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15120056CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22449 CUPERTINO RD CONTRACTOR:] t) ,,�,,f ( fS PERMITNO: 15120056 OWNER'S NAME: SUNNYVIEW LUTHERAN HOME I I DATE ISSUED: 12/07/2015 1 OWNER'S PHONE: 8182544124 1 , I PHONE NO: LICENSED CONTRACTOR'S DECLARATION License Class Laic. # (Is Contract r� 1 _ Date 17--l— 1 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 Compensation, as provided for by Section 3700 of the Labor Code, for the ,performance of the work for which this permit is issued. q have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws 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 regulationsper the Cupertino Municipal Code, Section 9.18. _ Signature~ '� Date 13 OWNER -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 (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 have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 inf&mation 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, JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ADA UPGRADES (SITE ACCESSIBILITY AND 2 RESTROOM MAIN DOORS) - LINKED TO PERMIT#15010066 Sq. Ft Floor Area: I Valuation: $48000 APN Number: 32615133.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITIIIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Lw Date: 12,11h 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: 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 25505,255L3, an 25P4. Owner or authorized agent: Date: ` CONSTRUCTION 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 Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 C JP €t`€ tC�IE} (408) 777-3228 • FAX (408) 777-3333 • building cDcupertino.orq ^- 1.5 ns 1 1 nTrUT i `n'KTCTn T Tr1m7nXT 1 I AnT1TTTnAT I AT TFR ATTnN / TT I i RF.VTCTnN / T)F.FF.RRF.D ORIGINAL PERMIT # PROJECT ADDRESS j( q ❑ OWNERAGENT APN# 1 OWNERNAME CONTRACTOR NAME PHONE 56wit IL itr tai4 t v� n VAC STREET`pADDIRESS CITY, STATE �IP FAX CONTACT NAME i PHONE E-MAIL j STREET ADDRESS a --� -3 ! , CITY, STATE, ZIP ! LA q I I q FAX ❑ OWNER ❑ OWNER -BUILDER. ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER + LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL CSL I CE@sYr i[CsP�s•C:� FAX STREET ADDRESS c CITY; STATE IP e 'Sc PHO E Gt C f?1 I C ARCHITECT/ENGINEER NAME T (• �—�ii� LICENSE NUMBER . EBUS, N ( LIC LT COMPANY NAME §§ E-MAIL�VVI ` �\ ... r STREET ADDRESS ^ CITY, STATE, ZIP PHONE r„ C� �' Z 7_ s DESCRIPTION OF WORK / c C VQ� 0 EXISTING USE I PROPOSED USE CONSTR. TYPE # STORIES USE TYPE I OCC. SQ.FT: VALUATION ($) EXISTG NEW FLOOR DEMO t T u AREA AREA AREA NET AREA BATHROOM - KITCHEN - OTHER REMODEL AREA REMODEL AREA REMODEL AREA ff DWELLING UNITS: IS A SECOND UNIT U YES SECOND 5 T uKr U r ca BEINGADDED? ®NO ADDITION? [-]NO E- APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES REUEIVED BY a TD,r VALUATION: PR r PLANNING APPL # �.NO PLANNING APPROVAL LETTER EICHLER HOME? [3NO By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on th p perty owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accura e. I agree to comply with all applicable local ordinances and state laws relating to building co struction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: �/� Date Z' I CITY OF CUPERTINO TUU U cmTnR A TMlP — RI T11DING DIVISION ADDRESS: 22449 Cupertino Rd DATE: 12/0712015 REVIEWED BY: Phuong EVALUATION: $48,000 APN: 325-15-133 BP#: PME Plan Check: PERMIT TYPE: Building Permi9�:'11 K TYPE: Tenant Improvement PRIMARY Commercial Building Permit Fee: Hourly Only? PENTAMATION 1 GENCOM' PERMIT TYPE: USE: Suppl. Insp. Fee: Reg. 0 OTjjj0q WORK ADA upgrades site accessibility and 2 restroom main doors -Linked to Permit#15010066 PME Unit Fee: SCOPE PME Permit Fee: Of , r: 3 f Jt NOTE. This estimate does not include fees due to other Departments (i.e.. Planning, Public Works, Fire, Sanitary Server District, School thDe or addn'l info. District, etc. These fees are based on the preliminaryinformation available and are onlyan estimate. Contact e t FEE ITEMS (Fee Resolution 1.1-053.& ?,' <`I3)FEE Q TY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes G) No $0.00Fs 2 hours Plan Check, Hourly R OT 0 0 hrs $0.00286.00 ISTPLNCx Suppl. PC Fee. •; eg. PME Plan Check: $0.00 Permit Fee: Hourly Only? $0.00 Suppl. Insp. Fee: Reg. 0 OTjjj0q $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? C Yes (F) No $0.00 Advanced. nced Planning Fee:, $0.00 Strong Motion Fee: 1BSEISIVIC0 $13.44 Bldg Stds Commission Fee: IBCBSC $2.00 . UBTOTAS $15.44 �___J Hours Inspections cz' $286.0 ISTINSP� Inspection, Hourly 0� Select an Administrative Item $572.00' TOTAL FEE $587.44 Revised: 10/01/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15120056 22449 CUPERTINO RD CUPERTINO CA 95014 (326 15 133) ICON BUILDERS 8889 E V IIA LINDA, SCOTTSDALE,AZ 85288 OWNER'S NAME: SUNNYVIEW LUTHERAN HOME OWNER'S PHONE: 818-254-4124 LICENSED CONTRACTOR'S_ DECLARATION License Class 13 Lic. 4861510 Contractor ICON BUILDERS Date 1 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: t. 