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12010137CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22263 N DE ANZA CIR -CONTRACTOR: RATTS CONSTRUCTION PERMIT NO: 12010137 OWNER'S NAME: PERRYMAN HEATH ET AL 49 MARTINS BEACH RD DATE ISSUED: 04/118012 OWNER'S PHONE: 4088684651 HALF MOON BAY, CA 94014 PHONE NO: (650) 492-5901 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALE] License Class95ILa) Lic. 4 SFDWL ADDITION OF 738 SQFT-3 BEDROOMS,I �., , t L �� (� Contractor 1710 BATH,DINING ROOM; REMODEL 360SQFT BEDROOM, �� LAUNDRY,PANTRY,34S FT RE-ROOF,20005 FT STUCCO, I hereby affirm that I am licensed under the provisions of Chapter 9 8/30/12- REVISION 0- ADD SKYLIGHT, REVISE CEILINGS, ADD (commencing with Section 7000) of Division 3 of the Business & Professions 16 LIGHTS AND 15 OUTLETS, REMODEL MASTER BATHROOM Code and that my license is in full force and effect. 120 SQ FT, ADD WET BAR SINK, CONSTRUCT PLANTER IN ENTRY, ADD IN'T'ERIOR WINDOWS IN HALLWAY -ISSUED 8/30 I hereby affirm under penalty of perjury one of the following two declarations: 1 have and will maintain a certificate of consent to self -insure for Worker's QS% Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $280000 performance of the work for which this permit is issued. 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 APN Number: 356 0 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORD IS NOT STARTED correct. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DA LAST CALLED INSP CTION. 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 -poi rce regulations per the Cup"' o Municipal Code, Section RE -ROOFS: 9.18. Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, l agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: 1 hereby affirm that 1 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) I, 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. 1 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 I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should 1 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 1 performance of the work for which this permit is issued. will maintain compliance with the Cu rti no Municipal Co Chapter 9.12 and I have artd 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 the Health & Safety Code, Sections 05, 25533, and 55 Owner or authorized agent: Date: 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 I CITY OF CUPIERTIN1O BUILDING PERMIT I BUILDING ADDRESS: 22263 N DE ANZA CI R OWNER'S NAME: PERRYMAN HEATH ET AL OWNER'S PHONE: 4088684651 ❑ LICENSED CONTRACTOR'S DECLARATION License Class � L--ic__,k �� S 1& -NI r -y ContractoAs �[j�I Y 1prgfDate 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. 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 1 certify that I have read this application and state that the above informa ion 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. Signaturc�T" - Date Z ❑ OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: 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 orctifczt, for sale (See,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. 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. 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. 1 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 CONTRACTOR: RATTS PERMIT NO: 12010137 CONSTRUCTION 49 MARTINS BEACH RD DATE ISSUED: 04/11/2012 HALF MOON BAY, CA 94014 PHONE NO: (650)492-5901 BUILDING PERMIT INFO: BLDG r ELECT PLUMB MECH RESIDENTIAL COMMERCIAL JOB DESCRIP'T'ION: SFDWL ADDITION OF 738 SQFT-3 BLDROOMSJ BATKDINING ROOM; REMODEL 360SQFTIIEDROOM, LAUNDRY,PANTRY,34SQFT RE-ROOF,2000SQ1"1' STUCCO, 5/8/12 REVISION 42- CHANGE SHEAR WALL DETAIL IN CRAWLSPACE, SHOW REPAIR OF ROTTED BEAM ON EAST SIDE, OF SFDWL -ISSD 5/8/12 Sq. Ft Floor Area: I Valuation: $220000 APN Number: 35602022.00 1 Occnpancy "Type: PERMIT EXPIRES IF WORK 1S NOT STARTED D WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM ]LAST CALLED INSPECTION. Issued by: 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. Signature of Applicant: Date: ALI, ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should f 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 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 5051 25533, an 2553 Owner or authorized agent: Date: l CONSTRUCTION LENDING AGENCY 1 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 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22263 N DE ANZA CIR CONTRACTOR: RATTS CONSTRUCTION PERMIT NO: 12010137 OWNER'S NAME: PERRYMAN HEATH ET AL 49 MARTINS BEACH RD DATE ISSUED: 04/11/2012 OWNER'S PHONE: 4088684651 HALF MOON BAY, CA 94014 PHONE NO: (650) 492-5901 ❑ LICENSED CONTRACTOR'S DECLARATION F F F BUILDING PERMIT License Class Lic. # �� I lSr� B INFO: BLDG ELECT PLUMB MECII I— RESIDEN'T'IAL F COMMERCIAL� �,�j P Contractor. mno (_V4_(�ttM Date `4 ® Ito t '� 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SFDWL ADDITION OF 738 SQFT-3 BEDROOMS,I (commencing with Section 7000) of Division 3 of the Business & Professions BATH,DINING ROOM; REMODEL 360SQFT BEDROOM, Code and that my license is in full force and effect. LAUNDRY,PANTRY,34SQFT RE-ROOF,2000SQFT STUCCO, 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. I have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area: Valuation: $220000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 35602022.00 Occupancy Type: APPLICANT CERTIFICATION I certify that 1 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 PERMIT EMPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non point so re ulations per the Cupertino Municipal Code, Section 9.18. Signature Issued by: ��}�� Date: Date ❑ OWNER -BUILDER DECLARATION RE -ROOFS: hereby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is the following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for I, as owner of the property, or my employees with wages as their sole compensation, inspection. will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: Date: I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: 1 have and will maintain a Certificate of Consent to self -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Section 3700 of the Labor Code, for the performance of the work for which this Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued, I shall maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health fety Code, Sections 25505, 25533, and 25534. 