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11100139CffT Y OF CU PIER'II NG BUffILDING IPIERMffT BUILDING ADDRESS: 22362 REGNART RD OWNER'S NAME: MARK AND BARBARA MCCAMISH OWNER'S PHONE: 6503249610 ❑ LICENSED CONTRA'CTOR'S DECLARATION License Classj` _ Lic. # / j 'vj 5 Contractor � ,'r 91 fil Ide r'c JK(r Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Seetion 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. 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 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 ermit. Additionally, the applicant understands and will comply with all no point source ns per the Cupertino Municipal Code, Section 9.18. L//A. / Signature � Date /` ❑ 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. 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, l 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. CONTRACTOR: VIA BUILDERS INC. 4600 EL CAMINO REAL STE 209 LOS ALTOS, CA 94022 PERMIT NO: 11100139 DATE ISSUED: 03 /27/2012 PHONE NO: (650)948 -1077 BUILDING PERMIT INFO: BLDG r ELECT F PLUMB r MECH F RESIDENTIAL F COMMERCIAL r JOB DESCRIPTION: ADD 1,964 SQ FT TO I STORY SFDWL TO INCLUDE GARAGE & SHOP, PORCH- REMODEL 215 SQ FT TO BATH, 455 SQ FT THROUGH OUT, REPLACE 15 WINDOWS LIKE FOR LIKE 10/16/12 - REV #1 - REVISE SHEAR WALL & 2 BEAM MODIFICATIONS- 11/20/12 -REV #1 ISS'D Sq. Ft Floor Area: 11 Valuation: $150800 APN Number: 36645014.00 1 Occupancy Type: ]PIERMff T IEX]P R ES N WORK ffS NOT STARTED WffT]H IN 180 DAYS OF 1P]Ell81`ffT ffSSUANC E OR 180 DAYS FROM ]LAST CALLED INS PIECUONo 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, 1 agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the He A & Safety Code, Sections 25505, 25533, and 25534. O r th . d cnt: � /'Zi r7 ' 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 ARCHITECT'S DECLARATION Date Y I understand my plans shall be used as public records. Licensed Professional CITY OF cCUP E]FgTINO BUILDING PERMIT BUILDING ADDRESS: 22362 REGNART RD OWNER'S NAIVE: MARK AND BARBARA MCCAMISH OWNER'S PHONE: 6503249610 ❑ LICENSED CONTRACTOR'S DECLARATION License Class .tom Lic. 4 7 0`3 6 5 Contractor \% -. ci Z V c 1 Q P r3 1 m c. Date g-2?- / 2— 1 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. CONTRACTOR: VIA BUILDERS INC. PERMIT NO: 1 1100139 4600 EL CAMINO REAL STE 209 DATE ISSUED: 03/27/2012 LOS ALTOS, CA 94022 PHONE NO: (650)948 -1077 BUILDING PERMIT INFO: BLDG F ELECT PLUMB F- 1091ECH r- RESIDENTIAL COMM[]E1RCLAL r- JOB DESCRIPTION: ADD 1,964 SQ FT TO 1 STORY SFDWL TO INCLUDE GARAGE & SHOP, PORCH- REMODEL 215 SQ FT TO BATH, 455 SQ FT THROUGH OUT, REPLACE IS WINDOWS LIKE FOR LIKE 1 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 Workers 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 Sq. Ft Floor Area: 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 -poiLourco regulations per the Cupertino Municipal Code, Section 9.18. Signature - Date ❑ OWNER- BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 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. 