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 02 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. 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. SignatureDate 03/15/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: r. 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 (Sce.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: t. 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. 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. 1 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. Date 03/15!2016 DATE ISSUED: 12/07/2015 PHONE NO: 310-450-5661 BUILDING PERMIT INFO: _ BLDG —ELECT —PLUMB _ MECH _ RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: ADA UPGRADES (SITE ACCESSIBILITY AND 2 RESTROOM MAIN DOORS) - LINKED TO PERMIT#15010066 REV #I - ALTERNATE MATERIALS AND METHODS FOR FIRE RATED ADA DOOR OPENER ISSUED 3/15/16 Sq. Ft Floor Area: I Valuation: $48000.00 APN Number: Occupancy Type: 326 15 133 PERMIT EXPIRES RF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 OAFS FROM LAST CALLED INSPECTION. Issued by: ABBY AYENDE Date: 03/15/2016 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: 03/1512016 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 1 store or handle hazardous material. Additionally, should 1 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, 2553 25534. Owner or authorized agent: Date: 03/15/2016 CONSTRUCTION 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 Professional D D CONSTRUCTION PERMIT APPLICATION v o 9y COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION a 10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255' CQJPERTti<!O (408) 777-3228 > FAX (408) 777-3333 ^ building(a,cupertino.org pp ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS n APN R 1 lel MAWER NAME PHONE E-MAIL STREETADDRESS CITY, STATE, ZIP � q J�oj,/ FAX V ;qNv 771 /// CONTACT NAME `�— I ' PHONE %1S- -Z5q _ i )l�� (/Q,( "� l E-MAIL STREET ADDRESS CITY, STATE, ZIP` 73: ❑ OWNER ❑ OWNTER-BUILDER ❑ OHT"ERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME s� i l� �J l LICENSE NU1vIB- l L O LICENSE 7YPE BUS. LIC ��01 grd CON4PAIYNA.A4) . + . l E-MAILV STREET ADDRESSw; /� CITY, STATE, 2IP PHONE Mo 3 Lc2 -�q%- -qol ARCHITECT/ENGINEER NAM t LICENSE NUMBER Q 1 t 0"-ri AA BUS. LIC n COMPANY NAME �, E-314AIL �fdr+ai:L JIB � A-7 '4*) j 1' ,1 STREET ADDRESS 5dl . s - �I ^ CITY, STATE, ZIP ��,� �� PHO6JN'5 � qJo� O �6 DESCRIPTION OF WORK6+ 1do com- a cl-r KA+' CnAk( -� oe-M-A-c- /Au SP- be t EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) ExISTG -NEN;' FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODELAREA PORCH AREA DECK ATB111 TOTAL DECRIPORCH ARFA GAR.AGE.SREA: DETACH ❑ ATTACH DWELLING UNITS: A SECOND UNIT ❑YES SECOND STORY ❑YES I_NGADDED? ❑NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEI\ y ' TOT-ALUATION: PLANKrNGAPPL-. []NO PLANTING APPROVAL LETTER EICHLER HOATE7 ❑ NO By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf V4,ave read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize re resentatives of Cupertino to enter the above-idenf led property, for inspection purposes. Signature of Applicant/Agent: �,-�� Date: 5� SUPPLEMENTAL INIFORMATION REQUIRED`RouTI G SLIP O� ER THE COU\TER a❑ BIII LDI\G PLA.\ REI IER Nell' SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building x. � permit for new building. '❑ E"RESS 0 PL4\\L\G PLS REQ IENi' Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ,'7;,j i ,❑'sT\DAIiD N ni Ing PUBLIC«oRl s F _ form if any Hazardous 1\4aterials are being used as part of this project. ❑ _ Copy of Plarming Approval Letter or Meeting with Planning prior to LARGE as )R;'0'S�\IT4R] TJI2E DEPT , SEt1'ERDISTRICT submittal of Building Permit application. �. .❑, ENVIRONMENTAL HEALTH , Bldo 4pp_2011. doc revised 06121111 R CITY OF CUP E][2TINO BUILDING PERMIT BUILDING ADDRESS: 22449 CUPERTINO RD CONT RACTOR:_JfC)yP' SW JdJ 1rS PERMITNO: 15120056 OWNER'S NAME: SUNNYVIEW LUTHERAN HOME DATE ISSUED: 12/07/2015 OWNER'S PHONE: 8182544124 PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL /' L ADA UPGRADES (SITE ACCESSIBILITY AND 2 RESTROOM Q License Class_ Lic. # (QLD `5 ( 0 MAIN DOORS) -1LI1� LINKED TO 1PIr1E31�/ IT#1501 0066 y tContrac�j� , i p Date 17-- -1 - 1!5 1 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: 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 Sq. Ft Floor Area: Valuation: $48000 performance of the work for which this permit is issued. 