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15040105CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22404 RIVERSIDE DR CONTRACTOR: CRAFTSMENS GUILD PERMIT NO: 15040105 INC OWNER'S NAME: NAU VANCE J AND VALERIE E 110566 S DE ANZA BLVD I DATE ISSUED: 04/14/2015 1 AI' @WNER'S PHONE: 4082557316 1 CUPERTINO, CA 95014 1 PHONE NO: (408)366 -1000 LICENSED CONTRACTOR'S DECLARATION License Class Lic.# Contractor f fit/} ai ate p 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. by affirm under penalty of perjury one of the following two declarations: and will maintain a certificate of consent to self - insure for Worker's JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] 202 SQ FT ADDITION, REMODEL (KITCHEN 254 SQ FT); (THROUGH OUT 684 SQ FT) Compensation, as provided for by Section 3700 of the Labor Code, for the P1prformance of the work for which this permit is issued. Sq. Ft Floor Area: t„ave and will maintain Worker's Compensation Insurance, as provided for by tL.. Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 35602007.00 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. Srt Date �l ❑ 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 Valuation: $150000 Occupancy Type: PERMIT EXPIRES W WORK IS NOT STARTED WITHIN 18 PERMIT ISSUANCE OR 180 DAYS OM LAST CALLED INSPECTION. Issued by: 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. 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 and,25534. wner nr anthneize'tlinvent_ n/t Mate. CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I 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 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 Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildingPcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT # PROTECT ADDRESS 2,q 4-b-1 V E�x C l y) v ,A + [1/ " V lA APN # 6 — e) �Z OWNERNAME AA p f AA A _A j e✓ PHONE +Q$ 2�5 —7�/' E -MAIL STREETADDRESS L 2�0� ��l�s ®�� b• CC. CITY, STATE,ZIP �� F7� �� �� O FAX CONTACT NAME 44 �!i d A/n ( !� I L/ PHONE +0 �s 10) 72 60 QT E-MAIL 411 V- F- &6,eA irS� E� STREET ADDRESS 10 Jr /- • p�A (►l �, /� ! N rA CITY, STATE ZIP �O P% FAXI� �t� (( 06 ❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT 0-*C.NTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME C ,Z.4 F�-j / hJ�� LICENSE NUMBER So7�s/) LICENSE,T�1,oP/E( BUS. LIC# // COMPANY NAME G'r L'lJ'Er�C(y7N)LrU� NG E-MAIL /�III�- �/1�7Gr,A�I�f(4 VJGU�LC) VG' FAX ADDRESS /0566„ C �JA AtzA �£`�n ' f CITY, STATE, ZIP Jf fJ�EFrl go PHONE ARCHITECT /ENGINEER NAME G �p� h,)� � I LICENSE NUMBER f� l���J 4I BFfUilSC . L] # COMPANY NAME 7 - -4 I )lVl�%✓ f f �� ftI E -MAIL EG, �/�/ (� C+ � M ° C��3 ltli6 STREET ADDRESS (b 6 / • I �. A�� -A , CITY, STATE, ZIP U C i� �p 1�' PHONE /� I DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES S J r USE OCC. SQQ..FT. VALUATION ($) L AREA FLOOR �%� AREA Z j> DD ARE TOTAL NET AREA / J'7 ®TYPE Y l*; ( Z C V BATHROOM REMODEL AREA KrrCHEN REMODEL AREAd.5 OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECKROORCH AREA GARAGE AREA: DETACH CH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES BEINC ADDED? ❑NO ADDITION? 1]NO PRE - APPLICATION [:]YES IF YES, PROVIDE COPY OF IS THE BLDG AN' ❑ YES RECE1VEDt TOTAL VALUATION: PLANNING APPL # ❑ No PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO "060 By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct,II Ilan Y Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construct' . I authorize resentatives,pf Cupertino to enter the above -i entifre property for inspection purposes. Signature Applicant/Agent: Date: ��f of ! SUPPLEMENTAL INFORMA ON REQUIRED TYPEat 1 - u *'* ,�PT♦'"AN�CHECK ,` tan...:, _,,.sua ROUTING, SIsIP„ ,_i.� rk:;r _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building OVER THi:<COUNTER ,�BUII,DING PLAN REVIEW t e permit for new building.` ExPRESS t x FLArnv1lvcPANRT VI�w Commercial Bldgs: Provide a completed Hazardous Materials Disclosure , k k x �.� sTAtvDnTtDkT1BTaCwoRxs .. k i €-fir ' }M b y t.. z _ form if any Hazardous Materials are being used as part of this project. , n Da^ LARG$u,. a era '��- r �" '- `�, � ❑' FII2E DE T' `' � 4 G�''rti� � Copy of Planning Approval Letter or Meeting with Planning prior to JOx a "SANrf ItYtsEwERDISTRICT submittal of Building Permit application. �0 Y,' �<i +Ex,. wa ..i;? m . _ i t... � Y f ei ,ENVIRONMENTAL;FIEAL1Hs„., -. •�, BldgApp_2 011. doc revised 06/11/11 JAI L� (/V--c CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 22404 riverside dr DATE: 04/14/2015 REVIEWED BY: Sean A BP #: l "VALUATION: 1$150,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex 2nd Unit? Yes (F) .No PENTAMATION 1 R3SFDADD USE: OTC. 0 Yes (E) No PERMIT TYPE: WORK 1202 sq ft addition remodel kitchen 254 so ft (through out 684 sq ft SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID Plumb. Permii Fee: CONSTR. 