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13110077CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21103 FENWAY CT CONTRACTOR: CAM PI CONSTRUCTION PERMIT NO: 131 10077 CO OWNER'S NAME: SOLNIT KENNETH T TRUSTEE & ET AL 12720 VISCAFNO RD DATE ISSUED: 03/I7/2014 NER'S PHONE: 4082535624 LOS ALTOS, CA 94022 PHONE NO: (650) 941-2908 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REMOVE MSTR BDRM FROM 2ND FLR (446 S.F); License Class. Lie. # y /Y CONSTRUCT I; 2 528 SQ FT FIRST FLOOR ADDITION; INTERIOR REMODEL Contractor �12UC71GfF)Date_ (1466 SQ FT) FIRST FLOOR. 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. 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 Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $285000 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 APN Number: 32654009.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that F 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 save180 DAYS FRO D 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 un stands and will comply ' Is Date: 31 11- with all non -point source regulations the Cuperti unicip'I Code, Section 9.18. 7 r 3 RE -ROOFS: Signature Date C / 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 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). 1 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 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 agement District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino , ipal o e, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, , and 4. Section 3700 of the Labor Code, for the performance of the work for which this 2 Owner or authorized a e Date: 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 indemnify and keep harmless the City of Cupertino against Liabilities, judgments, ARCHITECT'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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildincOCUDertino ora 00 \ CUPERTINO I \ M NRIV CONSTRI1CT-ION ADDITION ALTERATION / TI M RFV`ISI(iN / DEFERRED ORIGINAL. PRRMIT fi PROJECT ADDRESS w l� T % _ C^'""` l.f — 0 02 APN H 32 ( l OWNER NAME 1 LONE -17H 1 SOLO i PHONE 77" og-2S3—S6 z4- E-MAIL - `� KSo��I�f@ WAd, Lem STREET ADDRESS z I4s FcNwgq C -T CITY, STATE ZIP CNpelTivol CA 1)Sb1¢ FAX CONTACT NAME PHONE EMAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER 0 OWNER -BUILDER ❑ OWNERAG£NT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME (� �j LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME A LICENSE NUMBER BUS. LIC 4 COMPANY NAME �Ir _//�� . E-MAIL �p gW ,may +' 'p"'1' FAX C"7 w �"'[-„ �� T P STREET ADDRESS �,ee CITY, STATE, ZIP PHONE/ DFSCRIPTION OF WORK q $ z� 4 r:. . 6 A P A EXISTING PROPOSED USE CONSTR_TYPE 4STORIES USE TYPE OCC. SQ. FT. VALUATION (S) EXISTG .AREA 60,0 NEW FLOOR "' " ' DEMO A AREA 446. TOTAL ETAR:�lelpo 'P"�) BATHROOM REMODEL AREA t -1 KITCHEN REMODEL .AREA OTHER REMODELAREA/, �o Cyy// r PORCH AREA DE('F, AREA TOTAL DCCIJPORCH AREA GARAGE ATTACH AREA: DETACHkso _.. # DWELLING LflVITS IS A SECOND UNIT YES SECOND STORY ❑ YES "..... _.. BEINGADDED' RNO ADDITION? JSNO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YESRECEI VIED A Y: TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? NO"'}� S 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 construction. I authorize representatives Of Cupertino to enter the above -identified property for inspection purposes. "j Signature of f\ppllcantlAgcnt: ;,�� N, "��rf� / Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP Q OVER-THE-COUNTER BUILDING PLAN REVIEW _ New SFD Or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition pen -nit is required prior to issuance of building permit for new wilding. ❑ EXPRESS I& PLANNING PLAN REVIEW Bldgs: Provide a completed Hazardous Materials Disclosure L1 STANDARD ElPUBLIC WORKS. —Commercial form if any Hazardous Materials are being used as part of this project. O ❑ LARGE FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ submittal of Building Permit application. MAJORANITARY SEWER DISTRICT ENVIRONMENTAL HEALTH BldgApp_20ll.doe revised 06/21111 �---I CITY OF CUPERTINO I FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 21103 FENWAY CT DATE: 11/12/2013 REVIEWED BY: MELISSA PC FEE ID APN: 326 54 009 BP#:/002T -VALUATION: 1$28,5,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex 2nd Unit? Yes No PENTAMATION 1 R3SFDADD USE: OTC. 0 Yes (F) No PERMIT TYPE: WORK REMOVE MSTR BDRM FROM 2ND FLR 446 S.F . ADD 528 S.F TO 1ST FLR TO RECONFIGURE SCOPE KITCHEN & OFFICE/LABRARY AREAS & REMODEL REMAINING 999 S.F. ON 1ST FLR OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 528 $2,577.00 IR3PLNCK $1,617.00 IR3INSP $0.00 PME Plan Check: $0.00 F240 s.f. $626.00 Remodel, Kitchen (<=300 sf) IREMRESKIT Permit Fee: $1,617.00 Suppl. Insp. Fee:Q Reg. Q OT F0,01 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 528 $2,577.00 $1,617.00 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 haled nn the nreltminary infarmntion availahle and are anly an estimate. Contact the Dent for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eft' 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,577.00 F-9997 s.f. $628.00 Remodel, Other IREMRESOTH Suppl. PC Fee: Q Reg. 0 OT FO.01 hrs $0.00 PME Plan Check: $0.00 F240 s.f. $626.00 Remodel, Kitchen (<=300 sf) IREMRESKIT Permit Fee: $1,617.00 Suppl. Insp. Fee:Q Reg. Q OT F0,01 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cr7d'2bI7w (!(IPP" I'(0, JdrB bii,,tro(N(, Fcc, 0 0 Work Without Permit? 0 Yes E) No $0.00 Advanced PlanninL Fee: IPLLONGR $73.92 Select a Non -Residential Building or Structure G 0 r�llwl Cita trarr�. �rt�.or(rr�rr ia'�.� �. �_ Strong Motion Fee: IBSEISMICR $28.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $12.00 UBTUT $4,308.42 $1,254. 001 OTAL +'Et $5,562.42 Revised: 10/01/2013 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR SINAI. OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALI, 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: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millworkaj� — �� 00j _�. f _. —__ Cement Finishing EIectricaI Lki L, 1-��Z."f Kt C+ 10 Excavation �—i �o k.-� c,-ry .0 C.."IO K,7_...__....�. �, ? &6?e -- Fencing Flooring / Carpeting COX -6T j2vL7?C A-) 3 cP Linoleum / Wood i (!j3L6T n u at i W Glass / Glazing Heating l`TIfLL97U Insulation_ �.... . _ g . � .�} L ? .:. 11CTO ttS � ) Landscaping Lathing t7 t1 S W 7L-)'\ 16U 4 , 30OCf Masonry "Painting / Wallpaper sp i (fOJU-5T If o C rio . Paving Plastering o.q...__.1.1._ _._._� W Plumbing Roofing Lb s &ATvs Yzo -- Septic TankSheet �---- Metal LO ___.. Sheet Rock L pP -MnQ G:10 U -..._ Tilezm �iC-S 7AU C`T7Cd nb i Y4F a x / µ^ a._ -t Owner / Contractor Signature Date 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 l0. —:jL)V _ 1 PERMIT # 13 // D 0 3 OWNER'S NAME: ' '� L PI PHONE # q i — 02 GENERAL CONTRACTOR: i C'(1 S1YLUC:D010 BUSINESS LICENSE # ADDRESS: (`a 2v cp j p Llys CITY/ZIPCODE: j CEO 2Z *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 / Contractor Signature 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 l at