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 Oe o u d a ent: %Date: -1 �—Q-L_ forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.) to building construction, and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply ARCHITECT'S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22263 N DE ANZA CIR CONTRACTOR: RATTS CONSTRUCTION PERMIT NO: 12010137 OWNER'S NAME: PERRYMAN HEATH ET AL 49 MARTINS BEACH RD DATE ISSUED: 04/11/2012 OWNER'S PHONE: 4088684651 HALF MOON BAY, CA 94014 PHONE NO: (650) 492-5901 ❑ LICENSED CONTRACTOR'S DECLARATIONI BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic. # f— N[ECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SFDWL ADDITION OF 738 SQFf-3 BEDROOMS, I (commencing with Section 7000) of Division 3 of the Business & Professions BATH,DINING ROOM; REMODEL 360SQFT BEDROOM, Code and that my license is in full force and effect. LAUNDRY,PANTRY,34SQFT RF,-ROOF,2000SQFT STUCCO, 1 hereby affirm under penalty of perjury one of the following two declarations: 5/3/12 -REVISION #I- NEW PIER AT REAR DECK-ISSD 5/3/12 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 Sq. Ft Floor Area: Valuation: $280000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 35602022.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply 180 DAYS FROM (LAST CALLED INSPECTION. with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Issued by: Date: Signature Date ❑ OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is the following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1, as owner of the property, or my employees with wages as their sole compensation, inspection. will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant Datc: 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: 1 have and will maintain a Certificate of Consent to scif-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Section 3700 of the Labor Code, for the performance of the work for which this Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued, I shall maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health & Safety Code, Sections 25505, 2.5533, and 25534. 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 Owner or authorized agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.) to building construction, and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, Lender's Address costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply ARCHITECT'S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 1 understand illy plans shall be used as public records. Signature Date Licensed Professional X CONSTRUCTION PERNT r i, 0o r fl COMMUNITY � COMMUNITY DEVELOPMENT DEPARTMENT > BUILDING DIVISION 10300 TORRE AVENUE e CUPERTINO, CA 95014-3255 [a C aJ P E RT I W 0 I (408) 777-3228 ^ FAX (408) 777-3333 ^ buildin c ertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION / DEFERRED ORIGINAL PERMIT #! PROJECT ADDRESS // �' �^ ,n; APN # 12Z- 41!�)2_ 2 OWNER N E �, �Qi PHONE — 7�7` E-MAIL VK_��p Irl 1 til S DC6 Sin Ei 04 S (2 A " (2 STREETADZSz��'n^ ,ts• CI ,STATE, ZIP r f N� �e- FAX CONT NAME PH� Dom, 7- " 926/ E-MAIL S C. ry l i STREET ADDRE S �M�IPAO Z_Z2 'L�2�nA-2�• FAX 0g� 72S._01 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT 9CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRAC OR NA LICENS NUMBBEER� LIC E TYPE BUS. LIC # J,, 17 / MPA NAME E MAS\IL f f -Tvp�Sl (" Kr B j ST ET ADDRESS ` CITY, STATE, ZIP �- NE (t�2 `!17 PHONE / / r J� e)/ ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS ;� CITY, STATE, ZIP PHONE 1� DESCRIPTION OF WQAK C( C /J L i `!fl 1,1C r 1.1 GPJT� GC�� rZ k/-- EXLSTI USE PROPOSED USE CONSTR.TYPE #STORIES . ` USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY - "T—TOTAL VALUATION: PLANNING ADPL# ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ 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. I ha read this application and the information I have provided is correct. I have ad the DpSCitNtion of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bId g constructio . I author a repr sent Ives of Cupertino to enter the above -identified property for inspection purposes. Signature Date: 0 2W ZJ� 1 2 of Applicant/Agent: -- SUPPLEMENTAL INFORMATION REQUIRLkDJ PILXWCHECK-TYPE ROUTING SLIP OVER,THE COU!\TER ❑ UILDINGPLAN REVIEW B,, _ 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 1 -EXPRESS.'-,: = ` PLA1vNTISSGPLAN REVIEW„' Hazardous Materials Disclosure �,E STANDARD ., � ' oRKS O..PUBLICw.I� .; Commercial Bldgs: Provide a completed g p . form if any Hazardous Materials are being used as part of this project.' 