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12100155Cr. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 888 CANDLEWOOD DR CONTRACTOR: CHIEN-PING LU & PERMIT NO: 12100155 CHARLENE LEE OWNER'S NAME: CHIEN-PING LU & CHARLENE LEE 888 CANDLEWOOD DR DATE ISSUED: 03/04/2013 OWNER'S PHONE: 4088967209 CUPERTINO, CA 95014 I. PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lic. # CONSTRUCT A 182 SQ FT BEDROOM ADDITION; A 181 SQ FT FRONT ENTRY ADDITION; A 25 SQ FT BAY WINDOW; 8 Contractor Date SQ FT COVERED PORCH; 763 SQ FT OF REMODEL I hereby affirm that I am licensed under the provisions of Chapter 9 LIVING, (commencing with Section 7000) of Division 3 of the Business & Professions REV # 3 - REPLACE (E) 100 AMP PANEL, LIKE FOR LIKE, SAME Code and that my license is in full force and effect. LOCATION ISSUED 10/21/2013 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: $40000 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: 36919025.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FRO 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 % lU 11-3 granting of this permit. Additionally, the applicant understands and will comply Y Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. I RE -ROOFS: Signature Date 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. OWNER -BUILDER DECLARATION Signature of Applicant: Date: ereby a1Trm that 1 am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE nstruct 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. [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 Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 2550, 25533, and 25534. tn Z ��� Section 3700 of the Labor Code, for the performance of the work for which this (— Owner or authorized agent: Date: permit is issued. _. 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. 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, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence 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 regula ns per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date V M CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 888 CANDLEWOOD DR CONTRACTOR: CHIEN-PING LU & PERMIT NO: 12100155 CHARLENE LEE OWNER'S NAME: CHIEN-PING LU & CHARLENE LEE 888 CANDLEWOOD DR DATE ISSUED: 03/04/2013 OWNER'S PHONE: 4088967209 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL IJ COMMERCIAL License Class Lic. # CONSTRUCT A 182 SQ FT BEDROOM ADDITION; A 181 SQ FT FRON TRY ADDITION; A 25 SQ FT BAY WINDOW; 8 Contractor Date SQ FT COVE ED PORCH; 763 SQ FT OF REMODEL 1 hereby affirm that I am licensed under the oFLV#WN (commencing with Section 7000) of Division 3 of the Business & Pf�E k, Code and that my license is in full force and effect. YN #2= INSTALL (2) SKYLIGHTS-ISSD OTC 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: $40000 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: 36919025.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating hereby WITHIN 80 DAYS OF PERMIT ISSUANCE OR to building construction, and authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DA F LAST 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 Q 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: Signature Date All roofs shall be inspected prior to any rooting 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 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) owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE PI, struct 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) 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 Management District 1 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by , and 25534. the Health & Safety Code, Sections 505, 25, Section 3700 of the Labor Code, for the performance of the work for which this Owner authorized agent: Date: permit is issued. or I rtify that in the performance of the work for which this permit is issued, 1 shall @employ any person in any manner so as to become subject to the Worker's ompensation laws of Califomia. If, after making this certificate of exemption, I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non-prce regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. 