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13080186CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10773 BROOKWELL DR I CONTRACTOR: STONE CITY CORP OWNER'S NAME: ZHANG GUANGBIN AND XU RUI OWNER'S PHONE: 4086169054 ❑ LICENSED CONTRACTOR'S DECLARATION License Class 'f�, Lic. # ly a' v /% --1— Contractor 414 =4 7/ ( j T 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 -/—I- L 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 ❑ 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) t, 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. 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. 2830 OLIVE AVE FREMONT, CA 94539 JOB DESCRIPTION: RESIDENTIAL PERMIT NO: 13080186 DATE ISSUED: 09/20/2013 PHONE NO: (510) 219-3632 COMMERCIAL CONSTRUCTION OF A 536 SQ FT ADDITION TO LIVING ROOM. Sq. Ft Floor Area: I Valuation: $60000 APN Number: 36921012.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DA)RFROM LAST CALLED INSPECTION. Issued by: Date: 7.W'43 G 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 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. �1 Owner or authorized agent: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 1 understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION Qv 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408} 777-3228 • FAX (408) 777-3333 • buildingC@cupertino.org CUPERTINO ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/ Ti ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESSI r l � ) � YTI� 2f "V APN H OWNERNAME PHONE �� E-MAIL l STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME J tr� yC�� PHONE �3� E-MAIL esc�•,�Yu; o,, . STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME d LICENSE NUMBER LICENSE TYPE BUS LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK f1`� ` V i+ ✓V LI; , EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES c>" I I USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA /6 L / NEW FLOOR AREA i / (� DEMO AREA TOTAL NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DDETACH ❑ ATTACH # DWELLING UNITS. IS A SECOND UNIT ❑ YES SECOND STORY YES BEINGADDED? ONO ADDITION? C1N0 PRE -APPLICATION DYES IF )TS, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIV TOTAL VALUATION: PLANNING APPL # ❑ NO P N rjPPROVAL LETTER L. EICHLER HOME? ❑ NOf j ,, "�"' i7~' fit') G2'1i Y By my signature below, I certify to each of the following: I am the property owner or authorized a ent to act on the property owner's behalf. I have read this application and the information I have provided is correct. 1 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 cons do I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. L Date: Signature of Applicant/Agent: SUPPLEMENTAL INF MATION REQUIRED PLAN CHECKTYPE RO TPINGSL,IP ❑ OVER-THE-COUNTER ❑ BUMDINGPLAN 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 ❑ 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 ❑ MAJOR ❑ SANITARY SE\YERDISTRICT submittal of Building Permit application. - ❑ ENVIRONMENTAL HEALTH BldgApp_201I.doc revised 06.21111 CITY OF CUPERTINO FEW FEE ESTIMATOR - BUILDING DIVISION imADDRESS: 10773 brookwell dr DATE: 08/22/2013 REVIEWED BY: Mendez i APN: BP#: & "VALUATION: 1$60,000 *PERMIT TYPE: Building Permit if PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 2nd Unit? Yes No OTC. 0 Yes (F) No PENTAMATION 1 R3SFDADD PERMIT TYPE: WORK 536 s ft addition to living room SCOPE Suppl. Insp. Fee:Q Reg. Q OT OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,IV,V-B 536 $2,577.00 IR3PLNCK $1,617.00 JR31jVSP Permit Fee: $1,617.00 Suppl. Insp. Fee:Q Reg. Q OT 07 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Curstr?action TO.r: 0 Work Without Permit? 0 Yes E) No $0.00 TOTALS: 536 $2,577.00 r $1,617.00 Strom Motion Fee: IBSEISMICR 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 hated an the nreliminary information available and are only an estimate Contact the Dent for addn'1 info. FEE ITEMS Fee Resolution 11-053 Eff 711/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,577.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: 0 Reg. () OT 0.0 Ihrs $0.00 PME Plan Check: $0.00 Permit Fee: $1,617.00 Suppl. Insp. Fee:Q Reg. Q OT 07 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Curstr?action TO.r: 0 Work Without Permit? 0 Yes E) No $0.00 Advanced Plannin Fee: IPLLONGR $75.04 Select a Non -Residential E) Building or Structure r Strom Motion Fee: IBSEISMICR $6.