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15100008-2ND UNITCITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: - CONTRACTOR: PERMIT NO: 15140008 22343 MCCLELLAN RD UNIT 2 CUPERTINO, CA 95014 (357 05 004) DIANLI CHEN CONSTRUCTION CUPERTINO, CA 95014 OWNER'S NAME: HSUEH PO-JEN AND KONG PO DATE ISSUED: 04/27/2016 OWNER'S PHONE: (650) 303-9394 PHONE NO: (408) 888-2898 ,ICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Ej Lic. #856154 Contractor DIANLI CHEN CONSTRUCTION Date 03/31/2017 —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 (N) DETACHED 2ND UNIT (796 S.F.) I hereby affirm under penalty of perjury one of the following two declarations: 1. 1 have and will maintain a certificate of consent to self -insure for Worker's DEF #1 - ROOF TRUSS - ISSUED 11/7/2016 Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance, as provided for by iSection 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $200000.00 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 APN Number: Occupancy Type: and State laws relating to building construction, and hereby authorize 35705004 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 City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. ,Signature 1S I " Date 11/712016 Issued by: Abby Ayende Date: 04/27/2016 OWNER-BUELDERDECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RF, -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. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 11/7/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 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. I have and will maintain Worker's Compensation Insurance, as provided for by HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the 2. Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. pe Health & Safety Code, Section 25532(a) should I store or handle hazardous 3. I rmity that in the performance of the work for which this permit is issued, I material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino M cipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, ections 255, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 11 /7/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY 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 DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal I understand my plans shalt be used as public records. Code, Section 9.18. Licensed Signature Date 11/7/2016 Professional CONSTRUCTION PERMIT APPLICATION k COMMUNI T" DEVELOPMiENT DEPART10ENT . BUILDING DIVISION 10300 T ORRE AVENUE • CUPERTINO, CA 95014-3255 r CUP;lR€Ehta (408) 777-3228 cKXX (408) 777-3333 ^ buildinarc�cucerlinc.org ❑ YEW CONSTRUCTION []ADDITION FI ," -T FP kTI01\Ti TI �"Lig RE\ iC10�1 /�FFFRRFi� (�P,T(i v�T PPPt.IiT- PROIiCTADDRESS MC(,1Ch�oV) I EPwr /S-/ Ld000� STREET ADDRESS CITY, STi -, McClellan �d 14 -)310 '10 P= P_,i 2 CO\ CONTACT KIJ\SE PC) �U1 - I L ,4077 1 m (,LQ sTR D s j 3 M&� fF CI STATE, ZIP % `f AX r�07YER ❑ MN—M-131--DER ❑ mvI\-rtAGD\T ❑ COI\T?gCTOR 11C01M1,CTORAG`TT ❑ APC -_QCT El ENGINEER ❑ DE1�cL0a.ER ❑zx,-\,T CO�Tt4CT03 Ab4i� `� �� LICE? S-KLIJBER r g I LICE? SE Tl PE <' b 1 I HUS. LIC COA F' !I Fl, E ` ` 1\ -TL ! I F43 SpTREt i" DP Cid STATE. - - F1\ TY=;R?� s ME r.� i ICENSE AZr7��BER I BUS. LIC 4 /''^ 4 i� , a � � CO tTA:\TY KAME -- E-1 i -1L L � cc FP X STREETADDzL'SS � TW, TIP (C 4V,/ `.CT � Pr § DESCPJPTI O'v' OF 1MCPI: 6 . �(u ` S GN S'i- EXIS,F:G USE PROPOSED USE CONSTR i�?E -STORIES USE Ti'PE I OCC. I SQ.FT. I ZEAL-t:q'I'?0N (S) EXISTG hcW FLOOR DEi„0 TOTAL- .Pu'LA F3.EA ARE4 .1,ET AR EA I I BATEROO 4I P,.TTCHEIQ - 0Tr R - R0DEL.AREA .= 4 RM\d0DEL,hEA I REl✓ODELAP`A PORCHAREA DECKAF=A TOTAL DECK?ORCHA2EA G ARA. GE=.P.EA.: El DETACH ❑ ATTACH Di'E_L.'GL^\7T5: IS A SECOND IT [j IMS SFCOND [3 I EL GADDED? [D "m .OS ADDITION? [3.