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13070179 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6382 COTTONWOOD CT CONTRACTOR:PETER CONSTRUCTION PERMIT NO: 13070179 OWNER'S NAME: SURT AND JOYITA ROY 5925 TOMPKINS DR DATE ISSUED: 10/17/2013 OWNER'S PHONE: 4089731276 SAN JOSE,CA 95129 PHONE NO:(408)529-6412 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Class__ Lic.# 8:74�=&q 7 ADDITION OF 800 S.F. TO ENLARGE (E)MASTERBD RM& CREATE (N)STUDY/DEN,LIVING RM,DINING AREA&36 Contractor Date /p /� _(/ S.F. OF(N)PORCH AREA. REMODEL(E)MASTER BATH 1 hereby al,904.that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$140000 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:36918012.00 Occupancy Type: permit is issued. /—_7 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 WIT7AOM 80 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 DF 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 die granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:/O. 7/7 with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date iO—/ r( 3 All roofs shall be inspected prior to any roofing material being installed.If a roof is 70- installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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 1 store or handle hazardous 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 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 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505, 6533 and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: permit is issued. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,atter making this certificate of exemption,l 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 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 � CUPERTINO (408)777-3228• FAX(408)777-3333•building(@cupertino.orq El NEW CONSTRUCTION `U ADDITION ❑ ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS CO[TorI Wv6D G©u Q i APN N OWNER NAME SCJ I1 TC�`e!'(1g ]�V PHONE7 E-MA`1L(� 7 4of?9TS_ i2 S4��i"Royce YAttoo c.�;,t STREET ADDRESS 63&,:p CCT-ToN�C)C3 D GOV QT' CITY, STATE ZIP FAX c u PcIZ'r1r,,(.) CONTACT NAMEE-MAIL 5u�ii Q�� PHONE 4be�}3�12 � � Suilr,26y@�4heo•c—x-i STREET ADDRESS G3&2 C'C'TT6_J Wnr' CoLA T CITY,STATE, ZIP FAX �WNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME+]ETT- kAr`J fir" LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME ('}- E-MAIL FAX S�2UC.'I`lOr'J PKGc,N SC'�`-ILTIUW��idY10.i`.G�:� STREET ADDRESS�;q ZS I Grum pk)K6 p121 U c CITY,STATE,ZIP 5A-J TcZ6,C_A W 2n PHONE 4`08 5-512 �2-4 S� ARCHITECT/ENGINEER NAME LICENSE NUMBER +J BUS.LIC N COMPANY NAME perca )`MAIL�F�o=J��t7GT16'�1 •7�'1q FAX STREET ADDRESSCITY,STATE,ZIP PHONE S_925 tory pivAiS Pkwt5 `-N- ac15c 0-.4, G5l-2-r) DESCRIPTION OF WORK A'DDiTlcN "f-o t=RCti i A-+J1) Sl17b el= U005,6CW S , LgL_ c EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA V_,o AREA 1X©C_j AREA NET AREA a 0C20 BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UMTS: 7 IS A SECOND UNIT ❑YES SECOND STORY []YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION FINES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES REC• BY: I TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NOI is ' C>T�j By my signature below,I certify to each of the following: I am the property owner or authorized a o ac[ a propeee to s behalf. I have read this < i application and the information I have provided is correct. I have read the Description of Work and verify s agrcomply with all applicable local ordinances and state laws relating to building const tion. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent:- it Dater _7-1361, 013 ' SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THF 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 Lf'STANDARD ElPUBLIC WORKS form if any Hazardous Materials are being used as part of this project. j❑ 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 BIdgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 6382 COTTONWOOD CT DATE: 04/28/2014 REVIEWED BY: MELISSA APN: 369 18 012 BP#: 13070179 'VALUATION: Iso °-PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK REV# 1 -WIDEN 3 WINDOW OPENINGS - ISSUED 4/28/14 SCOPE El NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc). Theseees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff 7%1!13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes 0 No $0.001� hours Plan Check,Hourly Suppl. PC Fee: Q Reg. (0 OT 0.0 hrs $0.00 $139.00 1STPLNCx PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee;Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ('on", 1", fion /:r.t. Work Without Permit? 0 Yes 0 No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential 0 Thl" (,/Oocluncnfalilm Fc( Building or Structure 0 Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: 1 $0.00 $139.00 TOTAL FEE: $139.00 Revised: 04/01/2014 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 6382 COTTONWOOD CT DATE: 07/30/2013 REVIEWED BY: MELISSA AN: 369 18 012 BP#: �� l' *VALUATION: 1$140,000 *PERMIT TYPE: Building Permit PLAN CHECK T PE: Addition PRIMARY 2nd Unit? 0 Yes G No PENTAMATION USE: SFD or Duplex 1 R3SFDADD OTC? 0 Yes ONo PERMIT TYPE: WORK ADD11-ION OF }g3S.F. TO ENLARGE E MASTERBD RM & CREATE N STUDY/DEN LIVING RM SCOPE DINING AREA& 36 S.F. OF (N) PORCH AREA. REMODEL (E) MASTER BATH (60 S.F.) OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. R-3 (Custom) II-6,111-B,IV,V-B 793 $2,577.00 IR3PLNCK $1,617.00 IR3INSP TOTALS: 793 $2,577.00 $1,617.00 MECH,HOURLY 0 Yes 0 No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY ® Yes .Q No Meeh. Plan Crcck l'krmh. .1'/(11?t.;WC 6 I:7cc. Piurr C;hG<ck llech.Permit Fee: Plumb.Permit P; Elec. Permit Fe, Other Alech.Insp. Other Plumb Insp. Ll Other Elec.Insp. Hoch. Insp.Fee: Plumb. Insp. Fee: Elec.Insp. Fee' NOTE: This estimate does not include fees due to other Departments(e.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 ETf 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,577.00 = s.f. Remodel,Bath(<=300 s fl Suppl. PC Fee: Q Reg. O OT0.0 hrs $0.00 $626.00 1REMRESBAT PME Plan Check: $0.00 Permit Fee: $1,617.00 Suppl. Insp. Fee:Q Reg. Q OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conoraction Tux: F-1 Administrative Fee: 0 Work Without Permit? 0 Yes Q No $0.00 0 Advanced Planning Fee: IPLLONGR $111.02 Select a Non-Residential G Truvel Documentation Fees: Building or Structure 0 Strong Motion Fee. IBSEISAECR $14.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $6.00 SUBTOTALS: 1 $4,325.02 $626.00 TOTAL FEE: 1 $4,951.02 Revised: 07/01/2013 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6382 COTTONWOOD CT CONTRACTOR:PETER WANG PERMIT NO: 13070179 OWNER'S NAME: SUJIT AND JOYITA ROY 100 CONCORD CIR DATE ISSUED: 10/17/2013 OWNER'S PHONE: 4089731276 MOUNTAIN VIEW,CA 94040 PHONE NO:(650)906-8788 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL ❑ ADDITION OF 800 S.F.TO ENLARGE(E) MASTERBD RM & License Class Lic.#1 5?T_6�j - CREATE(N)STUDYIDEN, LIVING RM, DINING AREA &36 Contractor 0 Date S.F.OF(N)PORCH AREA. REMODEL(E) MASTER BATH I hereby affir that 1 am licensed under the provisions of Chapter 9 REV#I-WIDEN 3 WINDOW OPENINGS-ISSUED 4/28/14 (commencin 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: 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. Sq.Ft Floor Area: Valuation:$140000 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:36918012.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I hav 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 FROM 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 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 roofing material being installed. If a roof is installed without first obtaining am inspection ove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION / Signature o want ate: / I hereby affirm that 1 am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVER E CLASS"A"OR BETTER 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety, Code,Sections 25505,25533,and 25534. 