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $3.00 SUBTOTALS; $4,278.04 $0.00 , TUi`AItFT+;E' $4,278.04 Revised: 07/0.1/2013 The City of Cupertino Water Resources Protection Ordinance (Ordinance No. 07-1992) requires the issuance of Streamside Modification Permits for the development or modification of properties containing or abutting a stream including all properties located within 50 ft. from the top of bank. The purpose of the ordinance is to protect natural stream resources vital to stream stability, functionality and wildlife habitat. The Cupertino City Council adopted a comprehensive set of Guidelines and Standards which form the basis for the evaluation of land use near streams and the issuance of Streamside Modification Permits. The Guidelines and Standards were developed in cooperation with the Santa Clara Valley Water District and can be found online at Select "City Services/Public Works/Engineering Development/Pennit Applications!Streamside Modification Permit" Slope Stability Protection Area Toe of bank Among other requirements, the Guidelines and Standards establish the criteria for a Slope Stability Protection Area, or area between a structure and the stream, which may increase building setback requirements. Generally, the width of the Slope Stability Protection Area will be between 10-25 ft. from top of bank. Structures or modifications within the Slope Stability Protection Area are discouraged. In the event a structure or modification is proposed within the Slope Stability Protection Area, the project applicant will be required to hire a licensed engineer to perform a geotechnical evaluation to determine if site conditions are suitable. Under some circumstances, the City may require on-site geotechnical analysis even if the slope stability requirements are met. The Public Works Department and Planning Department will review improvement plans for streamside developments to verify the design guides and permit conditions described in the Guidelines and Standards have been adequately addressed. The improvement plans shall include: a) Location of all existing and proposed improvements b) .Location of all surface `eater resources within 100 ft. c) Location of Top of Bank and distances between any improvements and Top of Bantle, and the site topography with appropriate contour intervals d) Location and direction of existing and proposed surface drainage, including runoff fi-om roof, downspouts, gutters, parking areas, and culverts including proposed storm water infiltration devices. e) Existing condition of stream bank an..d/or stream bed (i.e. vegetat.ion, roads, paths, erosion problems, etc. f} Areas prone to flood g) Specific measures and/or improvements to protect stream(s) from water quality impacts h) Location and type of existing and proposed landscaping materials, including riparian vegetation i) Proposed grading and earth movement including quantity and depth of cut and till, placement of fill and how it will be treated in proximity to a stream. Please provide typical cross-sections through graded areas(s) j) Proposed alteration(s) to banks and beds of stream(s) k) All improvements intended to enhance, protect or restore natural resources on the site and in adjacent stream(s) A complete listings of Standards for Improvement Plans is available from the Public Works Department. Exemptions: The following modifications are exempt from the requirements of obtaining a Streamside Modification Permit, provided the modification is not within the stream: 1. Less than three cubic yards of earthwork- 2. arthwork2. haterior building construction and alterations 3. Erection of storage buildings not greater than 120 sq. ft. 4. Replacement of sewer or water laterals 5. Re -roofing 6. Wood fences six feet in height or less 7. Exterior decks less than or equal to 30" above grade 1. Location of all existing and proposed improvements, including existing and proposed buildings, other structures, concrete and/or other impervious surfaces,, fences, decks, swimming pools and related discharge connections, septic tanks, leach fields; utilities, trails; easements, wells, etc: 2.. Location of all surface ivater..resources; including where streams; :waterbodies;:. wetlands (inc d' nC** * Section 404 Federall _- rotected, o :;State protected, a .y y P 1. wetlands); or other sui:face water resources are located on or=withrn::100 feet of the proposed activity:.. _...... . 