0 'LARGE 0` FIREDEPT,., _ Copy Of Planning Approval Letter or Meeting with Planning prior to DMA JOR SANITARY SEWER DISTRICT submittal of Building Permit application. D, ENVIRONi«NTALHEALTH 11.doc revised 06/21111 Ij9v ❑ NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT ` BUILDING DIVISION 10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255 flBjffl�00 (408) 777-3228 a FAX (408) 777-3333 a buildinq(dcupertino.org ❑ ADDITION ❑ ALTERATION / TI REVISION /DEFERRED ORIGINAL PERMIT' V PROTECT ADORES_A 2&r � •� �n `—h 1�� APN # OWNER AME PHONE E-MAIL STREET ADD STATE, ziP FAX ES Z / CO� t COMA NAME ^2_9I 9�[J u�v / Y� J G'A/ •C STREET ADDRESS STATE ZIP / FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACIORAGENT ❑ AR=CT ❑ ENGB4FIM ❑ DEVELOPER ❑ TENANT CONTRA OR LI SE NUMBER LICENSE TYPE Bus. LIC # COMP AME ` E-MAIL FAX STREET ADDRESS CTY, STATE, ZIP PHONE �o —�� • ARCHTTECT/FNGi aZR NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAH FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCMMON OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES I USE TYPE OCG SQFr. VALUATION (Sj EXLSTG NEWFLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA U DETACH []ATTACH DWELLING UNITS: ISA SECOKI) UNIT ❑YES SECONDSTORY C1 YES _77 BEING ADDED? ANO ADDITION? []NO PRE -APPLICATION OYES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY -' Y• TOTAL VALUATION: PLANNING APPL # ONO PLANNING APPROVAL LETTER EICHLE'R SOME? ❑ NO By my Signature below, I certify to each of the following. I am the property owner or authorized aeent to act on the pTpperty.owner's behalf.1 have read this application and the information I have provide correct I have read a Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil ' nstruction. [authorize presentatives of Cupertino to enter the above -id fled nroperty for inspection purposes. Signature of Applicant(Agent Date: l�- SUPPLEMENTAL DITFORMATION REQ D PLAN CHECK TYPE ROUTING SLIP R-TBS -COUN= BUU.DINMAN AN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building tRESS permit for new building. ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C1STANDARD 11 PUBLIC WORIS.9 form if any Hazardous Materials are being'used as part of this project ❑ LARGE ❑ Fm DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to C1 MAJOR ClS ►NiTARY SEWER DISTRICT submittal of Building Permit application. ❑ mwmoNMENTAL HEALm . B1dgApp_ Ol Ldoc revised 06/21/11 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT ° BUILDING DMSION l 10300 TORRE AVENUE ° CUPERTINO, CA 95014-3255 �r� �� (408) 777-3228 ° FAX (408) TT7-3333 ° buildin-g(a.cupertino. O—Z�2 ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ R=T0N / DEQ' PFn narGTTYAT. PFR TT it PROTECT ADDRESS ^ APN 0 OWNER NAME PHONE E_MAB /jQ ai V1�4Ail STREET ADDRESSz 26� STATE ZIP / FAX 1 CONTACT N PRONE J Z V, V\ ( I" SCREE �N SS Z� ST � Ci , / FAX -9A �`S Va-, yD ❑ OWNER ❑ OWNER-BUD.DMt ❑ OWNERAGE;T 0 INTRACTOR ❑ CONTR4CTORAGENT ARCHITECT 13 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LICENSE NU� LICENSE TYPE BUS. LIC A COMPANYN E MAB aM FAX . &'a> "Zoe 6 9G � � SIREL7 ADDRESS�4.4I M g f � % tPHONE LM -S90( ARCHITEC IENGMiU NAME LICENSE NUMBER BUS. LIC f! COMPANY NAM$ E-MAIL FAX STREET ADDRESS CITY, SPATE, ZIP PHONE DESCRIPTION OF WORK C� EXISTING USE PROPOSED USE CONSTR TYPE $ STORIES USE TYPE OCG 5QF1'. VALUATION (5) E MTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET ARE4 BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODELAREA PORCH AREA 05CIIARFA TOTAL DECK/PORCH AREA GARAGE AREA: El DETACH - []ATTACH A DWELLING UNITS: ISA SECOND LIMIT OYES SECOND STORY ❑ YES 3WG ADDED? []-NO ADDITION? []NC PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEc/ID TOTAL VALUATION: PLANNING ADPL # NO PLANNING APPROVAL LETTER EICHLER ROh6? ❑ NO By my signature below, I certify to each of the following: I am the property owner or authorized aeent to act an the pr!perty.owners behalf. Thave read this application and the iafO®ation I have provided is correct I have read the D ti of Work and verify it is accraate. I agree to comply with all applicable local otdinances and state laws relating to buil ' cti o ' enta ' Of Cupertino to enter the above -id ed p7perty far fi spection purposes. Signature Of Applicaat/Agent Date: — SUPPLEIYIENTAL INFORMATION REQ PLAN CHECK TYPE ROU n NG SLIP ❑ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building OVXR-TBE-Co> NTKR BU'ILDmGPLAN REVTEw permit for new building. ❑ EXPRESS ❑ PLANIUNGPLAN RZVMW _ Co==ial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLICwomo form if any Hazardous Materials are being'used as part of this project ❑ LARGE ❑FIRE DEPT _ Copy of Pl=ing Approval Letter or Meeting with Planning prior to El MAJOR C1S.iPnPARY SEWER DISTRICT submittal of Building Permit application. ❑ E1WMO MENTAL HEALTH B1dgApp Z011.doc revUed 0612I/11 TE C OM I�G�3MCTM pERPUT GQG° FUCAT11Oo N9 t:OIVIIVIUNI T Y DEVELOPMENT DEPAR T iVIEN T ^ BUiWiNG DIVISION 10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255 I (408) 777-3228 • FAX (408) 777-3333 - bulldinard)cLi Tertino.nra r_1 NFW CONSTRUCTION NSTRI_Tf T10N ATITITnCIN I 1 AT TFR ATTON) TT -,ted 1 RFViC10TT / TIFFFRRFII ORT(_TNAT PFRMIT # PROJECT Z 2RESS� �1 AI'N # S"� ?_-2, OWNER NAME if7PHONE E-MAIL h! 1 STREET ADDRESS ,STATE, ZIP C^ FAX IMP CONTACT NAMEI' ONE E-MAIL. , a� STREET ADDRESS ITY, STAT', ZIP FAX CA q " 'e_Z AJ (pc tJ _7,? - ®/fig; ❑ OWNER ❑ OWNER -BUILDER 1:3OWNER AGENT CJ CONTRACTOR 11CONTRACTOR AGENT 11ARCHITECT 11 ENGINEER 11 DEVELOPL•R 11 TENANT CONTRACTOJI.NAAM 1 "V LTCENSQErBER LICENSE TYPE BUS. LIC # COMPANY,, N NIE 41!IAIL FAX15 STREET ADDRESS TY TE, ZIP PHONE jk ARCHTTECT/ENG1NEEk NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PI TONG DESCRJPT10N OF WORK c / � �� 0 � � EXISTING USE PROPOSED USG CONSTR. TYPE # STORIES 7 ;� .