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15070116 (2)F CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 830 STENDHAL LN CONTRACTOR: DAN FULGA DBA PERMIT NO: 15070116 AXISCON LLC OWNER'S NAME: LIOU DEREK AND CATHERINE AMY P O BOX 471 DATE ISSUED: 11/13/2015 OWNER'S PHONE: 4085977546 REDWOOD ESTATES, CA 95044 PHONE NO: (408) 507-2733 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL [:] /�� CONSTRUCT ONE STORY ADDITION (314 SQ FT); License Class %j� �7`T Lic. # BATHROOM Contractor � Date/l16 �lJ REMODEL (148 SQ FT); KITCHEN REMODEL (136 SQ FT); .Ya'c1 OTHER REMODEL (1770 SQ FT); REROOF (2312 SQ FT); 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 Sq. Ft Floor Area: Valuation: $350000 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 APN Number: 37541020.00 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 WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR 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 DAYS FROM LAST 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 Issued by: �/� C Date: h granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section RE -ROOFS: 9.18. ,/,/Y � 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 I 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, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: Date: 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 830 STENDHAL LN CONTRACTOR: DAN FULGA DBA PERMIT NO: 15070116 AXISCON LLC OWNER'S NAME: LIOU DEREK AND CATHERINE AMY P O BOX 471 DATE ISSUED: 11/13/2015 OWNER'S PHONE: 4085977546 REDWOOD ESTATES, CA 95044 PHONE NO: (408) 507-2733 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL ❑ CONSTRUCT ONE STORY ADDITION (314 SQ FT); License Class Lic. # 93y Y BATHROOM REMODEL (148 SQ FT); KITCHEN REMODEL (136 SQ FT); Contractor ,.? _��t Date IZ —/G—IS OTHER REMODEL (1770 SQ FT); REROOF (2312 SQ FT); I hereby affirm that I am licensed under the provisions of Chapter 9 REV # 1 - STRUCTURAL CHANGES FOR DRYROT REPAIR AT GARAGE - (commencing with Section 7000) of Division 3 of the Business & Professions ISSUED 12/16/15 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 Sq. Ft Floor Area: Valuation: $350000 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 k I>N Number: 37541020.00 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 WO IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITM I F P E IT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 18 SPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the ?/ Date: granting of this permit. Additionally, the applicant understands and will c y Y with all non -point so rce regulations per the Cupertino Municipal Code, Section 9.18. Signature Date 2-' % I S RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: 1 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 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 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 I 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 CAertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sectio 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: 12-JJ'— 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 1 CUPERTINO, CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DI 1 - 10300 T ORRE AVENUE • CUPERTINO, CA 85014-3255 3 (408) 777-322B - FAX (408) 777-3333 - buildinolacutiartino.org Lj NEW CONSTRUCTION LJ ADDITION PROi f ZDRESS_57-6AJ D 14A Z L PER2ya'r 11 1 So �- a ff- APN,- 3 -� Z V owNl R N - i�Z 4 f-1 N1 I PHO os Sq 7 7S - >✓ n S T?, T ADDRESS CITY, STATE Z FAX Oniq N a I; cu kzv?� 'j(3 CONTACT AM -E PHO).LE-I✓..47 (on ySy �I ZS Q s (e ,z • C STRu�D SS CITY, Ski: Z3 FAX �J D DS ❑ O'AWM ❑. ON'!.'R-BUII DER ❑ OWNZR kC--=I t CON-IFLSCTOR ❑ COAFIR.SCTOR AGENT ❑ 'aCHE-ECT ❑ a M=P fit ❑ DEQ ppm ❑ - f * r A. ( LIC )"SENUW.EER I L1C�.SPTYPE CON CORN V� ^ ( BUS.LIC8 'J fF A u COMPJJN) 1.4'.