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15040007CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10185 N STELLING RD CONTRACTOR: CRW INDUSTRIES PERMIT NO: 15040007 OWNER'S NAME: CITY OF CUPERTINO 5346 SCOT -FS VALLEY DR STE E DATE ISSUED: 04/23/2015 OWNER'S PHONE: 4087773232 SCOT -FS VALLEY, CA 95066 PHONE NO: (831) 426-0743 0 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL E] �� DRY ROT REPAIR FROM WATER DAMAGE License Class Lic. # �vryry�� Contractor Date .7 I hereby affirm that I am licensed under the provisions of Ch pter 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 hvo 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: $2000 performance of the work for which this permit is issued. 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: 32654049.00 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 OT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 18 OF P 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 FROMy LLED INSPEC ION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, ... .... —� costs, and expenses which may accrue against said City in consequence of the fes' 23 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 y�C� All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 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 25505, 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: Date: 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, 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLICATION IS 11-21 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION I�I 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingna cupertino.org CUPERTINO ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 10185 N. Stelling Rd. APN # _WV 540,1 q o-) OWNERNAME City of Cupertino PHONE (408) 777-3232 E-MAIL alexa@cupertino.org STREETADDRESS 10300 Torre Ave. CITY, STATE,ZIP Cupertino, CA 95014 FAX CONTACT NAME Alex Acenas PHONE (650) 255-6565 E-MAIL aIexa@cupertino.Org STREETADDRESS 10300 Torre Ave. CITY. STATE, ZIP Cupertino, CA 95014 FAX 4OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Bill Burr LICENSE NUMBER 402484 LICENSE TYPE B BUS. LIC # COMPANY NAME CRW Industries, Inc. E-MAIL bburr@crwindustries.com FAX (831) 466-9597 STREET ADDRESS 5346 Scotts Valley Dr., Ste. E CITY, STATE, ZIP Scotts Valley, CA 95066 PHONE (831) 426-0743 n kGii9r 4/FNGINEER NAME Tim Hyde, 5.E. LICENSE NUMBER BUS. LIC # COMPANY NAME akh Structural Engineers, Inc. E-MAIL hyde@akhse.com FA,X (408) 267-7919 STREET ADDRESS 1505 Meridian Ave„ Suite B CITY, STATE, ZIP San Jose, CA 95125 PHONE (408) 978-1970 x 14 DESCRIPTION OF WORK Replace -in-kind water -damaged plywood at shear walls along the north hallway that runs east -west per 5tructural Engineer s recommen atlon. Provide new R-19 poper-f aced batt insulation at insulation exte.roor walls where old wnter-dnmnqed hott was removed Install new 112" thick - moisture -resistant gypsum board. Tape, mud and paint to match existing. EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ONO ADDITION? ONO PRE—APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY T TAL VALUATION: PLANNING ADPL # []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO — Al a 210-00 By my signature below, I certify to each of the following: 1 am the property owner or authorized a n the property owner's beh lf. 1 have read this application and the information I have provided is correct. I have read the Description of Work and verify itis accurate. I agree to comply with all applicable local ordinances and state laws relating to buil g nstuction. I honze repAesentatives of Cupertino to enter the above -identified property forinspection purposes. Date: Signature of ApplicanUAgent: 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 ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 UNREASONABLE HARDSHIP EXEMPTION FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C,B.O., BUILDING 10300 TORRE AVENUE • CUPERTINO, CA 9 FICE COPY (408) 777-3228 • FAX (408) 777-3333 • building(a�cupertino.orq For Tenant Improvements where the Cost of Construction does not exceed $139,934.00 / �� C/ -(� SITE ADDRESS 10185 N. Stellin Rd. APN ° -0e_%/ BP# Cost to make feature CITY Q12CIIiI39 I ZIP 95014 TOTAL CONSTRUCTION COST A $...9.,PQQ................................... DESCRIPTION OF WORK: dr rot re air 1. Path of travel to accessible entrance. The following is a list of costs to provide access features in order to comply 100% with the current State Title -24 Disable Access Standards.(AII costs to be documented by actual bids or other information accepted by the Buildina Official.) Accessible Features Complies with If not, list required upgrades in order for Cost to make feature Description of access features to be provided: current standards? features to fully comply? fully accessible? 1. Path of travel to accessible entrance. No Install truncated domes $ 1,800 2. Cost of providing a primary entrance. (Including but PERCENTAGE (20% minimum expenditure is require 20 % not limited to, thresholds, landings, door hardware, Yes $ max. door pull, etc. 3. Cost of providing the primary path of travel to the specific area of alteration, structural repair, or Yes $ addition. 4. Cost of providing accessible restroom facilities. No Provide req'd clearances and aisle widths $ $ 20,000 5. Cost of providing an accessible drinking fountain. (If No Provide high/low drinking fountain $ 41000 required or if a drinking fountain is provided.) 6. Cost of providing accessible public telephones (if No Provide accessible public phone $ 4,000 provided) 7. Cost of providing other accessible features, including Yes Accessible parking, accessible counter $ but not limited to, parking, storage, alarms etc. TOTAL COST OF ACCESS FEATURES (B): $ 29,800 Has the same tenant performed work in the same tenants ace within the last three ears? No Calculate (B / A) x 100% 331 Description of access features to be provided: Install truncated domes along accessible path of travel from right-of-way (N. Stelling Rd.) to the main building entry. TOTAL COST OF PROPOSED UPGRADE $ 1,800 PERCENTAGE (20% minimum expenditure is require 20 % ARCHITECT OR ENGINEER OF RECORD INFORMATION: I certify that the above noted information is true and correct. Name (print): Alex Acenos, AIA Signature: Date: 4-9-2015 ----------------------------------------------------------------------- FOR DEPARTMENT USE ONLY --------------------------------------------------------- --------------- ❑ The above named project has been denied an unreasonable hardship exemption under 2010 CBC Section 1134B.2.1. ❑ The above named project has been granted an unreasonable hardship exemption from the requirements of the State of California CCR -Title 24 (Regulation for the Accommodation of the Disabled) pursuant to 2010 CBC Section 1134B.2.1. COMMENTS: Building Official Designee (print): _AtOp—A, Signature: ate: HardshipExemplionFornz 2012.doe revised 10/17/13