� USE TYPE OCC. SQ.FT. VALUATfON (b) EXISTG AREA NEW FLOOR AREA DEMO TOTAL AREA NETAREA,?o V �I' /✓-(JG/ BATHROOM KITCHEN OTHER / REMODEL AREA REMODEL AREA REMODELAREA,Z(/ PORCH AREA DECK AREA TOTAL DECK/PORCH AREA OACH # D 'CLING UNITS IS A SECOND UNIT ❑��YTS SECOND S'FORV ❑ YE. 61 BEINGADDW? ADDITION? n D L n nor: nonr rrn Tram Ohms rc hTe PRnyrnr. rnoy nr Tq ruc,mnr ,v ❑,..�vrc PLANNING APPL # []NO PLANTING APPROVAL LETTL•R I EICIILF,R HOME? nrrr-n; LLB r�mAt . .w u _ Q AILV ATO" hBy my signature below, f certify o each on the rouowmg: i am ute property owner or authonzeu agent to act on the property owners Denali. i have read this iJ J 1 Iii i� 11.. ..,7 . t 1 1� ani i � i vrn ,. ,�7 . .: f. 1 .1 . ;tl ..11 t: ..lel.. 1.. I J V u.0 r �.. ,r;pt; ., a . ,"..i ; agr . u nilly w. ..pp ., u . .,,.. yu. Ordinances and state laws relating to bui construction. I'111th repLsentatives of Cupertino to enter the above -i entified operty for inspection purposes. Signature of Applicant/Ag nt Date: SUPPLEMENTAL INFORMATtOA4EVAFED P..LAN CITECK TYPE I ROUTING SLIP �jj U OVER-THE-COUNTER Il I E 3IL�G PLAN REVIEW A.T CFTI Or Ah,16farnile ri-Ali—S: Apply fnr dcmnlitinn nr it fnr -a rr r -•---- existing hnilding(sl. Demnlition nermit is required nrior to issuance of Mlilding j I] Permit for new bulldlnQ. ❑ EXPRESS I L�Jy Pry„ANNING PI,AV REVIEWll l,uilhriGCclai mugs: rruVILLI: a Gufllpl GlGU 11aZa1'UUUS AVI8lC1'Ia1S 1115GIUStIrC � LCrSl AP1UAKU I �1 PUBLIC WUHKS �1 F....».:.f 1a ai-C 1u.si.ub uo..ag yay,,uC a Y'uJwl. a y laz.......s ARatwu:u, ❑ LARGE FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to Q ❑ aL_sea �I—�� ,nY �E�„�o �T� P��T submittal of Building Pennit application. I IhI�� u ENVIRONMENTAL HEALTH () BidgApp_2011.doc revised 06121111 VA CITY OF CUPERTINO Fm'-ff FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the Preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/11) ADDRESS: 22263 N Deanza Circle DATE: 08/30/2012 REVIEWED BY: Sean WI /,. Permil Fee., APN: BP#: 12010137 "VALUATION: 1$60,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Pl unb. Insp. Fee: PENTAMATION 1GENRES PERMIT TYPE: WORK Revision #3: Add 1 skylight, revise ceilings, add 16 lights and 15 outlets remodel master SCOPE bathroom (120 sq ft), add wet bar sink, construct planter in entry, add interior windows in hallway. NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the Preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/11) Mcch. Plan Check Plumb. Plan Check 0.0 1 hrs $0.00 Elec. Plan Check 0.0 hrs $0.00 WI /,. Permil Fee., Plumb. Permit Fee: IPPERMI Elec. Permit Fee: IEPERMIT Other ;tTech.Imp,0-1— Other Plumb Insp. ETrs—L$45.00 Other Elea Ehn]Insp. $45.00 Rech. Insp. F... Pl unb. Insp. Fee: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the Preliminary information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # $400.00 Skylight ISKYL<10SF I <= 10 s.f. Suppl. PC Fee: Q Reg. () OT 0.0 hrs $0.00 PME Plan Check: $0.00 120 j s.f. $600.00 Remodel, Bath (<=300 sf) IREMRESBAT Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee -.0 Reg. Q OT 0.0 1 hrs $0.00 31 Electrical $89.00 IBREMRECEP Recep/Switch/Outlets PME Unit Fee: $0.00 PME Permit Fee: $90.00 0 # Plumbing $0.00 1BPFIXTURE Fixture or Trap Construction .Tm': Administrative Fee: ]ADMIN $42.00 Work Without Permit? Yes 0 No $0.00 Advanced Planning Fee: $0.00 �.J hours $133.00 Inspections 1STINSP Inspection, Hourly E) 0z Travel Documentation Fee: ITRA VDOC $45.00 Strong Motion Fee: IBSEISMICR $6.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $3.00 SUBTOTALS: $186.00,$1,222.00 TOTAL FEE: 1 $1,408.00 Revised: 07101/2012 W"irr"MT rwm 4"7rTrhTr11MrT7rT,\Trh OCCUPANCY TYPE: TYPE OF CONSTR. F1LR AREA s.t FEE ESTIMATOR — BUMDRNGII.DMSIGN ` ADDRESS: 22263 n. de anaa circle DATE: 01/2312012 REYI[EWED BY: bob s. IBP ]FEE ID R-3 (Hillside, Custom) II-B,111-B,IV,V-B APN: 1BP#: / O 3"VA. LIIIATIION: 1$220,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex 2nTd Unit? Yes o No PENTAMATIION 1R3SFDADD USE:O Yes l`)No PERMIT TYPE: WORK 738 s.f. 3 bedrooms 1 bath dinin . remodel 360 s.f. bedroom laund ant . 34 s uare Esfddd SCOPE of. 2000.s.f. stucco. relocate furnace and water heater, add A/C unit, repair deck and new flight ofC OCCUPANCY TYPE: TYPE OF CONSTR. F1LR AREA s.t PC ]FEES PC FEE IID BP ]FEES IBP ]FEE ID R-3 (Hillside, Custom) II-B,111-B,IV,V-B 738 $4,511.00 IR3HPLNCK $1,731.00 1R3HINSP $0.00 PME Plan Check: $0.00 3,400 s.f. Re -roof $476.00 IREROOFRES Permit Fee: $1,731.00 Supp[. Insp. Fee -0 Reg. COT Q Q hrs $0.00 2,000 s.f. Restucco $589.00 ISTUCOAPP PME Unit Fee: $0.00 PME Permit Fee: $44.00 0 # $914.00 Deck / Deck Railing IDECKwoOD Deck & Deck Railing TOTALS: 738 $4,511.00 1 1 $1,731.00 MECH, HOURLY 0 Yes G No P]LUNIB, HOURLY Q Yes Q No EILEC, HOURLY Q Yes E) No Mech. Plan Check 0.0 hrs $0.00 Plan Check Fee: Mech. Permit Fee: IMPERMIT $4,511.00 F-360-1 s.f. $457.00 Other Mech. Insp. Ll hrs $44.00 �3;?,i•r..,,.': Suppl. PC Fee: Q Reg. Q OT 11 0.0 hrs $0.00 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the urelindnary information available and are only an estimate. Contact the Dept for addn'l info. ]FEE ITEMS (Eee Resohrtion 11-053 &. 7%1/111 FEE QTY/FEE DISC LITEMS Plan Check Fee: $4,511.00 F-360-1 s.f. $457.00 Remodel, Other IREMRESOTH Suppl. PC Fee: Q Reg. Q OT 11 0.0 hrs $0.00 PME Plan Check: $0.00 3,400 s.f. Re -roof $476.00 IREROOFRES Permit Fee: $1,731.00 Supp[. Insp. Fee -0 Reg. COT Q Q hrs $0.00 2,000 s.f. Restucco $589.00 ISTUCOAPP PME Unit Fee: $0.00 PME Permit Fee: $44.00 0 # $914.00 Deck / Deck Railing IDECKwoOD Deck & Deck Railing # $130.00 Mechanical IBAPPLOT Other Appliance/Equip Work Without Permit? Q Yes Q No $0.00 Advanced Planning Fee: PLLONGRNGR $95.94 Select a Non -Residential Building or Structure 0 Travel Documentation Fee: ITRAVDOC $44.00 Strong Motion Fee: IBSEISMICR $22.