The URL can be used to link to this page

15110023CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS; iCUPERTINO CONTRACTOR: PERMIT NO: 15110023 22445 CUPERTINO RD CA 95014 (326 15 130) SAMUAL CONSTRUCTION 2141 CAROBWOOD LN SAN JOSE, CA 95132 OWNER'S NAME: FRONT PORCH COMMN & SERVS DATE ISSUED: 08/23/2016 OWNER'S PHONE: 408-454-5600 PHONE NO: 408-221-7900 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class ]a tic. #1:;564772 Contractor SAMUAL CONSTRUCTION Date 04/30/2017 —BLDG _ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing _ MECH _ RESII)ENTIAL _ COMMERCIAL With Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: "SUNNYVIEW LUTHERAN HOME" - ADD (N) SUNROOM TO (E) I hereby affirm under penalty of perjury one of the following two declarations: READING ROOM (182 S.F.) 1. 1 have and will maintain a certificate of consent to self -insure for Worker's / Compensation, as provided for by Section 3700 of the Labor Code, for the performance for is of the work which this permit issued. ,� 013-111, ! 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. Sq. Ft Floor Area: Valuation: $45000.00 APPLICANT CERTIFICATION certify that 1 have read this application and state that the above - information is correct. II agree to comply with all city and county ordinances APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 32615 130 representatives of this icity to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant understands and'will comply with all non -point source regulations per 'the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. v K-----7? Signature Date 08/23/2016 Issued by: KIM DUNBAR OWNER -BUILDER DECLARATION Date: 08/23/2016 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. 1, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation', will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (See.7044, Business & Professions Code). Date: 08/23/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance pfthe work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the s. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Coil pensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the �, the Health & Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall r� be deemed revoked. J Owner or authorized agent: APPLICANT CERTIFICATION Date: 08/23/2016 I certify that I have read this application and state that the above information is CONSTRUCTIOA>; LADING AGENCY I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above' mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and ;keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands DECLARATION ARCHITECT'Sbd and will comply with all non -point source regulations per the Cupertino Municipal uses public records. 1 understand my plans shal1l1bee used a Code, Section 9.18. / Licensed Signature Date 08/23/2016 professional i CUPERTCtNO, ❑ NEW CONSTRUCTI011 CONSTRUCTION PERMIT APPLICATION 151, COW4UNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildiinno(d).cuoer<ino.ora ❑ ADDITION . F" ALTERATION/TI I 1 RF.VTCThwIT)FFT=.RRFI> 07QTrrrTAT AFR,,=m PRO7ECP fDDPESS(f { n f� APNnVn OWNERNANr —g✓ PHONE —�w--j E•NAIL �IIiV�GWt J%%l UY �Y�vt I f.� ®fv BtI Adr 2S -S- STREET ADDRESS 22- 4f `S* CITY, STATE, ZIP ,/y PCiM6 0 CONTACT NAME PHONE 00 STREET ADDRESS CITY, STATE, ZIP FAX iD OWITtR ❑. OWNER -BUILDER OV7h.-IAGENi ❑ CONTRACTOR ❑ CONT'RSCTORAGENT ❑ ARCHITECT 0 ENGINEER ❑ DzVsLOI,ER ❑ TETANr CONTRACiORNA'ME LICENSENU1,1BER LICENSE TYPE BUS. 11C COIJ ANYNA?S:5 bvu5i I P -MAIL FAX eA I J GCf 4m(J-ei( I �1G � a ST C P pRr e ��j * ;ZIP SiS, 4.y SI3 BV — PHONE +meq _ -_ ;F�✓.E g q I LICENSE NU MER � i� % � BUS, LIC m COMPANY NAS /j % ®c' B�°'�s K 1'" ( E-MPIL { ,� VV\ i -00 e x FAX P' � -Q. `ZIP STREET ADDRESS ESS j 0 `?3 � f `11f � CITY, STATEv, � q 3 ' ,9 �� PHONE DESCRIPTION OF WORK r- Z 54-1n, -y EXISTING USE PROPOSED USE CO 'SIR E�.�ST01I S - USE TYPE OCC. SQ.FT. V,4LUATION (S) -E�-c--fie- EXISTG AREA. +� y�d� T NEW FLOOR AREA li DEMO I AREA TOTAL ?-tf AREA ' �'� V ��!!! ��A to ( __ -- I yyy777y�7gq��^ 4 w 0 /_ BATHROOM REMODEL AREA KITCHEN j�/ REMODEL AREA d OTHER RE1,30DEL AREA I I ' .( /" I PORCHAREA DECK AREA TOTAL DECK)PORCH AREA i GARAGE. AREA: DETACH - p_ a r® ," 901r ❑ ATTACH 'DWEELLIINNGUNI : ISASECONDUNIT ❑YES SECOND STORY []YES BEING ADDED, Ar NO ADDITION?0 w PRE -APPLICATION [3 YES IF YES, PROVIDE COPY OF PLANNINGAPPLm PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES- EICHLERHOME?XI.0 �"EDBI =_.