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14070014FILE I c2 A _1; 93 � CERTIFICATE OF VERIFICATION CF3R- MCH -20 -H Duct Leakage Diagnostic Test (Page 1 of 3 ) Project Name: 7540 Bollinger Enforcement Agency: City of Cupertino Permit Number: Dwelling Address: 7540 Bollinger City: Cupertino Zip Code: 95014 A. System Information O1 Space Conditioning System Identification or Name System 1 02 Space Conditioning System Location or Area Served Whole house 03 Building Type from CF -113 Single family 04 Verified Low Leakage Ducts in Conditioned Space (VLLDCS) Credit from CF1R? No, credit is not taken 05 Verified Low Leakage Air Handling Unit (VLLAHU) Credit from CF1R? No, credit is not taken 06 Duct System Compliance Category New MCH -20a - Completely New Duct System B. Duct Leakage Diagnostic Test 01 Condenser Nominal Cooling Capacity (ton) 0 02 Heating Capacity (kBtu /h) 80 03 Conditioned Floor Area served by this HVAC system (ft2) 2000 04 Duct Leakage Test Condition Test final 05 Duct Leakage Test Method Total leakage 06 Leakage Factor 0.06 07 Air Handling Unit Airflow (AHUAirflow) Determination Method Heating system method 08 Measured AHUAirflow This field or section is not applicable 09 Calculated Target Allowable Duct Leakage (cfm) 104 10 Actual duct leakage rate from leakage test measurement (cfm) 59 11 Compliance Statement System passes leakage test Registration Number: 215- A6345834A- M2000001A -M20A Registration Date /Time: 2015 -10 -02 13:40:50 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 -1.006 Report Generated: 2015 -10 -02 11:24:02 2013 Residential Compliance Schema Version: 0.551SDD CERTIFICATE OF VERIFICATION CF3R- MCH -20 -H Duct Leakage Diagnostic Test (Page 2 of 3 ) B. Duct Leakage Diagnostic Test 12 Notes C. Additional Requirements for Compliance 01 System was tested in its normal operation condition. No temporary taping allowed. Outside air (OA) ducts for Central Fan Integrated (CFI) ventilation systems, shall not be sealed /taped off during duct leakage testing. CFI OA ducts that utilize controlled motorized dampers, that open only when OA ventilation is required to meet 02 ASHRAE Standard 62.2, and close when OA ventilation is not required, may be configured to the closed position during duct leakage testing. 03 All supply and return register boots were sealed to the drywall. 04 Building cavities were not used as plenums or platform returns in lieu of ducts. 05 If cloth backed tape was used it was covered with Mastic and draw bands. 06 All connection points between the air handler and the supply and return plenums are completely sealed. Visual Inspection at Final Construction Stage (applicable if system was tested at rough -in) After installing the interior finishing wall and verifying that the above rough -in tests was completed, the following procedure must be performed For all supply and return registers, verify that the spaces between the register boot and the interior finishing wall are 07 properly sealed. If the house rough -in duct leakage test was conducted without an air handler installed, inspect the connection points 08 between the air handler and the supply and return plenums to verify that the connection points are properly sealed. 09 Inspect all joints to ensure that no cloth backed rubber adhesive duct tape is used. 10 Verification Status Pass 11 Correction Notes for this table The responsible persons signature on this compliance document affirms that all applicable requirements in this table have been met unless otherwise noted in the Verification Status and the Corrections Notes in this table. D. Determination of HERS Verification Compliance All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order for this Certificate of Verification as a whole to be determined to be in compliance. 1 01 1 Complies: All specified verification protocol requirements on this document are met. Registration Number: 215- A6345834A- M2000001A -M20A Registration Date /Time: 2015 -10 -02 13:40:50 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 -1.006 Report Generated: 2015 -10 -02 11:24:02 2013 Residential Compliance Schema Version: 0.551SDD CERTIFICATE OF VERIFICATION CF3R- MCH -20 -H Duct Leakage Diagnostic Test (Page 3 of 3 ) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Verification documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Ph Mark Draper /ffozll� Company: Date Signed: FRI Energy Consultants, LLC. 2015 -10 -02 13:40:50 Address: CEA/ HERS Certification Identification (if applicable): 21 N. Harrison Ave, Suite 210 City /State /Zip: Phone: Campbell CA 95008 408 - 866 -1620 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Verification is true and correct. 