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $9.00 SUBTOTALS: $6,456.94 $2,566.00 TOTAL IEEE: $9,022.94 120 L 013 `3--- if'%TfrIPR7 �1n if'+Tf T71DArTfD rT1�Tf1aT�T J V1 11 R 11 N.D 11` � kt.) 11 11 11, 1L 111 V `!.N FEE ESTIMATOR - BUILDING DIVISION Plumb, Plan Check ADDRESS: 22263 No. Deanze Circle DAT1E: 0510812012 REVR EWED BY: Sean FLtech. Permit l=ee: APN: 1BP#: 1,20LOL3j *VALUATION: Iso "PERMIT TYPE: Building Permit PLAN CHECKTYPE: Addition PRIMARY SFD or Duplex Plumb, Insp. Fee: PENTAMATION 1GENRES USE: $0.00 PERMIT TYPE: A. WORK Revision #2: Change shear wall detail in crawls ace and show repair of rotted beam on east side of SCOPE residence. J Nfech. Plan Check Plumb, Plan Check _ Elec. Plan Check FLtech. Permit l=ee: Phimb. Permit Fee: L7ec. Pennit Fee: Other Mauch. Insp. Other Plumb Insp. a Other Elec. Insp. C Alech. Insp. Fere: Plumb, Insp. Fee: Glec.lnsp. Fee: 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 preliminary information available and are only an estimate Contact the DeDt for addn'l info, FEE ITEMS (Fee Resolution 11-053 Glf' 7/1/11) Plan Check Fee: Hourly Only? 0 Yes Q No FEE $0.00 QTLY/FEE 1` ESC =MS 1 hours Plan Check, Hourly $130.00 ISTPLNCK Suppl. PC Fee: Q) Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. Q OT Q,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conslivetion Ta_r: Adiniaistratl ve Fee.: 0 E) Work Without Permit? Yes E) No $0.00 Advanced PlanningFee. $0.00 Select a Non -Residential Building or Structure E) G Travel Documentation Tees: Strong Motion Fee: $0.00 Select an Administrative Item Bldp- Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $130.00 TOTALFE $130.00 Revised: 0410112012 CUfigERTONO t A) \ I I. q t I t�► I". � I.� t( � I I� g t I l!) I". I I S H unlfling Departmemt City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 - Fax: 408-777-3333 JOB ADDRESS: Z.7_ o ° PERMIT # �eo o OWNER'S NAME: D o° o ,� -=%2V PHONE # lo FA LZ, GENERAL CONTRACTOR: o o BUSINESS LICENSE # ADDRESS: - �dITY/ZIPCODE: ° o *Our municipal code requires all (businesses working in the city -4 have a City of Cupertino business ii6nse. v NO BUILIDIING FINAL OR IFIINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL TIlII� GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITE' OF CUP ERTIINO BUSINESS LICENSE. I anon not nosing any subcontractors: Signature Please check applicable subcontractors and complete the following information: (Date V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Ca^A z Electrical Lau � � 01— fie,Excavation Excavation Fencing Flooring /Carpeting A� Linoleum / Wood Glass / Glazing Heating Insulations Landscaping Lathing Masonry Painting / Wallpaper6V-L 4 a Paving Plastering Plumbing Roofing"i 7S / Septic Tank Sheet Metal Sheet Rock Tile l Owner / Contractor natnur- ate ' i Building Department CITY OF CUPERTINO 10300 TORRE AVENUE a CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3228 a FAX: (408) 777-3333 CJ MAR CIA L INSPECTION AND TESTING AGREEMENT BY: Project Name: fza revvzl�-a W Date: `- Project Address: 2-2-Zly3 MPc,, Naba�, C _ Permit #: 7. ® D D d 57 To permit applicants of projects requiring Special Inspection and/or Testing per CBC Section 1704: BEFORE A PERMIT CAN BE ISSUED: The Owner, General Contractor, Project Architect/Engineer and Special Inspector shall acknowledge the required special inspections, testing and conditions. When determined by the Building Inspection Division, a pre -construction conference with the parties involved will be held to review the special inspection requirements and procedures. Special inspection and testing shall meet the minimum requirements of CBC 1704. The following conditions are also applicable: 1. Contractor is responsible for notification to the Special Inspector or Agency regarding individual inspections for times listed on the attached Schedule and noted on the City approved plans. Adequate notice shall be provided so the Special Inspector has time to become familiar with the project and do a thorough job for all inspections. 2. Each Special Inspector shall submit his qualifications to the City and is subject to a personal interview for pre -qualification. Special Inspectors shall display an approved identification badge :when performing the function of a special inspector or upon request, and must have a valid ICBO Certification for the type of work being inspected. 3. Duties and Responsibilities of the Special Inspector are: A. Observe the work for conformance with the CITY APPROVED (stamped) design drawings and specifications and applicable workmanship provisions of the CBC. L11 NOTE: Shop drawings may be used only as an aid to inspection. B. Bring non -conforming items to the immediate attention of the contractor and note in daily report (Ref. Item 4). If any such item is not resolved in a timely manner, or is about to be incorporated in the work, notify the Building Inspection Division and the Project Engineer or Architect immediately by telephone at 408-777-3228, or in person. Revised 7/16109 Special Inspection and Testing Agreement C. Furnish reports of tests and inspections directly to the Building Inspection Division, Engineer and Architect of record and others as designated. These reports are to include the following: Describe inspections and test made with applicable locations List all non -conforming items Indicate how non -conforming items were resolved or indicate unresolved items as applicable Itemize changes authorized by Architect, Engineer, and Building Inspection Division, if not included in non-conformance items D. Insure that an adequate number of pre -qualified special inspection personnel are on the job, based on the intensity of activities, quality of work performed and the various operations occurring. E. Submit a FINAL LETTER OF COMPLETION to the Building Inspection Division stating that, to the best of his knowledge, all items requiring special inspection and testing were accomplished, approved and reported in conformance with the approved design drawings, specifications, approved change order and the applicable workmanship provisions of the CBC. Items not in conformance, unresolved items or any discrepancies in inspection coverage (i.e. missed inspections, "periodic" inspections performed when "continuous" inspections were required, etc.) shall be specially itemized in this report. F. FINAL LETTER OF COMPLETION shall be signed by the Licensed Registered Engineer of the Special Inspection Agency of record. 4. Each Special Inspector shall complete and sign the Special Inspection Record of each day's inspection and provide a daily handwritten report in a format acceptable to the Building Inspection Division (to remain at the job site with the contractor for review by the Building Department's Inspector). Content of the daily reports shall be per Item 3C above. 5. Work requiring a special inspection, and the performance of a special inspection, shall be monitored by the City's building inspector. City approval is required prior to placement of concrete. General Contractor shall notify 408-777-3228, 24 hours in advance for each day special inspections will be conducted. 6. Special inspections are to be performed on a CONTINUOUS BASIS, meaning that the SPECIAL INSPECTOR IS ON SITE IN THE GENERAL AREA AT ALL TIMES OBSERVING THE WORK REQUIRING SPECIAL INSPECTION. Periodic inspections may be approved by the Building Inspection Division and, if approved; shall be noted on the SPECIAL INSPECTION AND TESTING SCHEDULE. 7. Only the City approved Testing Agency of record shall sample, transport and test materials. Only the City approved Special Inspection Agency of record shall provide special inspectors. Independent inspectors may be pre -approved by the Building Inspection Division per Item 2 above. Special Inspection and Testing Agreement 9. BEFORE AN OCCUPANCY PERMIT CAN BE ISSUED: The Special Inspector or Agency shall submit a FINAL LETTER OF COMPLETION, per item 3E above, directly to the Building Inspection Division. 10. Copy of SPECIAL INSPECTION AND TESTING SCHEDULE, SPECIAL INSPECTION AND TESTING AGREEMENT, SPECIAL INSPECTION RECORD, and SPECIAL INSPECTION DAILY REPORT, SHALL BE AT THE JOB SITE. ACKNOWLEDGEMENTS Sip -nature Owner: �---� General Contractor: QxSpecial Inspector or Agency: Project Engineer/Architect: Building Inspection Division: . �� L Company TPA6G 'EmGi,ra-Rs �, �, �• Gam: -a - Building Department CITY OF CUPERTINO 10300 TORRE AVENUE o CUPERTINO, CA 95014-3255 C U P E RTQ N ® TELEPHONE: (408) 777-3228 o FAX: (408) 777-3333 SPECIAL INSPECTION AND TESTING 7- 2 ZA D J w z, Project Address Project Title To owner of projects requiring Special Inspection or testing per Chapter 17 of the 2007 California Building Code, please acknowledge and return to the City: BEFORE A PERMIT CAN BE ISSUED: The Owner, or his representative, on the advice of the responsible Project Engineer or Architect, shall complete, sign and submit the attached form "Structural Tests and Inspection Schedule" to the Building Department for review and approval. The owner and his general contractor, where applicable, shall also acknowledge the following conditions applicable to Special Inspection and/or testing. 1. Contractor is responsible for proper notification to the Inspecting or Testing agency for items listed. 2. Only the testing laboratory should take samples and transport them to their laboratory. 3. Copies of all laboratory reports and inspections are to be sent directly to the City by the Testing Agency. 4. Inspection agency to submit names and qualifications of on-site special inspectors to the Building Department for approval. 5. The Special Inspector is under the authority and is responsible to the Building Official. All inspection concerns and/or problems encountered are to be brought to his attention immediately. 6. Special inspectors may be required, as a minimum, to provide weekly reports to this department of all inspection activity. 7. It is the responsibility of the contractor to review City approved plans for additional inspection or testing requirements that may be noted. 8. BEFORE AN OCCUPANCY PERMIT CAN BE ISSUED: The inspection agency shall submit a statement that all items requiring testing and inspection have been fulfilled and reported. Those items not tested and/or inspected shall be noted in this statement. Copy of statement is to be maintained at the job site for City's Building Inspector's review prior to final inspections. s Signature 84a& cfi&4go Testing/Inspection Agenc ignature City Plan Check engineer's Signature Proje t Engineer or Architect Signature Contractor's Signature 4 Revised 7/16/09 Building Department CITY OF CUPERTINO 10300 TORRE AVENUE o CUPERTINO, CA 95014-3255 TELEPHONE: (408) 777-3228 o FAX: (408) 777-3333 STRUCTURAL CT>IJll8A1L TIESTS AND IINSP'IECTMNS SCHEDULE Prior to issuance of a building permit, the Owner, on the advice of the Architect or Engineer, shall complete, sign and submit this.form to the building Official. ,, Project Na e�o Date ZZ ? zp'cG crlGia►C � Project-Aaress Testing/Inspection Agency ' Sftcaa, w5r. ii NAL' Owner's Name Signature & Title Owner hereby certifies that the Testing/Inspection Agency named above has been engaged to perform structural tests and