25505, 25533, and 25534. I will Worker's Compensation laws of California. If, after making this certificate of maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the exemption, I become subject to the Worker's Compensation provisions of the Health & Safety Code, Section 25532(a) should I store or handle hazardous Labor Code, I must forthwith comply with such provisions or this permit shall material. Additionally, should I use equipment or devices which emit hazardous be deemed revoked. 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 APPLICANT CERTIFICATION the Health & Safety Code, 1 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 Owner Owner or authorized agent: — relating to building construction, and hereby authorize representatives of this city r 1-16 Date:CONSTRUCTION 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 LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance consequence of the granting of this permit. Additionally, the applicant understands of work's for which this permit is issued (Sec. 3097, Civ C.) and will comply with all non -point source regulations per the Cupertino Municipal Lender's Name Code, Section 9.18. Lender's Address � Signature ' Date ARCHITECT'S DECLARATION [ 6-1-16 I understand my plans shall be used as public records. CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10645 CORDOVA RD CUPERTINO CA 95014 (342 22 099) OWNER'S NAME: OWNER'S PHONE: LICENSED CONTRACTOR'S DECLARATION License Class GENERAL BUILDING CONTRACTOR Lic. #633307 Contractor KELLY CONSTRUCTION INC Date 04/30/2018 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. I 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. permit is issued. APPLICANT CERTIFICATION 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 Date OWI -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 (See.7044, Business & Professions Code) z. 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 following three 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. 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 this permit is issued. s. 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. CONTRACTOR: CONSTRUCTION INC MOUNTAIN VIEW, CA 94040 PERMIT NO: 14060193 ISSUED: 10/09/2015 PHONE NO: (650) 965-9052 BUILDING PERMIT INFO: _ BLDG —ELECT _ PLUMB _ MECH _ RESIDENTIAL _ COMMERCLAL JOB DESCRIPTION: **LOT C** CONSTRUCT 3 STORY HILLSIDE SFDWL (2712 SQ FT): GARAGE (441 SQ FT); AND PORCH (75 SQ FT); RETAINING WALL(S) ATTACHED/NEAR FOUNDATION (SEE PLN SHT S8.1). REV # 1 - NECESSARY CHANGES DUE TO GRADING (PIERS, RETAINING WALLS); MINOR FLOOR PLAN CHANGES. ISSUED 6-1- 16. REV #2 - 9/1/2016 MINOR REVISIONS TO FOUNDATION PLANS/DETAILS TO REFLECT SITE CONDITIONS. ISSUED 9-13-16 Sq. Ft Floor Area: I Valuation: $500000.00 APN Number: Occupancy Type: 342 22 099 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Leeacv Date: 10/09/2015 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 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. 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 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 Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code ections 25505, 25533, a d 25534. Owner or authorized agent:. Date: C RUCTION 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 Address Date ARCHITECT'S DECLARATION I understand my plans shall be used as public records. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 14060193 10645 CORDOVA RD CUPERTINO CA 95014 (342 22 099) OWNER -BUILDER OWNER'S NAME: DATE ISSUED: 10/09/2015 OWNER'S PHONE: PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic. # Contractor OWNER -BUILDER Date —BLDG _ELECT —PLUMB COMMERCIAL MECH RESIDENTLAL 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: **LOT C** CONSTRUCT 3 STORY HILLSIDE SFDWL (2712 SQ FT): I hereby affirm under penalty of perjury one of the following two declarations: GARAGE (441 SQ FT); AND PORCH (75 SQ FT); RETAINING 1. I have and will maintain a certificate of consent to self -insure for Worker's WALL(S)ATTACHED/NEAR FOUNDATION (SEE PLN SHT S8.1). 