2. 1 am the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification (responsible rater). 3. The installed features, materials, components, manufactured devices, or system performance diagnostic results that require HERS verification identified on this Certificate of Verification comply with the applicable requirements in Reference Appendices RA2, RA3, and the requirements specified on the Certificate of Compliance for the building approved by the enforcement agency. 4. The information reported on applicable sections of the Certificate(s) of Installation (CF2R) signed and submitted by the person(s) responsible for the construction or installation conforms to the requirements specified on the Certificate(s) of Compliance (CF1R) approved by the enforcement agency. S. I will ensure that a registered copy of this Certificate of Verification shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of Verification is required to be included with the documentation the builder provides to the building owner at occupancy. Builder Or Installer Information As Shown On The Certificate Of Installation Company Name (Installing Subcontractor, General Contractor, or Builder /Owner): Responsible Builder or Installer Name: CSLB License: HERS Provider Data Registry Information Sample Group Number (if applicable): Dwelling Test Status in Sample Group (if applicable) Tested HERS Rater Information HERS Rater Company Name: FRI Energy Consultants, LLC. Responsible Rater Name: Responsible Rater Signature: Mark Draper Responsible Rater Certification Number w/ this HERS Provider: Date Signed: K4ZI V CC2006527 �/'� P 2015 -10 -02 13:40:50 Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 215- A6345834A- M2000001A -M20A Registration Date/Time: 2015 -10 -02 13:40:50 HERS Provider: CaICERTS CA Building Energy Efficiency Standards Report Version: 2013 -1.006 Report Generated: 2015 -10 -02 11:24:02 2013 Residential Compliance Schema Version: 0.551SDD I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 7540 BOLLINGER RD , CON RUCTIONNCO N I PERMIT NO: 14070014 OWNER'S NAME: RUNPING LI P O BOX 31983 1 DATE ISSUED: 12/08/2014 I OWNER'S PHONE: 4089668850 1 OAKLAND, CA 94604 1 PHONE NO: (510) 228 -6665 ❑ LICENSED CONTRACTOR'S DECLARATION License Class_ -- Lic. #_ �! Contractor /Date 1 hereby affirm that am licensed under the provisions 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 erformance of the work for which this permit is issued. ave and will maintain Worker's Compensation Insurance, as provided for by ection 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point ypurce�5�gulations per tT Cupertino Municipal Code, Section 9.18. j� I l Signature_ NI I ),IV I k—,11 ^ _Date ❑ OWNER- WUILDER DECLARATION I hereby affirm that I 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 or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (See.7044, Business & Professions Code). 1 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. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date r BUILDING PERMIT INFO: BLDG ELECT PLUMB r r I� MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: CONSTRUCT A ONE STORY ADDITION AT FRONT OF SFD (554 SQ FT), FRONT COVERED PORCH (24 SQ FT); REMODEL KITCHEN (150 SQ FT); REMODEL MASTER BATH 6/4/15 - REV # 1 - REVISE STRUCTURAL DETAILS FOR CEILING RAFTERS AND BEAMS. ISSUED 6/8/15 Sq. Ft Floor Area: I Valuation: $100000 APN Number: 35924004.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSlP�ECTION. Issued by: ill v �CZ 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: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupert}'�o MunicKate: Chapter 9.12 and the Health &Safety Code, Sections 5505 D�533, an I 1 Owner or authorized agent: —11 1 - , ild / CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Profess I CITY OF CUPERTINO BUILDING PERMIT 1 BUILDING ADDRESS: 7540 BOLLINGER RD 1 CONS R UCTOION R: WIN CO GON I PERMIT NO: 14070014 I OWNER'S NAME: RUNPING LI I P O BOX 31983 1 DATE ISSUED: 12/08/2014 1 OWNER'S PHONE: 4089668850 ! OAKLAND, CA 94604 I PHONE NO: (510) 228 -6665 1 K LICENSED CONTRACTOR'S DECLARATION License Class Lic. 4 iJ Z a6 El Contractor ` �1� * Date I _ 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 maintains 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 wort} for which this permit is issued. J 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 