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 l 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. APN Number: 36645014.00 Valuation: $150000 Occupancy Type: PERMIT MIT IEXPIR ES IF WORK IS NOT STARTED EIlD WITHIN IN 120 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. ION. Issued by: �� ft� 1✓� %Ci/� Date: --7'c'l�? Id 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 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(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 o author' d age A Date: 33 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 q �1 CONSTRUCTION PERM T APPUCAT N®N COMMUNITY DEVELOPMENT DEPARTMENT ^BUILDING DIVISION 10300 TORRE AVENUE ^ CUPERTINO, CA 95014 -3255 (408) 777 -3228 e FAX (408) 777 -3333 > building(a)cupertino.ora CUPERTIkN4 ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI REVISION / DEFERRED t ORIGINAL PERMIT # f 1 e CO M PROJECT ADDRESS APN # 3& 115 — ©/� OWNER NAME ,, C /, 06 - /j ! 4 PHON'E _r%9-ft- /0 E -MAIL STREET ADDRESS , 1 '•�Ly'I J CITY, ZIP �p G+� I FAX iJ CONTACT NAME 9 ^ orlrz2 PH NE o -� 0 -036: E -MAIL o (f - A-13011 v @, 6 tl , ca STREET ADD CITY, STATE, ZIP f ff �' d+� o1 l 0 5 o-3 k ZZ � �l %I I ❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMVd LICENSEUME UrII '� -7 CdO BUS.LIC# .- C l o n r �z 7 �2 2 COMPANY NAME klldeli O E -MAIL FAX STREET ADDRESS %%/ 5D {/ /1 CITY, STATE, ZIP PHO /NE�� ARCHITECT/ENGINEER NAME, LICENSE NUMBER BUS. LIC # ('E1 n Ssa 1 vt COMPANY NAME E -MAIL FAX STREET ADDREW > d• CI Y, ST T , ZIP ` 9 PHONE 2,2?- 2156 ri C�'I .1<e.cl- rive, oSe C�} 11 _ DESCRIPTION OF WORK A& J / 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 DECKIPORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS. IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED'. []NO ADDITION? ONO PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES REC VE 13 a OTAL VALUATION: ".a PLANNAGAPPL# []NO PLANNING.4PPROVpLLETIER EICHLERHO!•�? E] NOS - (IM By my signature below, ] certi to ach of the f lowi ;: I am the property owner or auth ize gent to act on the property owner's behalf. I have read this application and the informati I h e provide i corr ct. I have read the Description of Work d verify it is accurate. I agree to comply with all applicable local ordinances and state laws rela b ilding on. authorize representatives of Cupertino to enter the above- identified property for inspection purposes. Date: Signature of Applicant/Age SUPPLEMENT TNFORMATI REQUIRED Q ;.FT 1NCHECKTYPE,,, -.,_ r : ,-- ROUTINGSLIP• New SFD or Multifamily dwellings: Apply for demolition permit for ❑ _ existing building(s). Demolition permit is required prior to issuance of building OVER THE; COUNTER x, BUILDINGPL4NREVIEtiV permit for new building. ❑ E ESS" ❑ PLAj"NGPLANREVIE \Y _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sTANDARD v ' a rx'. ❑ PUBLICUORKS form if any Hazardous Materials are being used as part of this project. ❑� F " El Copy of Planning Approval Letter or Meeting with Planning prior to LARGE ' tl ❑ - FIRE AEPT ❑ _ submittal of Building Permit application. I;IAaoR„ 3 SANITARY SER ER DISTRICT Z.:: ❑ �ENTMONTAENTAIL HEALTH , CUPERTINO ❑ NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICAT110N COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION 10300 TORRE AVENUE ^ CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 - building(@,cupertino.org j �y ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # 6 PROJECT ADDRESS - - - _ APN # 366- / `/ W P o E -MAIL STREET ADDRESS I r� f I , / FAX � ,r e l CONTACT NAME \ [ PHONE ^ E -MAEL ) - o� STREET ADDRESSA (r art KO V &JPO CITY, STATE. ZIP L2 'A ® FAX ❑ OWNER El OWNERBUILDER ❑ OWNER El CONTRACTOR gcomRA/CCORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �Q r LICENSE NU, ERR v �� C iJ LICENSE TYPE BUS. LIC tl COMPANY NAME \ V E-MAIL FAX I� v, Cj e �s ��� STREET ADDRESS CITY, STATE, ZIP PHONE o .. `t6 ARCHITECTIENGINEER NAME CENSE NUMBER BUS. LiC A eD Cr.L6 L COMPANY NAME C E -MAIL FAX J 1 STREET ADQ� S t ?, CITY, STATE, o CA -T ( DESCRIPTION OF WORK �t •t �� � � , � \`� C \ l>• C�►� r� s 6 s �o��� _ log s -(L s4ry s - t (E) LVI&4045 6e 1� e I- EXISTING USE PROPOSED USE CaN_gILTYPE #STORIES f �t 1 l USE TYPE OCC. SQ.FT. VALUATION (S) AREAL AREA N FLOO �3 DAREA TNETTAR.EA S C-E 3 K"., �6rz '.. BATHROOM KITCHEN ''..... REMODELAREA REMODEL AREA OTHER REMODEL AREA LISS' PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH / t � Q ❑ ATTACH # DWELLING UNITS: IS A SECONIf UN TT ❑YES SECOND STORY []YES BEING ADDED? [2NO ADDITION? &NO PRE - APPLICATION ❑YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY. VALUATION: PLANNING APP # ❑NO PLANNING APPROVAL LETTER EICHLER HOME? NO J 0/)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 havb 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 uilding construction. J autborize representatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLE INFORMATION REQUIRED PLAN CR CIC TYPE ROUTING SLIP ❑ OYER- THE - COUNTER E a'ulin],NG 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 3" . MRTNGPLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure S®' TArmAIW usUC WOMO form if any Hazardous Materials are being used as part of this project. 11 ❑�� DEP LARGE _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ ❑ ARY submittal of Building Permit application. MAJOR SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH, BldgApp_2011.doc revised 06121111 ea CITY OF CUPERTINO FMRS, FEE ESTIMATOR - BUILDENG DIVISION OCCUPANCY TYPE: ADDRESS: 22362 regnart rd. DATE: 90/18/2091 IRIEVff EWED BY: bobs. PC FEE RD APN: �j— 5-v/ IBP #: ///00/-3" *VALUATION: 1$150,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? Yes o No OTC. 0 Yes DNo PIEN7AMATIION 1 R3SFDADD PER M17 TYPE: WORK PME Plan Check: SCOPE $0.00 OCCUPANCY TYPE: TYPE OF CONSTI L IF1LR AREA s.ff. PC FEES PC FEE RD BP FEES BP FEE IIIID R -3 (Custom) II- B,111- B,IV,V -B 1,964 $2,608.10 /R3PLNCK $2,192.80 /R31NSP I;fPI. 111.' +' ' PME Plan Check: $0.00 455 s.f. Remodel, Other $457.001REAMESOTH Permit Fee: $2,192.80 Suppl. Insp. Fee.0 Reg. COT Q•Q hrs $0.00 15 # Window / Sliding Glass Door $522.00 1WINREP Replacement PME Unit Fee: $0.00 PME Permit Fee: $0.00 TOTALS: 1,964 1 $2,608.10 1 1 $2,192.80 M ECH, HOURLY 0 Yes; 0 No PLUMB, HOURLY 0 Yes 0 No EILEC,1HiOURLY 0 Yes E) No Ve.::dr. Ill,'), Ch '<:': � ! >hV,i'7, l'i'ar C "`i�Er:& � 1 t; . 