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11090085CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22755 SAN .IUAN RD I CONTRACTOR: WJB-CANYON LLC PERMIT NO: 11090085 OWNER'S NAME: WJB-CANYON LLC 2175 DE LA CRUZ BLVD DATE ISSUED: 12/05/2011 13 License Contractor PHONE: 4082349061 LICENSED CONTRACTOR'S DECLARATION Lie q I hereby affirm that 1 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. 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 3706 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 doe work for which this permit is issued. APPLICANT CFRTI FICATION 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 stale laws relating to building construction, mid hereby authorize representatives of this city to enter upon the above mentioned properly 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 OWNER-RUILDF.R DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Low 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(See.7044, Business & Professions Code). hereby affirm under penalty of perjury one orthe 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 Califomia. 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 CFRTI FI CATION 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 slate 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 liabililies.judgments, �ts, and expenses which may accrue against said City in consequence of the ming of this permit. Additionally, the applicant understands and will comply wnh all non•nya-m cc - i(tic a u iunicipal Code, Scutum 9.18. /11 SANTA CLARA, CA 95050 1 PHONE NO: BUILDING PERMIT INFO: BLDG r ELECT i— PLUMB r MECH r RESIDENTIAL {— COMMERCIAL r JOB DESCRIPTION: CONSTRUCT 2 STORY SFDWL STRUCTURE(4405SQFO. INCLUDES NEW DECK(470SQFT),AT7ACIIED GARAGE(487SQFT) VACANT LOT Sq, Ft Floor Arco: I Valuation: $500000 APN Number: 34217068.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by:-� - ._�-------_.. Date:f2..J ,—,�/ RE -ROOFS: All roots shall be inspected prior to any roofing material berg installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials fur inspection. Signature of Applicant:_ Date. ALL ROOF COVERINGS TO RE CLASS "A" OR BETfER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Ilealth & Safcly Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &Safety CQ& Sections 25505, 25533, and 25534. Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of wxk's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ,ARCi11TECT'S DECLARATION I understand my plans shnll he used as public records. Licensed CITY OF CUPERTINO BUILDING PERMIT r BUILDING ADDRESS: 22755 SAN JUAN RD CONTRACTOR: TBEH-T$-I Z Ah A— PERMIT NO: 11090085 OWNER'S NAME: WJB-CANYON LLC DATE ISSUED: 12/05/2011 OWNER'S PHONE; 4082349061 PHONE NO: si LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E] CONSTRUCT 2 STORY SFDWL STRUCTURE(4405SQFT), License Class V= Lic. �f INCLUDES NEW DECK(470SQFT),ATTACHED Contractor _. I AJ(JVi� (-(M�� Dale . .POl� ' 40a GARAGE(487SQFT) VACANT LOT ;fl I hereby affirm that I am licensed under the provisions pter 9 REV # I - ADD DECK BETWEEN DINING RM & LIVING RM AND CHANGE (commencing with Section 7000) of Division 3 of the Business & Professions DOOR TO WINDOW IN (E) BATHROOM - ISSUED 3118/14 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 Sq. Ft Floor Area: Valuation: $500000 performance of the work for which this permit is issued. 1 have and wiit 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: 34217068.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and slate 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 1$0 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 A FRO SPECTION. 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 s y: a e: r with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. R 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (See.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 flee following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(x) should I store or handle hazardous 1 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 Management District I performance of die work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25 05, 25y3, and 25534. Section 3700 of the Labor Code, for the performance of the work forwhich Ibis permit is issued, Owner or authorized agent:Dater ,t. 