3. Location of Top: of Bank and distances between anyMprovements and: Top of. Bank; and site topography with appropriate contour intervals::. 4. Location and direction'of existing and proposed surface drainage, including runoff from roof, downspouts, gutters, roads, parking areas and culverts, including proposed storm water infiltration devices. 5. Existing condition of stream batik and/or stmam tied (i.e., vegetation; roads, paths, erosion problems, etc).... 6.. All parts of the site that areaocated within ili arut prone to.flooding as shown on . FEMA or Santa Clara Valley Nater District maps. - 7.: Specific riseasuices..and/or.impiovements to protect. streams andlor`waterbodies fioni water quality impacts. . S. Location and type of existing and proposed la.ndscapina materials, inchiding riparian vegetation. 9. Plans for modifying existing vegetation; including .riparian vegetation. 10. Proposed grading and earth movem6nt including quantity and depth of cut.. and fill, placement of fill and how it will be treated in proximity to streams/waterbodies, Please proNdde typical cross-sections through graded areas. CITY -OF CUPEkTINO STREAMSME PERMIT DATE:. PROPERTY ADDRESS: PROPERTY OWNER: CITY HALL 10300 TORRE AVENUE CUPERTINO, CA 95014 PHONE (408) 777-3354 FAX (408) 777-3333 PUBLIC WORKS DEPARTMENT File No: APN: PHONE NO. PERMITTEE: PHONE NO, CONTRACTOR PHONE NO. SOILS ENGINEER: PHONE NO. ATTACHMENT: YES [ ] NO [ ] This property lies within the Streaniside Protection Area, abutting or being in close proximity to a stream (within 50 feet from the top of bank). This project is not eligible for an exemption from the Guidelines and Standards For Land Use Near Streams. All improvements have been designed, and resources protected, to the City's satisfaction in general accordance with the Guidelines and Standards for Land Use Near Streams. APPRO«D BY: Distribution: Owner P.W. File OWNER'S SIGNATURE: DATE: Revised 5107 PROPERTY OWNER (IF DIPFFRENT): PROPERTY ADDRESS: NAME OF STREAM AND/OR WATERBODY WITHIN 100 FT OF SITE: TYPE(S) OF STREAMAVATERBODY (SEE GRAPHICS A THROUGH G); IS ANY PART OF..THIS STREAMLWATERI30DY WITHIN.THE:SITE BOUNDARIES?. IF SO, IS THE STREAMAVATERBODY.(A) PERENNIAL;' (B),INTERMTTTE ; OR (C).EPHEMERALT. IS THERE A WETLAND. WITHIN '2,00 FT OF THE SITE? IS .IT.: A SECTIO` 404 FEDERALLY DELINEATED WETLAND? WILL GRADING.:.AND/OR EARTH ; A40VEMENT:, OCCUR RTITIIN; `. AN EXISTING FLOODPLAIN? IF SO, HOW MUC1-i? DOES THE PROPOSED PROJECT INVOLVE ANY CONSTRUCTION WITHIN A STREAM OR WATEKBODY . BETWEEN AIN EXISTING TOP OF BANK? - DOES TIIE.. PROJECT, INVOLVE UTILITY. PIPE:..: LINES;. DIRECTIONAL BORING. OR. TRENCHING't - ...:.::............ DOES THE PROJECT PROPOSE TD DIVERT TIIE NATURAL, FLOW OR CHANGE THE EXISTING BED OF A. ' STREAM OR WATERBODY7 DOES THE PROJECT INVOLVE THE PRESENT OR PLANNED REMOVAL OF WATER FROM A STREAM OR WATER3ODY FOR STORAGE OR USE ON SITE') IS PROJECT LOCATED WITHIN A STREAMSTDE PARCEL IS ALL OR PART OF A STREAM OR WATERBODY ATTHE SITE OWNED IN FEE OR HELD TN EASENJENT BY THE SCV WD? IS ALL OR A PORTION OF THE SITE LOCATED WITHIN AN AREA PRONE TO FLOODING AS SHOD;T' ON FEMA, CALIFORNIA DEPT OF WATER RESOURCES OR SCVWD MAPS? DOES THE PROJECT. AFFECT.THE:FOLLOWING: FISH HABITAx .MANAGE 17ENT 15LAN`AREA {FHMPA) e_ MITIGATION.AND AIONITORINGPLANAREA (MMP AND SCVR'D:.PROJECT) • NETIGATION AND MONITORING PLAN: APPROVED BY'A LOCALJURISDICTION • HABITAT CONSERVATIONPLANAPPROVED BY.ALOCAL JURISDICTION. EXISTING OF PLANNED RESTORATION PROJECT APPROVED BY A LOCAL, JURISDICTION, • EXISTING OR PLANNED FLOOD PROTECTION PROJECT DOES THE PROJECT PROPOSE ENHANCEMENTS FOR VEGETATION, WILDLIFE OR. FISH RESOURCES'? DOES THE PROJET PROPOSE THE USE, GENERATION. OR STORAGE OF HAZARDOUS MATERIALS ON DOES A PROBLEM EXIST ON THE SITE, SUCH AS SIGNIFICANT STREAMBED. OR BANK EROSION, THAT . APPEARS TO BE RELATED TO OFF-SITE ACTIVITIES? WILL A HYDROLOGY REPORT OR HYDRAULTC .ANALYSIS. BE... REQUIRED.: FOR:. THE PROJECT? LS IT LIKELY THAT OTHER LOCAL, STATE OR FEDERAL PERMITS MAY .BE NEEDED FOR THE PROPOSED PROJECT"? HAS THE APPLICANT BEEN PROVIDED WITH THE ATTACHED LIST OF FEDERAL AND STATE NATURAL AGENCIES? WILL A SITE VISIT BE CONDUCTED? AGENCIES THAT MAY REQUIRE PERMITS Use this chart to help you determine which agency may be involved in your project. A checked box indicates that an cgency may be involved and should be contacted, but does not mean they definitely will be involved. 4.112 USER MANUAL: GUIDELINES & STANDARDS FOR LAND USE NEAR STREAMS ° -u L 0s O .