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15010142-F CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21180 CANYON OAK WAY CONTRACTOR. PERMIT NO: 15010142 OWNER'S NAME: WHETZEL SIMON HAN AND DECONINCK ELL /Ksv DATE ISSUED:04/21/2015 OWNER'S PHONE: 4084992536 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ �j Q, CONSTRUCT(N)OUTDOOR PAVILION(810 S.F.)WITH License Class Lic.# ` b i q /n .� GAS n � ) �" FIRE PLACE,OU'T'DOOR]KITCHEN W/ELECTRICAIL& Contractor � Date ' U PLUMBING&(N)ARI3OR(526 S.F.)W/ILIGHT FIXTURE. 1 hereby affirm that I am licensed under the provisions or 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 Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$200000 2.1mve 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 APN Number:34259003.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating i�'ITHIN 180 DAB'S®F PERMIT ISSUANCE®I8 to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 Dyl FROM LAS C A LED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,an s which may accrue against said City in consequence of the granti of this pe nWt understands and will comply Issued by: ➢)ate: with I non-point regula rtino Municipal Code,Section 9.18 n RE-ROOFS: Signa re Date —2 "`� 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 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,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 Iicensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 or the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,SectioWoulds r handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,sh d r devic s which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as deft d byQuali Management➢District I performance of the work for which this permit is issued. will maintain compliant with tell Code,Chapter9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Co ,SectnSection 3700 of the Labor Code,for the performance of the work for which thisOwner or authorized agenDater permit is issued. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must 1 hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITEC'T'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CONS ITRUCTM PERM11T APPUC ATIJONED D COMMUNITY DEVELOPMENT DEPARTMENT° BUILDING DIVISION o 10300 TORRE AVENUE°CUPERTINO,CA 95014-3255 Ca.DPERT ONO (408)777-3228° FAX(408)777-3333° building(a)cupertino.org 0 NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PRdJECT ADDRESS 21180 Canyon Oak Way APN a 342-59-003 OWNER NAME PHONE E-MAIL Simon Whetzel & Ellen deConinck 408-499-2536 simonhan@me.com STREET ADDRESS 21180 Canyon Oak Way CITY, STATE,ZIP Cupertino, CA 95014 FAX CONTACT NAME Tom Conroy/Kikuchi Kankel Design Group PHONE 650-726-7100 &MAILtconroy@kkdesigngroup.eom STREET ADDRESS CITY,STATE, ZIP FAX 730 Mill Street Half Moon Bay.CA 94019 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ® ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTORNAME ,TBD LICENSE NUMBER LICENSE TYPE BUS.LIC h COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME Tom Conroy LICENSE NUMBER 2005 BUS.LIC# COMPANY NAME Kikuchi Kankel Design Group EMAIL teonroy@kkdesigngroup.com FAX STREET ADDRESS 730 Mill Street CITY,STATE,ZIP Half Moon Bay,CA 94019 PHONE 650-726-7100 DESCRIPTION OF WORK New covered pavilion and gas fireplace; arbor; outdoor kitchen; landscape lighting and miscellaneous electrical; general landscaping '0 y 7'�r4 Z EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES R3/U 1 R3/U1 V-N 2 USE TYPE occ. SQ.FT. VALUATION(S) EEXIS G 4750 NEWFLOOR0 DEMO TOTAL AREA 0 NET AREA 4750 Pavilion&firep ace 810 $150,000 BATHROOM KITCHENOTHER 0 REMODEL AREA 0 REMODEL AREA O REMODEL AREA Arbordr $30,000 PORCH AREA DECK AREA TOTAL DECKMORCH AREA GARAGE AREA: DETACH 1301 0 1301 ATTACH Landscape Ligh ing N/A $20,000 #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY [1YES 1 BEING ADDED? ®NO ADDITION? O PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES _D 13 y"'� TOTAL VALUATION: PLANNING ADPL# [$NO PLANNING APPROVAL LETTER EICHLER HOME? 200.000 By my signature below,I certify to each of the following: I am the property owner or authorized agent a property o half. 1 have read this application and the information l h ve rovi d is ct. a read the Description of Work and verify it is accufate. I agree to comply w licable local ordinances and state laws r ing u I 'ng ons u ion. I thorize represe atives of Cupertino to enter the ab ve-identi ed property for inspection ses. Signature of Applicant/Agent: Date: SUPPLEMENT TION R D PLAN CHECK TYPE ROUTING SLIP t New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THF,-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06121!11 CITY OF CUPERTINO FEE ESTIMATOR— BUff LDffN G D1VffSION ADDRESS: 21180 CANYON OAK WAY DATE: 0112612015 REVIEWED BY: MELISSA APN: 342 59 003 BP#: � *VALUATION: 1$200,000 '°PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDADD USE: PERMIT TYPE: WORK CONSTRUCT N OUTDOOR PAVILION 810 S.F. WITH GAS FIRE PLACE OUTDOOR KITCHEN SCOPE W/ELECTRICAL& PLUMBING & (N) ARBOR (526 S.F.) W/LIGHT FIXTURE. RE-LANDSCAPE ®, Ifech. Plan c;'ie( Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check 0.0 hrs $0.00 Atec:h. 1"a rru[Fee: Plumb.Permit Fee: IPPERMIT Elec. Permit Fee: IEPERMIT Orher l/(_•h. Inst} Other Plumb Insp. HFrs_j $48.00 Other Elec.Insp. 0.0 hrs L$48.00 llech.hz'aP. Fee: hisp. ["CC Lire Ir-;l>. i4 NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on thepreliminary information available and are on/ an estimate Contact the De t for addn'l into. FEE ITEMS,Lee Resolution 11-053 L: 711/131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 510711 s.f. Patio Cover/Sun Room Suppl. PC Fee: 0 Reg. C OT O,Q hrs $0.00 $1,864.00 IPATIowooD I Wood PME Plan Check: $0.00 = # Covered Porch Permit Fee: $0.00 $1,003.00 IcovPoncll Suppl. Insp. Fee:Q Reg. 0 OT 0.0 hrs $0.00 11 Electrical PME Unit Fee: $0.00 $72.00 IBREMFIXT Fixtures,Lighting PME Permit Fee: $96.00 14 # Electrical (:r'l)t.m-10i!n Tax: $48.00 IBREMRECEP Recep/Switch/Outlets Administrative Fee: (ADMIN $45.00 1 # Plumbing Work Without Permit? 