0 ��O(�gT, Signature Date I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 888 CANDLEWOOD DR CONTRACTOR: CHIEN-PING LU & PERMIT NO: 12100155 CHARLENE LEE OWNER'S NAME: CHIEN-PING LU & CHARLENE LEE 888 CANDLEWOOD DR DATE ISSUED: 03/04/2013 OWNER'S PHONE: 4088967209 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL IJ COMMERCIAL 11 CONSTRUCT A 182 SQ FT BEDROOM ADDITION; A 181 SQ License Class Lic. 4 FT FRONT ENTRY ADDITION; A 25 SQ FT BAY WINDOW; 8 SQ FT COVERED PORCH; 763 SQ FT OF REMODEL Contractor Date LIVING, I hereby affirm that I aro licensed under the provisions of Chapter 9 REV # 1 - ADD CALIFORNIA ROOF AND OPEN TRELLIS (commencing with Section 7000) of Division 3 of the Business & Professions PATIO AT FAMILY ROOM, FLIP KITCHEN LOCATION, Code and that my license is in full force and effect. EXTEND FRONT COVERED PORCH, AND RAISE CEILING I hereby affirm under penalty of perjury one of the following two declarations: OF MAIN LIVING ROOM - ISSUED 5/23/2013 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: $40000 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: 36919025.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS ERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS 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 23 granting of this permit: Additionally, the applicant understands and will comply I by Date: 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. 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain 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 the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 255 , 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: 7 Date:'' �J 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, 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 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 re ations per the Cupertino Municipal Code, Section Licensed Professional 9.18. f Signature Date MA CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 888 CANDLEWOOD DR CONTRACTOR: CHIEN-PING LU & PERMIT NO: 12100155 CHARLENE LEE OWNER'S NAME: CHIEN-PING LU & CHARLENE LEE 888 CANDLEWOOD DR DATE ISSUED: 03/04/2013 OWNER'S PHONE: 4088967209 4 -OS — CUPERTINO, CA 95014 PHONE NO: 1' 0,S—SS 16 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL T� License Class Lic. a CONSTRUCT A 182 SQ FT BEDROOM ADDITION; A 181 SQ FT FRONT ENTRY ADDITION; A 25 SQ FT BAY WINDOW; 8 Contractor Date SQ FT COVERED PORCH; 763 SQ FT OF REMODEL I hereby affirm that I am licensed under the provisions of Chapter 9 LIVING, (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: 1 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: $40000 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 APN Number: 36919025.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 880 DAYS FRO LLED 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 - Issue Date: granting of this permit. Additionally, the applicant understands and will comply with allnon -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. If a roof is installed without first obtaining an inspection, 1 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). 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) 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 Management District I performance of the work for which this permit is issued. will maintain compliance with the Cuperti" Municipal Code, Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 2550 5533, nd 25534. Section 3700 of the Labor Code, for the performance of the work for which this ¢ � Da permit is issued. Owner or authorized agent: 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. ft; after making this certificate of exemption, 1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address - I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point sour a reg bions per the Cupertino Municipal Code, Section Licensed Professional 9.18. F /Date �` 1't' Signature r� CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(akupertino.orq 4kz, ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION./TI REVISION ( DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS )c � 771 APN N OWNER NAME PHONE `t_4 S- L T� `f" (� E-MAIL n - STREET ADDRESS , �y AS jjj CITY, STATE, ZIP / t %� /j- l� 111 j C FAX 1 CONTACT NAME PHONE` �1_ , / �j b E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX AOWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC H COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE int DESCRIPTION OF WORK I / n V � � � � � V �i 1 i (ltL•. ""C EXISTING USE PROPOSED USE CONSTR. TYPE N STORIES I USE TYPE OCC. SQ.FT. VAL-AT10N(S EXISTG NEW FLOORDEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREADECK AREA TOTAL DECK/PORCH AREA GARAGE AREA. DETACH ❑ ATTACH k DWELLING UNITS: IS A SECOND UNIT (DYES SECOND STORY []YES BEING ADDED? El NO ADDITION? ❑NO PRE -APPLICATION [:]YES IF YES. PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEi6i TOTAL L VALUATION: PLANNING APPL N ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO I \4 By my signature below, I certify to each of the following: I am the property owner or autho z agent 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 Wor and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buAngc struction. I uthorize representatives of Cupertino to enter the ve-1 entified property for inspection purposes. � Signature Applicant/Agent: '' Date: of Iz SUPPLEMENTAtINFORMATION REQUIRED PLANCHECKTYPE ROUTING SLIP 16 OVER-THE-COUNTER ❑ BUILDING 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 ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS 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 to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVH2ON1}ENT'AL HEALTH BldgApp_201 Ldoc revised 06/21/11 rs CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUI'ERTiN+U (408) 777-3228 • FAX (408) 777-3333 • building aacupertino.org .. n NEW CONSTRUCTION n ADDITION I � ALTERATION / TI •� REVISION / DEFERRED ORIGINAL PERMIT to PROJECT ADDRESS �j �pn C w a Q APN N 1 < < ��� � ;:2) r � / ��I l�/(� OWNER NAME PHONE MAIL STREET ADDRESS/'G" ] �), CITY, STATE, ZIP C�J ( Ca �� ` IE CONTACT NAME PHONE /FAX -MAIL C STREET ADDRESS , l� CITE, STATE, ZIP FAX ( J ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE R LICENSE T E BUS. LIC N O COMPANY NAME E- L� FAX STREET ADDRESS �V / p� CITY, STATE, ZIP rL/ PHONE, AF CHITECT/ENGIN£ NAMEU� LICENSE NUMBER 9US. COMPANY NAME E-MAIL V �FFAJ STR T DIM // . CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EX_tSTRJG USE PROPOSE USE ONSTR. _ S E N RIE U T E OCC. SQ.FT. VALUATION ($) AREA AREE)GSTGwA LOO DSA T A V VIP-) P BATHROOM KITCHEN 0 REMODEL AREA REMODEL AREA RE ODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH ARE GARAGE AREA DETACH / / M TrACH N DWELLING UNITS: IS A SECOND UNIT D SECONDSTORYI ❑YES BEING ADDED? ❑NO ADDITION? ❑NO 5LE-5PLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLD AN ❑ YES RECEIVED -BY: TOT VALUATION: PLANNING APPL k ❑ NO PLANNING APPROVAL LETTER EICHLER H ME? ❑ NO*'+_` n By my signature below, I certify to each of the following: I am the property o�authorizedto act on the property owners beha9f. Ihavereadibis application and the information I have provided is correct. I have read the Desfy it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representer the above -id tified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION RfQUIRED PLAN CHECK TYPE ROUTING SLIP _ New SPD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER BUILDING PLAN REVIEW 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 ❑ PU13LIC WORKS 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 to ❑ SEWER DISTRICT submittal of Building Permit application. MAJOR SANITARY ❑ ENVIRONMENTAL HEALTH BldgApp_2011. doe revised 06/21/11 C-UPERTINO I F-1 1 I NFW CON'TP11CTION CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building aacugertino.orcl ADf)TTTCIN F7 AITFRATICIN/TI 1. WIN /r)PFPRRFTI ORVITNAI PFRMITif PROJECT ADDRESSQ�, a Ca (\ r\ APN # C I��1 OWNER NAME r— I _ _ ��I l PHONE lj�— yQ E-MAIL �li f �IC471 ��� j`yr"`� n) STREET ADDRESS ��r �� '/ CITY. STATE, ZIP r�jj(/ FAX Vj (A 0 CONTACT NAME /� �rl D r _ _ ( IN IX Las - PHONE" . t• f t -7>07 E-MAIL STREET ADDRESS I 1�� CIT , STATE, ZIP Fy OWNER OWNER -BUILDER El OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME e C� f1 Ylk ctrl' LICENSE NUMBERLICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS / / CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME 10ENSE NUMBER s BUS. LIC # COMPANY NAME � � � n � E-MAIL � FAX _/ a i /Y�/I/ ` /� STREET ADDRESS j / `�C�•K�� CITY, STATE, ZIP_5;9- CV94 PHONE (� l% I !J DESCRIPTION OF WORK R�C� o\ J A t�t �/ F HCJ wekdd Icf 7l k`1 iu- �� Ce; _, f l� i E_11JfvCJl(C,0 1 Lo EXISTING E % Z lD_ PRO ED USE CONS . TYPE # ST S I USE TYPE OCC. SQ.FT. VALUATION ($) EXIST G NEW FLOOR DEMO TOTAL f7 AREA t y,6 AREA AREA NET AREA BATHROOM REMODEL AREA KITCHEN OTHER REMODEL AREA ` 1 X f �- REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: EIDETACH []ATTACH # WELLING UNITS: ISA SECONDUNVT ❑YES SECONDSTORY []YES BEING ADDED? []NO AUDITION? []NO PRE -APPLICATION ❑YES IF YES, PROTIDE COPY OF IS THE BLDG AN ❑YES RECEIVED Y:TOTALVALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EIi;HLER HOME? ❑ NO _ By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin co t ction. I autho ze representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: �TGY v\ SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP 0 OVER-THE-COUNTER ❑ BUILDING 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 ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS 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 to ❑ ❑ submittal of Building Permit application. MAJOR SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH y I� B1dgApp 201 Ldoc revised 06/21/11 r F 315- M Is CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building cDcupertino.org ❑ PLUMBING ❑ MEQ-IANICAL []ELECTRICAL ❑ MISCELLANEOUS MEP MISIC # 17,1 00155 PROJECT ADDRESS vl G i fiLRi� `�Gl APN 0 OWNERNAME PHONE (`'„f �Jf �Z E-MAIL C: STREET ADDRESS /� GI (J17 ` ... lv" CITY, STATE,Z�'1-P� f ^ c- X'� FAX _ CON'T'ACT NAME C J V/v PHONE E-MAIL 1 O VlolwlG •I, STREET ADDRESS CITY, S TE, ZIP % / IAGENT FAX 6WNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ cor, I'OR ❑CONrRACTOR ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC N COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAMILY BUILDING: ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN FLOOD ZONE ❑ YES ❑ NO IS THE BLDG AN ❑ YES EICHLER HOME? ❑ NO DESCRIPTION OF WORK /C���//�� V' C> e L`• TOTAL VALUATION: RECEIVED BY: 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 conmc i3n. I authorize reprXsentatrves of Cupertino to enter the abov/e�dntifiprope fort inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY ❑ OVER-THE-COUNTER pwp Er+ ❑ EXPRESS J W 5 ❑ STANDARD U a ' 4 - ❑ LARGE ❑ MAJOR MEPMiscApp_201 1. doc revised 06/21/11 ffi CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a cupertino.org NF -N CONSTRUCTION ADDITION ❑ ALTERATION / TI .SSI_ ,P,$V1$IQN / DEFERRED ORIGINAL PERMIT # l ` L V 0 1 15—s PROJECT ADDRESS s: ` jQ _ 9 _Q �r �J\ L APN # I t 1 G 369 1� % OWNER NAME �� / PHONE�/- s &MAIL P lJ2ti_ '� f 1L i STREET ADDRESS`^ `^ ni tS 'l Iy' CITY, STATE, ZIP FAX 11 CONTACT NAME , y� PHONE , _ '� ` � �;(� EMAIL I i J ;L ; U • 1lu�rv�c, )ti f e ,tit �, ( STREET ADDRESS CITY, STATE, ZIP U �l FAX l' OWNER ❑ OWNER-B=ER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME' j `�rd LICENSE NUMBER LICENSE TYPE BUS. LIC # i COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME '7 LICENSE NUMBER BUS. LIC # COMPANY NAME ! E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK V L /�s��v Qom, f91' -G }'1Gr��� I/wry Ccs L��►'G�// —FF EXISTING USE PROPOSED USE CONSTR. TYPE S7 USE TYPE OCC. SQ. -FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA Z BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREATOTAL DECK/PORCH AREA GARAGE AREA: LJ DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT E] YES SECOND STORY E] YES BEWGADDED? ❑NO ADDITION? ❑NO PRE -APPLICATION [:]YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES TOTAL VALUATION: PL.ANNIWG APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? []NO By my signature below, I certify to each of the following: i am the property owner or au o' izedo a n the operty owner's behalf. I have read this application and the information I have provided is coact. 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 buildin cons tion. I authorize resentatives of Cupertino to enter the above dentified f r inspection purposes. rperty 7 S ignature of Applicant/Ager i Date: t �. SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUILDING 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 ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS _ 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 to ❑ NIAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doe revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION OCCUPANCY TYPE: ADDRESS: 888 Candlewood Dr DATE: 10/22/2012 REVIEWED BY: Sean PC FEE ID APN: BP#: 'VALUATION: 1$40,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY USE: SFD or Duplex 2nd Unit? - Yes •) No OTC? C) Yes ©No PENTAMATION PERMIT TYPE: 1 R3SFDADD WORK Construct a 368 sq ft one story addition. SCOPE 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 368 $1,512.00 IADDPLCK $1,230.00 IADDINSP Elec. Insp, 1,ee: PME Plan Check: $0.00 Permit Fee: $1,230.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: TOTALS: 368 $1,512.00 $1,230.00 MECH, HOURLY © Yes 0 No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY C) Yes Q No MISC ITEMS Plan Check Fee: Nfech. Pcerrnit Fee: Plumb. Permit Fee: Elec. Peonir ! ; Other Afech. Imp Ocher Plumb Insp. Other Elea. Insp. 7- Alech. Insp, Fee: Plumb. hrsp. Fee: Elec. Insp, 1,ee: 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 nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eft' 711/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,512.00 Select a Misc 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: $1,230.