14020075 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19971 LA MAR DR CONTRACTOR:FOUR SEASONS HOME& PERMIT NO: 14020075
SOLAR
OWNER'S NAME: DAVE&LINDA WYCKOFF 1029 BLOSSOM HILL RD STE 4 DATE ISSUED:06/13/2014
OWNER'S PHONE: 4082524707 SAN JOSE,CA 95123 PHONE NO:(488)600-8570
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
CONSTRUCT SUNROOM WITH ELECTRICAL(325 SQ FT);
License Class__ Lic.4 DEMOLISH SHED LOCATED IN EASEMENT.
Contractor, , & ✓ Date I REV# 1 -EXTEND SUNROOM BY 1 FT(25 S.F. TOTAL)-
I hereby affirm that I am licensed under the provisions of Chapter 9 ISSUED 8/11/14
(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:
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:$33825
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:36910040.00 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 T 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 F AST C ED INSPECT ON.
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 Iss y: a
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Dat 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
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)
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 Cupertino Municipal Code,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Section nd 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date l r
permit is issued.
1 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,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-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CONSTRUCTION PERUHT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISIO
10300 TORRE AVENUE•CLIPERTINO, CA 95014-3255
CUPERTIPIO (408) 777-3228 • FAX(408)777-3333• building(-)cupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ALT-ERATION/TI REVISIO /DEFERRED ORIGINAL PERATIT n
PROJECT ADDRESS APN �-r -� -
011WIERNP.ME vPHO'N'E I E-MAIL
� A/� Cyt r a-
STREET ADDRESS n CITY, STATE,ZIP FAX
Y31,*71 J?- I yr ti
CONTACT NAME PHONE E-MIA.IL
STREET ADDRESS CITY,STATE, ZIP FAX
❑ O,,WER ❑ ORTER-BL-II-DER ❑ ORT'ER AGENT ❑ CONTRACTOR ❑CONIILACTOR AGE171 ❑ ARCH1T-CT ❑E-14GWEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC
COMPANY NAME E-MAIL F.4X
STREET ADDRESS CITY,STATE,ZIP I PHONE
ARCHTTECTfENGINVEERNAME LICENSENUMBERO?L� BUS.LIC
COMPANY NAME t ^ ��✓G4' E-MAIL l FAX
STREET ADDRESS G r CITY,STATE,ZIP PHONE
d
DESCRIPTION OF WORK v. J A-
EXISTING USE PROPOSED USE CONSTR TYPE m STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NTW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA RE140DEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
.ATTACH
DWELLING UNITS: IS ASE ONDUNIT ❑YES SECOND STORY EYES
BEING ADDED? ❑NO ADDITION? NO
— -
----PRE-A-PPLIC:4TION-�1'ESIr-1'-ES,PROVIDELOP�-OF _I$_IHE BLDG.i1 1 t5 EIS
T
A <` TOAL VALUATION:
PLAN'N'ING APPL� ❑NO PLANNING APPROVAL LETTER I EICHLER HOME?
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 i�accuMfe. I agree to comply with all applicable local
ordinances and state laws relating to building co/§truction. I authorize representatives of Cupertino to enter the above-identified(property for inspection purposes.
Signature of Applicant/Agent: � Date:
SUPPLEMENT. L INFO IZNTATIC)N REQUIRED p CHECKTIPE _, {_ ., ixorrrri�Gcilr_
New SFD or Multifamily dwellings: Apply for demolition permit for -� � =�
0 OVE-T FrCOUNTER _BUII�ItGPL4�REYIEFTJ .
existing building(s). Demolition permit 9s required prior t0 issuance Of building =nom1
permit for new building. Q EA PRESS* �� �u y r � a ��PLAININI\GPL�?NRES7E�r � a
_Commercial Bldgs : Provide a completed Hazardous Materials Disclosure ;IO YEA } � � � �uBLI �voRls �
form if any Hazardous Materials are being used as part of this project. ' „�
_Copy of Planning Approval Letter or Meeting with Planning prior toxo = �
T' iA00 � ❑ SAN1TYItISEPTERDISZRICT d
submittal of Building Permit application.
Bldogpp_2011.doc revised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR -BUILDING DIVISION
ADDRESS: 19971 LA MAR DR DATE: 08/11/2014 REVIEWED BY: MELISSA
A91 APN: 36910 040 BP#: 14020075 'VALUATION: Iso
-PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1 GENRES
USE: PERMIT TYPE:
WORK REV# 1 - EXTEND SUNROOM BY 1 FT 25 S.F. TOTAL - ISSUED 8/11/14
SCOPE
FT J
Ll _L_
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . These fees are based on the prelimina information available and are only an estimate Contact the Dept/or addn 7 info,
FEE ITEMS (Fee Resolution 11-053 Eff 7,1:13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? ®Yes ) No $0.00 1 hours Plan Check, Hourly
Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $143.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-(j) Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
0
Work Without Permit? 0 Yes ) No $0.00
Advanced Planning? I ee: $0.00 Select a Non-Residential G
Building or Structure 0
Stron,�,, Motion Fee: $0.00 Select an Administrative Item
Bldg Stds Commission Fee: $0.00
SUBTOTALS: $0.00 $143.00 TOTAL FEE: $143.00
Revised: 07/10/2014
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19971 LA MAR DR CONTRACTOR:FOUR SEASONS HOME& PERMIT NO: 14020075
SOLAR
OWNER'S NAME: DAVE& LINDA WYCKOFF 1029 BLOSSOM HILL RD STE 4 DATE ISSUED:06/13/2014
OWNER'S PHONE: 4082524707 SAN JOSE,CA 95123 PHONE NO:(488)600-8570
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑
CONSTRUCT SUNROOM WITH ELECTRICAL(325 SQ FT);
License Class Lic.# � � �� �J DEMOLISH SHED LOCATED IN EASEMENT.