-:— TOTAL, Vp,LUAT ANO fo ,ming: I am the propel] o��mer or authorized agent to act on the property owner's behalf. I have read this By my signature Ibelovv, I certify to each oon.- application and the information I have pro s rre t. I have read the Description of'Work and verify it is accurate. I agree to comply v,,ith all applicable local ordinances and state laws relating to buildns` c ' n. I authorize representatives 'of Cupertino to enter the above-identity"ed property for inspection purposes. Signature of Applicant/Agent: Date: UPPLElviENTAL INS 1ATION REQUIRED O R't•HE-COTiNTEI2� _ BLTIiDL'�GPLA��2E�SEGY - New SFD Or Multifamily d -Wellings: Apply for demolition permit forLL existing buildi ig(s). Demolition permit is required prior to issuance of building for newibuilding.%PAESS �I 4QI�ZlGPL4v PE�iP�§ -. permit Bldgs: Provide a completed Hazardous Materials Disclosure = AD ARD PVB c otzTzs 3 s_ _Commercial for if any Hazardous Materials are being used as part of This project. = - ' � i,�RG� ,,•�� _ Copy of Planning Approval Letter or _Meeting with Planning prior toaoR� �FIIEDEPT ��AnirzYSERVTsrRrcr submittal of Building Permit application. � _.� -- BldgApp_20II.doc revised 06121111 C I As CITY OF CUPERTINO -,t FEE ESTIMATOR - BUILDING DIVISION"""'- im,ADDRESS: 22445 Cupertino Rd. DATE: 11/04/2015 REVIEWED BY: PAUL PC FEE ID APN: 32615130 BP#: *VALUATION: 1$45,000 *PERMIT TYPE: Building Permit 182 PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building $1,117.00 Civil / Religious activities PENTAMATION 1A2 I USE: Suppl. Insp. Fee -.(E) Reg. OT 0.0 in BQ zone? Q Yes No PERMIT TYPE: WORK "Sunnyview Lutheran Home" - Add N Sunroom to E Reading Room 182 S.f. PME Permit Fee: $0.00 SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID A-2 II-A,111-A,V-A 182 $6,707.00 IA2PLNCK $1,117.00 IA2INSP Permit Fee: $1,117.00 Suppl. Insp. Fee -.(E) Reg. OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $540.54 /rr�inlslrrzli� e Fee: G Work Without Permit? Yes (F) No $0.00 TOTALS: 182 $6,707.00 ��r�c;iriirt°a�lr�tir�n 1°�>��., $1,117.00 Strong Motion Fee: 1BSEISMICO MECH, HOURLY 0 Yes E) No PLUMB, HOURLY Q Yes E) No ELEC, HOURLY ®' Yes E) No t ..' "'fan f .'lit'.:/ tnFb. 111(pi Che'c'k: t`''ree. I'lon Clieck Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F) Reg. OT to c. hrs t fl,"Ir !'hrntb 11"sp. o.r ger I:Iec. ltup. tech, ImP' 1, Permit 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 ees are based on the nreliminar information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff'.' ?/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $6,707.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (F) Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,117.00 Suppl. Insp. Fee -.(E) Reg. OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $540.54 /rr�inlslrrzli� e Fee: G Work Without Permit? Yes (F) No $0.00 Advanced Planning Fee: IPLLONGC $52.78 Select a Non -Residential Building or Structure 0 � ��r�c;iriirt°a�lr�tir�n 1°�>��., Strong Motion Fee: 1BSEISMICO $12.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS:'` $8,431.92 $0.00 TOTAL FEE: $8,431.92 Revised: 10/01/2015 �[\, r k/ /Z CITY OF CUPERTINO 1 511 QQ&3 FFF F4TIMATOR — RITII,DING DIVISION imlADDRESS: 22445 Cupertino Rd. DATE: 11/04/2015 REVIEWED BY: PAUL APN: 326 15 130 BP#: *VALUATION: 1$45,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building hrs Civil / Religious activities PENTAMATION 1 GENCOM I USE: $0.00 in BQ zone? 0 Yes No PERMIT TYPE. WORK "Sunnyview Lutheran Home" - Add N Sunroom to E Readin Room 182 S.f. 0.0 hrs $0.00 SCOPE c. ; NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Pire, sanitary sewer District, scnool n:,.•_ „•,. 1 Tl.,. ,. f.... ,. 1... .,./ .... "L_ nlisr. nFnrwrniinrr ni/nh/o ani/ aro nn/Ir "m OCl/mato Cnntart the nPnt far a/do 1 info. FEE ITEMS (Fee Resolution 11-053 Ef,' 711,'132 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =s.f. $859.00 Patio Cover / Sun Room 1PATIOENCW Wood, Enclosed Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $0.00 G Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure 0 Strong Motion Fee: IBSEISMICO $12.60 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $2.00 SUBTOTALS: $14.601 $859.00 TOTAL FEE: $873.60 Revised: 10/01/2015