1'a"arr (.'i;,:ch :'r. r'L;iA. r�r.r!'t: f(, f'f:'t: IpF &Ili /+. .P(.:"TiF1i f'.'.e: 215 s.f. $588.00 Remodel, Bath (< =300 sf) 1REMRESBAT E 1-7 (7r °i! {u't`,.th'C. lit 1'"). a1:. "1'.'7. ' >< " +;. f, i� { >• �at7s�i 1i7, i. >i.i /3. L; '�: I;fPI. 111.' +' ' NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the nrelindnary information available and are only an estimate Contact the Dent far addn'l info. FEE ITEMS 0 ee Resolution 11 -053 E f _711/111 FEE QTV/1FIEE MIISC ITEMS Plan Check Fee: $2,608.10 215 s.f. $588.00 Remodel, Bath (< =300 sf) 1REMRESBAT Suppl. PC Fee: 0 Reg. COT 0.0 hrs $0.00 PME Plan Check: $0.00 455 s.f. Remodel, Other $457.001REAMESOTH Permit Fee: $2,192.80 Suppl. Insp. Fee.0 Reg. COT Q•Q hrs $0.00 15 # Window / Sliding Glass Door $522.00 1WINREP Replacement PME Unit Fee: $0.00 PME Permit Fee: $0.00 �))C)rJtd'it7fl'(TtiY1 /,t,�' , `.t.0 /fil1Y='71'1t 6.7141'R.' 1- •? ?F;. 0 Work Without Permit? 0 Yes No $0.00 Advanced Plamning Fee: PLLONGRNGR $255.32 Select a Non - Residential Building or Structure 0 0 Travel 1�oc rrtrr<r7lzxt; art F -ef,�„ Strong .Motion Fee: 1BSEISMICR $15.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $6.00 SU113TOTAILS: $5,077.22 $1,567.00 T ®TAIL 1FEE: $6,644.22 Revised: 1 0101 /2 01 1 CIT Y OF CUP E8TINO FM� 0 FEE ESTIMATOR - BUR LMNG DRVERON -- ADDRESS: 22362 REGPIA►RT RD !DATE: 10/9612012 REVIEWEID BY: SYLVIA Lfc:c /r. Permil Fee: APN: BP #: f *VALUATION: $800 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD Or Duplex USE; Elec. lnsp. Fee: PIENTAMATION PERMIT TYPE: 1GENRES WORK R EVISION #1- REVISE SHEAR WALL & 2 BEAM MODIFICATIONS SCOPE -- 1Lfech. Plan Check Plumb, Plan Check Elec. Plan Check � - — Lfc:c /r. Permil Fee: Plumb. Permit 1"ve: lalec. Permit Fee: Other hfech. Imp. Other Plumb Insp. Other Elec. Insp. C Mech. lnsp. Fee: Plumb. hrsp. Tee: Elec. lnsp. Fee: 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 Dreliminary information available and are only an estimate Contact the DeDt for addn'l info. FEE ITEMS (Fee Resolution 11 -053 ff 711/12 IEEE QTR' /IEEE MISC ITEMS Plan Check Fee: hourly Only? C) Yes E) No $0.00 2 hours Plan Check, Hourly $266.00 ISTPLNCK Suppl. PC Fee: (0 Reg. 0 OT Q,Q hrs $0.00 PME Plan Check: $0.00 Permit Fee: hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee-0 Reg. () OT Q,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction .Tax: Administrative Fee: Q Work Without Permit? 0 Yes (D No $0.00 Advanced Planning Fee. $0.00 0 hours Inspections $133.00 11STINSP Inspection, Hourly 0c Travel Documentation Fees: Strong; Motion Fee: IBSEISMICR $0.50 P Select an Administrative Item I 0 Bldg Stds Commission .Fee: IBCBSC $1* SUBTOTALS: $1.50 $399.00 TOTAL, FEE: $400. Revised: 10101/2012 �6L� CONTRACTOR ACTOR / SU3CO1� '1RACT ®R UST Building DepartunM City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 403- 777 -3228 Fax: 408- 777 -3333 JOB ADDRESS: PERMIT # ,_ 0. 1.5q OWNER'S NAME: r46 ' (; 6. PHONE # SO 'lry -/07 GENERAL CONTRACTOR ` ` `'' BUSINESS LICENSE # ADDRESS. CITY /ZIPCODE: Zos ! 