Loading...
12120003I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 22765 SAN JUAN RD I CONTRACTOR: CRAFTSMENS GUILD I PERMIT NO: 12120003 OWNER'S NAME: 11ASHEMI SIAMAK AND NEHAWANDIAN NASI 1 10566 S DE ANZA BLVD I DATE ISSUED: 05/30/2013 1 OWNER'S PHONE: 4083091495 1 CUPERTINO, CA 95014 1 PHONE NO: (408)366 -I000 LICENSED CONTRACTOR'S DECLARATION License Class # Contract Date ((0 I hereby affirm t at 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 9.18. � f Signature � l_Q.1ii /lJ�� Date _ ° A / r; ❑ OWNER- BUILDER 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) 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: 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 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. Signature Date. JOB DESCRIPTION: RESIDENTIAL u COMMERCIAL CONSTRUCT NEW TWO(2)STORY SINGLE FAMILY DWELLING (3,591 SQFT)LIVING AREA & 492 SQFT ATTACHED GARAG AND 88 SQFT COVERED PORCH REVISION # 1 - REPLACE WOOD FRAME WITH CONCRETE SLAB AT REAR PORCH AREA - ISSUED 9/16/2013 Sq. Ft Floor Area: I Valuation: $600000 APN Number: 34222031.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DA BALLED INSPECTION. ;:d Date: �6 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(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, Sectt 25505, 25533, and 25534. Owner or authorized age _ Date: 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional I CITY OF CUPERTINO BUILDING PERMIT I IBUILDING ADDRESS: 22765 SAN JUAN RD I ICNC TRACTOR: CRAFTSMENS GUILD I PERMIT NO: 12120003 OWNER'S NAME: HASHEMI SIAMAK AND NEHAWANDIAN NASI 110566 S DE ANZA BLVD 1 DATE ISSUED: 05/30/2013 1 OWNER'S PHONE: 4083091495 1 CUPERTINO, CA 95014 1 PHONE NO: (408)366 -1000 1 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # SO / g 1 f Contractor C e- A-r—r ' M -C t Ca O' Date V 30/7d/ 3 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 9.18. Signature f- Date ❑ 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 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. Signature Date JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CONSTRUCT NEW TWO(2)STORY SINGLE FAMILY DWELLING (3,591 SQFT)LIVING AREA & 492 SQFT ATTACHED GARAGE AND 88 SQFT COVERED PORCH Sq. Ft Floor Area: I Valuation: $600000 APN Number: 34222031.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN Ofi DAYS OF PERMIT ISSUANCE OR 180 DAY RO LAST CALLED INSPECTION. Issued by: ( Date: i 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. 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: Date: ( ,f 2 - 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 Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22765 SAN JUAN RD CONTRACTOR: CRAFTSMENS GUILD PERMIT NO: 12120003 INC OWNER'S NAME: HASHEMI SIAMAK AND NEHAWANDIAN NASI 10566 S DE ANZA BLVD DATE ISSUED: 05/30/2013 OWN R'S PHONE: 4083091495 CUPERTINO, CA 95014 PHONE NO: (408)366 -1000 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL G License Class_ Lic. # J CONSTRUCT NEW TWO(2)STORY SINGLE FAMILY DWELLING Contractor G n g 2 t �c� stn C4be (3,591 SQFT)LIVING AREA & 492 SQFT ATTACHED � M S GARAGE AND 88 SQFT COVERED PORCH I hereby affirm that I am licensed under the provisions of Chapter 9 REV # 2 - REVISE TRUSS CALCULATIONS - ISSUED 4/22/14 (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 Sq. Ft Floor Area: Valuation: $600000 performance of the work for which this permit is issued. lave and will maintain Worker's Compensation Insurance, as provided for by �ftction 3700 of the Labor Code, for the performance of the work for which this APN Number: 34222031.