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 1 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 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 1 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 3.L 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,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISI 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228• FAX (408) 777-3333 • build ingaacupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/T1 REVISION/DEFERRED ORIGINAL PERMIT 4 I '3 d in '�L 9 PROJECT ADDRESS l o l CT APN q — O! 2 OWNERNAME > PHONE- E-MAIL L,ts L�Cr'`f �` ���4-kAQ G' STREET ADDRESS CITY, STATE,ZIP, FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX 7OUT'ER ❑ OWNER-BUILDER ❑ OWNERAGEN-r ❑ CON'T'RACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME - LICENSE NUMBER C/ LICENSE 7YPE BUS.LIC d d�'�- ff COMPANY NAME E-MAIL ?/AX cottic-- STREET ADDRESS CITY,S ATE,ZIP PHONE ARCHITECr/ENGTNEER NAME LICENSE NUMBER BUS.LIC k COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR-TYPE F 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±TOTALDECKIPORCH AREA GARAGE AREA: DETACH ATTACH .`.'DWELLING UNITS: OND UNIT ❑}'ES SECONDSTOR1' ❑YESDDED? E]NO ADDITION? E]NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES VED BX= TOTAL VALUATION: PLANMNG APPL R ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑N By my signature below,I certify to each of the following: I am the property owner o Drize _ ;toct on grope ov pier's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work anderccura agree to complywith all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to r the ve-identified property for inspection purposes. Signature of Applicant/Agent: Date: 2-6 Lf SUPPLEMENTAL INFORMATION REQUIRED PLAN i=CKTYPP: ROUTLNG SLIP New SFD or Multifamily dwellings: Apply for demolition permit for [' GAIER THE-Cor.I R ❑ BETH DING!'LAN existing building(s). Demolition permit is required prior to issuance of building permit for new building. d RI,• P! ,. N h1,'%E.\ _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. ?.trit:F 1 FiRi.D:rt,I Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. \A�'"` `_" 1.:!:x;�>\et,i sats E` I 1L HEALfl' BIdgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6382 COTTONWOOD CT CONTRACTOR:PETER WANG PERMIT NO: 13070179 OWNER'S NAME: SUJIT AND JOYITA ROY 100 CONCORD CFR DATE ISSUED: 10/17/2013 OWNER'S PHONE: 4089731276 MOUNTAIN VIEW,CA 94040 PHONE NO:(650)906-8788 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL ADDITION OF 800 SQFT TO ENLARGE(E) MASTERBD RM License Class $ Lic.g �� 7 CREATE(N)STUDYIDEN, LIVING RM, DINING AREA &36 SQFT OF(N)PORCH AREA.REMODEL(E) MASTER BATH 60 Contractor Date K-100-119- REV#2-UPGRADE PANEL TO 200 AMP,SAME I hereby affi m that I am licensed under the prf ovisions of Chapter 9 LOCATION. CHANGE ROOF-[NG MATERIAL FROM (commencing with Section 7000)of Division 3 of the Business&Professions ASPHALT SHINGLE TO LIGHTWEIGHT TILE -ISSUED Code and that my license is in full force and effect. 6/18/14 1 hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$140000 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:36918012.00 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 DAY IT SUANCE 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 DAY M LAST INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature � � ?�' Date "" SL 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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 1 hereby affirm tinder 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(x)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 the Health&Safety Code,Sections 25 nd 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Dater permit is issued. I certify that in the performance of the work for which this permit is issued,1 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,1 must 1 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 source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX(408)777-3333• building 5)cupertino.org CUPERTINO D NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI VISION/DEFERRED ORIGINAL PERMIT# 7 G / 0 1 9 PROTECT ADDRESS APN d 7� G / -Q V /�i/� o7VIAJaoO Cr e-44PE4//N b OWN'ERN'AME (�U ,,)_(1 QaPHONE e/psf y �s/��� E-MAIL SUJ I j J -7 STREET ADDRESS �• d. CITY, STATE,ZIP �9L(QCQ NiJ �-�4 `�flJi y FAX CONTACT NAME SU PHONE Leo p. Gp.� %2- E-MAIL S'U..1 /(�•'`y,�y ( C[).Ltn./ STREET ADDRESS c CITY,STATE,ZIP J FAX 62 Cb i�NiJ6D� C�' �OWNER ❑ OWNER-BUIL DER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME (mer LICENSE NUMBER ) I(5LICENSETYPE BUS.LIC tt COMPANY NAME C � � �� E-MAIL � .� C at K(�s'-�v�c �. STREET ADDRESS ,, /�M� `�� CITY,STATE,ZIP /'� �frJl� v PHONE 1;46cc h ARCHITECT/ENGINEER NAME �/ LICENSE NUMBER BUS.LIC x J / COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK OO Ar AA ro 7-00 � l a,�,¢ ( S R�-� o c-&A -D n C' V b d trvt'IOLAT I,0 l ( tAJ& ,l EXISTING USE PROPOSED USE CONSTR.TYPE I STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXLSTG NEW FLOOR DE1`90 TOTAL AREA AREA AREA NET AREA tb. BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA IDECK AREA TOTAL DECKfPORCH AREA GARAGE AREA: DETACH I]ATTACH k DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES TOTAL VALUATION: PLANNING APPL k ❑NO PLANNING APPROVAL LETTER EICHLER HOME? I . 0 MAN By my signature below,I certify to each of the following: I am the property owner or autho on the pro owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work an verify 1t is accu agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter th e-id/e�ntified/property for inspection purposes. Signature of Applicant/Agent: I' Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP —New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-TAE-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 Q STANDARD ❑ PUBLICFVORKS 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 SENVER DISTRICT 1..: �. .. ❑ ENVIRONMENTAL REALTH BldgApp_201 1.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 6382 COTTONWOOD CT DATE: 06/18/2014 REVIEWED BY: MELISSA APN: 36918 012 BP#: 13070179 `VALUATION: Iso `PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or DuplexPENTAMATION 1GENRES USE: PERMIT TYPE: WORK REV#2 - UPGRADE PANEL TO 200 AMP SAME LOCATION. CHANGE ROOFING MATERIAL SCOPE FROM ASPHALT SHINGLE TO LIGHTWEIGHT TILE - ISSUED 6/18/14 Elec. Plan Check 0.0 hrs $0.00 Elec. Permit Fee: IEPERMIT Other Elec.Insp. 0.0 hrs $47.00 NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District, etc. . Theseees are based on the prelimina information available and are only an estimate. Contact the De l or addn'1 info. FEE ITEMS (Fee Resolution l 1-053 E ' 7.'l%l3) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 1 hours Plan Check, Hourly Suppl. PC Fee: ) Reg. 0 OT 0.0 1 hrs $0.00 $139.00 ISTPLArCx PME Plan Check: $0.00 200 1 amps Electrical Permit Fee: $0.00 $47.00 1aELEC2no Services Suppl. Insp. Fee.0 Reg. Q OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 Constrzrction TUU Administrative Fee: IADMIN $44.00 0 Work Without Permit? 0 Yes 0 No $0.00 G Advanced Planning Fee: $0.00 Select a Non-Residential E) Travel Documentation Fee: ITRA VDOC $47.00 Building or Structure A Strong Motion Fee: $0.00 Select an Administrative Item BI Stds Commission Fee: $0.00 SUBTOTALS: $138.00 $186.00 TOTAL FEE: $324.00 Revised: 04/01/2014 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: � PERMIT# OWNER'S NAME: u -� PHONE# GENERAL CONTRAC OR: 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 SUBCONT13,,ACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. !, I am not using any subcontractors: 9 — — Signat a Date Please check applicable subcontractdrrs and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring /Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date