inspections during construction, as checked below, to satisfy all applicable portions of the Building Code. Prior to issuance of an occupancy permit, the Inspection Agency shall submit a statement that all items of designated work performed were reported. Any items checked, but not test or inspected, will be noted and explained. Whenever any designated items on this list are ready for sampling, testing or inspection, it shall be the responsibility of the Contractor to give timely notice to the Inspection Agency so that the required services may be performed. REINFORCING STEEL: Tensile & Bond, one set per heat per tons Inspection of Placement Inspection of Welding MASONRY: Preliminary Acceptance Tests (Masonry Unites, Wall Prisms) Subsequent Test (Mortar, Grout, Field Wall Prisms) Inspection of Grouting nspection of Placement & Grouting NS ASPHALTIC CONCRETE: Mix Designs Inspection of Batch Plant Core/Test Field Inspection Suitability Tests Specific Gravity Asphalt Content Sieve Analysis K Factors Stabil ometer Value 5 Swell STRUCTURAL STEEL: Sample & Test (list specific members below) Shop Identification & Welding Inspection Shop Ultrasonic Inspection Shop Radiography Field Welding Inspection Field Bolting Inspection Metal Deck Welding Inspection INSULATING CONCRETE: Sample & Test Unit Weights a Structural Tests and Inspections Schedule CONCRET E SHOTCRET E GROUT MORTAR TESTS ANIS INSPECTIONS Aggregate Tests for Designs Suitability of Aggregates Mix Designs Test Panel Batch Plant Inspection ' Cement Grab Sample Inspect Place Compression Tests Cast Specimens Pick-up Samples Shrinkage Bars Yield Check Air Check Dry Unit Weight PRECAST/POST-TENSIONED CONCRETE: Reinforcing Tests Inspection of Reinforcing Placement Tendon Tests Inspection of Tendon Placement Inspection of Concrete Placement Inspection of Concrete Batching Inspection of Panel Attachments & Inserts Inspection of Panel Installation Compression Tests Inspection of Stressing/Transfer PILING, CAISSONS, CAPS, TIES: Inspection of Reinforcing Placement Inspection of Concrete Placement — Inspection of Concrete Batching UNDERPINNING: Inspection of Steel Fabrication Inspection of Reinforcing & Forms Inspection of Concrete Placement Inspection of Tiebacks FIREPROOFING: Inspection of Placement Density Tests Thickness Tests Inspect Batching FILL MATERIAL: Acceptance Tests Moisture -Density Determination Field Density ROOFING: Inspection of Placement Sample & Test STRUCTURAL WOOD: Inspection of Fabrication Inspection of truss Joist Fabrication Sample & Test Components Inspection of Glu Lam Fabrication Shear Diaphragms ADDITIONAL INSTRUCTIONS OR OTHER TESTS & INSPECTIONS ��aQGit'rl-% -sem¢_ acL�o-r �-pds Io e- y- C X 0 WoZ' 1 An Evaluation of the impacts to Trees at 22263 N. De Anza Cirele � Cupertino, California Assiignmek I was asked by George Schroeder, Planner, City of Cupertino, to review the risks to trees by the proposed construction of new additions to the house at 22263 N. De Anza Circle, Cupertino, California - 0 A o an e�servaii ous -� I visited the site on October 4, 2011, in which I met th(o(�Oraetoi Mn T'U Waugh. I reviewed -. 0, �� , I the project plan in relation to the 8 trees on the property. Mr. Wakdescribed'the proposed plan in considerable detail; including drainage; which made it. much 6e� for me to access the impacts to the existing trees. The 8 trees are listed on the Field Data Sheet attached to this report. The particulars of the 8 trees (species, trunk diameter, height, spread, and structure) are included on this field observation form. The health and stnlchlral integrity of each specimen are rated on a scale of 1-5 (Rxcellent - Extremely poor), as follows: (l) Excellent, (2) Good, (3) Fair, (4) Poor, (5) Extremely Poor. I have assigned numbers to the trees. Their locations are shown on the attached Site Plan mark- up. Impacts mt--.-_ t� t__ - - m.___ u t .�.t t__. at__ t__ 111G1G WUUlU UG 11U SGIIUUS 11111)41 LS LU 11GG tt 1 Ul tt G Uy L11G CU11Jt1Ul%L PlU(3USGU U11 L11G r.4Jl SIUC. The Cypress Tree # 3 would be removed in order to construct the footing of the new addition on the east side of the residence. i, 111G Coast redwuvl1 �JNLLUj(l J'l /t�/ l l'dJ)!1ice It `t would likely sul-Im Jlg'llllll:im, 11 11UL severe, root damage 9 &result of the trenching for the new footing. Tree # 4 is currently in poor health and would not? -likely survive any amount of the root loss. For this reason, I consider Tree # 4 a loss. Tree # J is a healthy coast 1-I ve Uak kv "Quercus agr folia). llle excavation lUl the fUot111g to `Ulc addition would likely result in minor root damage, if any at all. The new addition is far enough south of Tree # 5 that no pruning would be required of this tree. There would be no need to install protective fencing to preserve Tree # 5, because it is located on a lA.l1l G1 2fLccp slope and 11 1b JLL11 VLuluGLL U.' 1111�1UJlllg 1111LLG1 Jlllly �1LQ11 LJ 111G1UU111g' 111G L:L111ll11U11 black berry (Ribes species), which has sharp thorns. There are 3 small coast redwood (Sequoia sempen irens) Trees # 6, 7, and 8 located on the west side of the property up slope from the proposed new addition on the east side of the residence. Tree # 7 has died. Trees # 6 and # 8 should not suffer significant root damage because of their small size. Mr. Waugh stated that anew retaining wall was being considered for the front yard. 1 advised Mr. Waugh that it would be essential that the soil cut for the new retaining wall inust be no closer than 8 feet from the nearest side of the trunk of Tree # 2. conclusions Tree # 3 would be in conflict with construction of the new addition. Assuming the project would be approved, Tree # 3 would be removed and replaced. Tree # 4 is in very poor condition and could not survive the expected root damage. Removal and replacement would be a viable alternative, in my opinion. P The risks to Tree # 5 would be insignificant. The risks to Tree # 6 and 8 would be minimal. A new retaining wall constricted in the front yard could pose a significant risk to Tree # 2, unless the wall were located a sufficient distance from this tree. Recommendations 1. I recommend that Trees # 3 and 4 be replaced. 