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM L ED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply ate: �i z with all non -point source re lations per the Cupertino Municipal Code, Section 9.18. Signature '' Date — Z O --2 f 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. ❑ ONVN'ER- BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous 1 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 Owner or authorized agent: Date: r Zo permit is issued. 1 certify that in the performance of the work for which this permit is issued, 1 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, 1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records, granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. I Signature Date CCUUPERTINO p� NEW CONSTRUCTION .%I Z 00 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • build ing(a)cupertino.org ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # Inn PROJECT ADDRESS Z 7 t/z, C e -A �� t �y /� K t r/ L. /�. APN 0 C� 2 —Z 2 4- C� �r OWNER NAME MO � jj r 1 } � !` /`! T / PHONE s(,,� i-3 ©mil 1 QL / `r / i E -MAIL $��F M%�K @yAse(/�A(� e STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME ` d ,�A I I 1 [ lI PHONE (5 o Q 4) 7— 2 61 -MAIL M 14 U* �S MEN s (qty( L0 ' g f1i'Z L STREET ADDRESS j/ 6�. -11ITY, STATE, ZIP ` ctP� y - �6 ^ Q�� / /�❑ J FAX (Sg'p'���y —� ISdG ❑ OWNER ❑OWNER - BUILDER ❑ OWNER AGENT CONTRACTOR IycoNTRACTOR AGENT ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME l%Q�rfN��� `� D 'N LICENSE NUMBER LICENSE TYPE BUS. L1C COMPANY NAME /Q'J�C �tNS /j� �L^ E-MAIL opf� �/ _ 6`61 1Ob `FAX� 1C�r STREET ADDRESS �flLVrj CITY, STATE, ZIP G olozw n Aro ems} AC/ PHONE�y�� ARCHITECTIENGINEER NAM. t7�r I) %dC f�" i'U) COMPANY NAME E -MAIL M�L c F- ox f T5,0 M ES GNU 1 I-0 (A1 FAX - 4 a 8 — <.6 W4A STREET ADDRESS CITY, STATE, ZIP PHONE�109' 36-4; I bee DESCRIPTION OF WORK a o i7J / r ` U� CT s�� i lt'�iiy`u -cam C.�` W/ 71 N u.cu EXISTING USE ^ �� 1z PROPOSED USE ail CONSTR. TYPE V B 44 STORIES 2- USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG 15W AREA Gh NEW FLOOR �y AREA M91 DEMO �` AREA TOTAL 4tj8 � NETAN 12W�t.C.l(V` / (� Y(3 /� R'� 2 ^'f X00 (�i.�# J t7C,.� -✓ CJU BATHROOM REMODEL AREA rI KITCHEN/ REMODEL AREA 4 A� OTHER REMODEL AREA A �i GA k- (f _ I v` 14 PORCH AREA DECK AREA TOTAL DECK/PORCH AREA C L+ GARAGE AREA: DETACH ATTACH � � jJ # DWELLING UNITS: CLA.,a IS A SECONID UNIT ❑ YES BEING ADDED? F3<0 SECOND STORY 'ES ADDITION? ❑NO PRE - APPLICATION ❑ TES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES " RECELY Y TOTAL VALUATION: PLANNING P3PL # ❑NO PLANNING APPROVAL LETTER EICHLER HONIE? )RNO W O By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read lscription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building o n, orize rep entatives of Cupertino to enter the above- ii dent ified property for inspection purposes. ~ �L 3 -90 Q 1 2 Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TNPE zouTlNC`SLIP "0 OVER-THE-COUNTER, HUILDINGPLANREVIEw. 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. ❑ E.CPRESS PLANNING PLAN REVIEW 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 t0 El: 11IAJOR SANITARY SERER DISTRICT submittal of Building Permit application. =` " ❑ ENNTRONNIENTAI:HEALTH .S S y 4 ZZ BldgApp_2011.doc revised 06121111 -1. -: DG.4 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 CUPERTINO (408) 777 -3228 • FAX (408) 777 -3333 • building(cDcupertino.org NEW CONSTRUCTION ❑ADDITION ❑ALTERATION /TI VISION NkFERRED ORIGINAL PERMIT# PROJECT ADDRESS Z`� n' �` N # V�� 2. 