4o z z . *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: i Signature Date Please check applicable subcontractors and complete the following infou-niation: V SUBCONTRACTOR BUSINESS DAME BUSINESS LICENSE # Cabinets & Millwork vt��.e� 2- S Z Cement Finishing v,I Je-a. -r -2- -2-6 Z V' Electrical hC. - 6Q I V Excavation N,W Fencing Flooring / Carpeting U a 2 Z5 �- ✓ Liholeum / Wood 13v, o�c, rs J Glass / Glazing p j G s 61 us S //�� d. 915 -- Heating V `J�D11 -t CY < 22 5 Z Insulation 7P6>riZ1VL 77013,01,4--toyl. 6200 1 ,vik Landscaping V Lathing '.f -A elk, Masonry Painting / Wallpaper VfA- "G ► ACS' Q,S as Paving V =pr tJ\�ir Plastering J Plumbing J Roofing CO c9u���t `�� r/ Septic Tank V --A -ZU1 I J P rr L/ Sheet Metal VT W rf 22 2 V Sheet Rock AM 0(14 'ate 5 01 Tile l US a&0305 Owner / Contractor Signature Date RECIFIlvP113 MAY 0 2 2012 BY: oil THIS'(. it FY u 1 ON 1lmilding Ijepa11111T E J _! n 14I N (1 �7 CIIYUFCUI'CItII�VU O STRUCTION I0.100TORREAVENUE CUI'Clill \U.('i \9i1n1•I.12i.� I I:I.CI'FIO \E: 008) 47 -3218 • I -AX: (103)777.5313 SITCIAL INSPEC'I'10N ANI) TES'1'1NG AGREEMENT Ihnjcct Nmuc:cC l�,I? Dote: -- �2.23coz: projccl i \(Idrvss; 2 JZ'qqnaiZq R Pcnnil 11: I� �00�3� To permil upplicmns of prolecls repairing Special Inspei lion and /ur Tes(Ing pier CBC Section 1704: fff•.PORE A PERMIT CAN BE ISSUED: The Owner, General Conlractor, I'ruiccl Architecl /Engineer fold Special Inspector shall lick owledge late required special inspections, lcsling and condilians. When deternipned by (lie Building Inspecdoii Division, it pre- conslrucliun conference with the parties involved will he held to review the special inspection requirements and procedures. Special inspection and lcsling shall meet the minimum requirements of CBC 1704. The following conditions are also upplicuble: I. Contractor is responsible fur nudlietliun to the Special Inspector or Agency regarding individual inspections for little$ listed un the allnclaed Schedule and noted an (lie City approved plans. Adequate notice shall be provided so the Special Inspector has lime to become fnnlillnr \vita the project and do n thorough jut) for all inspections. 2. Each Spccinl Inspector shall subunit his qunliticutions to lite City nod is sutliect Ina persannl inlaview I'm• pre- qunliliadiun. Spccinl hisliwors shill display nn approved iticnlilicntion t)ndge when performing the ru nciinn of n spiccial Inspector or upon request, and must have n valid ICIIO Ccitilicatirm for lite type ol'work Rein(, insliecled. 3. Dulics and Itcspauslbllitics of dtc Spccinl Inspu ctor aaL: A. Observe the hark Iur cunl'urnumcc with the cru APPROVED (slomped) design cravings and spceilicaliuns And applicable work nnunshi1) provisions ofilae CI1C. NOTE: Shop drawhigs folly be used (I • 'is au old to inspection. It.' Bring non- cuml'anning ilcats to lite hunictliatc ouenllmr oldie cumnictor and mute in dally reporl (Itef. Item 4). If oily such item is not resolved in a lintel• manner, or Is aboul to be incorporated in late work, nolil'y line Building Inspcelion Division and file Pruiecl Envitteea or Architect ittuac(lintcly by lclephooc ill 408. 