01) Other Plumb Insp. Other Elec. Insp, El vk,ch. hasp. Fee: Plumb. hasp. Fee: R -3 (Custom) II- B,III- B,IV,V -B 202 $1,091.00 JADDPLCK $1,057.00 IADDINSP Administrative f+'ee: Select a Non - Residential Building or Structure Select an Administrative Item TOTALS: 1 202 $1,091.00 Trcn,el Docurnenlalhm Fees: Strong Motion Fee: IBSEISMICR $1,057.00 Blda Stds Commission Fee: IBCBSC MECH, HOURLY, Yes No PLUIVLB, HOURLY Q° Yes Q No. ;EI;EC, HOURLY `Yes ° .Q.No"�` Ifech. Plan Check Pbunh. Plun (:'heck Elec. Plan Check L1ech. Permil Fee: Plumb. Permii Fee: l.kc. Permit Fee: Olhcr 6 /ech. Insp. Other Plumb Insp. Other Elec. Insp, El vk,ch. hasp. Fee: Plumb. hasp. Fee: Elec. Insp. fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, tire, 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'l info. FEE ITEMS (Fee Resolution 11 -053 E . 711113) Plan Check Fee: Suppl. PC Fee: Q Reg. Q OT W01 hrs FEE $1,091.00 $0.00 QTY /FEE 254 s.f. $645.00 MISC ITEMS Remodel, Kitchen (< =300 sf) IREMRESKIT PME Plan Check: $0.00 5R71 s.f. Remodel, Other $575.00 IREMRESOTH Permit Fee: $1,057.00 Suppl. Insp. Fee:Q Reg. Q OT 0. hrs $0.00 PME Unit Fee: PME Permit Fee; $0.00 $0.00 Construction Tar: Administrative f+'ee: Select a Non - Residential Building or Structure Select an Administrative Item E) E) 0 Work Without Permit? Yes E) No Advanced Planning Fee. IPLLONGR $0.00 $28.28 Trcn,el Docurnenlalhm Fees: Strong Motion Fee: IBSEISMICR $19.50 Blda Stds Commission Fee: IBCBSC $6.00 ` SUBT 0TALS:�` $2,201.781$1,220. 00 TOTAL FEE:., $3,421.38 Revised: 04/01/2015 CONTRACTOR S UBCONTRACTOR LIST Building 'Department City Of Cupertino I 0300'1'oj-re Avenue Cupertino, CA 95014-3255 'Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS:22404 RIVERSIDE DRIVE . . PERMIT # 15040105 . ...... . .......... OWNEWS NAME: NAU VANCE J AND VALERIE E ito L&........_.................... .............................._ .................. . ...................... ........................................ I .......... GENERAL CONTRACTOR: CRAFTSMEN'S GUILD .. . .... ... PH-ON E # 408-366-1000 . . . ................ . . ... 1SINESS LJCI.ENSE 1/ 17526 ADDRESS: 10566 SOUTH DEANZA BLVD. _ ....... . .......... ................. . ........ . . . ................................ . . ­­­ . . . ..... Cl,'['Y/z1'P(.',ODE: CUPERTINO, CA *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUIT.,DING FINAI, OR FIN.A.1, OCCUPANCY INSPECTION(S) W11, BE SCHEDU . L.ED UNTIL ]'HE (I.ENERAL (.,'0N,rR,4,CTO.R AND Al2; SUBCONITkCTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS 1,1C.IENSE. I and not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date t/ SUBCOM"RA CTOR BUSINESS NAME BUSINEss I.AC ENSE 1 Cabinets & Millwork NIVIYA CABINETS 27554 .... . ....... . .......... Cernent Finishing NONE Electrical MARTIN SANCHEZ CONSTRUCTION 27311 Excavation...................................... Fencing ............ .. _-NONE NONE Flooring/ Carpeting SAY FLOORING 6zw Wpm V, LinolCLIM / Wood NONE Glass Gazing .... . .... .... MARTIN SANCHEZ CONSTRUCTION 27311 Fleating MARTIN SANCHEZ CONSTRUCTION 27311 Insulation MARTIN SANCHEZ CONSTRUCTION 27311 Landscaping .......................... ........................................... NONE Lathing .. . SORIA PLASTERING 34862 Masonry NONE ....... ... . . ........ ......... .. - Painting Wallpaper - ----- ---------- . . MARTIN SANCHEZ CONSTRUCTION ........... . . . .. 27311 Paving ................. . .. . -_ NONE . . ............ . ... . Plastering SORIA PLASTERING ................ .... . 27311 Plumbing MARTIN SANCHEZ CONSTRUCTION . . . ............ 27311 Roofing .. .. . ..................... ................. . ....... __ . ........... .......... ............ ................... . . . . . ........... R. A. CONSTRUCTION 21382 ..... ......... ... Septic Tank .............. ............... .......... .......... . ..... ......... NONE ................. . ......... .. .. . ...... . ...... . _-- __ .............. Sheet Metal ................... NONE ...................... ............ . . . ........ . . . . .. ............................ . .. . ........ Sheet Rock MARTIN SANCHEZ CONSTRUCTION . . .. . ............ .......... .................... 27311 . . .. . ......... . . . . -Tile MARTIN SANCHEZ CONSTRUCTION ... . . ........... . 27311 . . .. . ...... .............. . ...... . ........ Owner/ Conttrac V-Signature FEBRUARY 23, 2016 Date TW