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, alter making this certificate ofexcmption, 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 (See. 3097, Civ C.) Lender's Name APPLICANT CERTIMCATiON Lender's Address I certify that 1 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 consequbnce of the 1 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 Y CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22755 SAN JUAN RD CONTRACTOR: WJB-CANYON LLC PERMIT NO: 11090085 OWNER'S NAME: WJB-CANYON LLC 2175 DELA CRUZ BLVD DATE ISSUED: 12/05/2011 OWNER'S PHONE: 4082349061 SANTA CLARA, CA 95050 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lie. # Contractor Date 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: 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 main lain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work forwhich 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 grantingof this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. S ignature Date Q OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following hvo 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (See.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 mariner 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. 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, theapp icant understands and will comply with all non-po' rce u a the u i unicipal Code, Section 9.18. MECH r RESIDENTIAL r COMMERCIAL r JOB DESCRIPTION: CONSTRUCT 2 STORY SFDWL STRUCMRE(4405SQFT), INCLUDES NEW DECK(470SQFf),ATTACHED GARAGE(487SQFT) VACANT LOT Sq. Ft Floor Area: I Valuation: $500000 APN Number: 34217068.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by a Date:r�—� f� 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. 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 Munagement District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &-Safety Cod Sections 25505, 25533, and 25534. Ow r EI nzc tgeu� 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 Add ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingacuppaino.org CUPERTINO 1 ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATIONftS RBVISIO \IDEF D PROJECT ADDRESS �] rj l jC1 ry i -3 `.3 OWNERNAME W AV-itL• ��1`�j� PHONE lJ�C) STREET ADDRESS MY, STATE, ZIP FAX V CONTACT NAME PHONE7�E-MAI 4(�Tci t STREET ADDRESS C[TY STATE, ZIP Cl OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT NTRACTOR NAME„AM LIC EN �iSJM{B'E LICENSE TYPE BUS. LIC # \ i C �l'3KS C ( OMPA YNAME N? E-MAILI FAX k. -r— 5A -v A A STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGiNBER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESK TION OF vrORK �� 7 EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DDETACH ❑ ATTACH 9 DWELLING UN:TS: IS A SECOND UNIT ❑ YES SEC No STORY []YES BEINGADDEG? ❑NO ADDITION? ❑NO PRE -APPLICATION ❑ YFS IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES 1-RECEIVBY: � -„ ' •,” r -`•_ TOTAL VALUATION: PLANNING APPL U ❑ NO PLANNING APPROVAL LEITER EICHLER HOME? E]NO By my signature below, I certify to each of the following: I am the property owner or authorize 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. 1 a Rhorize representatives of Cupertino to enter the above -identified property for inspection purposes. ( Signature of Applicant/Agent: I Date: [IJ A� l y i _ m _ SUPPLEMENTAL INFORMAT110N UIUD rLnN cilEcic TYr � $ovruvss sLiP= `sUIInI>\c New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building ovEli rIlE courlTER ; PLAn>iEvlEw ermit for new buildin p g•LAIVNIIVGI'LAN,RRVIEW^, Commercial Bldgs: Provide a completed Hazardous Materials Disclosure EI'97aNnARi) ? . ,: '" Li WoRcs'' form if any Hazardous Materials are being used as part of this project. ❑ ` ❑'FIRE LARGE. DEE �• Copy of Planning Approval Letter or Meeting with Planning prior to MAJOR " ❑ SANITARY SL'FVER submittal of Building Permit application. ;, � ; DISTRICT m , , , ; `, .,-. a❑;'ENVIRONMENTAL-HEALTII-, ;. BldgApp_201 1. doc revised 06/21/11 CITY OF CUPERTINO ��JJ1 FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees dice to other Departments (Le Planning, Public Works, Fire, Sanitary Sewer District, Seltool District. eta). These fees are based on the Dreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS Lee Resolution 11-053 Eff.' 711/13) ADDRESS: 22755 SAN JUAN RD DATE: 03/1812014 REVIEWED BY: MELISSA ,rr>c;lr. P3?:wit l=ee: APN: 342 17 068 BP#: 11090085 VALUATION: $0 =PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SPD or Duplex USE: Phlmb. Insp. Free: PENTAMATION 1GENRE PERMIT TYPE: i WORK