777 -3228, nr in person. Revlsed 7/16109 RECEIVED MAY 012017 Sp -6111 III-SIRNlinP null Tuslhgl Agrceinum C. I'urltish mporls ufluMs and insliveliults dii -eclly ht (lie Iluildhtg inspection Division. EPVingr mil AmIdum ormcom and umers its designmed. 'I Ilese wpolls Pro to include lire following: Descrihc inspections Pod lest lild(lb wifli uliplicable locntioas List nil tton•cuPlolutiug heals - n - 11111ICBIe holy nun•coufurming Il6pts'w4:m resulmd ur Indicate tultitpivcd items as opplienblc a ItelttW chmtgcs authorized by Archlicel, lingincer, mud Building Inspection Division. ifnol included in note- coil rurtnm►ce items D. Insure (lint nn ndcquatc number of prc•qunlifted spcclul inspeclion liersonnel arc un the Juh, based on the intensity of uctiviiics, qunlily ol'work perronucd mud the various operations occurring, li. Submil n FIN " Al. LF17 CsR OF COMPLUMN to lire Building Inspection Dieislon $lnlhlg 111111, to the lict ot'his knowledge, nil ilems requiring spcei,d inspection and tcsliug were accumplisht;d, approved and reported In conrurnmance with the approved design drawings. specilicaliun2%; approved cl unge order and line nppllcnblc work ton Psi III provisions of the CDC. Itcnis.iun in conronmmocc, unresolved heats or Pity disempancics in inspection coverage (im..ndssed inslicetirnts, "licriodic" insimflo ns perforated when "continuous" insitcettous %�erc mjuired, e1c.) shall be specially, hcnilved in this report. R FINAI, I.li7 "I:filt OF COMPUTION shall In signed by lite Licensed Itcgislered Engineer of the Sliccinl-:lnspceliou Agency of reconl. 4. Each Spcchll luspeour shrill comptcle mild sign the �1>rcinl q`Pecticni.Rccm•cl ofench dny's inspeullon mid provide n dally hnudwriuea repon in a funmtt nceeptable to time nuitdin. Inspection UiviFion (lo rcmnin III Ilie jub site with the cmurnctor lbr rcvicw by the Building Depmrinient's Inspector). Coulcnl ul'Ihc tinily reports shnll he lier lent W nbove. i. 11'ulk 1�quiring it 1IICCInI 111 \IiecllUll, mud Ihu perful7nuucc ul'u sprcial lPSpcetionl slutll bo ntoulured by file Cily's building inspector. City nplxoval isYcquircd prior to pinccutcnt of couerelc. Gcnefol Cottlniclor sllnll nolilj',IOR•777 -3228, 2,l Ituurs in uth-rirtLc liir eacli dny sliccinl insliectiulls will be culiducicd. G. Special insliecdons nre to he perforated un n C'U 1 IVl)t?l1S 13ASIti, meaning dial tine SITCIAL INSPECI'Ult IS OJJ 8I.1 -E IN - 1.111: (WNERAL AMA AT ALL TIMES OBSERVING THE WORK REQUIRING SPECIAL INSPEC-fION. Perilnile Inspections Piny he approvod by the Iluildiny hlspcclion Division and, Ifopprovedl shall lie Poled oil die SPECIAL INSPECTION ANO TESTING SCI Usnlll,G. 7. Only lice City nppruvcd Tcming Agency ol'record shall smnplc, transpnrt mad lest Ptnterials. S. Only the Cit%, apps aved sliminl loSpcctiou Agcucy ol'rscord shrill provide specinl Inspectors. ladcliendcnt inspccinrs nmy lic pre•nppnived by the BidIding hispecliun Division per Item 2 abovo. Special htspccliun and Tes(illp Alaccmenl 9. BEFORE AN OCCUPANCY PLI(tMT CAN Ill: 1W )ED: The Specinl Inspector or Agency shall submit n 11NAL LETTER OF COMPLETION. per item R nhuve. directly In the Building Inspccliun Division. 