22 OWNER NAME Q �^ H �, PHONE E -MAIL STREET ADDRESS ,Z Z 6 S OLu —TV CLiA CITY, STATE, �. ' FAX CONTACT NAME + -�}+ w` ; PHONE A - AIL VM CL �� S STREET ADDRESS O\ �6 57' _ / CITY, STATE, I,� PC: / FAX C:./ZIi r, ❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAM$ 9 LICE IS N ER LICE ' TYPE BUS. LIC # wLes COMPANY NAME �j 1k E -MAIL FAX STREET ADDRESS `C j CITY, STATE, ZIP PHONE ARCHITECTIENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG 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: LJ DETACH ❑ ATTACH k DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY E) YES BEING ADDED? ❑NO ADDITION? ❑NO PRE - APPLICATION ❑ YES IF IBS, PROVIDE COPY OF IS THE BLDG AN ❑ YES - _- -- TOTAL VALUATION: PLANNING APPL k ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? 14 ' By my signature below, I certify to each of the following: I am the property o Amer uthor' agent to act o the perry own half. I have read this application and the information I have provided is- ect. I have read the Description of Work and verify it ' accura I agree to comply with all applicable local ordinances and state laws relating to buildin,g..const tion. I 1019horize representatives of Cupertino to ent the a e- identified property for inspection purposes. Signature of Applicant/Agent: ate: ,�- SUPPLEMENTAL FORMATION REQUIRED PL iv caEC rE sI it ❑ b" J ❑ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building oII1NTER BUILDING PLAN REV7Ew permit for new building. ❑. "EaPRESS= El PLAI�NINGPLANREVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑sTA�DARn ��' ❑ PUBLIOP'ORKS 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 ❑ r ❑ submittal of Building Permit application.t^ mAaoR SA\ITARY SE�VERDISTRICT BIdgApp_2011.doc revised 06/21/11 4) FM_7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 22765 SAN JUAN RD DATE: 04/14/2014 REVIEWED BY: NIELISSA APN: 342 22 051 BP #: 12120003 "VALUATION: Iso PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: WORK REV # 2 - REVISE TRUSS CALCULATIONS SCOPE PME Plan Check: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt etc ). Thorn feec an, hnced an the nroliminary infarmatinn available and are nnly an octimate_ Cnntact the Dent for addn'l infa- FEE ITEMS (Fee Resolution 11-053 L_f. . T1,132 FEE QTY /FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (F) No $0.00 2 hours Plan Check, Hourly $278.00 ISTPGNCK Suppl. PC Fee: (F) Reg. OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.1E) Reg. OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 G Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non- Residential Building or Structure Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $0.001 $278.001 TOTAL FEE: 1 $278.00 Revised: 04/01/2014 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building(a.cupertino.org B ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS ,!I iJ APN # OWNER NAME ' PHONE E -MAIL STREET ADDRESS r CITY, STATE, ZIP FAX CONTACT NAME ', -_ PHONE E-MAIL IJ o7'»al'il • f STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME tt tt� MM .. N 1h LICENS NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS I / CITY, SIATE, ZIP PHONE a ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTK TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ❑ ATTACH #DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY []YES BEING ADDED? []NO ADDITION? []NO PRE - APPLICATION Q YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES KEI?Iuf'sTi $V;; ' , TOTAL VALUATION: PLANNING APPL # NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO , By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf I 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 c cI. I thorize representatives of Cupertino to enter the above- identi d prope for in ction purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMA ON QUIRED X,APt' ko �p