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15020139 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10211 S DE ANZA BLVD CONTRACTOR:-IUD_TjaBE PERMIT NO: 15020139 UEIERMWED OWNER'S NAME: SHTEIN PROPERTIES 2 DATE ISSUED:02/24/2015 OWNER'S PHONE: PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ��� b ACCESSIBILITY BARRIER REMVOVAL; BATHROOM License Class Lic.# UPGRADE(64 SQFT)AND NEW WOOD WALKWAY; Contractor� ��S�u�t^.�CWate Q CONSTRUCT � NEW DECK FOR DINING(233 SQ FT) 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. Sq.Ft Floor Area: Valuation:$35000 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 APN Number:35910060.10211 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 FR A T CALLED 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 Issued by: Date: S with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Z RE-ROOFS: Signature ` 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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) 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 I have and will maintain aCertificate 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 25505,2553 ,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized ager . 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 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. 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 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. Signature_ Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERT NO, CA 95014-3255 60T (408)777-3228• FAX (408)777-3333.buildino(o1cupertino.orq CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS 102-11 3PhAAIa,4 9114-4 APN4 35a C to L9.00 OWNER NAME PH E-MAIL 70 Co--�' 14Z�W� �10� � lq-fj STREET ADDRESS off' CITY, STATE,ZIP FAX CONTACT NAME ;< L/All , /� Ii/1 q p�j/ PHO an i 2-S'-7 f Q� E-MAIL� STREET ADDRESS I 0 L PZ A A 'Z "P l v CITY,STATE, ZIC'" i jl14id C /�l&0/1jL FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAM LICENSE NIJA4BER LICENSE TYPE BUS.LIC# COMPA F.^j1C,� ^�y STREET A © V v -43TY,ST '/ o ARCHITECT/EN IN IiR Nf�M$ LICENSE NiJMBER BUS.LIC 1� / COMPANY ME C•_(� E-MAIL FAX STREET ADD ESS \/ ,{, C T Z � / �(� - P ONE I( 1 i t DESCRIPTION OF WORK ��I r E>-'STING USE PROPOSED USE CONSTR TYPE #STORIES (� � USE TYPE OCC SQ.FT. VALUATION($) EXISTG NEW FLOORDEMO .3 TOTAL AREA AREA C6 AREA NET AREA BATHRO 4 KIT N OTHER JJ REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: EIDETACH ❑ATTACH k DWELLING UNTIS: IS SECOND UNIT 0-79S. YES SECOND STORY ❑YES BEING ADDED? NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES REt:EIVED BI' ..�, TOTAL V U.4TION: PLANNINGAPPL9 ❑NO PLANNING APPROVAL LETTER EICHLERHOME? [3 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 buildi truction. I aut riz representatives of Cupertino to enter the above-identi le roperty for i ection purposes. SignatureofApplicant/Agent: Date: 2 Zd SUPPLEMENTAL INFORMATIO REDPiANCAE TYPE- RovTiNcslP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ p\'ERTAE-COUNTER ❑ BUILD�GPLANI2EVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ E7iPRESs � PLANNII�GPLANRE\LEIv _Commercial Bldgs: Provide acompleted Hazardous Materials Disclosure ❑ sTAn�nxD ❑ r�BiTCwoxTcs form if any Hazardous Materials are being used as part of this project. LARGE+ y �� ❑ ii TSE DEPT � _Copy of Planning Approval Letter or Meeting with Planning prior to p4AroR` ❑ $AnITARY sEv�ExTISTTucr ]f submittal of Building Permit application- t BldgApp_201 Lcloc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 1C) S T)E� AN-2,' . DATE: 01/0812015 REVIEWED BY: Sean APN: BP#: `VALUATION: 1$35,000 °PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1 B TI USE: PERMIT TYPE: WORK Accessibilit barrier removal: Bathroom upgrade 64 s ft and new wood walkwa ; construct new deck SCOPE for dining (233 sq ft). OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. B(Tenant Improvements) II-B,III-B,IV,V-B 0 $0.00 $0.00 TOTALS: 0 1 $0.00 $0.00 MECH,HOURLY 0 Yes E)No PLUMB,HOURLY Q Yes ( No ELEC,HOURLY ( Yes Q No P", ((`e'. Ll I NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Theseees are based on the prelimina information available and are only an estimate. Contact the Dept-for addn'l info. FEE ITEMS ffee Resolution 11-053 E 7'1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel,Bath(<=300 sf) Suppl. PC Fee: 0 Reg. Q OT 0.0 hrs $0.00 $645.00 IREMRESBAT PME Plan Check: $0.00 = # Deck/Deck Railing Permit Fee: $0.00 $503.00 I DECKWOOD Deck(wood) Suppl. Insp.Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? 0 Yes ( No $0.00 0 Advanced Planning Fee: $0.00 Select allon-Residential Q Building or Structure A Strong Motion Fee: 1BSEISMICO $9.80 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $11.80 $1,148.00 TOTAL FEE; $1,159.80 Revised: 01106/2015