0 Yes 0 No $0.00 $72.00 IPGASRES Piping,Gas<=4 Outlets 0 Advanced:Planning Fee: $0.00 Select a Non-Residential G Travel Documentation Fee: ITRA VDOC $48.00 Building or Structure 0 d Strong Motion Fee: IBSEISMICR $26.00 Select an Administrative Item BldgStds Commission Fee: lBCBSC $8.00 SUBTOTALS: 1 $223.00 $3,059.00 TOTAL FEE: $3,282.00 Revised: 01106/2015 STATEMENT OF SPECIAL. INSPECTIONS, 2013 CBC COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O.,BUILDING OFFICIAL CUPf"Rl YP�a I 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 (408)777-3228-FAX(408)777-3333•buildingcDcupertino.org SITE ADDRESS L d �,rz.(1 1(1 oc"t W(x APN 342-59-003 s ®� Owne.......Simon•Whetzel&.Elle.,..de.Coninck .... Contractor,.PVew,Canaan,Landscapingt Inc. 21280 Canyon Oak Way 6081 Meridian Ave Suite 70 316 Address........ ..-....... ... ... . .......................................................I..... Address............... City/St.....Cupertino,CA 95014 408-499-2536 San Jose,C........ 12b 468-26�-2gw .. Zip...........................Phone.................:... City/St..:..............................................Zip...................Phone........................ Applicant..Kikuchi.f..Kankel..Design Gr.QUp...................................... Engineer/Architect.....51AL r4u- i :...� .................. 730 Mill Street Address........................................................................................................... Address.�'3�`.U..� s...�-:.......J�1:..... ., ..... ci /st.......Nalf Moon Bay, CA2 p4019 F�50-726-7100 ty Pone..................... PROJECT DESCRIPTION: Steel& wood framed backyard pavilion&open lattice trellis This"STATEMENT OF SPECIAL INSPECTIONS"is submitted in fulfillment of the requirements of CBC Sections 1704 and 1705. This form is structured after and used by permission from the Structural Engineer Association of Northern California's(SEAONC)mode statement of Special inspections. Also, included with this form is the following: ❑ "LIST OF SPECIAL INSPECTION AGENCIES(page 2). A list of testing agencies and other special inspectors that will be retained to conduct the tests and inspections for this project ❑ "SCHEDULE OF SPECIAL INSPECTION"(page 3-6). The Schedule of Special Inspections summarizes the Special Inspections and tests required. Special Inspectors will refer to the approved plans and specifications for detailed special inspection requirements. Any additional tests and inspections required by the approved plans and specifications shall also be performed. Special Inspections and Testing will be performed in accordance with the approved plans and specifications,this statement and CBC Sections 1704, 1705, 1706, 1707,and 1708. Interim reports will be submitted to the Building Official and the Design Professional in Responsible Charge in accordance with CBC Section 1704.1.2. A Final Report of Special Inspections documenting required Spacial Inspections,testing and correction of an pancies noted in the inspections shall be submitted prior to issuance of a Certificate of Use and Occupancy(SectiorAinal Report will document: • Required special inspections. • Correction of discrepancies noted in inspections. 87 The Owner recognizes his or her obligation to ensure that the construction complies with the approved permit documents and to implement this program of special inspections. In partial fulfillment of these obligations,the Owner will retain and directly pay for the Special Inspections as required in CBC Section 1704.1. This plan has been developed with the understanding that the Building Official will: C Review and approve the qualifications of the I . - ...��---,,, th e {{`�-�,�� //�� 4 Monitor special inspection activities on the jo site �rpec spe - rs ar- qu i+ ('t tdh";�performing their duties as called for in this Statement of Speoi tion. �J �' L� u a Review submitted inspection reports. a Perform inspections as required by the local building code. !have read and agree to comply with the terms and conditions of this statement Prepared By: Project a/Engineer 0 Architect '' ----� c'2 c� Registered Design Professional in Charge Si natus .. `..��.... .......................Lic.#.../....1..0..1...1..................Date: ...J/u// ....�3 Owner Name: `'' Owner's Authorization Signature...... ........ .. .......................................................Date: ......$/T— Inspection Agency/Inspector Name 66 j5�i } e@ CS Si natur .. ...,.................. .........Lir.#............. ..... .............15 ��..Date: Building Official or designee: Signature... ..........:... ...._................................ Date:... �1 SpeciolmpectiorrFornr.2012.doe revised 09/06111