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13080069CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21391 VAI AVE CONTRACTOR: AVA CONSTRUCTION PERMIT NO: 13080069 OWNER'S NAME: CHANG BENJAMIN M AND ELLEN M 21060 HOMESTEAD RD APT 216 DATE ISSUED: 11/20/2013 OWNER'S PHONE: 4082525765 CUPERTINO, CA 95014 PHONE NO: (408) 387 -0999 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL❑ ❑ LICENSED CONTRACTORS DECLARATION License Class Li,. 0 / 4 5 0 "l 3 CONSTRUCT 636 SQ FT OF ONE STORY ADDITIONS; ff Contractor 44c, 1� IV ✓+s# 3 INTERIOR REMODEL; REMOVE AND RELOCATE O 4 at• oo. Date ©2D Ti URNACE INTO I hereby affirm that I am licensed under the provisions of Chapter 6 ATTIC; UPGRADE ELECTRICAL PANEL TO 200 AMP. (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: $200000 perf nnance of the work for which this permit is issued. or 6•c and will maintain Compensation Insurance, as provided for by /�1 ectum 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 36205016.00 Occupancy Type: 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 I 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 S FROM LAST C LED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of granting of this permit. Additionally, the applicant understands and comply Issued by: ate: with all non -point source regulations per the Cupertino Municipal Code, Section 9.I8. �Cl�r A 2A RE- ROOFS: w,v ,9-J20 Signature Dale / V� 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 1 am exempt from the Contractor's License Lew 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(x) 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 /� %4 � Owner or authorized agent. {- ("1/O�i Dater permit is issued. 1l 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 (See. 3097, Civ C.) Lender's Name Lender's Address 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, pRCHITECF'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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building akupertino.org ❑NEW CONSTRUCTION ❑ADDITION ❑ALTERATION /TI ❑ REVISION /DEFERRED ORIGINALPERMIT# 16m] PROJECT ADDRESS 2 111 e �vt APN k ' L Z— 6 S- O I 11 U R 1 i'fYt�, C r D JV V OWNERNAME ^ e�C1 A� NG u�J PHONE E -MAIL STREET ADDRESS t .ir, V' R`J� CITY. STATE. ZIP CO e, J 1, � liw�"T -�/[1 FAX CONTACT NAME R Q,,, C a+� v PHONE 14 DlP !/ 1�T-rr a l�.J ? .(L E -MAIL eML I LSLaS LJ eG L Oy STREET ADDRESS rq` \ "O ��) � CITY, STATE,, ZIP P Cy FAX N tot VP. eJ'�h° I WNER ❑ OWNER- BmLDER ❑ OWNER AGENT ❑ CONTRACmR ❑ CONTRACTOR AGENT ❑ ARCaHECr ❑ ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTORNAME ,Q�f n /1 ]t�v� b V ry--�S(vu C �^ LICENSE NUMBER LICENSE TYPE BUS. LICK COMPANY NAME A` A GQK S I yv C-�q E -MAIL FX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECOENGBJEERN � LICENSE NUMBER / qL�� BUS. LIC# C K�A COMPANYNAME n •( o E-MAIL Qs' _e `B� FAX O ;P/ / L) . / STREET ADDRESS G /7� Z /o6a O lSTl9OPC� CITY, STATE,ZIP /v¢3Ziro PHO $uG•�r7 197 P DESCRIPTION OF WORK vIC r,J r `n `aS{ ! hP lro. r� nti �° 2Y1 �dr e w:r, AH �Ir'I1r Yoo wI AdVl ro-• A . I I 441 �l s ` P11 11 a er „I J /t 'fk an 1! P -+C kcv) o de !7 F�1 1 EDISTINGU E PROP t E �S^ NSTK T?O�TE Q., •+JeNtf.+ 9STOROSS USE TYPE OCC. SQFI. VALUATION (S) K-4, CY n R4 Neu 1 AREAL 21�y AREA FLOOR 2.St� AREA O TOTAREk BATHROOM KITCHEN r OTHER RFMODELAREA 1!:r:;-C> REMODELAREA 17 REMODELAREA PORCH AREA DECK AREA TOTALDECK RCH AREA GARAGEAREA: WACH �0 0 12-C) 5b TACIT gDWELLBJG IRHIS: ISASECOND UNIT ❑YES BEING ADDED? SECOND S TORY ❑ ADDITION? _f PRE - APPLICATION QS IF YES, PROVIDE COPY OF PLANNINGAPPL# O PLANNINGAPPROVALLEITER ISTHEBLDGAN I_I YliE EICHLER HOME? O RECEIVED BY: TOTALVALUATION: By my signature below, I certify to each of the follow I am tb er or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided' rrect ve read the Description of Work and verify it is accurate. I agree to comply with at] applicable local ordinances and state laws relating to buildin tru n. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of ApplicantlAgent: f7 --trA— Date: B, ! - ?e:) SUPPLEMENTAL INFORMATION REQUIRED Fun CHECK TYPE ROUTING SLB ❑ OVER - THE - COUNTER ❑ BUILDING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW — Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11 STANDARD 13 PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 Ldoc revised 06121111 41. iet ��,�,,���� CITY OF CUPERTINO 1rml FEE ESTIMATOR — BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: Ben and Ellen Chang I DATE: 08109/2013 REVIEWED BY: larrys PC FEE ID APN: 362 -05 -016 BP #: 206-0ei ' `VALUATION: 1$200,000 PERMIT TYPE: Building Permit I PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? 0 Yes 19 No I OTC. Oyes O No PENTAMATION 1 R3SFDADD PERMIT TYPE woRK addition at rear side new master bedroom bathroom and closet and to enlarge family room and dining SCOPE room. Addition at front to add new living room. Remodel existing bath and kitchen. OCCUPANCY TYPE: TYPE OF R. CONSTR FLR AREA s.t PC FEES PC FEE ID BP FEES BP FEE ID R -3 (Custom) II- B,III- B,IV,V -B 636 $2,577.00 1R3PLNCK $1,617.00 IR3INSP Elec. Insp. Fee: $1,617.00 Suppl. Insp. Fee:Q Reg. O OT 0,0 1 his $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tar: Administrative Fee. O 0 Work Without Permit? O Yes O No $0.00 TOTALS: 636 $2,577.00 Travel Documentation Fees: $1,617.00 Strong Motion Fee: IBSEISlNICR MECH, HOURLY O Yes O No PLUMB, HOURLY O Yes E) No ELEC, HOURLY O Yes Q No Ltech. Plan r Phuub. Plan Check Elec. Plan Check ,1. Perwi! Fee.: Plumb. Permit Fee: Elect. Permit Fee: Other ,tfech. i:.,. Other Plumb lnrp. Other Elev. Insp. Ej Ilech. Insp. Fee: - Plumb. bap. Fee: Elec. Insp. Fee: NOTE: This esdraate does not include fees due to other Deparhnents (le. Planning, Public Works, Ptre, sanitary sewer District SOON District eta ). These fegv are based on the prefinddna in ormadon available and are only an estimate Contact the De t or addn'l in o. FEE ITEMS (Fee Resolution 11 -053 Efi' 7/1/121 FEE QTY/FEE I MISC ITEMS Plan Check Fee: $2,577.00 = s.f. Remodel, Bath (< =300 sf) $626.00 IREMRESBAT Suppl. PC Fee: Q Reg. O OT F0701 his $0.00 PME Plan Check: $0.00 190 s. f. Remodel, Kitchen (< =300 sf) $626.00 IREMRESKIT Permit Fee: $1,617.00 Suppl. Insp. Fee:Q Reg. O OT 0,0 1 his $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tar: Administrative Fee. O 0 Work Without Permit? O Yes O No $0.00 Advanced Planning Fee: IPLLONGR $89.04 Select a Non - Residential 0 Building or Structure Travel Documentation Fees: Strong Motion Fee: IBSEISlNICR $20.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $8.00 SUBTOTALS: $4,311.04 $1,252.001 TOTALFEE: $5,563.04 Revised: 0 7/0 112 01 3 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408-777-3333 JOB ADDRESS: Ve— PERMIT# 13 0800 OWNER'S NAME: PHONE # o S ZS 2- GENERAL CONTRACTOR: Avok BUSINESS LICENSE # '320 �g ADDRESS: -Z—\66C Ct3 CITY /ZIPCODE: cl� 5©1 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date j/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile / Contractor Signature Jev G , Date CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21391 VAI AVE OWNER'S NAME: CHANG BENJAMIN M AND ELLEN M ON\'NEWS PHONE: 