14030049 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7592 HOLLANDERRY PL CONTRACTOR:IACOMINI PERMIT NO: 14030049
CONSTRUCTION
OWNER'S NAME: FARKAS STAN LEY R AND HILLARY J 203I TRUMA LN DATE ISSUED:03/26/2014
OWNER'S PHONE: 4082576487 GILROY,CA 95020 PHONE NO:(408)806-8599
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL 0
[� q //�� EXTEND FAMILY ROOM INTO ENCLOSED PORCH AREA
V
License Class Li -( 0 / 47 SQ,
z� ENLARGE M.SUITE TO INCLUDE KITCHEN REMODEL,
Contractor Date REPLACE(2)VENTS IN BATHROOMS 542 SQ FT
I hereby 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 udder 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:$80000
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:36229007.00 Occupancy Type:
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 180 DA LA ALLED INSPECTIO
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 2
granting of this permit. Additionally,the applicant understands and will comply V: Date:
with all non-point source regulations per the Cupertino Municipal Code,Sect
9.18.
RE-ROOFS:
Signature r Date_ Al I 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. 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 nd 2553.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Dater
permit is issued. -/
1 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.
Date
I
i CONSTRUCTION PERMIT APPLICATION >��
COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION �Vv
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX(408)777-3333 •buiidln, y^, ng trey
CUPERTINO - �---
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT tl
PROJECT ADDRESS APN
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OWNER PHONE
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WNF.R ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CON IRACTOR ❑CONTRACIOR AGENT ❑ .ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME 1 LICENSE NUMBER LICENSE TYPE BUS.LIC it
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CO%IPANY NAMEF:-MAIL FAX
STREET ADDRESS U3 S /f-�M /� CI`I 1',ST'QT',7,e S�O L D P"°NV6 84 6 83-91
ARCH ITEC 71INGINEER NAME. G LICENSF Nti64BBEjR / BUS.LIC-
COMPANY NAME C,MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
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61
EXISTING USE PROPOSED USE CONSTR.TYPE. STORIES
USE TYPE OCC, SQ.FT. VALUATION(S)
EXIST) NEW FLUOR DFb10 TOTAL
AREA .� ARE4 AREA NET AREA
BATHROOM rrrCHEN OTHER
REMODEL AREA REMODEL ARE 23 c REMODEL AREA
PORCH AREA DECK AREA TOTAL DECriiPORCft AREA GARAGU ARCA: DETACIJ(
ATTACH
DWELLING UNITS. IS ASECONDUNIT n -S SECONDSTORY ❑)ES
BEING ADDED? [3 NO ADDITION? [3 NO
PRGAPPLICATION OYES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVP)BY: _77016k VALUATION:
PLANNING APPL s [].NO PLANNING APPROVAI,LE77ER EICHLER HOME? ❑NO
By my signature below,I certify o tach of the following: 1 am the property owner or authorized agent to act Oft th property owner's behalf. 1 have cad this
application and the information Mide rrect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws rel' tictition. I authorize representatives of Cupertino to enter the•bove-i entified roperty for inspection purposes.
Signlature ofApplicant/Agent "� — -" —--— Date:
SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition pen-nit for ❑ OVER-THE-COUNTER 'BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ ExP ' . PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD ❑ PUBLIC WORKS
fo_rm 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 HEAL'T'H
BldgA1)p201 Ldoc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 7592 hollanderry pl DATE: REVIEWED BY: 80000
APN: BP#: I �� *VALUATION: 1$80,000
'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY 2nd Unit? 0 Yes No PENTAMATION
SFD or Duplex OTC? 0Yes 1R3SFDADD
USE:
®No PERMIT TYPE: �
WORK extend family room into enclosed porch area 47 sq, enlarge m.suite and kitchen area replace 2 fans
SCOPE in bathrooms 542 sq ft
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
R-3 (Custom) II-B,111-B,IV,V-B 0 $0.00 $0.00
TOTALS: 0 $0.00 $0.00
MECH,HOURLY 0 Yes (D No PLUMB,HOURLY Q Yes ) No ELEC,HOURLY 0 Yes Q No
F] - I 1 0
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 reliminar information available and are only an estimate. Contact the De t or addh 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 71131 FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? ®Yes ) No $0.00 2 hours Plan Check, Hourly
Suppl. PC Fee: (j) Reg. 0 OT0.0 hrs $0.00 $278.00 ISTPLNCK
PME Plan Check: $0.00 = s.f. Remodel, Other
Permit Fee: $0.00 $488.00 IREMRESOTH
Suppl. Insp. Fee:Q Reg. Q OT Q.Q hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
0
Work Without Permit? 0 Yes 0 No $0.00 )
Advanced Planning Fee: $0.00 Select a Non-Residential (2)
Building or Structure 0
i
Strong Motion Fee: IBSEISMICR $8.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $4.00
SUBTOTALS: $12.00 $766.00 TOTAL FEE: $778.00
Revised: 01/15/2014