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 � NECESSARY CHANGES DUE TO GRADING (PIERS,-._, 2. I have and will maintain Worker's Compensation Insurance, as provided for by RETAINING WALLS); MINOR -FLOOR PLAN CHANGES. ISSUED 0 -1 - Section 3700 of the Labor Code, for the performance of the work for which this 16. permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APPLICATION EXT'D TO 9/27/15 Sq. Ft Floor Area: Valuation: $500000.00 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 APN Number: Occupancy Type: inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which 342 22099 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. PERMIT EXPIRES II+' WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR Signature Date 6 1-16 180 DAYS FROM LAST CALLED INSPECTION. OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the Issued by: SEAN HATCH �� Date: 10/09/2015 ✓)% f following two reasons: 1. 1, as owner of the propert); or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for RE -ROOFS: sale (Sec.7044, Business & Professions Code) All roofs shall be inspected prior to any roofing material being installed. If a roof is affirm under penalty of perjury one of the following three declarations: Signature of Applicant: 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 Date: 6-1-16 performance of the work for which this permit is issued. 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE ' I certify that in the performance of the work for which this permit is issued, I I have read the hazardous materials requirements under Chapter 6.95 of the / shall not employ any person in any manner so as to become subject to the California Health & Safety Code, Sections 25505, 25533, and 25534, 1 will Worker's Compensation laws of California. If, after making this certificate of maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the exemption, I become subject to the Worker's Compensation provisions of the Health & Safety Code, Section 25532(x) should I store or handle hazardous Labor Code, I must forthwith comply with such provisions or this permit shall material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I be deemed revoked. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and APPLICANT CERTIFICATION the Health & Safety Code, Sections 25505, 25533, and 25534. 1 certify that I have read this application and state that the above information is all ordinances and state laws correct, I agree to comply with city and county Owner or authorized agent:, relating to building construction, and hereby authorize representatives of this city Date: 6 1=16 ✓ to enter upon the above mentioned property for inspection purposes. (We) agree CONSTRUCTION LENDING AGENCY_ to save indemnify and keep harmless the City of Cupertino against liabilities, I hereby affirm that there is a construction lending agency for the performance judgments, costs, and expenses which may accrue against said City in of work's for which this permit is issued (Sec. 3097, Civ C,) consequence of the granting of this permit. Additionally, the applicant understands Lender's Name and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Lender's Address Signature Date 6 1_16 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. f CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 14060193 10645 CORDOVA RD CUPERTINO CA 95014 (342 22 099) KELLY CONSTRUCTION INC MOUNTAIN VIEW, CA 94040 OWNER'S NAME: I (DATE ISSUED: 10/09/2015 1 I OWNER'S PHONE: I I PHONE NO: (650) 965-9052 I License Class B Lic. #633307 Contractor KELLY CONSTRUCTION INC Date 04/30/2018 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. I hereby affirm under penalty of perjury one of the following two declarations: is issued. APPLICANT CERTIFICATION 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 ode, Section 9.18. Signature' Date 09/30/2016 OWNF�R-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the two reasons: I, as owner of the properly, 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 following three declarations: i. 1 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. 1 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. 3. 