REV # 1 -ADD DECK BETWEEN DINING RM & LIVING RM AND CHANGE DOOR TO WINDOW 1N SCOPE (E) BATHROOM NOTE: This estimate does not include fees dice to other Departments (Le Planning, Public Works, Fire, Sanitary Sewer District, Seltool District. eta). These fees are based on the Dreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS Lee Resolution 11-053 Eff.' 711/13) lferh, !'torr Check Plrrnrh. I'tcrr "'heckElev. Plan C'hed, ,rr>c;lr. P3?:wit l=ee: Phimb. Permil Fee: Flac, Perin it Fee: 011wr ,lfech. Insp. Other Plurtil Insp. 01her Eley. Insp, ,Medi. Insp. Fuc• Phlmb. Insp. Free: Ekc. Insp, Fee - NOTE: This estimate does not include fees dice to other Departments (Le Planning, Public Works, Fire, Sanitary Sewer District, Seltool District. eta). These fees are based on the Dreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS Lee Resolution 11-053 Eff.' 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 1 hours Plan Check, Hourly $139.00 ISTPLNCK Supp!. PC Fee: Q Reg, Q 0T 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? ® Yes G No $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0,00 Constrrtction Tax: T7_ r1.Lfl!2119i4f!'CIdiVL' Fr�L'' E) Work Without Permit? 0 Yes Q No $0.00 Advanced PlanninL Fee: $0.00 Select a Non -Residential Building or Structure A Trrn'el boctrrnentution Fees: Strong Motion Fee: $0.00 1 07 hrs Inspections $139.00 ISTINSP Inspection, Hourly Bld Stds Commission Fee: $0.00 SUBTOTALS: $0.00 $278.00 TOTAL FEE: $278.00 Revised: 01/1512014 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS; 22755 SAN JUAN RD CONTRACTOR- B'17-="g64W PERMIT NO: 11090085 'HETEM7tINED OWNER'S NAME: WJB-CANYON LLC AAA Cj)nrtrwG DATE ISSUED: 12/05/201 I OWNER'S PHONE: 4082349061 1 PHONE NO: _ LICENSED CONTRACTOR'S DECLARATION JOS DESCRIPTION: RESIDENTIAL COMMERCIAL, CONSTRUCT 2 STORY SFD WL STRUCTURE(4405SQFT);—` License Class_ Lic. # Q ( INCLUDES NEW DECK(470SQFT),ATTACHED �.•_ _ {� p�^L ,L Contractor l AN7-k(U A tN-( (QaL Date GARAGE(487SQFT) VACANT LOT t I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions1 Code and that my license is in fill 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 • Sq. Ft Floor Arca: Valuation: $500000 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: 34217068.00 Occupancy Type. - permit is issued. APPLICANT CERTIFICATION I certify that i have read this application and state that the above information is PERMIT EXPIRES . F WORK IS NOT STARTED 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 WITHIN 18 F PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS F M LOT 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 I granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: . with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: ignature Dated 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 Jam exempt from the Contractor's License Law for one of the following ttvo 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, r , wil I 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. 1 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) shout dA kore or handle hazardons I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should 1 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 Ail" 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 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 5i 33, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Q permit is issued. Owner or authorized agent: Date: �`f I certify that in the performance of the work for which this permit is issued, l 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, 1 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 1 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 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 19 ADDRESS: 20955 scb DATE: 0212012014 REVIEWED BY: Mendez -IS APN: BPH: ''VALUATION: 1$70,OOF PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY USE: Commercial Building I'larmb. 101sp. Fee: PENTAMATION PERMIT TYPE: SOL4R-COM WORK whole foods- install 4 evc stations located on side of parking lot 200 amps SCOPE NOTE: This estiniate does not include fees due to oilier Departutents (i. e. Planning, Public Works, Fire, Sa►ritary Server Districl, ScIlool District, etc.). These.fees are baser) on the prelinainary information available and are only an estimate. Contact the Dept for addn'I info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) rbfeah, !'lam Check Phunh. flan Check Elue. Plan Check Yell pernra reo Plamb. P4,1721ir Pee: l;lec Awrnrir Fee Onco, .lferh, Insp ofl,er Plumb Insf, Olher Eirc. Insp. E1__L_ A th. fasp. Fix.; I'larmb. 