ov 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. i�xt+ls� Bldgs: Provide a completed Hazardous Materials Disclosure, S1YiRi} ' n _Commercial form if any Hazardous Materials are being used as part of this project.l� _ Copy of Planning Approval Letter or Meeting with Planning prior to C ore CI >r> submittal of Building Permit application. � �i3�Rt3NlVttrSl't' H�AI�T'� : BIdgApp_2011.doc revised 06121111 Building Department City Of Cupertino 10300 Torre Avenue upertino, CA 95014 -3255 Telephone: 408 - 777 -3228 CU PERTI NO Fax: 408 - 777 -3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: !z;- T(o5 Sqh ;'vote, aooA PERMIT # .� 3 OWNER'S NAME: SiArvCtJ4. q mi 6, N A PHONE # 140jr - 3 OQ .Q GENERAL CONTRACTOR: Cfa rn e.,,r t1; I BUSINESS LICENSE # ADDRESS: j,j . CITY /ZIPCODE: c-4 er ' *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 Date Please check applicable subcontractors and complete the following information: 4oF- 2aq 14- /1-5 O*Iontractor Signature / !Date t5 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical I/ J):�- F 1 ac. Nf',NI Excavation Martin Saf)c D. Z Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation /✓Iqi� Ao Co,.� Slr . ;Z Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Z, Plumbing Rol Plot -^ b` ZR 50 Roofing A P un f e-4-O 21 W Z Pb ! ( Septic Tank Sheet Metal Sheet Rock MCI {fir! s6tAc ,n- CCP^S1 ;Z4311 Tile 4oF- 2aq 14- /1-5 O*Iontractor Signature / !Date t5 FM-7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School ni.ctrieL otr_ L Thoco feet are hacod an the nreliminary intarmatinn availahlo and are nnly an estimate. Contact the Dent far addn'l info. FEE ITEMS (Fee Resolution 11 -053 E� 711112) ADDRESS: 22765 SAN JUAN RD DATE: 05/21/2013 REVIEWED BY: MELISSA Plan Check Fee: Hourly Only? 0 Yes (E) No APN: 342 22 031 BP #: `VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PME Plan Check: PENTAMATION 1GENRES PERMIT TYPE: WORK 4TH SUBMITTAL PLAN CHECK FEES SCOPE Suppl. Insp. Fee-0 Reg. 0 OT NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School ni.ctrieL otr_ L Thoco feet are hacod an the nreliminary intarmatinn availahlo and are nnly an estimate. Contact the Dent far addn'l info. FEE ITEMS (Fee Resolution 11 -053 E� 711112) FEE QTY /FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes (E) No $0.00 2 hours Plan Check, Hourly $266.00 1sTPLNCK Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-0 Reg. 0 OT 10701 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Collso.m.7ion Tax: ri(�!l11lIl.CII "CII1L'ir Fee: Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential 0 Building or Structure 0 i Travel 0ocTtlnenh,16ill Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS:` $0.00 $266.00 TOTAL FEE $266.00 Revised: 04/29/2013 FM-7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 22765 San Juan Rd DATE: 12/0311012 REVIEWED BY: RDW PC FEES APN: - , s "VALUATION: 1$600,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: 2nd Unit? Yes • No PENTAMATION 1 R3SFDW PERMIT TYPE: WORK I Construct new two story SFD 3,591 s /ft living area 492 s /ft attached garage and 88 s /ft covered SCOPE porch. OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R -3 (Custom) II- B,111- B,IV,V -B 4,171 $3,058.38 1R3PLNCK $3,358.32 1R31NSP Permit Fee: $3,358.32 Suppl. Insp. Fee-.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1 # new units $629.29 ( 0 G Work Without Permit? Yes (F) No $0.00 TOTALS: 4,171 $3,058.38 .,_ t:Ii', / , T L�JU('Pfh`Tc'Yf�GiFttd? $3,358.32 Strong Motion Fee: IBSEISMICR 1 0,P r,... 