4082525765 ❑ LICENSED CONTRACTOR'S DECLARATION License Class__ Lic. N Q � 5 01A Contractor Al Cek-tl j n Dates I A o 1!; I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations:) 1 have and will maintain a certificate of consent to self -insure for Worker' IF /1. Compensation, as provided for by Section 3700 of the labor Code, for t1KF 11 ,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 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. )� a e� f' Signature r ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec-7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self - insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the tabor 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 CONTRACTOR: AVA CONSTRUCTION 21060 HOMESTEAD RD APT 216 95014 PERMIT NO: 13080069 DATE ISSUED: 11202013 PHONE NO: (408) 387 -0999 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ CONSTRUCT 636 SQ FT OF ONE STORY ADDITIONS; INTERIOR REMODEL; REMOVE AND RELOCATE FURNACEINTO ATTIC; UPGRADE ELECTRICAL PANEL TO 200 AMP. REVISION N4- RE E SIDING TO FRONT OF SFDWL 570 SQ FT- ISSD OTC 2/182015 Am # Sq. Ft Floor Area: Valuation: $200000 APN Number: 36205016.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM) ZAST CALLED INSPECTION. Issued by: Date: C�9! 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25 , 25533, and 25534. Owner or authorized agent: � ate: 12 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.) Leader's Name ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21391 VAI AVE I CONTRACTOR: AVA CONSTRUCTION I PERMIT NO: 13080069 OWNER'S NAME: CHANG BENJAMIN M AND ELLEN M 1 21060 HOMESTEAD RD APT 216 I DATE ISSUED: 11202013 O\\'NER'S PHONE: 4082525765 ❑ LICENSED CONTRACTOR'S DECLARATION License Class___._ Lic. 9 cJ '7 �� V3 RA Contractor rr 1 A C'_sr �f Y ,/ t K-Date _2_1 L 1 hereby affirm that 1 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. 1 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 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. 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 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. I ) Signature Date jz1r^- u / ❑ 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 or offered for sale (See.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, 1 must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 1 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 CUPERTINO, CA 95014 I PHONE NO: (408) 387 -0999 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ CONSTRUCT 636 SQ FT OF ONE STORY ADDITIONS; INTERIOR REMODEL; REMOVE AND RELOCATE FURNACE INTO ATTIC; UPGRADE ELECTRICAL PANEL TO 200 AMP. REV N 3 - ADD ADDITIONAL 405 S.F. TO AREA OF REMODEL (FROM 1028 S.F. TO 1433 S.F.) - ISSUED 9/12/14 Sq. Ft Floor Area: I Valuation: $200000 APN Number: 36205016.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 1jaDAJ5MF PERMIT ISSUANCE OR 180 Der FR Q T J4 '' A LI •ED INSPECTION. -7�oby 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. [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 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25 05, 25533, and 25534. ( 99 Owner or authorized agent: e� Date:l // 2 f L.n 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 �����,���,, CITY OF CUPERTINO 11�' -w, FEE ESTIMATOR - BUILDING DIVISION ( ADDRESS: 21391 vai ave DATE: 02118/2015 REVIEWED BY: Mendez Elec, Plan Chrek pPN: BP#: I 'VALUATION: $0 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY Other Vec. Imp. PENTAMATION SFD Or Duplex USE: P Elec. Insp. I-ee: PERMIT TYPE: WORK REVISION #4- REVISE SIDING TO FRONT OF SFDWL 570 SQ FT- ISSD OTC 2/18/2015 Suppl. Insp. FeelD Reg. O OT 0.0 SCOPE $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 fop, are based on the prelimina information available and are ontv an estimate. Contact the De t it addn'I info. FEE ITEMS (Fee Resolution 11 -053 E . 