101sp. Fee: rlcc'. Insp. roe. NOTE: This estiniate does not include fees due to oilier Departutents (i. e. Planning, Public Works, Fire, Sa►ritary Server Districl, ScIlool District, etc.). These.fees are baser) on the prelinainary information available and are only an estimate. Contact the Dept for addn'I info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS Pian Check Fee: $0.00 = # $424.00 Alternative Energy System 1CHRGSTA EV Charging Station Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Supp). Insp. Fee:(! -)Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Const),netion Ttix: Adrninislrnfive Fee: Q 0 Work Without Permit? O Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 i Tlwvel Documentation !Fee's: Strong,Motion Fee: IBSEISMICo $14.70 Select an Administrative Item Bldg, Stds Commission Fee: 1BCBSC $3.00 SUBTOTALS: $17.70 $424.00 TOTAL FEE: $441.70 Revised: 0111512014 CONSTRUCTION PERMIT APPLICATION 4 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 850143255 C PERTINO (408) 777-3228 • FAX (408) 777-3333 • building Qcupertino.org NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION 1 DEFERREDORIGINAL PERMIT # PROJECT ADDRESS o f cC�ri/� APN 0 f ! V� 8 OWNER NAPHONE WME J� �D�j . Ee4k-1�21�`'tS Gi`@> Caccu STREET ADDREssl.it J 1 7C L� /. , �_% C71 -Y, STATE ZIP G FAY CONTACT NAME :i�/P G ( k iJ L [/`,� STREET ADDRESS T� r q C W CITY, SLATE ZIP FAx El OWNER IWIM-BUILDER �❑ OWNIItAGENT ❑ co?,rmCTOR 0COMIR4CIORAGmrr ❑ ARCHITECT ❑ ENGINEER Cl DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX . STREET ADDRESS CITY, STATE, ZIP PHONE ARCHiCECT/ENGINE.ERNAME AVw LICENSE NUMBER BUS. LIC 4 COMPANY NAME EMAIL FAX STREET ADDRESS CITY, STATE ZIP PHONE DESCRIPTION of WORK EXUnN! IISE PROPOSED�J.F Jc CONSTRTYPE 9STO usyE��-E7 occrrr�� s Fr. Q VALUATIONs (' EXISTQQ �f AREA G AREA �/ RL}• �- D"A NFCAAREA BATHROOM REMODELAREA KrrCHEN REMOOELAREA OTHER REMODEL AREA PORCHAI DECKAREA TOTALpECK/PORCHAR } GE DETACH �'ATTACH I �S ' HDWELLING UNITS: ISA SECOND UNIT []YES BEING ADI)ED7 O SECO tI STORY ADDCTION'! PRE -APPLICATION []YES IF YES. PROVIDE COPY OF PLANNINGAPPLO NO PLANNING APPROVAL LETTER ❑ IS THE BLDG AN DYES EICHLERSOME? O ILECEiVED BY � TOTAL VALUATION: f ly By my signature below, I certify to each of the following. I am the o owner or authorized agent to act an the prpperty owner's behalf. I bave read this application and the information I ha"read t ' u of Work and verify it is accurate. t agree to comply with all applicable local ordinances and state laws rela ' o buildin n c -t ' e re ves of CuperdrLo to enter the abo ntified property for inspection purposes. Signatof Applicant/Agent Date: SUPPLEMENTAL NFUR-MATMIR xhQUN D PLAN CRECKTYPE ROUTING SLIP R��. MMR ' E�->ru INGFLAi Raw _ New SFD or Muldfalnily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ 87LPRFS5 L -I PI ANRING PLAN REMW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. 9-v",Rn ❑ LARGE ❑ XVOR O'-ru—SLIC WOP-WS �j�x-HJCED>_rPT u SANITARY SE1VER DISTRICT ❑ EN-IMON IENTAL HEALTH BldgApp 2OlLdac revised 45121111 CITY OF CUPERTINO I'� I FEE ESTIMATOR -- BUILDING DIVISION -.'VjkADDRESS: 22755 san juan rd. DATE: 11/09/2011 REVIEWED BY: bob s. PC FEE ID APN: BP#; "VALUATION: 1$500,000 rPERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: 2nd Unit? • Yes No PENTAMATION 1 R3HILL PERMIT TYPE: WORK construct new 2 storV sfd. SCOPE 0,0 OCCUPANCY TYPE: TYPE OF CONSTPL FLR AREA S- PC FEES PC FEE ID BP FEES BP FEE ID R -3 (Hillside, Custom) II-B,III-B,IV,V-B 5,462 $5,322.05 1R3HPLNCK $4,225.10 IR3HINSP Permit Fee: $4,225.10 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Constr. Tax: F 1 # new units $582.00 dr!>tu�iti'!r'crli� e Fee: 0 Work Without Permit? O Yes 0 No $0.00 TOTALS: 5,462 $5,322.05 Tm,e/ Documentation T eev $4,225.10 StrongMotionFee: IBSEISMCR NOTE: This estimate does sot include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. ete-1 These fees are based os the nrelininary isformallou available and are an1v an estimate. Contact the Dent for adrhs'I info. FEE ITEMS Tee Resolxtion 11-053 Eff 7/1f11) Piech.. Kan Check Plum 1), Plan Chwck Ii7ec. !'lcrrr Ch'. -Ch r'yhtr:h. I'enrr;: lire: N71mb, Pel:wt flee: De4�_ Pernd: Fcu: ofherins!".Ll Orl;e1• Phu,rl; Lr,;,n_ OIh(er F_rc;:_ lrnn. iviech. Imp. b&.