� y LA CL CAI° C i In ° .2 GJ A Q! G❑ Q V ° E C° L L C fA A H d rn z I v 'n i2 o:Cy U a <UJ 63 Involve work on the bank of a river, stream, or lake? X X X X X X Involve excavation of the bank? X X X X Involve placement of piers? X X I X X X X stabilization or erosion control? X X X X X X Require me removal o riparian or other wetland _ vegetation? X X X X X X X Involve planting riparian or wetland vegetation? X X X X X X Affect native plants, wildlife, or fisheries? X X X X X Result in stormwater discharge into a creek or wetland? X X X X X X evert oro struct the natural flow or change the natural bed or bank of a creek or wetland? X X X X X X Involve repair, rehabilitation, or replacement of any structure or fill adjacent to a creek or wetland? X X X X X X Involve placement of bank protection or stabilization structures or materials (e.g., gabions, rip rap,' concrete slurry/sacks)? X X X X X Involve building any structure adjacent to a creek or wetland? X X X X X X Involve tism ang 71 d ite enhancement, attraction, or harvesting devices and activities? X X X X X 4.112 USER MANUAL: GUIDELINES & STANDARDS FOR LAND USE NEAR STREAMS DESIGN GUIDE -19 GUIDELINES AND STANDARDS l.V USER MANUAL: GUIDELINES & STANDARDS FOR LAND USE NEAR STREAMS 4.113 � V •N } _ dZ c 4S u� U3 oti a Q,c` uaX �ta.3 Z U H �Clm v a Use materials rom a streambed (including but not limited to boulders, rocks, gravel, sand, and wood debris)? X X X X X X X Require the disposal or deposition of debris, waste, or any materia! containing crumbled, flaked, or ground pavement with a possibility that such material could pass into a creek or wetland? X X X X X X K Involve the removal of any materials from, or add fill to, a creek or wetland? X X X X X X X X Involve grading or till near a creek or wetland? X X X X X X !nvolve a bridge or culvert? X X X X X X Involve utility pipe lines? X X X X Involve a septic leach field near a creek or wetland? X X X X Require a water well near a creek or wetland? X -X X X Involve work within historic o existing coastal wetlands? X X X X X Remove water from a creek for storage or direct use on non -riparian land? X X X X X X X X Require that hazardous materials be generated and/or stored on site? X X X X Take place in, adjacent to, in a building adjacent to or near a river that has been designated as "wild and scenic" under state or federal !ow? X X X X X USER MANUAL: GUIDELINES & STANDARDS FOR LAND USE NEAR STREAMS 4.113 DESIGN GUIDE 19 GUIDELINES AND STANDARD5 I.V �+ L .0 n ?,o � 's. a 3 ii d h Q. a H 07 a [� a C i H a� V e� g Q CI C L a0 U d o a o a a Oo o •a c CM >'a� Z u cnQ: CCrm u a <w M� Require water to be diverted from a river, stream, or lake for the project or activity? X X X X X X X Affect water quality by the deposition of silt, an increase in water temperature, a change in the pH level, or in some other way? X j X X X X X ccur m an area where endangered or rare plant species are thought or known to occur? X x X X X Occur in an area where endangered or threatened fish, bird, or animal species are thought or known to occur? X I X X X X X PERMITTING TOOLS 2l. CONSTRUCTION -RELATED g. Wash out facility for concrete, point, PERMIT CONDITIONS FOR drywall, etc. STREAMSIDE RESOURCE h. Location of portable toilets PROTECTION (Ratified by the Collaborative - _ 1. \+Vlt.�I IIL VIIV71^I GILIGV WVIM iY U1G4 on March. 24,2005) management controls (i.e., sediment traps, berms, silt fences, sand bags, INTRODUCTION dikes, geotextiles and mats, mulching, The following are standard measures seeding and plantings). needed to protect stream resources during I• Measures for managing hazardous construction. There may be other regulatory material on site, including fuel. programs or regulations that also address these issues. When approving permits k. As appropriate, stream protection and for development in streamside areas, the permit conditions for the project. local permitting agency will include these as conditions of approval for each permit granted. On the proposed projects Site Plan, or as an attachment to it, show specific measures/ improvements, including illustrations or diagrams, which address and include: a. Wet weather protection measures b. Erosion protection measures c. Methods and locations for cleaning tools and equipment d. Dust control measures e. Litter prevention. measures f. Debris collection and removal measures USER MANUAL: GUIDELINES & STANDARDS FOR LAND USE NEAR STREAMS 2.33