^. I E-MAIL FAX STREET ADDRESS_ CITY, STAia, ZIP ( � D -(AX S ID PHON-B Itio / .o O � 5 Gk-' e- 9 -1 ARC'r=_CT/ENG7)4`_ERNEj✓:° LICENSE>\��? SER I BL'S. LIC R COMPANY NfJ�mI E -Mf iI FAX S'rREET ADDRESS I CITY, STAir,, ZIP I PH011;E JESCP2 T TON OF WORK - r2iau KS a h of r _ -0---- n- CF D 1 7F EXISTING L PROPOSED USE USE CONS -11L TYPE k STOR_S USE I TYPEI OCC. SQ.FT. tiALUATION (S) r .ATG NEW FLOOR DE1.0 T07f3 f REA A9EA AR= A NET AREA BATT -ROOM KITCIMN OTZ_::t REMODEL AREA REMODEL AREA Ra,40DEL f IRE.A PORCHAREA DECKAREA TOTAL DECK/PORC'ItR.A G%.RAGEAR_A: LJDEACH ❑ATTACH �D) tmiNGUNTrs: IS A SECOND UNIT ❑YES SECOND STORY ❑VEE BEING ADDED'. [-]NO__ ADDITION? ❑NO _ - r/ PRE -APPLICATION DYES IF 1=5, PROVIDE COPY OFIS THE BLDG AN ❑ YZS "_ TOTAL VALUATION: PLANNINGAPPLR ❑NO PLANNII.GAPPROVALLT]`R I EICHLERHOTIE? ❑NO By my signature below, I certify to each of th foilD•winQ: I am the property owner ora _ ,- to act on the propeftow-ner's behalf. I have read this application and the informationI have p I e is c t. I have read the Description �*ork and verify it is accurate. I agree toaomply with all applicable local ordinances and state laws relating to ing ns tion. I authorize representatives -of Cupertino to enter the above-identi:5ed property for inspection purposes. SismatureofApplieant/A:ent: Date: 17'—&-15 SUP LEMS. T .L LNF 1ATION REQiJIRED t y • -s New SFD or A4ultifarnily cl%vellin_s: Apply for demolition pe, -reit for existing building(s). Demolition pe, --,nit is required prior to i nuance of building ,�` $ permit for new building. Pz ��n GPL�� priZEu _ Commercial Bldgs: Provide a comtpleed Hazardous Materials Disclosure�L foal if any Hazardous Materials are being used as part of this project. All Copy of Planning Approval Letter or Meeting with Planning prior to Building Perrrtit 7 ` submittal of application. B1dg4pp_M11.d6c revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION 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 onh, an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/131 ADDRESS: 830 STENDHAL LN DATE: 12/16/2015 REVIEWED BY: MELISSA .�: � • APN: 375 41 020 BP#: 15070116 *VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: /wee. /r s/;. PENTAMATION 1GENRES PERMIT TYPE: WORK REV # 1 - STRUCTURAL CHANGES FOR DRYROT REPAIR AT GARAGE - ISSUED 12/16/15 SCOPE 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 onh, an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/131 tech. I'lttr; - r'hrwb. teeh .�: � • 1,1u;0" ' , ; , nr , ��: 1 I�Icc. I e%r,f,it F"" diher ;Lf� c Oilier .l'1 un . it <. > Other er h1c- Inco. Suppl. PC Fee: Q Reg. Q OT I'lrrrrilj. • /wee. /r s/;. 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 onh, an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/131 FEE __F_ QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? () Yes Q No $0.00 1 7 hours $143.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: Q Reg. Q OT ro.0 Ilrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee:Q Reg. 0 OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ("t -m Siruct ion I'v, .4(hnint:slrufive Tee: 0 Work Without Permit? 0 Yes ) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure G 7iwvel Documentation T', e, Strong Motion Fee: $0.00 1.0 hrs $143.00 Inspections ISTINSP Inspection, Hourly Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $286.00 TOTAL FEE: 1 $286.00 Revised: 10/01/2015 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building@cupertino.org 15o74911L ❑ NEW CONSTRUCTION ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS ^ y APN # � I _ O7— Q OWNER NAME NK. A MS. pfgWc 4 A viow PHONEE-MAIL 4v& - 5°I% •`I54t cic t iotn @ yall00. co STREET AgpRESS 00 S ffAL_ ct-I CITY, STATE, ZIP FAX