l have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save . indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will eompl with all non -point sour e regulations p the Cupertino Municipal Code, Se K 9.18. _ R I Signature ❑ OWNLR- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self - insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, l 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. l agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date JOB DESCRIPTION: RESIDENTIAL F-] COMMERCIAL 0 CONSTRUCT A ONE STORY ADDITION AT FRONT OF SFD (554 SQ FT); FRONT COVERED PORCH (24 SQ FT); REMODEL KITCHEN (150 SQ FT); REMODEL MASTER BATH Sq. Ft Floor Area: I Valuation: $100000 APN Number: 35924004.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PE. IT ISSUANCE OR 180 DAYS FRAM LT CALLED INSPECTIO . 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, l agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should 1 store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Muni ipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25;05, 25533, aid 25534. Owner or authorized agent: Date{_!; 1 t t CONSTRUCTIO WLENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Profession L:'i.irSS . CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION [�� 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 v (408) 777 3228 • FAX (408) 777 -3333 • building Cupertino org bo � CUPERTINO ❑ NEW CONSTRUCTION ADDITION ❑ ALTERATION / TI ❑ REVISION I DEFERRED ORIGINAL PERMIT n PROJECT ADDRESS 75- 44 60 77, 35 �2 DO K J OWNERNA.ME �1 PHONE / / n E -MAIL / (� STREETADDRESS r CITY, STATE, ZIP FAX CONTACT NAME �HI � -al T-" /- I - ti ('f,j•� (� (� PHONE ( I O E -MAIL STREET .ADDRESS CITY, STATE, ZP F.AX S OTC ❑ oANTR ❑ owNER- Bumi)ER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARc=.c —r 'GLNEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME I LICENSE NUMBER LICENSE TYPE BUS, LIC COMPANY NAME E -MAIL F.A-X STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT /ENGINEER NAME /. y'Tx / LICENSE NUMBER BUS. LIC 9 G(' �( COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP- PHONE DESCRIPTION OF WORK r CJ r— i EXISTING USE PROPOSED USP CONSTR.TYPE «STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXLSTG NEW FLOOR DEMO TOTAL AREA AREA � / AREA NET AREA �1 C/ BATHROOM REMODEL AREA KITCHEN REMODEL AREA T / OTHER REMODEL AREA PORCHAREA DECK AREA TOTAL DECKNORCH AREA GARAGE AREA: 7DETACH ATTACH s DRELLING UNITS: IS A SECOND UNIT El YES SECOND STORY []YES BEINGADDED? El NO ADDITION? ED NO -- PRE- APPLICATioN- -DYES - -IF YES,PROVIDE.LOPY OF ______ _IS THE BLDG -A-N _ t TOTAL VALUATION: PLAN",.4NGAPPL4 ENO PLANNING APPROVAL LETTER EICHLERHONtE? El NO By my signature below, I certify to each of the following: I am the property ov3n agent to ac e property owner's behalf. I have read this application and the information I have provided is correct. I have read t e Desc Ion of Work and verify it Is accurate. 1 agree to comply with all applicable local ordinances and State laws s relating to buildi e constructio I authori epresentatives of Cupertino to enter the above -id ti ied roperty for inspection purposes. Signature of ApplicznUAeent: — Date: SUPPLEME NTAL 1NFORMA ON REQUIRED cxECxT�PE xotrrL.csilP New SFD or Multifamily dv� ellintrs: ply for demolition permit for © BtII�II�6PL41� existing building(s). Demolition permit is required prior to issuance of bui]drng # ovER TxllcounTER REVIE�i� a permit for new building. ° ❑> PRESS , ❑ PS ANfiI1G PLAN RES lEfiJ+ ERa } xL R S 1. =`c _ Commercial Bldgs: PrOVide a completed Hazardous Materials Disclosure Q STAhADaRD _ PLSLIG�yoRxs ? F _ form if any Hazardous Materials are being used as part of this project.' ` y � } ❑ Copy of Planning Approval Letter or Meeting with Planning prior to �.ARG$' � ,EIItE DEkT _ MDrox� s f� ,tTAxi stRDisTRICr submittal of Building Permit application. t,is' '- r } t - i]3`ENVIRON7�1EhTA3iEALT13 { Bldg4pp_201 T doe Devised 06121111 i'W R - CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 7540 BOLLINGER RD DATE: 07/03/2014 REVIEWED BY: MELISSA APN: 359 24 004 BP #: `VALUATION: j$100,000 ' PERNIIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY USE: SFD or Duplex 2nd Unit? Yes • No OTC? Q Yes �No PENTAMATION PERMIT TYPE: 1 R3SFDADD WORK ADD 554 S.F. TO CREATE N BEDROOM N HALL BATH & N LIVING ROOM. REMODEL E SCOPE KITCHEN (150S.F.) & MASTER BATH (50S.F.) OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE 1D BP FEES BP FEE ID R -3 (Custom) II- 13,111- B,IV,V -B 554 $2,577.00 IR3PL)VCK $1,617.00 IR31NSP $0.00 PME Plan Check: $0.00 50 s.f. $ 00 Remodel, Bath (< =300 sf) IREMRESBAT �Y Permit Fee: $1,617.00 Suppl. Insp. Fee-(j) Reg. Q OT O,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 554 $2,577.00 $1,617.00 T MECH, HOURLY 0 Yes E) No PLUMB, HOURLY Q Yes ) No ELEC, HOURLY 0 Yes Q No Lj 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 nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS 1,'ec Resolution 11 -053 Eff. 7j'13 FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,577.00 150 s.f. .00 Remodel, Kitchen (< =300 sf) IREMRESKIT 6 Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 50 s.f. $ 00 Remodel, Bath (< =300 sf) IREMRESBAT �Y Permit Fee: $1,617.00 Suppl. Insp. Fee-(j) Reg. Q OT O,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 T T 7 G) Work Without Permit? 0 Yes C!) No $0.00 Advanced Planning Fee: IPLLONGR $77.56 Select a Non - Residential Building or Structure E) i e Strong Motion Fee: IBSEISMICR 00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $4.00 SUBTOTALS: $4,285.561$1,252.001 TOTAL FEE: F $5,537.56 Revised: 07/01/2014 CONSTRUCTION PERMIT APPLICATION *'0 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIV1SIO FO 10,300TORRE AVENUE • CUPERTI NO, CA 95014 -3255 CUPERTINO (408) 777 - 3228• FAX (408) 777 -3333 • buildinaLL-cupertino.ora ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI , SION / FERRED ORIGINAL PERMIT 9 H d DO PROJECT ADDRESS 77-� Qoff"`qj eT C�ff Art'417 0 OWNER NAME PHO. d E -MAIL D f gp - O 39 STREET ADDRESS CITY, ( TATE, ZIP FAX CONTACT NAME P NE Yttf'-Tt'on Chew 786 -8 E -MAIL 1 -Z 9 6, mSn.CC-7 STREET ADDRESS -/o A CI1 Y ScT I FAX - 13 a yy, tiY1 S '> ❑ OWNER ❑',OWNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT . ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LICENSE NUMBER LICENSE TYPE BUS. LIC # LV1') ( 0OIAPANY NAME 1nf s1� � C� G��S `�Y✓ �nC, E -MAIL N r rn 1 >rG f'hS vt , G� FAX STREET ADDRESS' CITY STATE ZIP 049 (kr PH NNE A-gk v ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC k COMPANY NAME' E -MAIL FAX STREET ADDRESS, r CITY, STATE, ZIP PHONE DESCRIPTION OF WORK {pA� � I t -to a At VV e4'k Y10-4 �2 ` ��� c E>ZSTING USE PROPOSED USE CONSTR. TYPE STORIES USE TYPE OCC. SQ.FT. VALUATION (S) F-NaSTG NEW FLOOR- DEMO TOTAL AREA AREA AREA NET AREA ... BATHROOM KITCHEN. OTHER. REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDETACH []ATTACH K DN'ELLJNGUNITS: IS A SECOND UNIT ❑ YES SECOND STORY []YES BEING ADDED? []NO ADDITION? ❑NO PRE - APPLICATION [1 YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES PLANNING APPL 0 ❑N0 PLANIPTAIGAPPROVALLETTER EICHLERHOME7 - ... .� By my signature, below, I certify to each of the follo«Ning: 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 relating to building construction. Zuthorize. representatives of Cupertino to enter the above -id ntified property fo spection purposes. Signature of Applicant/Agent: Date: 8UPPLEMEN INFOR1fATION REQUIRED ,cl cx >1 zov csLrP � � New SFD or Multifamily dwellings: Apply for demolition permit for - existing building (s). Demolition permit is required prior to Issuance of building O'rERTHE�OUhTER �- BUII,DL'�GPL REVIEW � permit for new, building. me EXPRESS- �{ v . I PLANI�LRGPLANIiEVIEW r: _ON- _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure — B�vtoR�cs form if any Hazardous Materials are being used as part of this project, � s 010 � _ Copy of Planning Approval Letter or Meeting with Planning prior to SERDISRrCT��" submittal ofByilding Permit application.MAaoR�sAhITAR BldgApp_2011.doc revised 06121111 )'r CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION imlADDRESS: 7540 Bollinger Road DATE: 06/04/2015 REVIEWED BY: PAUL Plan Check Fee: Hourly Only? © Yes Q No APN: BP #: `VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PME Plan Check: PENTAMATION 1 GENRES I PERMIT TYPE: WORK 6/4N15 -REVISION TO CEILING BEAM /STRUCTURAL SCOPE Suppl. Insp. Fee:Q Reg. Q OT NOTE. This estimate does not includeJees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District etc/_ These fees are based an the nreliminary information available and are only an estimate. Contact the Dent for addn'I info. FEE ITEMS (Fee Resolution 11 -053 E : 7%1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? © Yes Q No $0.00 2 hours Plan Check, Hourly $286.00 ISTPGNCK Suppl. PC Fee: (F) Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential E) Building or Structure 0 Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $286.00 TOTAL FEE: $286.00 Revised: 05/07/2015