\O PR= t:C A- '\ 1 ` c5 T YES. PROVE -DE COPY OF IS THE BLDG . \ LS ❑ ” P Ei EC BY _ � ;7 q 1 OT ".t \ ^ _ti. Ti0 PLfi,.\"\SGA'?r. ❑\0 PL��'_'\G:-pPRO\.-,LLTEA I EICHLERHC'�lE? ❑?;�0 I <s; By Lv signaturesigmature bcflow, I ce i = to etch of the iollo L -g: I ana the prop -ry owner o authorized aEent to act on e property owner's behalf,I have ad this appii„ anon and she 7r ro, raz.ion I have u -17i --d is correct. I h �'e read h Description of"Fork orl and , g ;t is acct ate I wee to comply with all zpallcable local . a ordm -ic s and to la�,s r 7a �Da to buil a ca -s .oa. - =rrl tonze * uresemtatives of CLDe; Lino to enter th above-io fried + op , �y =oi ;nspectiop purposes. e 5 i.-IIatL, e, of.-raphca-iilAgent. Date: �E SUPPLEl\4EltTAL I'NF'O MATIOIT REQUIRED PLA\CF_EChTIPS MI P.OLIIRG�TIEi "' e,�- SFD cr?,fultirai 7i;y d; eilir.as:Apply -7for deolit`'iion unit for 1 O�ERTPFCOL'\aER '1 SLiLDI1GP _ _ ,�..1 tJu11-i-g(s) D �noli-Lio 1 • enin k s -eC =-d D-ior ' ua�,.� 1•i•?in �_.. r P..r_ t Is .L_r _ : v. �O :S>�c;: �,. 0: Li_�._._ . _ . .�-.. gluPa f 4-� i,DerT:.,i7Cr ne-w building. 1PREs� CO:,,_7:c ..lal. Baas, PrCFi Cie a CCI ,pl..:ed F-aZ_r.dou�- R/_tera15 DiscicS�_-e D.: ST '\'D tiD. . - 1 n 'SLIC\ ORIS`; OJecL ❑ J ?RGE - FIRE- DT �--Prior..c CcY} oIP1cSLnina_ Approval Le�er ertv`eefIia ith Pl�rninato ❑ '�L�.JOR � S�'�Ir submittal ofBuilding Pern7•t application. R1 SFTi'x•RDr�TRICT _ AE. BId.g<pp_2011.dOO t•evised 05/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: - PERMIT NO: 15100008 22343 MCCLELLAN RD UNIT 2 CUPERTINO, CA 95014 (357 05 004) DIANLI CHEN CONSTRUCTION CUPERTINO, CA 95014 OWNER'S NAME: HSUEH PO-JEN AND KONG PO OWNER'S PHONE; 408-326-9770 LICENSED CONTRACTOR'S DECLARATION License Class B Lic. #856154 Contractor DIANLI CHEN CONSTRUCTION Date 03/31/2017 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. I hat 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 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 4/27/2016 OWNER- B ERDECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 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. i. 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. a. 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 l 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 4/27/2016 DATE ISSUED: 04/27/2016 NO: (408) 888-2898 BUILDING PERMIT INFO: BLDG —ELECT —PLUMB MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: CONSTRUCT (N) DETACHED 2ND UNIT (796 S.F.) Sq. Ft Floor Area: Valuation: $200000.00 APN Number: Occupancy Type: 357 05 004 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Avende Date: 04/27/2016 au&k N%4k RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 4/27^ /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 agent: Date: 4/27/2016 N TRU TI N 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255CUPERTING . 408 777-3228 • FAX 408 777-3333 • building (Qcuoertino.ora Np.W CtWCTRTT('TT(-)V F-1 AT)T)TTR1N I 1 ST TFT ATT(1TS /TT F RF\TTCT()V IT1T='L'L"DD7Pn r)DT!_TKTAT DCDIIT-r u PROJECT ADDRESS "P CaI V 9C.. 9 itf APNu ,l- — 0() V, OWNER NAME o� ry PHONE, ter- E-MAIL aA`iu, % . A STREET ADDRESSCITY ,. STATE, Zj� , � FAX c, 2CONTACT (/V NAME �j� _ PHONE Psi ai� � v E-MAIL 5 / w1%at ADDRESS ADDRESza,rtxtod CITY, STATE, ZIP FAX ,,2_9 El OWNER 11 OWNER -BUILDER EloATLRAGENT ElCONTRACTOR 13CONTRACTOR AGENT 2S, ARCHITECT ❑'ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �• LICENSE NUMBERI' LICENSE TYPE i BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME V fi r LICENSE NUMBER LJ BUS. LIC m COMPANY NAME-' E-MAIL FAX p STREET ADDRESSS CITY, STATE; ZIP PH01 /o C 6 C DESCRIPTION OF WORK 2-A-0 - - f ' 1 AJ EXISTING USE PROPOSED USE CONSTRTYPE- #STORIES ( USE TYPE I OCC. I SQ.FT. VALUATION (S) EXI TG NEW FLOOR DEMO TOTAL - - AREA AREA AREA NET AREA BATHROOM. KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK1ISASI TOTAL DECK/PORCH AREA GARAGE AREA: DETACH - - ATTACH n DWELLING UNITS:CONDUNIT E]YES SECONDSTORY []YESING ADDED? NO ADDITION? E]NO - PRE-.SPPLICATION OYES IF YES, PRO VIDE COPY OF I PLANNING APPL R NO PLANNDAG APPROVAL LETTER IS THE BLDG AN ®- EICHLER HOM 1t0 3t$C£TED BY - TOTALUAr I:�� . 