73) .ifech. Plan Cheek Phumh Pic", Chrck Elec, Plan Chrek ifech. Permit Fee: Plumb. Pconit Fee: F,lec Permit Id: Other Ucch. Insp. Other Plumb Imp. Other Vec. Imp. 11ech. /?UP. Pipe: Plumb. hup. Fee: Elec. Insp. I-ee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, school District etc ) These fop, are based on the prelimina information available and are ontv an estimate. Contact the De t it addn'I info. FEE ITEMS (Fee Resolution 11 -053 E . 73) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. FeelD Reg. O OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: O G Work Without Permit? Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential 8 Building or Structure 0 Travel Documenta /ion Fees Strong Motion Fee: $0.00 0.5 I his Admin. /Clerical Fee $45.00 lADA17N Bldg Stds Commission Fee: $0.00 SUBTOTALS: 1 $0.00 $45.001 TOTAL FEE: $45.00 Revised: 02/14/2015 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildinG(okupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI- REVISION / DEFERRED ORIGINAL PERMIT # t PPM=AnnRCR APN# OWNERNAME PHONE yd9_655 -.q EMAB. STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE E -MAIL STREET ADDRESS CRY, STATE, ZIP FAX 11 OWNER ❑ OWNER - BUDDER ❑ OWNER AGENT 11 CONTRACTOR 13 CONTRACTORAGENT Il ARCHUECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LICENSENUMBER LICENSE TYPE BUS. LTC# COWANYNAME E -MAIL FAX STREET ADDRESS CRY, STATE, ZIP PHONE ARCHITECrIENGINEER NAME LICENSE NUMBER BUS. LTC# COMPANY NAME E-MAIL FAX STREET ADDRESS STATE. ZIP PHONE .CITY, DESCRIPTION OF WORIC ` d'N nn iron Y/O/%l 10tAIQY S 1 a -0 U✓1'7 V S O S t \K 5 76 S �� EXISTNG USE PROPOSED USE CONSTRTKPE #STORIES I USE TYPE OCC. SQ.FT. VALUATION (5) EXLSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODEL AREA PORCHAREA DECKAREA TOTALDECK/PORCHAREA GARAGE AREA: DETACH ❑ATTACH #DWELUNGUNRS: MASECOIIDm1r' ❑YES SECOND STORY [3YES - BEMGADDED? E]NO ADDITION? []NO PRE - APPLICATION ❑YES WYES,PROVIDECOPYOF ISTHRaLDGAN ❑YES =1 -�ED3Y TOTAL VALUA ON: PLANING APPL# []NO PLANNINGAPPROVALLTTTER EICIILER HOME! [] NO -= _ 4thDuperty By my signature below, I certify to each of the following: I am the property owner or authorized agent to act b 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 con cocoon. I authorize representatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant/Agent; � Date -. I — 15 ^ , rj SUPPLEMENTAL INFORMATION REQUIRED - I ROUTING PL.tNCE_GKTiTE - SLIP — I�R- _New SFD or Multifamily dvrellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of buildine THE- coLVER _ ariLDL�srLA -'. RE�aE >v permit for new building. - E\PRES< _ rLAi:�c el..�N RENIett _ Commercial Bldgs Provide a completed Hazardous Materials Disclosure - 'Tk" RD ❑ PLBLICINOP S TOM if any Hazardous Materials are being used as part of this project. — r LARGE - FIRE DEPT _ Copy of Planning Approval Letter or Meetimg with Planning prior to - DLaJOR Ll Submittal of Building Permit application. S.4SITART SEtYEF DISTIUCT - - - 11 ENVIRONMENTAL Ue° i TA B1dgApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not includejees due to other Departmems p.e. manning, I..on.:.r..•...., • •• �•••••••••� -• ° °•-• School Cnnmrt the Dent for adtt mo. District, ete.. 7nese ees are aaserr an - FEE ITEMS (Fee Resolution 11 -053 Eff 7%11131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 D s.