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 09/30/2016 BUILDING PERNUT INFO: —BLDG —ELECT _ PLUMB _ MECH _ RESIDENTIAL _ COMMERCL&L JOB DESCRIPTION: **LOT C** CONSTRUCT 3 STORY HILLSIDE SFDWL (2712 SQ FT): GARAGE (441 SQ FT); AND PORCH (75 SQ FT); RETAINING WALL(S) ATTACHED/NEAR FOUNDATION (SEE PLN SHT S8.1). - 9/1/2016 MINOR REVISIONS TO CIVIL, PLAN FOR SITE, TIONS. ISSUED 9/30/2016 -- Sq. Ft Floor Area: I Valuation: $500000.00 APN Number: Occupancy Type: 342 22 099 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: SEAN HATCH RR -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: r Date: 09/30/2016 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 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 Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534 Owner or authorized a Date: 09/30/2016 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: CONTRACTOR: PERMIT NO: 14060193 10645 CORDOVA RD CUPERTINO CA 95014 (342 22 099) KELLY CONSTRUCTION INC MOUNTAIN VIEW CA 94040 OWNER'S NAME: DATE ISSUED: 10/09/2015 OWNER'S PHONE: PHONE NO: (650) 965-9052 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class 'GENERAL BUILDING CONTRACTOR tic. #633307 Contractor KELLY CONSTRUCTION INC Date 04/30/2018 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. 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 �� r— Date I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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 (See.7044, Business & Professions Code) 2. 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: 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. 3. 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 —BLDG —ELECT —PLUMB MECH _ RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: **LOT C** CONSTRUCT 3 STORY HILLSIDE SFDWL (2712 SQ FT): GARAGE (441 SQ FT); AND PORCH (75 SQ FT); RETAINING WALL(S) ATTACHED/NEAR FOUNDATION (SEE PLN SHT S8.1). REV # i - NECESSARY CHANGES DUE TO GRADING (PIERS, RETAINING WALLS); MINOR FLOOR PLAN CHANGES. ISSUED 6-1- 16. REV #2 - 9/1/2016 MINOR REVISIONS TO FOUNDATION PLANS/DETAILS TO REFLECT SITE CONDTI'IONS. ISSUED 9-13-16 Sq. Ft Floor Area: Valuation: $500000.00 "N Number:I Occupancy Type: 342 22 099 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: L_egacv 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 ofApplicant: ROOF COVERINGS TO BE CLASS "A" 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 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 Cupertino Municipal Code, Chapter 9.12 and the Health &Safety Code ections 25505, 25533, a d 25534. Owner or authorized age :_ Date: C& I IICTION LENDING AGENCY 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 Address ARCH]JECT'S DECLARATION I understand my plans shall be used as public records. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10645 CORDOVA RD CONTRACTOR: OGRADY BRIAN J AND PERMIT NO: 14060193 THERESA M OWNER'S NAME: OGRADY BRIAN J AND THERESA M OWNER'S PHONE: 853 CAMPBELL AVE DATE ISSUED: 10/09/2015 LOS ALTOS, CA 94024=PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL **LOT License Class_ Lic. # C** CONSTRUCT 3 STORY HILLSIDE SFDWL (2712 SQ FT): GARAGE (441 SQ FT); AND PORCH SQ FT); Contractor (75 RETAINING WALL(S) ATTACHED/NEAR FOUNDATION (SEE Date 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: Sq. Ft Floor Area: Valuation: $500000 t. 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, APN Number: 34222099.00 Occupancy'Type: as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I APPLICANT CERTIFICATION PERMIT EXPIRES IF WORK IS NOT STARTED I certify that I have read this application and state that the above information is WITHIN 180 D RMIT ISSUANCE OR correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 180 D ALLED INSPECTION. 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 -` ate d' 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 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. OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: 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 le (Sec.7044, Business & Professions Code) HAZARDOUS MATERIALS DISCLOSURE I, as owner of the property, am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the construct the project (Sec.7044, Business & Professions Code). California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & I hereby affirm under penalty of perjury one of the following three declarations: Safety Code, Section 25532(a) should I store or handle hazardous material. 