2 �� (/ -_ By my signature below, I certify to each of the following: I am he prope r orauthorized, _eIi o� �n the property owner's behalf. a , read this application and the information I have provided is correct. I hav Tea the Descr' ion of Work and verify it is accurate. I agree to -comply with all applicable local ordinances and state laws relating to bu' din; nstruction. I auori e represen ives'of Cupertino to enter the above-ide ified pro erty for inspection pu o 11 Date: Signature of ApplicantlAgent: SUPPLEMENTAL IN RMATION REQUIRED ;4 -h � P.IrA3� CHEC%T1�E _ � _ �;«-320UTII�GSLTP;_ `z � New SFD or Multifamily d -Wellings: Apply for demolition permit for RPM o«R Ta�coTn TER BvuDL.G L NREVI v existing building(s). Demolition permit is required prior to issuance of building . for building. - ExPxEss zx -� PLA3�'I'LRGPLei'Tv ILESiEW permit new Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sTu.DARDn puBlc�oRxs_ 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. ��vTA70R.�, -Sr'G\TTARYSI:S'4�I2DIST'RICT B7�-VSLtOI4MEI1T4LARAIS'I'A�-=- Bld.-App_2011. doc revised 06/21/11 K 7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION IiAADDRESS: 22343 MCCLELLAN RD DATE: 10/01/2015 REVIEWED BY: MELISSA APN: '357 05 004 BP#: 15 Gd 00 O$ VALUATION: 1$200,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY USE: SFD or Duplex 2nd Unit? Yes % No PENTAMATION PERMIT TYPE: 1 R3SFD2NDD WORK CONSTRUCT N DETACHED 2ND UNIT 796 S.F. SCOPE $1,666.00 OCCUPANCY TYPE: TYPE OF FLR AREA CONSTR. s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) 11-B,111-B,IV,V-B. 796 $2,654.00 IR3PLNCK $1,666.00 IR3INSP TOTALS: 796 $2,654.00 $1,666.00 Adech. Plan Check I I Phimh . Plon Check Elec, Pla;i Check ' Tech Permit lee: Phimb. F'ef latit Fee: Elec. Perrnit fee: Othe r Mech. Jnsp} Other Plurrih .Irina. Other l-lec. Insp. ;llech. Imp. Fee: Phimb. Imp. Fee: Elea Insp. Fee: NnTF. Thic ectimate does not include fees due to other Denartments (i.e. Plannine. Public Works. Fire. Sanitary Sewer District, School District, etc.). Thesefees are based on the preliminary information available and are. only an estimate. Contact the Dept_ for addn'l info. FEE ITEMS (Fee Resolution II -053 Elf. 7/1/13 FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,654.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Reg. O OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,666.00 Suppl. Insp. Feer Reg. OT 0.0 . hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tak` IBCONSTAYR 1 #new units $684.98 �iclrninr.strrxf se ' ?: 071A Work Without Permit? O Yes (E) No $0.00 Advanced Planning Fee: IPLLONGR $111.44 Select a Non -Residential 0 Building or Structure Strong Motion Fee: lBSEISMICR $26.00 Select an Administrative Item k Bldg Stds Commission Fee: IBCBSC $8.00 s.SVBTfJTALS= $5,150.42 $0.00 a0�- $5,150.42 Revised: 07/02/2015 /� 'r V Vu FILE —27— CHIA-CHING LIN 45741 CHABLIS COURT FREMONT, CA 94539 TEL:5105869380 Nov. 2, 2016 Building & Safety Division 10300 Torre Avenue Cupertino, CA 95014 mainly is to notify you that 1, Chia -Ching Lin, P.E., have inspected the framings of the single family house located at 22343 McClellan Road, CA. The construction of the wood framings, is found acceptable and g to the requirements by the city approved plans and the current California t. Code, and general construction practices. If you have