- IJ(t!!fr1 17 1p, 1""(,L,; L;ie(', Inv5 . j"(fe' NOTE: This estimate does sot include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. ete-1 These fees are based os the nrelininary isformallou available and are an1v an estimate. Contact the Dent for adrhs'I info. FEE ITEMS Tee Resolxtion 11-053 Eff 7/1f11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $5,322.05 Select a Mise Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $4,225.10 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Constr. Tax: F 1 # new units $582.00 dr!>tu�iti'!r'crli� e Fee: 0 Work Without Permit? O Yes 0 No $0.00 Advanced Plannjq Fee: PLLONGRNGR $710.06 Select a Non -Residential 0 Building or Structure O A Tm,e/ Documentation T eev StrongMotionFee: IBSEISMCR $50.00 Select an Administrative Item Bldg_Stds Commission Fee: 1BCBSC 20.00 SUBTOTA 10,909.21 $0.00 ,,__ TOTAL FEE: $10,909.21 Revised: 10/01/2011 e,_ % CITY OF CUPERTINO ro FEE ESTIMATOR - BUILDING DIVISION 19ADDRESS: TYPE OF CONSTR. DATE: 0911312011 REVIEWED BY: bobs. PC FEE ID 1 APN: —207, r/,5-37 SGi/7 " p#: BP FEE ID *VALUATION: 1$500,000 *PERMIT TYPE: Building Permit " PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex USE: 2nd Unit? Yes No PENTAMATION 1R3SFDW PERMIT TYPE: WORK construct new 2 story sfd includes new deck. SCOPE Suppl. Insp. Feed Reg. O OT OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 5,462 $3,089.75 1R3PLNCK $4,014.25 1R31NSP Permit Fee: $4,014.25 Suppl. Insp. Feed Reg. O OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Constr. Tax: 'A 1 new units $579.61 .d mini,titrative P'ee: G Work Without Permit? Q Yes Q No $0.00 Advanced PlanningPee: PLLONGRNGR TOTALS: 5,462 $3,089.75 $4,014.25 $50.00 NOTE: This estimate does not include fees due to other Depts (i. a Public Works, Sanitary Seiver District, School District, etc.). These fees are based on the nrelinunarv, information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS O'ce Resolution 11-053 Efl.' 71111 1) aech. Won Che Plumb. Plan C ieek Flee. Plan Chu,* Ytrel:h. }'r>.r; .;t } c:n,; f''tuntb. Permit Felt: tic. ;'ernrir Fee: uiller lleoh, hup.Ll I Other Plumb 71,ip, ofhw— r_lfve, hap, Lj Insp, r;fw. P"'umb. lol p. Pe": face. limp, Fee. NOTE: This estimate does not include fees due to other Depts (i. a Public Works, Sanitary Seiver District, School District, etc.). These fees are based on the nrelinunarv, information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS O'ce Resolution 11-053 Efl.' 71111 1) FEE QTY/FEE M1SC ITEMS Plan Check Fee: $3,089.75 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: (D Reg. O OT o hrs $0.00 PME Plan Check: $0.00 Permit Fee: $4,014.25 Suppl. Insp. Feed Reg. O OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Constr. Tax: 'A 1 new units $579.61 .d mini,titrative P'ee: G Work Without Permit? Q Yes Q No $0.00 Advanced PlanningPee: PLLONGRNGR $710.06 Select a Non -Residential G Building or Structure Q � 7; u7rc.�i Documentation Fees: Strom, Motion Fee: IBSEISMICR $50.00 Select an Administrative Item Bldg Stds Commission Fee: IBCMS: �, SUBTOT $8,463.67 $0.00 TOTAL FEE: 1 $8,463.67 Revised: 09/02/2011 CUPERTIN�jO�P Building Department J City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777.3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: '2-'Z1 517 37)k v uA-w rLo PERMIT # ti O C( b OWNER'S NAME: PHONE # GENERAL CONTRACTOR: WA %c& BUSINESS LICENSE # cS/` ADDRESS: CITY/ZIPCODE: 5 U *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 Date Please check applicable subcontractors and complete the following information: Owner / o actor Signature T;3 S sw v-r-yA W FZ4 n V Z Date 90 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical j'Z, Sr try Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating (!�L b G0-4� Insulation Landscaping .; . .L- Lathing Masonry Painting / Wallpaper •-7 Paving Plastering Plumbing �t Z2a Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / o actor Signature T;3 S sw v-r-yA W FZ4 n V Z Date 90 CUPERTINO PERMISSION TO COPY BUILDING PLANS AFFIDAVIT COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building@gupertino.org APN 342-17-068 BUILDING PERMIT#: 11090085 DATE OWNER NAME: SITE ADDRESS: 22755 San Juan Road REQUESTOR'S NAME: PHONE #. FAX #: DESCRIPTION OF PLANS REQUESTED ❑ FULL SET ❑ PARTIAL SET DESCRIPTION AND NUMBER OF PAGES: PURPOSE: I, the undersigned declare as follows: I. I have requested a copy of the above-described building plans, documents and/or reports. 