1. I have and will maintain a Certificate of Consent to self -insure for Worker's Additionally, should I use equipment or devices which emit hazardous air Compensation, as provided for by Section 3700 of the Labor Code, for the contaminants as defined by the Bay Area Air Quality Management District I will performance of the work for which this permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this is issued. Owna* 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 I hereby affirm that there is a. construction lending agency for the performance of work's must forthwith comply with such provisions or this permit shall be deemed for which this permit is issued (Sec. 3097, Civ C) Lender's Name revoked. Lender's Address APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION 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 I understand my plans shall be used as public records. upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Licensed Professional 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 (�i&4 — CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 14060193 10645 CORDOVA RD CUPERTINO CA 95014 (342 22 099) KELLY CONSTRUCTION INC MOUNTAIN VIEW, CA 94040 OWNER'S NAME: DATE ISSUED: 10/09/2015 OWNER'S PHONE: PHONE NO: (650) 965-9052 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lic. #633307 Contractor KELLY CONSTRUCTION INC Date 04/30/2018 _ 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: **LOT C** CONSTRUCT 3 STORY HILLSIDE SFDWL (2712 SQ FT): I hereby affirm under penalty of perjury one of the following two declarations: GARAGE (441 SQ FT); AND PORCH (75 SQ FT); RETAINING 1. I have and will maintain a certificate of consent to self -insure for Worker's WALL(S) ATTACHED/NEAR FOUNDATION (SEE PLN SHT S8.1). / Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. REV #3 - 9/1/2016 MINOR REVISIONS TO CIVIL PLAN FOR SITE I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 the Labor Code, for the of the work for which this CONDITIONS. ISSUED 9/30/2016 of performance permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above Sq. Ft Floor Area: Valuation: $500000.00 information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize Number: Occupancy Type: representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the 42 3 42 22 099 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 PERMIT EXPIRES IF WORK IS NOT STARTED source 09/30/2016 f, Issued by: SEAN HATCH OWNS, -BUILDER DECLARATION Date: 10/09/2015 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: r. I, as owner of the property, or my employees with wages as their sole RE -ROOFS: compensation, will do the work, and the structure is not intended or offered for 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 sale (Sec.7044, Business & Professions Code) inspection. 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). Signature of Applicant: I hereby affirm under penalty of perjury one of the following three declarations: Date: 09/30/2016 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 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the s. I certify that in the performance of the work for which this permit is issued, I California Health & Safety Code, Sections 25505, 25533, and 25534. I will shall not employ any person in any manner so as to become subject to the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous Worker's Compensation laws of California. If, after making this certificate of material. Additionally, should I use equipment or devices which emit hazardous exemption, I become subject to the Worker's Compensation provisions of the air contaminants as defined by the Bay Area Air Quality Management District I Labor Code, I must forthwith comply with such provisions or this permit shall will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and be deemed revoked. the Health & Safety Code, hereby affirm that there is a construction lending agency for the performance to save indemnify and keep harmless the City of Cupertino against liabilities, of work's for which this permit is issued (Sec. 3097, Civ C.) judgments, costs, and expenses which may accrue against said City in Lender's Name consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Lender's Address Code, Section 9.18. ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Signature Date 09/30/2016 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 14060193 10645 CORDOVA RD CUPERTINO CA 95014(342 22 099) OWNER/BUILDER MOUNTAIN VIEW,CA 94040 OWNER'S NAME: DATE ISSUED: 10/09/2015 OWNER'S PHONE:(408)286-1723 PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic.#633307 Contractor OWNER/BUILDER Date 04/30/2018 —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: **LOT C**CONSTRUCT 3 STORY HILLSIDE SFDWL(2712 SQ FT): I hereby affirm under penalty of perjury one of the following two declarations: GARAGE(441 SQ FT);AND PORCH(75 SQ FT);RETAINING 1. I have and will maintain a certificate of consent to self-insure for Worker's WALL(S)ATTACHED/NEAR FOUNDATION(SEE PLN SHT S8.1). Compensation,as provided for by Section 3700 of the Labor Code,for the REV#6-REVISE RETAINING WALL DESIGN-ISSUED 4/23/19 performance of the work for which this permit is issued. REV#1 -NECESSARY CHANGES DUE TO GRADING(PIERS, 2. I have and will maintain Worker's Compensation Insurance,as provided for by RETAINING WALLS);MINOR FLOOR PLAN CHANGES. ISSUED 6-1- Section 3700 of the Labor Code,for the performance of the work for which this 16 permit is issued. REV#2-MINOR REVISIONS TO FOUNDATION PLANS/DETAILS TO APPLICANT CERTIFICATION REFLECT SITE CONDITIONS. ISSUED 9-13-16 1 certify that I have read this application and state that the above REV#3 -MINOR REVISIONS TO CIVIL PLAN FOR SITE information is correct. I agree to comply with all city and county ordinances CONDITIONS. ISSUED 9/30/2016 and state laws relating to building construction,and hereby authorize REV#4-RECONFIGURE SIDE AND REAR PATIOS,INCLUDING representatives of this city to enter upon the above mentioned property for RETAINING WALLS AND STAIR LOCATIONS;RECONFIGURE inspection purposes. (We)agree to save indemnify and keep harmless the BEDROOM#2 TO CREATE FORMAL LIVING AREA,ADD(N) City of Cupertino against liabilities,judgments, costs,and expenses which WINDOWS,CHANGE ELECTRICAL AND SHEAR WALL;CHANGE may accrue against said City in consequence of the granting of this permit. WINDOW SIZE AT 1 ST FLOOR BEDROOM AND NEW WINDOW 2ND Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. FLOOR;RECONFIGURE KITCHEN LAYOUT;CHANGE CEILING AT FORMAL DINING ROOM FROM VAULTED TO FLAT AND NEW LIGHTING LAYOUT. Signature Date 4/23/19 REV#5 -REVISED SITE WORK TO CREATE PATIOS AND STAIRS WITH CONSTRUCTION OF RETAINING WALLS(252 LF TOTAL)- OWNER-BUILDER DECLARATION ISSUED 1/14/19 I hereby affirm that I am exempt from the Contractor's License Law for one of the DEF#1 -ROOF TRUSS CALCULATIONS.ISSUED 8/17/2017 following two reasons: owner of the property,am exclusively contracting with licensed Sq.Ft Floor Area: Valuation:$500000.00 contractors to construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: APN Number: Occupancy Type: 1. 1 have and will maintain a Certificate of Consent to self-insure for Worker's 342 22 099 Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. j 2. I have and will maintain Worker's Compensation Insurance,as provided for by PERMIT EXPIRES IF WORK IS NOT STARTED Section 3700 of the Labor Code,for the performance of the work for which this WITHIN 180 DAYS OF PERMIT ISSUANCE OR 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 Issued by: Legacy exemption,I become subject to the Worker's Compensation provisions of the Date: 10/09/2015 Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. RE-ROOFS: APPLICANT CERTIFICATION All roofs shall be inspected prior to any roofing material being installed.If a roof is I certify that I have read this application and state that the above information is installed without first obtaining an inspection,I agree to remove all new materials for correct. I agree to comply with all city and county ordinances and state laws inspection. relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree Signature of Applicant: to save indemnify and keep harmless the City of Cupertino against liabilities, Date:4/23/19 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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER Code, Section 9.18. HAZARDOUS MATERIALS DISCLOSURE Signature Date 4/23/19 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 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: . 