177 j NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Distrirt. etc ). These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS Lee Resolution 11 -053 E(: /7/1'12) FEE QTY /FEE MISC ITEMS Plan Check Fee: $3,058.38 Select a Misc Bldg /Structure or Element of a Building Suppl. PC Fee: C) Reg. () OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $3,358.32 Suppl. Insp. Fee-.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXR 1 # new units $629.29 ( 0 G Work Without Permit? Yes (F) No $0.00 Advanced Planning Fee: IPLLONGR $542.23 Select a Non - Residential E) Building or Structure .,_ t:Ii', / , T L�JU('Pfh`Tc'Yf�GiFttd? Strong Motion Fee: IBSEISMICR $60.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $24.00 SUBTOTALS: $7,672.22 $0.00 - TOTAL FEE: $7,672.22 Revised: 10/01/2012 CUPERTINO TEMPORARY CERTIFICATE OF OCCUPANCY FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 - building(akupertino.org APN y� AMOUNT BP #: U Pir o DAT 3v �S' VALUATION: $, %i =�� SITE ADDRESS: 22_761's - l 4 TCO EXPIRATION 3U l 'S FEE: $2$6.00/fY10 7 t�/L O�pINER'S NA PHONE _ _ \ r MAILING ADDRESS (if different from site address): CO�rz? 5 /7' �r s PHON FAX # E #: % - G'9- 66 CONTAQT: L / /197 C/ / vl Ott �L� PHONE #: FAX #: / TEMPORARY CERTIFICATE OF OCCUPANCY INFORMATION BOND TYPE: ❑ SURETY BOND AMOUNT (19,o' VALUATION / /� [BLDBONDS] $ O�c.L0e CODE El CHECK ❑ CASH BOND OF BOND: 5K min -10K max Ci EDITION: TCO EXPIRATION 3U l 'S FEE: $2$6.00/fY10 / � TOTAL FEE: E Z�b �—TTTEMPOCC] DATE (6 MONTHS MAX): USE TYPE OF CONSTR FLOOR AREA OCC LOAD LEVEL COMMENT 2 APPROVED WITH CONDITIONS- is o�jJ Si nature :................ .. r ���Z I I S ❑ APPROVED ............................... Date:...................... APP �,r� OVED H G NDITI $ c r WI Other: Signature:........ :- :.......... ��,// ............................... Date:.1..:.Z. j.'� ❑ APPROVED ❑APPROVED WITH CONDITIONS` OTHER DEPARTMENT ]AGENCY APPROVALS: Planning / .. S' rtatur . �: ......... ,.: ... _ ................. Date:.....�..�...S APPROVED ❑ APPROVED WITH CONDITIONS` ire Signature:..........., ... '. Signature: Jy ............. Date:.... -� .. .�.. ..(� ❑ APPROVED 2 APPROVED WITH CONDITIONS- is o�jJ Si nature :................ .. r ���Z I I S ❑ APPROVED ............................... Date:...................... APP �,r� OVED H G NDITI $ c r WI Other: Signature:........ :- :.......... ��,// ............................... Date:.1..:.Z. j.'� ❑ APPROVED ❑APPROVED WITH CONDITIONS` *CONDITIONS OF COMPLETION - Attach a letter signed by the contractor and owner of the property stating the list of items required to be completed for each individual Department before final occupancy can be granted. Include approximate completion dates for each item. The undersigned covenant and agree as a condition to the approval of the above request for temporary occupancy to have the building or buildings complete and in compliance with all building codes, ordinances and regulations and ready for inspection prior to the expiration date specified. If this Temporary Certificate of Occupancy expires, the total amount of the bond may be forfeited and the non - compliance may result in an enforcement action. Owner �. contractor ....... Date: ... gIZ ..LS Signature :...................'... / /........................ Date:ia.�.�i.. /S ..... This temporary certificate ensures that all fire protection and life safety systems have been completed, inspected, successfully tested and approved for the specific areaof the building-s)ecified above to provide a reasonable degree of safety to the occupants from fire and Building Official: ..................Print:..'...: ,, ..� - Date :....':.........- ... ... ....... DEPARTMENT ACTION: r de ination, copies to: 1) applicant, 2) permit file TempOccForm_2013.doe revised 717114