2. That the copy of the plans shall be used ONLY for maintenance, operation, and use of the building. 3. That the drawings are instnunents of professional service and are incomplete without the interpretation of the cerci fed, licensed, or registered professional of record. 4. That subdivision (a) of Section 5536.25 of the California Business & Professions Code states that a licensed architect who signs plans, specifications, reports or documents shall not be responsible for damage caused by subsequent changes to, or use of, those plans, specifications, reports or documents where the subsequent changes or uses, including changes and uses made by state of local government agencies, are not authorized or approved by the licensed architect who originally signed the plans, specifications, reports or documents, provided that the architectural service rendered by the architect who signed the plans, specifications, reports or documents was not also a proximate cause of the damage. I have read the above provisions and attest that the above statements are true and agree to abide by the limitations stated therein. Y agree to pay a fee of $42 at the time of affidavit submittal for the service requested. I am aware that the actual reproduction of any plans, documents and/or reports will be done at an additional cost based on the size and number of the documents to be reproduced. As the person requesting the copies, I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Requestor's Name (Print) Requestor's Signature Date TO BE COMPLETED BY THE ARCEITECT/ENGINEER OF RECORD: The City of Cupertino has received a request for permission to duplicate plans or documents that were originally prepared by your office. Pursuant to Section 19851 of the Health & Safety Code, the Building Department prior to copying plans or documents prepared by a licensed, registered or certified professional, must first attempt to contact the preparer for permission to copy the plans or documents. Failure to respond to this letter within 30 days will be interpreted as consent for the duplication of the plans. ❑ I agree to give permison for 2th-re eren ns and/or documents to be copied. ■❑ I do not agree Barre Barnes 10-21-13 Licensed Professional(print) Professi pal's Signature Date CopvP1ansAffTdav11, 3-2013 " Nov.21.2011 08:41 AM 4088274252 PAGE. 4/ 18 2010 CALGREEN RESIDENTIAL CHECKLIST .- MANDATORY ITEMS fir 1'I COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPERTINO ALBERT SALVADOR, P.E., 0.13.0., BUILDING OFFICIAL 10300 TORRE AVENUE + CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 7T7-3333 - Luildii tino.nr PURPOSE; The 2010 CalGreen Code applies to all newly constructed hotels, motels, lodging houses, dwellings, dormitories, condominiums, shelters, congregate residences, employee housing, factory -built housing and other types of swellings with sleeping accommodations and new accessory,buildings associated with such uses. Existing site and landscaping improvements that are not otherwise disturbed are not subject to the requirements of CAI -Green. Project Name: W J B Canyon LLC Single family Home. Project Address: 22755 San Juan Road, Cupertino Project Description. New Single FamilyResidence Instructions - 1. The Owner or the Owner's agent shall employ a licensed professional experienced with the 2010 California Green Building Standards Codes to verify and assure that all required work described herein is properly planned and implemented in the project. 2. The licensed professional, In collaboration with the owner and the design professional shall initial Column 2 of this checklist, sign and date Section 1 - Design Verification at the end of this checklist and have the checklist printed on the approved plans for the project. 3, Prior to final inspection by the Building Department, the licensed professional shall complete Column 3 and sign and date Section 2 - Implementation Verification at the end of this checklist and submit the completed form to the Building Inspector. Column 2 Column 3 MANDATORY FEATURE OR MEASURE Project Verification Re uirements A PLANNING / I DESIGN Planning and Design -Site Preservation 4.104.1 A site plan and Inventory of the site is developed and used to minimize site disturbance In order preserve desirable existing natural resources and minimize future adverse effects on the proposed structure. Planning and Dosign - Site Development 4.106.2 A plan is developed and implemented to manage storm water drainage during construction. 