£ Remodel, Other Suppl. PC Fee: Q Reg. OT 0.0 hrs $0.00 $503.00 IRE RESOrx PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 Ins $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? O Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure O Trore! Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.001 $503.001 TOTAL FEE: $503.00 Revised: Umuiwia ADDRESS: 21391 VAI AVE DATE: 09/1 212 01 4 REVIEWED BY: MELISSA APN: 362 05 016 BP #: `VALUATION: $0 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1R3SFDREM PERMIT TYPE: USE: WORK REV # 3 -ADD ADDITIONAL 405 S.F. TO AREA OF REMODEL FROM 1028 S.F. TO 1433 S.F. - SCOPE ISSUED 9/12/14 NOTE: This estimate does not includejees due to other Departmems p.e. manning, I..on.:.r..•...., • •• �•••••••••� -• ° °•-• School Cnnmrt the Dent for adtt mo. District, ete.. 7nese ees are aaserr an - FEE ITEMS (Fee Resolution 11 -053 Eff 7%11131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 D s.£ Remodel, Other Suppl. PC Fee: Q Reg. OT 0.0 hrs $0.00 $503.00 IRE RESOrx PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 Ins $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? O Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure O Trore! Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.001 $503.001 TOTAL FEE: $503.00 Revised: Umuiwia EPei Pow la F, is c....:...... c......,. n:...:,.. School Cnnmrt the Dent for adtt mo. District, ete.. 7nese ees are aaserr an - FEE ITEMS (Fee Resolution 11 -053 Eff 7%11131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 D s.£ Remodel, Other Suppl. PC Fee: Q Reg. OT 0.0 hrs $0.00 $503.00 IRE RESOrx PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 Ins $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? O Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure O Trore! Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.001 $503.001 TOTAL FEE: $503.00 Revised: Umuiwia Revised: Umuiwia CUPERTINO r CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • build .�iIt tqcu ee I.no.or M Ar%,MnW n At TFR ATInN ITI RI VI F.VIRION /DEFERRED ORIGINALPERMITH IM] BldgApp_201 Ldoc revised 06121111 APN # 6 2 - PROJECT ADDRESS I ( V0I }t JQ- r 3 OWNERNAME IJ Q Y" L �Ul� PHONE L{' -7 �0 I T E -MAIL STREET ADDRESS CITY, STATE. ZIP FAX CONTACT NAME i 4 PHONE �q� �30Gj E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER- BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT 11 ARCUDECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME AV - LICENSENUMBE'R Toq 3 LICENSETYPE f� BUS. LIC# COMPANY NAME E-MAIL MA- } ° C� A�GI.— Cov. S-E YUC'FiDh� FAX STREET ADDRESS 1 u / ^ i 1 S\ eF l Q ^ 1-F CITY, STATE. ZIP f �9 PHONE ARCIBTECnENGINEERNAME LICENSE NUMBER BUS. LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE. ZIP PHONE q DESCRIPTION OF WORK Aver /G 24 `Y3 rte de.( a .cc� EXISTBNGUSE ROPOSED USE CONSTR TYPE #STORFC USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA OOR DEMO AREA TOTAL NET AREA BATHROOM MCHEN OTIffR REMODEL AREA REMODELAREA REMODEL AREA PORCH AREA TOTAL DECK/PORCH AREA GARAGE AREA DETACH ❑ ATTACH IND #DWELLING UNISASECONDUNIT OYES SECONDSTOAY ❑YES BEING ADDED? []NO ADDITION? [3NO PRE - APPLICATIOff.ANNIN OVmECOPY OF ISTHE BLDG AN ❑YES RECEIVEDB TOTAL VALUATION: PLANNMGAPPLLANNINGAPPROVALLETTER EICHLERHOME? ONO B y my signature below,) certify to each of the following: I am the property owner or authorized a 's behalf. I have read this application and the information I have provided is correct I have read the Description of Work and verify rt is r gree to comply wrt��ble local