any question his, please let me know. �QROI:ESS/p�� 059066 5; Exp. 6-30-2017 Mwolw/w or� Chia -Ching Lin, P.E. 45741 Chablis Court Fremont, CA 94539 .. . .. . ... . . . . ....... ......... ... . ........... . . . . . . . . . . . . . . . .. .. .. . . . . . . . . . . . . . . ... . . - Building Department City Of Cupertino 10300 Torre Avenue. Cupertino, CA 95014-3255 C U P E RT I N O Telephone • 408-777-3228 Fax. 408-777-3333 CONTRACTOR / SUBCONTRACTOR LLT JOB ADDRESS x,2,3 MCC [tj iCq) i � CU: f !no �T6J PERMIT # /-'/0bbD7 If) Do oDS OWNER'S NAME. PL) b- QAu(Ci PHONE # 97M�T�- GENERAL CONTRACTOR. pion (i dhen BUSINESS LICENSE # ?S -6/J-4 ,ADD SS (pI�l W10 -1vt cupt'-, r, QYV)4 CITY/ZIPCODE Ct p9r 111)b 014 7,1-014 Cement Finishing , vu=—u--pa= 9;uuC irquues au uusiness.es worKmg in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors. f Signature Date Please check applicable subcontractors and complete the following information. b- C Owner / Contractor Signature - �' Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile b- C Owner / Contractor Signature - �' Date CUPERTINO PURPOSE UTILITY RELEASE REQUEST FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a�cupertino.org For residential single family or duplex construction, there are cases where gas and electric utilities are requested to be released prior to the issuance of the certificate of occupancy. Upon approval from the building inspector, the City of Cupertino is allowing both utilities to be released prior to the final sign -off of the building. INSTRUCTIONS 1. Download this form at: http://www.cu-oertino.org/index.aspx?page=297. 2. Complete the form and obtain signatures from both the owner of the property and the primary contractor. 3. Fax, E -Mail, Mail or hand deliver the original signed form to: City of Cupertino Building Division Attn: Utility Release Request Form 408-777-3228 office G00 Torre Ave. 408-777-3333 fax Cupertino, CA 95014 building(a,cupertino.org 4. Schedule a Gas Meter Release inspection (#403) and/or Electric Meter Release inspection (#404). Please note, a Gas Test inspection (#506) is required prior to or at the same time of the Gas Meter Release inspection. BUILDING INFORMATION (Please complete the following information): APN � Q� �Q BLDG PEIT #-S- MOoal l 5 r 6 6 DATES ' SITE ADDRESS: �25�� M(Xje(0') Gj C4) _ _ 1i0b C O I.ER'S AME: 1 � L? E; PU , E� PHONE #: FAX #: ��D r 3D7 _g3�jL1 > MAILING ADDRESS (if different from site address): CONTRACTOR:b)o )I dqe// FAX #: O" 0 0 0 / CONTACT: FAO#E #: /`,W' 7 �� 0,� 743 I request the City to release my utilities prior to obtaining a final inspection approval for the building. I fully understand the occupants of the building cannot move into the residence until they receive all of the required final sign -offs and the City has issued a certificate of occupancy for the building. Owner: ........ .................................. Print:.......... ....... ... ................................... Date:. r. ...... ........ Contractor:.. \'t% ............ ........................................I..... Print:.......... ........................................... Date:.. L� ............ UtilityReleaseForm 2011.doc revised 08/09/11 Cupertino Union School District 10301 Vista Drive, Cupertino, CA 95014 Tel (408) 252-3000 • Fax (408) 865-0326 10943 Developer Impact Fee Compliance The Cupertino Union School District has adopted Resolution Nos. 1403, 1404, and 141501, imposing developer impact fee pursuant to Government Code 53080. Building Permit Request The City of (U1"C K -TW O has received a request for a Building Permit described as follows: Residential Development Project Commercial/Industrial Development Project \ Name of Developer/Owner i �•l" ��$��` j� ff�� Project Address:�- Description: C U Yl S-'Tre -U C 7 �� N f: IA C f -t L D Z i i I) U NJ t T Square Footage:— Lot/Parcel #: t - 06 Permit #A r I no DD Date: 4 � !f � By: City Authorized Reliresentative Square footage will be verified by the city prior to issuance of a building permit; fees may be adjusted accordingly. Important Notice: Bring this form and payment to 10301 Vista Drive, Property Office. Cupertino Union School District gives no credit for total demolition of existing square footage area, which makes way for new construction as mandated in the Government Code Sections 53080, 53080.6 and 65995. SCHOOL DISTRICT DEVELOPER IMPACT FEE CERTIFICATE OF COMPLIANCE The authorized representative of the Cupertino Union School District has reviewed the 7 City of 0QP�P ) >U0' Building Permit Request described above and hereby certifies that the developer or authorized representative has met the requirements of the District's Developer Impact Fee requirements. Dated: Certificate not valid without District seal, initial, and date. By: Authorized l�5resentative Cupertino Union School District Fee: $/, 9 O 7 / Check No.: �0 Facilities Planning - White City - Yellow Requestor - Pink Accounting - Gold The City of 0 FREMONT UNION HIGH SCHOOL DISTRICT 589 WEST FREMONT AVENUE SUNNYVALE, CALIFORNIA 94087 408-522-2200 Developer Impact Fee Compliance Building permits will not be issued without a completed Certificate of Compliance Building Permit Application has received a request for a Building Permit described as follows: _ New Residential Development _ Residential Addition (501) sq. ft. or more _ Commercial Development Name of Owner/ Developer: fsur. Project Address: G -d1 itl I Lot/Parcel # >` US CY�� I Square Footage: Description: c ons -w UC % ( N) f) _T A 7c ! {C 1-) 2 N I> C)A l T Permit / Plan Check # 10000 c Date: 4- - I By: City Building Inspector Square footage verified by the city prior to issuance of a building permit; fees may be adjusted accordingly. Feeder Elementary District f ......................................:?J..1.................................................................... SCHOOL DISTRICT DEVELOPER IMPACT FEE CERTIFICATE OF COMPLIANCE The authorized representative of the Fremont Union High School District has reviewed the City of /'�/ • ,'r' i- h o f Building Permit Request described above and hereby certifies that the developer or authorized representative has met the requirements of the District's Developer Impact Fee requirements. Dated: '/ ' Lb - /6 By: Z a. pf ?, 14 1,/ 46 Certificate not valid without District Seal, Initial, and Date Distribution: Facilities Planning —White City — Yellow Fremont Union High School District Authorized Representative Fee $ / o /, ,/, , / 4 Requestor — Pink Accounting — Gold Dev. Impact Fee Compliance (Rev. 11/22/05) [12/08 — 1000] CUPERTINO Building Department CITY OF CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3228 • FAX: (408) 777-7606 OFFICIAL NOTIFICATION OF NEW/ADDRESS CHANGE TO: All Agencies FROM: City of Cupertino DATE: February 25, 2016 RE: New/ Change of Address APN #357-05-004 Please note the following new address assignment: 22343 McClellan Rd is adding a detached 2nd unit. The Main house will remain 22343 McClellan Rd and the detached 2nd unit will be 22343 McClellan Rd, Unit 2. See attached map. The new address will take effect 15 days from the date of this letter. Please update your records accordingly. If you have any questions, please call me at (408) 777-3246. Sincerely, Susan Winslow Administrative Clerk Cupertino Building Dept 408-777-3246 or suew@cupertino.org IAi AT ,ate � rh I � {;�' � ' .• i + te � .... 10545 - 1 u - r� � a � . � 1 E � ! % 1058 { 1 ' '>y 22347 _ �� ' 1 • F RT�- S ' It . fi , t •19 ! a. 22551: 14 �e � OA C l e- I l Ck VN I 2 Z 3 Y 7 0 e