4.106.3 The site shall be planned and developed to keep surface water away from buildings. Construction plans shall indicate how site grading or a drainage ® �-1 13 system will manage all surface water flows. Pap 1 of 5 Cul�ireen ZU!U-dor revirrd O8/Z7/11 Nov.21.2011 08:41 AM General 4.201,1 Low-rise.residential buildings shall meet of exceed the minimum standard design required by the California Energy Standards. Indoor Water Use 4088274252 PAGE. 5/ 18 I!I 4,303.1 Indoor water use shall be reduced by at least 20 percent using one,of 4.406.2 Where a local jurisdiofion does not have a construction and demolition waste management ordinance, a Construction waste management shall ® the follow methods. plan 'be submitted for approval to the enforcing agency, ® ❑ Water saving fixtures or flow restrictors shall be used per Table 4.303.2. Q ❑ A20 percent reduction in baseline water use shall be demonstrated per As of 7101/2011 ; TAble 4.303.1. 4,303.2 When using the calculation method specified in Section 4.303.1, multiple showerheads shall not exceed maximum flow rates. Q As of 7/01/2011 4.303,3 Plumbing fixtures (water closets and urinals) and fittings (faucets and showerheads) shall comply with specified performance requirements. As of 7101/2011 Outdoor Water Use 4.304.1 Automatic irrigation systems installed at the time, of final Inspection ®' ❑ shell be weather -based. Enhanced, Durability and Reduced Maintenance 4.406.11 Joints and openings. Annular spaces around pipes, electric cables, conduits, or other openings in plates at exterior wails shall be protected against the passage of rodents by Closing such openings with cement mortar, concrete masonry or similar method acceptable to the enforcing agency. Construction Waste Reduction, Disposal and Recycling 4.406.2 Where a local jurisdiofion does not have a construction and demolition waste management ordinance, a Construction waste management shall ® �] plan 'be submitted for approval to the enforcing agency, Building Maintenance and Operation 4.410.1 An operation and maintenance manual shall be provided to the building wopent or owner. rase 2 of 5 GalUreerr ?U1 U doc a eplmd 08127111 Q— - 4 Nov.21.2011 08:42 AM Project Name; Project Address: 4088274252 PAGE. 8/ 1.8 . CALGREEN SIGNATURE DECLARATIONS _W J B Canyon LLC Single Family Home 22755 San Juan Road, Cupertino Project Description: New Single Family Residence SECTION 1 -- DESIGN VERIFICATION Complete all lines of Section 1 — "Design Verification" and submit the completed checklist (Columns 1 and 2) with the plans and building permit application to the Building Department. The owner and design profeasionai responsible for compliance with CalGreen Standards have revised the plans and certify that the items checked ab aaaLba Incorporated into the project plans and will be implemented into the project in accordance wit e r en�__ Fti 8,2040 California Green Building Standards Code as adopted bythertgGf Cu 10/14/2011 owner's Signature Date WJ B Canyon LLC, Barre Barnes manager Owner's Name {Please Print) Deslgn Professional's Signature nate Builders Energy Services Inc. Dign r f io nal's Name (Please Print)t) 10/14/2011 SlgnatUre of License pro clonal responsible for CalGreen compllanoe Data Devon P Kelly Certification # 2008-297 _ Name of Uconae Professlonol responsible for CalGreen compliance (Please Print) Phone devon 9builders-energy. net Email Address for License Profassional responsible for CalGreen compliance SECTION 2 — IMPLEMENTATION VERIFICATION Complete, sign and submit the competed checklist, including column 3, together with all original aignalures on Section 2 to the Building Department prior to Building Department final inspection. I have inspected the work and have received sufficlent documentation to verify and certify that the project identified above was constructed in accordance with this Green puiiding Checklist and in accordance with the requirements of the 2010 California Green Building Standards Code as adopted by the City of Cupertino. Signature of License Professlonal responsible for CalGreen compllanoe Date Barre Barnes _ Name of License Professional responsible for Ca[Groon compliance (Please Print) Phone barrebarnos@mac.aom Email Address for Lloenso Professional responsible for Ga[Green compliance Yalta 5 OF CoUrreen 2010.etar revismi09/27/11