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Te -m Administrative Fee: Q Work Without Permit? Yes No $0.00 Advanced Plan.nin.� Fee: IPGGONGR $47.84 Select a Non -Residential Building or Structure Q Trcme! Documentation Fees: Strong Motion Fee: IBSEISMICR $4.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: 1 $2,795.84 $0.00 TOTAL FEE: $2,795.84 Revised: 10/01/2012 I CITY OF CUPERTINO R FEE ESTIMATOR - BUILDING DIVISION &ZA ADDRESS: 888 Candlewood Drive DATE: 01/08/2013 REVIEWED BY: Sean MN APN: BP#: 12100155 S ''VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY USE: SFD or Duplex 2nd Unit? Yes •' No OTC? 0 Yes No PENTAMATION PERMIT TYPE: 1 R3SFDADD WORK CONSTRUCT A 182 SQ FT BEDROOM ADDITION; A 181 SQ FT FRONT ENTRY ADDITION; A 25 SCOPE SQ FT BAY WINDOW; 8 SQ FT COVERED PORCH; 763 SQ FT OF REMODEL LIVING, DINING, p OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA (s.L) PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,111-B,IV,V-B 397 $1,512.00 IADDPLCK $1,230.00 IADDINSP lush-, i c" $0.00 1 # $467.00 Window / Sliding Glass Door I WINNEWNST I New (Non -Structural) Permit Fee: $1,230.00 Suppl. Insp. Fee -0 Reg. ! OTO Q hrs $0.00 0 # Skylight $400.00 ISKYL<IOSF <= 10 s.f. PME Unit Fee: $0.00 PME Permit Fee: $0.00 ('onsrruction .Tax: TOTALS: 397 $1,512.00 $1,230.00 MECH, HOURLY () Yes 0 No PLUMB, HOURLY Q Yes ) No ELEC, HOURLY Q Yes Q No MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No i:8: _ -' . I'e'YflJ71 l'i'e': `sl('rr. hftY1?I71 I`i'C: Suppl. PC Fee: Reg. OT LiV__ &c: $0.00 lush-, i c" 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 preliminary information available and are only an estimate. Contact the Dept/or addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 7� FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $1,512.00 F763 s.f. $534.00 Remodel, Other IREMRESOTH Suppl. PC Fee: Reg. OT 0.0 hrs $0.00 PME Plan Check: $0.00 1 # $467.00 Window / Sliding Glass Door I WINNEWNST I New (Non -Structural) Permit Fee: $1,230.00 Suppl. Insp. Fee -0 Reg. ! OTO Q hrs $0.00 0 # Skylight $400.00 ISKYL<IOSF <= 10 s.f. PME Unit Fee: $0.00 PME Permit Fee: $0.00 ('onsrruction .Tax: G Work Without Permit? Yes No $0.00 Advanced Planning Fee: IPLLONGR $51.61 ® hours $532.00 Plan Check, Hourly ISTPLNCK G 0i .lravel.Documentalion T'ee.'s: Strom,Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: $2,793.61 $1,933.00 TOTAL FEE: $4,726.61 Revised: 10/01/2012 CITY OF CUPERTINO r. "M7.5 , I FEE ESTIMATOR -BUILDING DIVISION ig ADDRESS: 888 candlewood dr DATE: REVIEWED BY: Mendez r'lleeiz. 1'rrrtnli Icrs: APN: BP#: 12100155 *VALUATION: 1$3,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or DuplexPENTAMATION USE: 1'fwnb, Insr. Fee: 1 GENRES PERMIT TYPE: WORK new skylights SCOPE �installo NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. These ees are based on the prelimininy information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution II -053 E . 7/I/I3) FEE QTY/FEE MISC ITEMS r'lleeiz. 1'rrrtnli Icrs: I'Gr. r,l, f'ti-rnft /-rrr: .. -.. .. flue t, He'll, In P.=7-- Otho -r Plumb Insp. Window / Sliding Glass Door wINREP Replacement Rlech, fus/r. t<Gc: 1'fwnb, Insr. Fee: l=ee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.. These ees are based on the prelimininy information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution II -053 E . 7/I/I3) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 # $418.0071 Window / Sliding Glass Door wINREP Replacement Suppl. PC Fee: (D Reg. ® OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 6.,)nsfruc:tion Tax: Adaziinistralh -e Fee, 01 G Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 Trca�!el i)r�c�rtrrlF�ntaaicltt Fees: Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $418.00 TOTAL FEE: $419.50 Revised: 10/01/2013 CITY OF CUPERTINO F -M -N, FEE ESTIMATOR - BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 888 CANDLEWOOD DR DATE: 10/21/2013 REVIEWED BY: MELISSA UNITS APN: BP#: "VALUATION: Iso *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: Amps PENTAMATION 1 REAP2 PERMIT TYPE: WORK REV # 3 REPLACE E 100 AMP ELECTRICAL PANEL SAME LOCATION SCOPE Suppl. Insp I APPLIANCE / EQUIP TYPE FEE ID QTY/FEE QTY UNITS BP FEES Elec. Permit Fee: IEPERMIT Services 1 ERT<200 Other Elec. Insp. 0.0 rs $47.00 100 Amps $47 Pertr, Suppl. Insp I PME Unit Fee: $47.00 PME Permit Fee: $47.00 Conswuction Tax: T7 - Administrative Fee: ]ADMIN 4.00 Work Without Permit? Yes C) No $0.00 TOTALS: t Travel Documentation Fee: ITRA VDOC $47.00 Strong Motion Fee: 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 Dreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/U132 FEE QTY/FEE Elec. Plan Check 0.0 1 hrs $0.00 Xlech. Permit Fee: Plumh. Permi; :. : Elec. Permit Fee: IEPERMIT blech. In.cp.07- Other Plumb Insp, Other Elec. Insp. 0.0 rs $47.00 He& Insp. Fee: Plumb. fuse. Fee: -" asp. fee: 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 Dreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/U132 FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl, P(' I,ee PME Plan Check: $0.00 Pertr, Suppl. Insp I PME Unit Fee: $47.00 PME Permit Fee: $47.00 Conswuction Tax: T7 - Administrative Fee: ]ADMIN 4.00 Work Without Permit? Yes C) No $0.00 Ar voneecl Plunnin�; Fees: t Travel Documentation Fee: ITRA VDOC $ .00 Strong Motion Fee: $0.00 Select an Administrative Item Lf sL Bldg Stds Commission Fee;_ $0.00 SUBTOTALS: $185.00 $0.00 TOTALFEE: H5OO Revised: 10/01/2013 CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • bulldlnQ(C77 WDerilno.orq Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS' E-5 APN BP# 1pt5'� V 5,= OWNER NAME ( OWNER ADDRESS n jj C� Vr 61 2a4l, llL) '/3U �T'i DESCRIPTION OF WORK: `t b4` - 2-1b Y6 We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. (_t.&,2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. CDQ3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. l understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. C4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. C-. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. UVjj6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject m_oo serious financial risk. &117. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. L_R�8, I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. O+a7ei-BuilderFor77t 2010.doc revisedO4114110 9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal evenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. LX10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. �(�11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide b(y` all applicable laws and requirements that govern Owner -Builders as well as employers. 01 .l agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any.financial loss you may sustain as a result of a complaint. Your -only remedy against unlicensed Contractors may be in civil court.. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable o the city may be required to be presented when the permit is issued to verify the propertv owner's signature.,.--\ I I I Property Owner's Signature: _/ s' V \-1,_ ( 0-0 Date://�, `t, J 9 ------------------------------------------------------------------------------------------------------------------------- ----------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHOPUZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revise -d'04114110 Building Department City Of Cupertino 10300 Torre Avenue 2 Cupertino, CA 95014-3255 C U P S RTI N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS:r ' w % `' PERMIT # 2-10 0 1 S,�' OWNER'S NAME: C e neC- PHONE # GENERAL CONTRACTOR: _ BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: 0 *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 /Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE 4 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 Owner /Contractor Signature Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-7/77-3228 C U P E RT I N O_ Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: V � ` t ll'e4 SUBCONTRACTOR OWNER'S NAME: '` f -� �_ ;�Y Ie� � L...- L.� ` ` '�' t PHONE # � � � 6 GENERAL CONTRACTOR:-' ,-� ., r--- BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: *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 / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum /Wood Glass / Glazing o�oZoZC� Heating 3 4///— f SInsulation Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date WATER-CONSERVING PLUMBING FIXTURES L 'I L OWNER CERTIFICATE OF COMPLIANCE 5aq p ,jSliz f COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION CUPE,RTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 •FAX (408) 777-3333 • building(a) upertino.ora Owner Name 1.�--h�PI'qq-Permit No. 4W )6LI M5S I � cAddress Y r� ,K o PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEENT,�IGNE AND RETURNED TO THE BUILDING DIVISION Please refer to the attached California Civil Code Sections 1101.1 — 1101.8 which are part of this Certification form. 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: I Date: /� q )p No Go to Question 2. 