10. Cupy nl'SPIiCIAI, INSPECTION AND TFSTING SCI IEDLILL. SPECIAL INSPECTION AND I'IsS'fli\t; AC RI'MIEW. S11rC'I'A1. INSPECTION RECORD, nod SPECIAL INSPIi.C'•1'IUN D� ILY RE110111 SI IALL Rli AT TIII:1O11 Srrf. ACICNOWLLUC:I?i► CWI'S Signature Generml Cuntrnctur: 41L . J �A � Special Inspector or Agency v�.J: Project Enbinccr/Aw1 m- Building luspecliun I)ieisirnr _ _ 001111 _tea jf3p lj e s Tqp [Testing Engineers Inc. � J nn Co 1,1 Kt, o T C,� CL -c_ a ma 5 S; n,d or 6L PL)ve- w-e- ch col 2 CAAd mar =OTARg AL ( ICH /� ter•_ ••;.. �OY I �t 1� 6� �C ,� 2 D -t DYeS� +F NOREGON I v 'I; .449150 MY COM'..4ISNE 11, 2014 ,! lAlihlin); Ucpmrlmcnl 'p t CI11'(lF('IlpFll71�0 103U0'fU11nE. \\'L>\UL' CUPIN11NO CAW01.1 -J25S C:Uf/I:RTINO 112I.11-PIIONF:(IM)7J -3US • FAX: (IM) 777-31,33 SPhCIAP. IRSPh:CTTON ANV,TE8'I'ING 2236_•2. Regnart Rd McCamish: j Project A(khess — -- Projcel'I'ille To n%ener of prujccls requiring; Slicciml htspcclion or testing; per Clriipler 17 of the 2007 Cnliliauin 131111(1619 Code, please ncknowlettge mill rebim to the City: BEFORE A PERMIT CAN Dr. ISSUE): 'I'hc Owner, or his mpreseuni ive, un lite n(Ivlcc ol'Ihc respunsible Project Fuglncer or Alrhi(ecl. shrill cunipletc, sign nn(I subluil the nllriehed roll,, "SUUelurnl'I'csls and Inspeclilni Sclicdulr' to lite Oulltling Department for review and approval. The owner mull his general conlruelpr, where npplicnble, shall also ack11nwicd9e the Iollotvlill; condillons nppllcablc to Special hispcctiml and /or lesliag. I. Cummcloi• is respunsibic fur proper nolilientiun to the lospecliug nr Tcsting agency far items limed. 2. Only the testing laboratory shuul(I Inke Snugiles cold Imnsporl them to Iheir Inbommq. 1. Cupies. of rill InboMmiy reports mul Inspections ore to lie sent dil•cclly In (he City by the Tesliug Agency. 4. hlspcclion n$cncy to submit n:nncs and qunlilications orlon -silo spceial iltspcclors (o late I3uildingDeparbucnl for approval. S. Tfic Spccinl Iltspcclor is under tits amhorhy ntul is reslinusible In llle Building Orlicini. All Inspection concems midar problems cncnumerc(I ore to lie brought to his nttcntion inumalinlely. fi. Special hispecton may be mquire(I, ns 11 minium11. to provide weekly repurls to IhiS dcpaittncot ufall inspectiun aclivily. 7. It is lite respuusibilily of tlic cottractur to review City upproml plans for additiumil Inspection ur (91ing rrquircmaus that may lie linic(I. S. III. OI(F AN OCCUPANCY PERMIT CAN n ISSUED: The inspection agency, doll smbnlit n ttdement (hml all items requiring W -Mint; mid hlfitclion have tweii lullilled and reptled. Those items not testc(1 m4for inspcctc(I shrill be nbtc(I Ill tills NIntenicill. Copy of stacnicill is to be n11dnlmine(1 at the job site for City's nitildiug Inspec(ur's review prior In llnnl Ils1welions. Owner's S( t csling(Inspcctwn Agcnc? Signnfule Clly Phil Chccl: englnecr's Sigmaure 1 Engineer (��Sip) tmc S Signidure I(eviscil 7/16109 Building Department CITY OF CUPEIMNO 10- TO TORRE AVENUE ' CUPF.RTI\0,CA930t4 -3235 7F.LEI'IIO,N?E(KJ3) %//-3228 • FAX: (4RS)777.3331 STRUC'T'URAL TESTS AND TNSPEC'I'IONS SCHEDULE Prior to issuance of n building permit, the Owner, on the advice of the Architcc(or Engineer, shall