ordinances and state laws relating to bu ding construction. I authorize representatives of Cupertino to enter tl ove- idwtinfied property for inspection purposes. R2- q Signature of Applicant(Agent Date: , SUPPLEMENTAL INFORMATION REQUIRED PLANCBECKTYPE ROUTING SLIP ❑ OVER - THE - COUNTER ❑ BUILDING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for _ existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNINGPLANREVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLICWORKS _ form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 Ldoc revised 06121111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21391 VAI AVE I CONTRACTOR: AVA CONSTRUCTION I PERMIT NO: 13080069 1 I OWNER'S NAME: CHANG BENJAMIN M AND ELLEN M 121060 HOMESTEAD RD APT 216 1 DATE ISSUED: 11202013 1 OWNER'S PHONE: 4082525765 1 CUPERTINO, CA 95014 1 PHONE NO: (408) 387 -0999 ❑ LICENSED CONTRACTOR'S DECLARATION License Classes Lie. N / q!5 Contractor 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 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 918 JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL REVISION #2 -CEILING FRAMING. ISSUED OTC 8/26/14 R VLSI ®N # Sq. Ft Floor Area: I Valuation: $200000 APN Number: 36205016.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: .�/%� /C�! Date: RE- ROOFS: Signature Dote —z6— L'` 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 1 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sce.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. 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 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 Signature of Date: ALL 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. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent 15- DaIe: C h„) CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address I understand my plans shall be used as public records. Licensed ��� CITY OF CUPERTINO F�l`r' - 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 tees are based on lire areliminary information availahie and are oniu nn retimatn Cnamrr a o noa� r . add.. n :..r FEE ITEMS (Fee Resolution 11 -053 Eft 7 %11131 ADDRESS: 21391 Via Ave DATE: 06/26/2014 REVIEWED BY: Sean th" i, N wl r�•, APN: BP #: `VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PME Plan Check: PENTAMATION PERMIT TYPE: F ORK Revision #2: Revise ceilin framin Ian. OPE Suppl.Insp. Fee-.0 Reg. Q OT NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These tees are based on lire areliminary information availahie and are oniu nn retimatn Cnamrr a o noa� r . add.. n :..r FEE ITEMS (Fee Resolution 11 -053 Eft 7 %11131 Chrrk i1. rta,: MISC ITEMS th" i, N wl r�•, $0.00 Select a Mise Bldg/Structure or Element of a Building O ... �ttuCO. I"f, 0.0 hrs 1'iPC i [21 /J. [" , PME Plan Check: $0.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These tees are based on lire areliminary information availahie and are oniu nn retimatn Cnamrr a o noa� r . add.. n :..r FEE ITEMS (Fee Resolution 11 -053 Eft 7 %11131 FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? () Yes Q No $0.00 Select a Mise Bldg/Structure or Element of a Building Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp. Fee-.