Contractor F_04AR e,t-A5-6N0 5C.c1jUC_ 40 13 -14
1 hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
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:$33825
have and will maintain Worker's Compensation Insurance,as provided for by
ylL$ection 3700 of the Labor Code,for the performance of the work for which this APN Number:36910040.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT,.EXP-1RES-IF-WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating WIT 180 DAYS OF PEtMIT 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 FR AST 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 sourc I ns r the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signatur Date 3— 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
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)
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
1 have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of 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 2 3 ,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this &
permit is issued.
Owner or authorized agen 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.
Date
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION K
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 �
CUPERTtN4
(408) 777-3228• FAX(408)777-3333• building(Dcupertino.org � T
❑NEW CONSTRUCTION 1 ADDITION ❑ ALTERATION/TI [_ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS ) / A j- ( n +� T1� APN# D
� 1yO
OWNER NAME !�I y, n �l tPHOO - Cj E-MAIL
STREET ADDRESS c JTM4P, 7-7_ I cZ} C� --1 J O 14 FAX mj
/V F'7W i '
CONTACT NAME PH NE MAIL .
STREET ADD S CITY ATE,ZIP FAX
I t_L_!A-M�, 12LI-
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 16 CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
alZ
COMPANY NAME -� E-MAIL FAX
STREET ADDRESS L STATE,B,7�P_ 1 C A Gf 2 -31 P
H I E L
r3Lu'I��S�Mi-NLr, R
ENGINEER jN
AME .F Pr !t] ISI LICENSE NUMBER BUS.LIC
ARCHITECT #
COMPANY NAME vT-� E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
EXIS G US PROPOSED USE CONS TSZ„TYPE !t STORIES
g, ; IV L USE TYPE OCC. SQ.FT. VALUATION(S)
rAL
SAG Gu RE FLOOR b DEMO NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA / REMODEL AREA ,�---�/ REMODEL AREA
PORCH AREA fECK AREA TOTAL DECK/POACH AREA GARAGE�A/REA: DETACH
it % I 7 1 ,9 ❑ATTACH
9 DWELLING UNITS: �J IS A SECOND UNrr ❑YES SECOND STORY []YES
BEING ADDED? NO ADDITION? 48NO
PRE-APPLICATION El YES IF YES,PROVIDE COPY OF iS THE BLDG AN ❑YES RECEIVED y g� `'' TOTA�
PLANNING ADPL# r_1 NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO11 l/l..
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on owner's behalf. I have read this
application and the information I prov' . co ect I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws r.1ati to bui g co c i n. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature ofApplicant/Age Date: {�_(4-
SUPPLE N TION REQUIRED p :ciciz2r � "Rovi�vcsms
New SFD or Multifamily dwellings: Apply for demolition permit for
�?OVgE
R
existin building(s). Demolition permit is required prior to issuance of building TII�COUNTER ;K ,„ � BUILDINGPI;ANREVIE94 �
a :
permit for new building. uv L9 P nvcPL �vt>
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD I i7B G Wo "
form if any Hazardous Materials are being used as part of this project.
Copy of Planning Approval Letter or Meeting with Planning prior to tsx �5
— '��J I.7A�S Rud k �" 1f �EWERDISTRIU� '�
submittal of Building Permit application.
BIdgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
ILIFEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 19971 la mar dr DATE: 02/12/2014 REVIEWED BY: Mendez
APN: BP#: V ,o?dV Z_5__ `VALUATION: 1$33,825
'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PENTAMATION 1 R3SFDADD
USE: -7 PERMIT TYPE: A
PRIMARY SFD or Duplex
WORK construct sunroom 325 sq ft electrical
SCOPE
F-1 LJ
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7i1/13l FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 DES.f. Patio Cover/Sun Room
Suppl. PC Fee: (2) Reg. Q OT 0.0 firs $0.00 $1,529.00 IPATIOENCW Wood, Enclosed
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Feer Reg. OT L0.0 firs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Work Without Permit? 0 Yes 0 No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Building or Structure
Strong Motion Fee: 1BSEISMICR $3.38 Select an Administrative Item
B1dgStds Commission Fee: IBCBSC $2.00
SUBTOTALS: $5.381$1,529.00 TOTAL FEE: $1,534.38
Revised: 01/15/2014
SMOKE / CARBON MONOXIDE ALARMS also
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ^l
CUPERTtNO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 /
(408)777-3228•FAX(408)777-3333 • building(ftupertino.org / �o
Permit No. (((
Address IT 71 0U I 1�O #of Alarms Smoke: s Carbon Monoxide: 11
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS,CERTIFICATE
HAS BEEN,��p AND RETURNED TO THE�BUHaDTNG DIVISION
PURPOSE
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 X X
bedroom(s)
On every level of a dwelling unit including basements X X
Within each sleeping room 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.
1 have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
U✓ - , Si nat e... .... .. � ..........r....4�1 �... .................. . ...............................Date-5h.. ..,(.. ...
Contractor Name:
Signature...................................................................Lic.#......................................Date: ...................
Smoke and CO for-rn.doe revised 03118114