complete, sign and submil this form to the building Official. ��oAml.l -- 2 -13 -12 Name Date alure Owner hereby ccrli ies Ihnt lite Test, %finspeetcan Agency onmcd above lips been engaged to perform structural tests and Inspections during construcflon, as checked bclojv, to sfilisfy fill applicable portions of lite Building Code. Prior to issuance of an occupancy pemnii, the Inspection Agency shall submit a slalemenl that all Items of designuted work performned were reported. Any items checked, but lint Icsl or inspected, will be noted mid explained. Whenever any (Icsignated items on This list arc rcndy for samplinE, (csting or inspecllon, it shall be the responsibility of the Coulmc(or (o give timely police to the h►spcclion Agency so that the required services may be performed. RCINFORCINO STEEL: Tensile fi Boad. mac sct per heal per ____Inns K inspcetion ofi'lacernetu HUD ' o qm. ( 7p6-M) In slice lion of Welding MASONRY: I'relimin.'ny AeecpLuue Tests (Masarry Unites. Wall Prisurs) Subscquenl Tesl (\lunar, Qmul. Piehl \Van Primes) hnspectlou orGrolting Inspccdan orPiaccnsnn R Ororlting ASPIIALTIC CONCRETE: Mis Designs . luspecilon ormtch Plant ` CorerTf31 Field Inspection Suhabilit' Tests _ Specific Gravity Asphalt Content _ SicN'e Analysis _ K Factors Stabilomcter Valuc STRUCTURAL STEEL: — Sample & Test (Ilse specific Itsctabcns Ulm) ...... Shop Identification & Welding haspeellon _ Shop tllnosonic Inspection Shop Radiography Field Wchling hlspMion Field Bolling lrnpcettoal Stool Dee: welding Inspection INSULATING CONCRETE: Sank R Yell — Unit Weights Shucl111111'I'ems 01111 I11spccli011s Schedule f'01Clll:'1' %lI0'1Cltl:'1' GIlUU1 \IOIYI, \Il ll?SI:tiA+VDI\SI'CU ONS ALgregnte'rcsts Cdr Resigns - _.. --- - -•� -- - -- — - - -- - SuilnhtlllyofAcgicg;tlrs " \6x Ucsipns + ��• - - 'I•csl Patel hatch Plant Inspection Ccuuuu Comb Sample — - - - - - -- — --- -- lury+eci P15cr — — — - - - -•- C'unipressiau Tests Cast Specimens — -- - Yick•npSamplcs '-- - -• - -- - - - - -- - - ----- Shliukngc Oafs Yield Chick- _ AIr Check - -- MY Unit %Vcigl0 PRE.CASTrPOS r•TrNS101 rn CONCRETE: • _ ItelnCnrciug'fcsts •_ InspecliatofReinCuicinpl 'Imenenl Tendon "I esls luspccliou ol'Tendoit Placement _ Inspecliuu urculmew I'laccntcnl _lospecliou ofC'oncretc Ontching Inspecliuu of Punel Allachnicuts fi lusew; _ m liccaou of I'micl Inswimiuu Cotupressioo Tests Inslirclioti of ShcssingiI'musrtr PILING. CAISSONS. CAPS, TIES: 10sliccliun ul•Rctulorciug I'laccnictu Iirspcclirnt of Cuncome Placcntcul luspeciiott orcencicte Dntching UNDCRPINIMIN is Inspcctitnt arStecl rnmcatiat _ luspectlun of Itcinfmcing .0 rtums inspeclino of Cuncrete Placement _ loycellanofTielincks 171101ItO0Y1 \C: _ luspeclirm of Placenuul Density Tests — 'fhlckucss'I'csls f lspecl hatching 111.1, MATERIAL: ___ Aceeplmice'fesls ,\7olshire•Denrily Detelmlimlfall Held Demil)• ROOMING: -_ htgtccllonofPlacemem _.Sample 1C 'rest ti"I RUM URAL WOOD: _Inspection amititirnliou _ Iuslucliun of truss Jnlu rnlnicellnn Sample & 'rest C'ongwncuts - _ Inspection of Glu Lam I'nbricnilnu . _ _ Shenr Dinplungnis ADUrrIO \AI.INs,n UCCIOVSOltofIwit *II:S'IS&INSPI {('710\5 t T