v �� �t✓��`f' CONTACT NAME ' • , VA tAV-— W 1AQ- L,10 0 PHONE fl i5 _ p� ,�IryI E-MAIL t t � RC1 '/ I aYck Ifm4" (L'F'AXI`"la•I�� STREET ADDR 11000 Ofz � ST_ *103 CI Y,STATE,`TZjIP UD� cA ��II ^L ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME W LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE. ZIP PHONE ARCHITECT/ENGINEER NAME J D4N LOF LICENSE NUMBER BUS. LIC # COMPANY NAME ��0�FA-F�TTVF E-MAIL FAX ,., S. 555t5. STREET ADDRESS O g�Y T �.:, 20 3 CITY, STAT, ZIP �ut , ^ (^ � l) ,O `V 1�t��1 , 1� WO PH NE . n 13 D �l'r TJ DESCRIPTION OF WORK FE�`� I� T'� AJ -4D OJ V A V 1 ♦1-f(Q op e V EXISTING USE R_3 PROPOSE USE CONSTR. Q,-3 u TYPE f� V #STORIES t USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA 221 fj 1 „� YJ NEW FLOOR AREA I •�� DEMO AREA �t^ IS TOTAL ( r NET AREA 257 0.1 V l BATHROOM REMODEL AREA 14& KITCHEN) REMODEL AREA I1�c 511 OTHER REMODEL AREA [ 0t 15 I �l/DETACII1 T 7 ` �' vT! ♦ V -fel o D 0 !+ PORCII AREA DECK AJREA TOTAL DECK/PORCII AREA GARAGE AREA: ATTACH �7� � # DWELLING UNITS: IS A SECOND UNITY []YES ADDED? XO SECOND STORY YES ADDITION? IBEING jfftjO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑YES R6C IV[D Hl'": TOTAL VALUATION: PLANNING APPL # []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ \O 3�Ifloa 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 have 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 relatin to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: D�uc: --7 r SUPPLEMEN L INFORMA N REQ IRED PLAN CHECK TYPE Roo1.1NG SLIP ❑ OVER-THE-COUNTER © BUILDING PLAN REVIEW' New SFD or Multifamily dwellings: Apply for demolition pen -nit for existing building(s). Demolition pen -nit is required prior to issuance of building pen -nit for new building. ❑' EXPPESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ElPUBLIC WORKS form, foif any Hazardous Materials are being used as part of this project. ❑ L,NRGE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MA.lon ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 1 �1 kLGREEN SIGNATURE DECLARATIONS Project Name: Project Address: Project Descripti SECTION 1 — DESIG-N VERIFICATION Complete all lines of Section 1 — "Design Verification" and submit the completed checklist (Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design professional responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked above are hereby incorporated into the project plans and will be implemented i project in accordance with the requirements set forth in the 2013 California Green Building Standards Code CUPERTIN, ado^ by the City of Cupertino. Buildingp / De ar#m NOV 13 2015 Owners Signature Date DEREK LIOU REVIEW FOR CODE CO Owner's Name (Please Pict' Re IeYved By r Design Professional's Signature Date Design Professionals Name (Please Print) Signature of License Professional responsible for CalGreen compliance Date Eric Kirk Name of License Professional responsible for CalGreen compliance (Please Pmt) Phone Email Address for License Professional responsible for CalGreen compliance SECTION 2 - IMPLEMENTATION VERIFICATION Complete, sign and submit the competed checklist, including column 3, together with all original signatures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficient documentation to verify and certify that the project identified above was constructed in accordance with this Green Building Checklist and in accordance with the requirements of ^ the 2013 California G e 8 'Iding Star gg" Code as adopted by the City of Cupertino. Signature of License Profession! responsible for CalGreen compliance Otte Name of License Professioral responsible for CalGreen compliance (Please Print) Phone (!"0"-L t% 5AJ—' EmailAddress f Professional responsible for alGreen comp'iance gcSn,S Cai_,._2014 Akw re tixd IItOW14