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cunsbvrcvion I"n, r!dmiuik-nzflit c 1 «. O E) Work Without Permit? O Yes Q No $0.00 Advanced Planning Fee: $0.00 0 hours Plan Check, Hourly E) $143.00 ISTPLNCK 1 O Travel l)ocumentalion Fcesc Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $143.00 TOTAL FEE: $143.00 Revised: 07/10/2014 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING Di 'S'ON 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 R*_,;-B (408) 777 -3228 • FAX (408) 777 -3333 • buildino t7.cupertino.org I K /''�/ ❑ ❑ 1—­'ION/TI REVISION /DEFERRED ORIGINAL PERMIT p D D0& 1 "NEW CONS "UCI KIN ADDITION ApEA PROTECT ADDRESS ;, �` ,,r` CA \ A APN N OWNERNAME en d PHONE E -MAIL STREET ADDRESS CRY, STATE, ZIP FAX CONTACT NAME PHONE E -MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR 0 CONTRACTORAGE'NT ❑ ARCHUECT ❑ ENGINEER El DEVELOPER ❑ TENANT CONTRACTOR NAMg I ` - / rl CO �. LICENSE NUMBER CA q5 O q'? LICENSE TYPE ` '1 J > n V /'Y BUS. LIC N FAX a COMPANY NAM E -MAIL (<am �a 1 ovr kam�ah cxva- Go '&C W.I. CITY, STATE, ZIP p L PHONE gv3-7T eji pGfQ i STREET ADDRESS ARCHITEC (ENGINEER NAME LICENSE NUMBER BUS. LIC N COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTIONOFWORK 1 1O 1 l /!'L er\ l� 1111 1 \VA !-M t/✓L tom\ C EXISTING USE PROPOSED USE COMM TYPE 4STORIES USE TYPE OCC. SQ.FM VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKNORCH AREA GARAGE AREA: DETACH [] ATTACH N DWELLING UNITSO ISASECONDUNrf ❑YES SECONDSTORY ❑YES BEING ADDED? ENO ADDITION? []NO PRE-APPLICATION DYES IT YES. PROVIDE COPY OF ISTHEBLDGAN ❑YES EIV REC DBY: TOTAL HAT] ON: PLANNGAPPLN []NO PLANNINGAPPROVALLETTER M EICHL ERHOME? []NO i/I^/ 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 1 have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives Of Cupertino to enter the above-identified property for inspection purposes. Q Date: D ov - 2 6 I ZI Signature of ApplicanttAgenC _� SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECKTYPE ROUTINGSLIP ??t���,,, OVER - THE - COUNTER I=pBUB.DING PLAN REVIEW - New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building / permit for new building. ❑ EXPRESS ❑ PLANNINGPLANREVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLICwORKS _ form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT. _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MMOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dg4pp_2011.doc revised 06121111 I CITY OF CUPERTINO BUILDING PERMIT I I BUILDING ADDRESS: 21391 VAI AVE I CONTRACTOR: AVA CONSTRUCTION I PERMIT NO: 13080069 1 OWNER'S NAME: CHANG BENJAMIN M AND ELLEN M 1 :1060 HOMESTEAD RD APT 216 1 DATE ISSUED: 1120/2013 1 OWNER'S PHONE: 4082525765 1 CUPERTINO, CA 95014 1 PHONE NO: (408) 387 -0999 I Id' LICENSED CONTRACTOR'S DECLARATION License Class Y Lic. # Q Z/ CD nS Conlmctor ate I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 1 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. APPLICANT CERTIFICATION I certify that 1 have read this application and slate that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature r Date t.4 ❑ OWNER- BUILDER DECLARATION 1 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 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 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 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL 1] CONSTRUCT 636 SQ FT OF ONE STORY ADDITIONS; INTERIOR REMODEL; REMOVE AND RELOCATE FURNACEINTO ATTIC; UPGRADE ELECTRICAL PANEL TO 200 AMP. REVISION #I- ROOF FRAMING. ISSD OTC 8/132014 Sq. Ft Floor Area: I Valuation: $200000 APN Number: 36205016.