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its plumbing, installation of water-conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Sign below and skip the rest of the form. Owner' Signature: zzc Date:�XNo Goto uestion3. ay w 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature:Date: Le - 4. No Go to Question 4. Q Is your real property built and available for use or occupancy on or before January 1, 1994? CJ ❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 110 1. 1 through 1101.8 do not apply. Sign below and skip the rest of the fon-n. �[ Owner' Signature: Date: 1_` )-I I >0 /� (ZS1 Yes My real property is built an available for use or occupancy on or before January 1, 1994. 1 Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached. My property is a single family residential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non-compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or irnprovements). ❑ My property is a multifamily residential real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or i nprovements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water - conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). ❑ My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or improvements shall require non- compliant plumbing fixtures to be replaced with water -conserving plumbing fixtures. SB407 2015.doc revised 02/04/15 1 Ornor before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). I/We, the owner(s) of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the water-conservini? plUAbA fixtures Qomply with the requirements as indicated in the. table below. Owner's (or OwnerAgont's) Signature: � "-L�1,L�a= Date:I`1C.¢-, 1y CoA Upon completing and signing this Certificate, please return it to the Building Division in order to final your 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB407 2015. doe revised 02/04/15 Non -Compliant Water -Conserving Plumbing Fixture Plumbing Fixture (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usage/Flow Rate Fixture Type Water Usage 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 /Flow Rate 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 Single -Family Multi -Family Commercial Residential Residential ' Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets: 1.28gallons/flush effective flush volume (the composite, average flush volume of two reduced flushes and one full flush Urinals Exceed 1.0 0.5 gallons/flush Gallons/flush Showerheads Exceed 2.5 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of gallons per minute U.S. EPA WaterSense Specification for Showerheads (A hand-held shower is considered a showerhead.) For multiple showerheads serving one shower, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. Faucets - Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 Lavatory per minute minute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets 0.8 gallons per minute @ per minute @ 60 psi; 20 psi minimum 0.8 gallons per minute @ 20 psi In common and public use areas: 0.5 gallons per minute @ 60 psi 1.8 gallons per minute t"@ 60 psi Faucets - Exceed 2.2 gallons 1.8 gallons per minute @ 1.8 gallons per minute 1.8 gallons per minute @ 60 Kitchen per minute 60 psi @ 60 psi psi Faucets May temporarily increase May temporarily up to 2.2 gallons per increase up to 2.2 minute @ 60 psi, and must gallons per minute @ default to maximum 60 psi, and must 1.8 gallons per minute @ default to maximum 60 psi 1.8 gallons per minute Where faucets meeting @ 60 psi the above are unavailable, Where faucets meeting aerators or other means the above are may be used to achieve unavailable, aerators or reduction. other means may be used to achieve reduction. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB407 2015. doe revised 02/04/15 CUPERTINO Address ff PURPOSE SMOKE / CARBON MONOXIDE ALARMS 61 'FILE OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building c-Dcupertino.org �[""C", 1 1505 — f\ -,,n Permit Nn_ 'n � W1_L.4J--j J� # of Alarms Smoke: Carbon Monoxid( C CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE ! AS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X On every level of a dwelling unit including basements X X Within each sleeping room I X Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. (or Contractor Name: I have read and agree to comply,with the terms and conditions of this statement Agent's) Name: I n 3 .... I.../V.�`.�..... v`.'.`.�.................................................................. Date: V1044_11 ... ................................................................... Lic.#...................................... Date:................... Smoke and CO form. doc revised 03/18/14