2. I recommend that the soil cut for a new retaining wall in the front yard be located a minimum of 8 feet from the nearest side of the trunk of Tree # 2. ?. Should the retaining wall be constructed using a soil cat 8 feet from the trt.- of Tree # 2, it would be essential to provide supplemental irrigation to Tree # 2 for a minimum of 1 year. In this event, 1 recommend that irrigation be applied once per week during the dry months of the year and that the water reach a depth of 18 inches per each application. Respectfully submitted, Michael L. Bench, Consulting Arborist International Society of Arboriculture Certification # WE 1897 American Society of Consulting Arborists Member 6 � 11 Perryman Residence Los Gatos, California Fie". Data Shcca 777F'A N no Ano* !`—l' T+1 Troc Nama .. .._..._ 17)AW __.. I'1R1-I Wrtht Gnrri __.. ..'... _�. _ WithGtrr ...... rnllFk Tnnrt _.. _ .rte_ Nntac .._.__ i European oiiVC 6/4 4/J IOU I5 4 3 `V CIy JFldl-�C l+dl�lUFly, 1,U11�11Jl;i aiJiC UIC- Ojeai a hope. hark _2 rnagt rarlwnnd _�(_1 (,n 1 F 1 1 Sequoia sempervirens 3 Cypress 15 70 25 2 1 Cupressus species 4 Coast redwood 38 90 35 4 3 5 Coast live oak 30 30 50 1 3 Surrounded by Dense Underslory Plants Quercia agritolia 6 Coast redwood 8 35 15 1 1 7 Coast redwood 6 ----- ----- ----- ----- Dead _ 9 Coast redwood 6 30 15 3 1 Drouoht stressed? L,iln ^ DBH= Diameter at Breast Height (4.5 Feet above - grade) Hghi = Canopy Heighi Sprd = Canopy Spread Hlth = Health Strc = Structure CD/IB = Co -dominant SICI115 wild inlbedueu Balk - hioh rick of nmh breakage Tood = Topped Prepared by Michael Bench Consulting Arborist October 4, 2011 BVG Gphone: nfo baggengineers.comInfo@baggenglneers.com 650.852.9133 fax: 650.852.9138 ENGINEERS 847 West Maude Ave, Sunnyvale, California 94085-2911 U E '�!4 / E # n SPECIAL INSPECTION REPORT �2rJ2, PL# 1kA I DSA / LEA # / Special Inspection Reports must be distributed to the parties listed below within 14 days of the inspection. Reports of non-compliant conditions must be distributed immediately. Separate reports shall be prepared for each type of special inspection, on a daily basis. Each report shall be completed and signed by the special inspector conducting the inspection. Project Name: Client Project #: PINTS — Date/Day: 5-21-IZ/DL�a,Yi Time Arrived: /}w, Project Location:' L'ZU Y1. Am., _6�-d� 1 3 pv rw C Time Departed: Contractor: )R 4s C.r1S�rU6bi3&'% Bldg Permit #- 1201013-7. Travel Time: 30w,1,, RT Inspection Coverage: ® Continuous [:].Periodic I ❑ Concrete ❑ Masonry ❑ Welding -Shop ❑ Prestressed Concrete ❑ High Strength Bolting ❑ Welding -Field ❑ Reinforcing Steel Expoxy Bolts/Dowel ❑ DSA Approved Documents: %♦ ✓/'/1i JlVt�l i7/na t P� 1114 IAF . J� 6,0"VIAJ L.y/n.ln ,_ r)/i,., /�i-:1 SZ .J Describe inspections made, including locations: Tests made: IiISNi I /4*yf/lo/i��Jn / /I�0/��I� .3 �ItoA IAJ.FC5 -R /-I /,or i /�'/)Y / A A;;` i� * I Q/f w6//` &iP/ 'o� //30 P List changes to approved plans by architect or engineer: /�l,,/uC ��y�a ✓ �i iY+ lam daAPab1 .Jr' //S/;tIi' /.JN+/, d fl-ld( C%/r In '4.)M' A/!, The Work Z WAS ❑ WAS NOT Inspected in accordance with the requirements of the D8A / Building Department approved documents Material Sampling ❑ WAS ❑ WAS NOT 5M N/A Performed in accordance with DSA approved documents The Work inspected ®MET ❑ DID NOT MEET The requirements of the DSA/Building Official Approved Documents cc: Project Architect Structural Engineer Project Inspector DSA Regional Office/Building Department Signature of Special Inspector Print Name / Title l�'�r5� 5,�.--��1 T� �uil.-�• (��/ice/'�Z Certification # Apr 23 12 10:40a Redwood Geotechnical Engi meq:. • REDWOOD GEOTECHNICAL ENGINEERING, INC. CONSULTING SOL, FOUNDATION 8 FORENSIC ENGINEERS Mr. Tom Waugh c/o Ratts Construction49-Martin's Beach Half Moon Bay, CA 94019 Subject: Foundation Excavations Reference: Proposed, Residential Additions 22263 North De Anza Circle Cupertino, California Dear Mr. Waugh: (408)227-1985 p.1 APR 2 3 Z01Z daw Project No. 2050SCL April 23, 2012 This letter summarizes ourobservation of foundation excavations for residential additions at the site. Foundation plans for the new residential additions were completed by Ratts Construction„8 Sheets (A1 dated 1/21/12 & S1.0 - S4.3, dated 1/13112). We completed a geotechnical investigation & December 16, 2010 report for this project. Our subsurface exploration encountered shallow landscape fills and native topsoil above dense, predominantly granular native soil. We were called to the site on April 17, 2012 to observe the completed foundation excavations. The new spread footing -excavations exposed firm sandy native materials. Our field observations4i6dicate that the foundation excavations for the building additions have been extended, into -firm native materials in conformance with our geotechnical recommendations. ,If you have questions regarding this letter or our geotechnical report, please call our office. Very truly -yours, INC. Copies: 3 to Addressee 1 to Mr. Dale Hendsbee; Structural Engineer 7450 Rafted Sr.; Gffmy, CA 95020 (408) 848.6009 • S.J. (408)227-5768 • Fox(408)W-6049 CJ