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 D PERMIT ISSUANCE OR 180 DAYS FR M LA CALLED INSPECTION. Issued by: Date: e. 13 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 Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: 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 CITY OF CUPERTINO WWI FEE ESTIMATOR - BUILDING DIVISION 191 ADDRESS: 21391 vai ave DATE: 081 13/2014 REVIEWED BY: Mendez Plan Check Fee: Hourly Only? () Yes Q No APN: BP #: "VALUATION: 1$1,500 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: WORK revision #1- roof framing SCOPE hrs 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 prelimina in ormation available and are only an estimate. Contact the Dept or addn 4 info. FEE ITEMS (Fee Resolution 11 -053 Efi' 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? () Yes Q No $0.00 2= hours Plan Check, Hourly $286.00 ISTPCNCx Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. Q OT p,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure OA ?i "r, �? F,rer_ Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $286.00 TOTAL FEE: $287.50 Revised: 07/10/2014 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO,'CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildino(G)cuoertino.orG 1— l ...... .................., rl a ",, n AFVictnwinFFFRRED ORIGIN.&LPERMITy LJ IYLW LVIYUfnVf -aav,a L- J..✓....•... -------- - - - -.. 13 `\ c.\, -,/` APNd PROtECTADDRESS �f se;Q n OWNERNAME .qe ,', E' C- S t/e � C G' I S� EMAIL p STREET ADDRESS I CITY, STATE, ZIP I FAX CONTACT NAME PHONE E -MAIL S, ,- .TADDRFSS CITY, STATE, ZIP FAX ❑ ❑ CONTRACTOR 0 CONrM CTOR AGENT [] ARCIMU I:1 LNGINEER 0 DEVELOPER ❑ TENANT El O` ,T-R ❑ Ov NER- Bb4DER OWNERAGEhT CONTRACTOR NAME A V f(A c /C - LI�`SE NUMBER LICENSE TYPE (/ BUS. L1C: COMPANY NAME E -MAIL FAX STREET ADDRESS CITY. STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSENUMBBR I BUS. LICK COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE 13ESCRPTIGN OF WORK ', `- ID051INGUSE PROPOSED USE I CONSTRTYPE V-STORIES USE TYPE OCC. SQ.FT. VALUATION (5) E)OSTG DEMO TOTAL AREA AREA NET AREA BAT HROOM HEN OTHER REMODEL. ARODELAREA REMODELAREA 4?=�FU�R POROIAREA TOTALDEC:K/PORCHAREA GARAGE AREA: DETACH ATTACH a1DVlELI]NGECOtf'D IP.7T ❑YES SECOND STORY ❑YES G ADDED? NO ADDITION? []NO ^r.�EkTrpN —Bl -- ,PgOYIDELOFV DF BLDGAN YFS -__ -_. ___ TOTALVALUATION: �O. Ate P"A WG APPLa ❑NO PLUDONG APPROVAL LETTER EICHLER HOME? El NO - Y By my signature below, I certify to each of the following: I am the property owner or authorinc zgent to act on the prepenr, c% \mer'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 amee to comply with all applicable local ordinances and state laws relating to buildine CO coon. I authorize representatives of Cupertino to enter the apbcvo-idetnified property for inspection purposes. �7 / - 2 _ ! SignaRUe of ApplicanUAa_erR -"-- SUPPLEMENTAL INFORMATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of buildm permit for new buildine. Cornmercial Bldgs: Provide a completed Hazardous Materials Disclosure _ form if any Hazardous Materials are being used as part of this project. - 3 – _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. B1dgApp_201 Ldoc revised 06121111 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Tone Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408-777-3333 JOB ADDRESS: 1. Q i PERMIT # O 20 Q OWNER'S NAME: e Y\ C VN 0.v\ PHONE # d uj Z -6 7 S GENERAL CONTRACTOR: J A BUSINESS LICENSE # Z O 7 ADDRESS: 10C/10 CITY /ZIPCODE: ct 5 O I *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date V SUBCONTRACTOR BUSINESS NAME BUSINESS LIC NSE # Cabinets & Millwork C6 b i N J 2-77-69 Cement Finishing ' Electrical M — e � C �j >'j ( 2 Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating L X C e ,e-, S 35-:3-75 Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing 172 v e -jeeife 3 Z 13Z Roofing d d Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature 6- zo -I-5 Date I—IT 3 /.