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 APN Number; 32615133.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 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 WITHIN 180 DAYS ®� PERMIT ISSUANCE ®� 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 OAFS FROM ]LASS' CALLED INSPECTION. 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 Issued by: Date: with all non -point source regulations er 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 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) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I 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, Section 25532(a) should I store or handle hazardous 1 have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, an255 . Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: — Date: 6 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 I 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 ARCHITECT'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 CUPERTINO COO � Sl R C- Inr PES v IT APP ICaT OO COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION 10300 TORRE AVENUE e CUPERTINO, CA 95014-3255 (408) 777-3228 ^ FAX (408) 777-3333 o building(cDcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED 15 12- bC ORIGINAL PERMIT # PROJECT ADDRESSZL14�y � „ ) AP1 # ��1 1515 - 133 w +W OWNERI` E PHONF I�_7,yy-�+�� EMMAIL I 'C STREET ADDRESS CITY, STATE ZIP n FAX SP2 V G CONTACT NAMEPHONE E-MAIL CNASTREET DRESS I .�7qq CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER (C f O _J t LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL • 1 _ + FAX STREET ADDRES CITY- STATE IP �� a S5�C PHON -� s �No ARCHIITECT/ENGINEER NAME IV LICENSE NUMBERl 1-7&( �� / li `a Il BUS. LJC # I n L COMPANY NAME E-MAIL FAX q-� S-7_ C� qq 1 ` + Ag XVII t i� I d STREET ©DRESS i CITY, STATE, ZIP PHONE ✓��- 73-7- 3 1 q DESCRIPTION OF WORK CS �'tt Gt cCQ SS , Q<S�SY00 M OAU D�(S EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDETACH '... ❑ ATTACH ''..... # DWELLING UNITS- IS A SECOND UNIT []YES SECOND STORY []YES BEINGADDED? []NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: TOTAL VALUATION: PLANNING APPL # []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO o /o By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on th p perry owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accura e. I agree to comply with all applicable local ordinances and state laws relating to building c struction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature ofApp] icant/Agent: Date: LL —7• 7P15 SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑" OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ 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 ❑ sANITARV SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 I. doc revised 06/21/11 CITY OF CUPERTINO IF", 7N, FEE ESTIMATOR - BUILDING DffVff SION Revised: 10/01/2015 ADDRESS: 22449 Cupertino Rd DATE: 12/07/2015 REVIEWED BY: Phuong NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. ThesefLes are based on thepreliminary information available and are onLy an estimate. Contact the Dfpt/oraddn'liq/o. APN: 325-15-133 BP#: *VALUATION: F$48,000 "PERMITTYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building U I SE: =PP 11 EPFNTAMATION RMIT TYPE: 1GENCOM WORK upgrades site accessibility and 2 restroom main doors) - Linked to Permit#1 5010066 �ADA SCOPE $0.00 Revised: 10/01/2015 A.vrw Fee: E17 ""e, NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. ThesefLes are based on thepreliminary information available and are onLy an estimate. Contact the Dfpt/oraddn'liq/o. FEE ITEMS (Tee Resonation 11-053 Eff 7,11,113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (D No $0.00 2 hours Plan Check, Hourly $286.00� IS7PLNCK Suppl. PC Fee: (E) Reg. 0 OT 1 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? ()Yes (!) No $0.00 Suppl. Insp. Feer Reg. C) OT 1 0.Q [—Lrs PME Unit Fee: PME Permit Fee. $0.001 Work Without Permit? Yes E) No $0.00 Advanced Plannjn� $0.00 hours Inspections $286.00 ISTINSP Inspection, Hourly� I T, 1 J. 1 ave Drw'u',newatiofli 11`et'�S' Strom,, Motion Fee: IBSEISMIC0 $13.44 Select an Administrative Item 1 Bidg, Stds Commission Fee: IBCBSC $2.00 SUBT0Tj=LS-.$15.44 $572.00 TOTAILFELE: $587.44 Revised: 10/01/2015 ALTERNATE iMviQTERIIAL S QUID METHODS l HODDS / MODDIFCATIJON FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 ^ FAX (408) 777-3333 • building(aDcupertino.org CUPERTINO ❑ REQUEST FOR MODIFICATION OF CODE (CBC 104.10, CFC 104.6) ® REQUEST FOR ALTERNATE MATERIAL, DESIGN OR METHOD OF CONSTRUCTION (CBC 104.11, CFC 104.9) ❑ REQUEST FOR HARDSHIP EXEMPTION OR EQUIVALENT FACILITATION (HEALTH AND SAFETY CODE 19957) To apply for this request, complete sections 1, 2, & 3 (ink or type) SITE ADDRESS 22449 Cupertino Road APN 325-15-130 DATE 11/06/2015 Front relopment Owner...........Po........ch...Dev...................................................... ................................................ PC #: Type:.V A Sprinklered......... 800 North Brand Boulevard, Glendale, CA 91203 Address......................................................................................................................... equivalency is provided. For alternate requests, applicant shall demonstrate suitability, strength, effectiveness, fire 3.............................. Permit* Stories: Martin Lakatos <MLAKATOS@frontporch.net> 818-254-4124 11 Email............................................................. Phone ...........................................R2 PLN #: .................................. Dept./Div ............................... Occupancy:........................... Floor Area:............................. Pauli....Engineering.., ..Inc. ............................. Title..Professional........Engineer............... A........................................... pplicant...... 2501 West Shaw, Fresno, CA 93711 Address ......................................................................................................................... Job Status: ........................... Occ. Load:............................ aulien Ineerin com 559-237-4408 Email..adminp9.. ......... Phone .......................................... ............... ......................................... ....'........6at eu......................... Use of Bldg: Apartments 2 1 REQUEST: For code modifications, please state the applicable code requirement and the extent of relief desired. For alternate requests, state the type of system proposed and design methods. Submit plans if necessary to illustrate request. Additional sheets or data may be attached. 11 R-4043 Ai ltomatir ind Pnwpr-ass'stpd doors and gates - 11 R-404 3 2 - Man[-., wereng de-aranre the - 2 existing automatic entrance doors located at Buildings B & C don't have the 24" clearance on the exterior side. Alternate Request: Use exception @ 11 B-404.3.2 - "Where automatic doors and gates remain open in the power off condition, compliance with Section 11 B-404.2.4 shall not be required" 3 JUSTIFICATION/FINDINGS OF EQUIVALENCY: For code modifications, applicant shall demonstrate that Code Section(s): CONDITIONS OF APPROVAL: special, individual reasons exist that make compliance with the strict letter of the ordinance impractical and that equivalency is provided. For alternate requests, applicant shall demonstrate suitability, strength, effectiveness, fire Exception to Section 11 B-404.2.4 resistance, durability, safety and sanitation that is equivalent to the code for a similar use. No. of Items: ............................ Attach additional sheets if necessary. The 2013 C R('. allows for an exception to Clearance t -q d, le to the fact that ai itomat'r donrs and gates remain open in the power off condition and when powered on the au m tic doors and gates are opened by pressure mats at the exterior and interior of each door DatePaid: ................................ i eviewedPetitio' S,nPrincipal Engineer a=4-- ...................................... Position:. .................................. .. Date: 1 B ....'........6at eu......................... r The Request is: BGRANTED 11DENIED Dept. Comments: CONDITIONS OF APPROVAL: B n No. of Items: ............................ FeeDue: $................................ DatePaid: ................................ Receipt No.: .............................. Processed by: ............................ /�-�� Ate, �.�...1�...b......... Buildin Official. ...................Print:oip?;!" ........+1. .`.........................Date: FireMarshal: ................. ................................................................... Print:................................................................................. Date:.................................. DEPARTMENT ACTION: After determination, copies to: 1) applicant, 2) permit file Altform_2015.doc revised 0710/,15 0 ALTERNATE MATERIIALS AND METHODS 4 nMli OW11C AT110H FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - buildingQcupertino.org CUPERTINO ❑ REQUEST FOR MODIFICATION OF CODE (CBC 104.10, CFC 104.8) ® REQUEST FOR ALTERNATE MATERIAL, DESIGN OR PAETHOD OF CONSTRUCTION (CBC 104.11, CFC 104.9) ❑ REQUEST FOR HARDSHIP EXEMPTION OR EQUIVALENT FACILITATION (HEALTH AND SAFETY CODE 19957) To apply for this request, complete sections 1, 2, 8 3 (ink or type) ADDRESS 22449 Cupertino RoadAPRI 325-15-133 DATE ®2/�9/�®( Owner,FRONT PORCH DEVELOPMENT PC#: ................ .................. V A Sprinkiered Type:................................... 800 NORTH BRAND BOULEVARD, GLEN.DALE, CA 91203 Address.................... 15010066.............. 11 B-202.3 Alterations, 118-404.3 ...............................................................-................. ................... Permit #: Stories: .3 ...... ............... ........ Martinlakatos<MtAKATOSQfrontpoprch:net> Phone.818-254-4124 �PLNEmail. ............................................... #: .................................. Dept./Div ............................... Occupancy:.R. ......................... Floor Area:............................ Pauli Engineering, Inc. Professional E sneer Applicant. ................................................................ Title.........................�................ 2501 West Shaw Avenue Fresno California Address..................................................................................... Job Status: ............... ........... Occ. Load:........................... admin aulien Ineerin corn 559-237-4408 Email............C°�. p..........9........... 9 .:......................... Phone..................... Use of Bldg: Apartments 3 REQUEST: For code modifications, please state the applicable code requirement and the extent of relief desired. For alternate requests, state the type of system proposed and design methods. Submit plans if necessary to illustrate request. Additional sheets or data maybe attached. 18" table 1113-40424.1, existing doors do not have the 18" clearance solution was double swin'q the doors, however due to the 1 hour rated corridor and the need for 20 minute door and frame assern le doors cannot double swing - there is no fire seal, latch or closer 3 JUSTIFICATION/FINDINGS OF EQUIVALENCY: For code modifications, applicant shall demonstrate that Code Section(s): special, individual reasons exist that make compliance with the strict letter of the ordinance impractical and that equivalency is provided. For alternate requests, applicant shall demonstrate suitability, strength, effectiveness, fire 11 B-202.3 Alterations, 118-404.3 resistance, durability, safety and sanitation that is equivalent to the code for a similar use. Attach additional sheets if necessary. Recil jest to pirovide a tbe I lse of Disability Systems, lnr. or eq, jai — ADA EZ Commercial Hal:ld"rao Don Opener, ADAEZ Pro Complete with Electronic Lock Interface & Electronic Strike Release to be installed on the public Men's and Women's restroom doors in Building A. Low-energy and power assisted door complies with ANSI-BHMA A156.19 (see attached plan) Petitioner's ........ition:.Principal Engineere Signatu -......Pos.....Dat/ Reviewed ...................Date:.......................... Buildin Official: ............. ...........Print:...... ... ....... ....................J........._..............Date:.. ..I�. ...G!I?�..... FireMarshal: ........................................ .... ..................... -- ......... Print:................................................................................. Date:.................................. DEPARTMENT ACTION: After determination, copies to: 1) applicant, 2) permit file Allf6rm_2015.doc revised 07101,15 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22449 CUPERTINO RD CUPERTINO CA 95014 (326 15 133) CONTRACTOR: ICON BUILDERS 8889 E VIIA LINDA, SCOTTSDALE, AZ 85288 PERMIT NO: 15120056 OWNER'S NAME: SUNNYVIEW LUTHERAN HOME DATE ISSUED: 12/07/2015 OWNER'S PHONE: 818-254-4124 PHONE NO: 310-450-5661 LICENSED CONTRACTOR'S DECLARATION License Class B Lic. #861510 Contractor ICON BUILDERS 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: 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. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code, Section 9.18. Signature___________________________________ Date 03/15/2016 OWNER - BUILDER DECLARATION 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 (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). 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 03/15/2016 BUILDING PERMIT INFO: BLDG ELECT PLUMB MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: ADA UPGRADES (SITE ACCESSIBILITY AND 2 RESTROOM MAIN DOORS) - LINKED TO PERMIT#15010066 REV #1 - ALTERNATE MATERIALS AND METHODS FOR FIRE RATED ADA DOOR OPENER ISSUED 3/15/16 Sq. Ft Floor Area: Valuation: $48000.00 APN Number: 326 15 133 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: ABBY AYENDE Date: 03/15/2016 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: 03/15/2016 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: 03/15/2016 CONSTRUCTION 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 Professional________________________________________________