10645 CORDOVA RD CUPERTINO CA 95014 342 22 099 PERMIT NO. 14060193 ( ) OWNER BUILDER F WNER'S NAME: DATE ISSUED: 10/09/2015 WNER'S PHONE:( PHONE NO:(650)965-9052 LICENSED CONTRACTOR' DECLARATION BUILDING PER MIT INFO: License Class Lic.#633307 Contractor OWNER BUILDER Date 04/30/2018 —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: I hereby affirm under penalty of perjury one of the following two declarations: **LOT C**CONSTRUCT 3 STORY HILLSIDE SFDWL(2712 SQ FT): 1. I have and will maintain a certificate of consent to self-insure for Worker's GARAGE(441 SQ FT);AND PORCH(75 SQ FT);RETAINING Compensation,as provided for by Section 3700 of the Labor Code,for the WALL(S)ATTACHED/NEAR FOUNDATION(SEE PLN SHT S8.1). performance of the work for which this permit is issued. REV#7-MINOR REVISION TO RETAINING WALL DESIGN ANDREVISE TYPE OF RETAINING 2. I have and will maintain Worker's Compensation Insurance,as provided for b WALL ALONG PROPERTY LINE TO Section 3700 of the Labor Code,for the performance of the work for which this PIER AND CONCRETE WALL-ISSUED 07/10/2019 permit is issued. REV#1 -NECESSARY CHANGES DUE TO GRADING(PIERS, RETAINING WALLS);MINOR FLOOR PLAN CHANGES, ISSUED 6-1- APPLICANT CERTIFICATION 16. 1 certify that I have read this application and state that the above REV#2-MINOR REVISIONS T information is correct.I agree to comply with all city and county ordinances O FOUNDATION PLANS/DETAILS TO and state laws relating to building construction,and hereby authorize .REFLECT SITE CONDITIONS.ISSUED 9-13-16 REV#3-MINOR REVISIONS TO CIVIL PLAN FOR SITE representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the CONDITIONS. ISSUED 9/30/2016 City of Cupertino against liabilities,judgments,costs,and expenses which REV#4-RECONFIGURE SIDE AND REAR PATIOS,INCLUDING may accrue against said City in consequence of the granting of this permit. RETAINING WALLS AND STAIR LOCATIONS;RECONFIGURE Additionally,the applicant understands and will comply with all non-point BEDROOM#2 TO CREATE FORMAL LIVING AREA ADD source regulations per the Cupertino Municipal Code,Section 9.18. WINDOWS,CHANGE ELECTRICAL AND SHEAR W (N) WINDOW SIZE AT 1ST FLOOR BEDROOM A ALL,CHANGE AND NEW WINDOW 2ND Signature Date 07/10/2019 FLOOR;RECONFIGURE KITCHEN LAYOUT;CHANGE CEILING AT FORMAL DINING ROOM FROM VAULTED TO FLAT AND NEW OWNER-BUILDER DECLARATION LIGHTING LAYOUT. REV#5-REVISED SITE WORK TO CREATE PATIOS AND STAIRS I hereby affirm that I am exempt from the Contractor's License Law for one of the WITH CONSTRUCTION OF RETAINING WALLS(252 LF TOTAL)- following two reasons: ISSUED 1/14/19 ) 1. I,as owner of the property,or my employees with wages as their sole REV#6-REVISE RETAINING WALL DESIGN-ISSUED compensation,will do the work,and the structure is not intended or offered for 4/23/19 sale(Sec.7044,Business&Professions Code) DEF#1 -ROOF TRUSS CALCULATIONS.ISSUED 8/17/2017 2. 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 following three declarations: Sq.Ft F 1. I have and will maintain a Certificate of Consent to self-insure for Worker's q Floor Area: Valuation.$500000.00 Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number: Occupancy Type: 2. I have and will maintain Worker's Compensation Insurance,as provided for by 342 22 099 Section 3700 of the Labor Code,for the performance of the work for which this y permit is issued. 3. )I certify that in the performance of the work for which this permit is issued,I PERMIT EXPIRES IF shall not employ any person in an manner so as to become WORK IS NOT STARTED y ome subJect to the Worker's Compensation laws of California. If,after making this certificate of WITHIN 180 DAYS OF PERMIT ISSUANCE OR exemption,I become subject to the Worker's Compensation provisions of the 180 DAYS FROM LAST CALLED INSPECTION. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Issued by:Leacy APPLICANT CERTIFICATION Date: 10/09/2015 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 cit RE-ROOFS: enter upon the above mentioned property for inspection purposes. (We)agree installed with 11 be inspected prior to any roofing material being installed.If a roof is to save indemnify and keep harmless the City of Cupertino against liabilities, out first obtaining an inspection,I agree to remove all new materials for judgments,costs,and expenses which may accrue against said City in inspection. consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Signature of Applicant: Code,Section 9.18. Date:07/10/2019 Signature Date 07/10/2019 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER HAZARDOUS MATERIALS DISCLOSURE Fread the hazardous materials requirements under C ornia Health&Safety Code,Sections 25505,25533 napter 6.95 of the n compliance with the Cupertino Municipal Code C d 25534. I will h&Safety Code,Section 25532(a)should I store or hander aza and the al. Additionally,should I use equipment or devices which le hazardous air contaminants as defined by the Bay Area Air emit hazardou; will maintain compliance with the Cupertino Municipal Management District] the Health&Safety Code,Sections 5534.deq 9.12 anG 25534. Owner or authorized agent: Date:0 /10/2019 CONSTRUCTION LENDING AGENC I hereby affirm that there is a construction lendingagency of work's for which this permit is issued(Sec.3097, for the performance Name Civ C..) Lender's Address ARCHITECT'S DE111''1LARAT10N I understand my plans shall be used as public records Licensed Professional , CITY OF CUPERTINO 1 I FEE ESTIMATOR — BUILDING DIVISION 6gADDRESS: , 10645 cordova rd DATE: 06/30/2014 REVIEWED BY: Mendez APN: BP#: VALUATION: 1$500,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY USE: SFD or Duplex 2nd Unit? Yes No PENTAMATION PERMIT TYPE: 1 R3HIL WORK construct 2 story sfdwl 3214 s , attached garage 440 and porch 173 s SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Hillside, Custom) II-B,III-B,IV,V-B 3,809 $5,514.28 IR3HPLNCK $3,566.36 IR3HINSP TOTALS: 3,809 $5,514.28 1 $3,566.36 -t- F-1 F-1 Other Ll NOTE: This estimate does not include fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School District Ptc.)_ These fees are hosed on the nreliminary information available and are only an estimate. Contact the Deptfor addn'l info. FEE ITEMS ,(Fee Resolution 11-053 Ef. 7/l/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $5,514.28 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $3,566.36 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1 # new units $659.99 E) Work Without Permit? Yes No $0.00 Advanced Planning Fee: IPLLONGR $533.26 Select a Non-Residential Building or Structure 0 � T t'Eal 1 f)';s °ti; r'r<'idlrha trrtt fc'c'.`: Strom Motion Fee: IBSEISMICR $50.00 Select an Administrative Item Bldkt Stds Commission Fee: IBCBSC $20.00 SUBTOTALS: 10,343.89 $0.00 TOTAL FEE: 1 $10,343.89 Revised: 04/01 /2014 CITY OF CUPERTINO lmVft FEE ESTIMATOR — BUILDING DIVISION - ADDRESS: 10646 cordova rd TYPE OF CONSTR. DATE: 06/30/2014 REVIEWED BY: Mendez APN:BP#: BP FEES VALUATION: $500,000 PERMIT TYPE: Building Permit II-B,III-B,IV,V-B PLAN CHECK TYPE: New Construction PRIMARY SF or Duplex USE: IR3HPLNCK 2nd Unit? -' Yes " No PENTAMATION PERMIT TYPE: 1 R3HIL i WORK construct 2 story sfdwl 3214 s attached garage 440 and porch 173 s SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Hillside, Custom) II-B,III-B,IV,V-B 3,809 $5,514.28 IR3HPLNCK $3,566.36 IR3HINSP $0.00 PME Plan Check: $0.00 Permit Fee: $3,566.36 Suppl. Insp. Feer Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 3,809 1 $5,514.28 1 $3,566.36 Lil 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 nreliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E 7.%1/13) FEE QTY/FEE MISC ITEMS I3Pet Plan Check Fee: .C,.t,_t f. "t. ..El , t. , fY,`'; .J.t . E_ ST _ LLJ ,f Suppl. PC Fee: (a) Reg. 0 OT0.0 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 nreliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E 7.%1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $5,514.28 Select a Mise Bldg/Structure or Element of a Building Suppl. PC Fee: (a) Reg. 0 OT0.0 Ins $0.00 PME Plan Check: $0.00 Permit Fee: $3,566.36 Suppl. Insp. Feer Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR Lil # new units $ 659.99 .. E t .. ... .._ 0 Work Without Permit? Q Yes Q No $0.00 Advanced Planning Fee: IPLLONGR $533.26 Select a Non -Residential Building or Structure E) 0 Strong Motion Fee: IBSEIShMICR $50.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $20.00 SUBTOTALS: 10,343.89 $0:00 TOTAL FEE: $10,343.89 Revised: 04/01/2014