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11060003
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21750 RAINBOW DR CONTRACTOR:BRUCE STEAKLEY PERMIT NO: 11060003 OWNER'S NAME: CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT f— PLUMB r— License Class Lic.# MECH RESIDENTIAL I— COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:NEW TWO-STORY SFDWL(5,702SQFT),PORCH(98 SQFT), (commencing with Section 7000)of Division 3 of the Business&Professions DECK(467 SQ FT)& ATTACHED GARAGE(493 SQ FT)ON Code and that my license is in full force and effect. EMPY LOT NO DEMO REQUIRED. TOTAL SQ FT 6,760 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 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 Sq.Ft Floor Area: Valuation:$1200000 permit is issued. APPLICANT CERTIFICATION APN Number:36603064.00 Occupancy Type: I certify that I have read this application and state that the above information is correct.l 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by: Date: I' Signature Date < OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,1 must O r or ai horize ent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that 1 have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non- oint source regulations per the Cupertino Municipal Code,Section 9.18. `n 6" 1 understand my plans shall be used as public records. Signature Yh Date �����12 Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 21750 rainbow dr. DATE: 09/12/2012 REVIEWED BY: bobs. APN: BP#: *VALUATION: Iso %PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK revise pad retaining wall add water tank. SCOPE CF,�rk i'lt,zC .cf.. 'J ',. tt .. /rrcj' )r . °�'trrr�„tts{ ✓ .., L , Itt�;t 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 7 info. FEE ITEMS(Lee Resolution 11-053 Ef. 7/1'11) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes 0 No $0.004 hours Plan Check,Hourly Suppl.PC Fee: Q Reg. 0 OT 0,0 hrs $0.00f $532.00 1STPLNCK PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Supp/.Insp.Fee Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C 017NIVi4 t o%7 1"av Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee. $0.00 4 hours Inspections 0 7roiclFecs: $532.00 1STINSPInspection,Hourly ©A Strong Motion Fee: $0.00 Select an Administrative Item Bldp Stds Commission Fee: $0.00 SUBTOTALS: $0.001$1,064.00 TOTAL FEE: $1,064.00 Revised: 07/01/2012 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21750 RAINBOW DR CONTRACTOR:BRUCE STEAKLEY PERMIT NO: 11060003 OWNER'S NAME: CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB" License Class Lic.# NIECH RESIDENTIAL COMMERCIAL Contractor Date JOB DESCRIPTION: NEW TWO-STORY SFDWL(5,702SQFT),PORCH(98 SQFT), I hereby affirm that I am licensed under the provisions of Chapter 9 DECK(467 SQ FT)& ATTACHED GARAGE(493 SQ EI')ON (commencing with Section 7000)of Division 3 of the Business&Professions EMPY LOT NO DEMO REQUIRED. TOTAL SQ FT 6,760 Code and that my license is in full force and effect. 1 hereby affirm under penalty FNCL of perjury one of the following two declarations: 1/3/2012-REV41-REVISE ONE(1)BEDROOM& BATIl,WINERY, , OSE CARPOR'h,RETAINING WALL,-ISSD I have and will maintain a certificate of consent to self-insure for Worker's NCL 5/2/12 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:$1200000 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:36603064.00 Occupancy"Type: permit is issued. APPLICANTCERTIFICATION 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 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 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 1 hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALI,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. l 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 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 1 performance of the work for which this permit is issued, will maintain compliance with the Cupe tino Muni Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the health&Safety Code,Sections 2 5,25533 25534. Section 3700 ofthe Labor Code,for the performance of the work for which this Owner or authorized agent: Date: 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,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 agai t said City in consequence of the I understand my plans shall be used as public records, granting of this permit.Additionally, he plicant understands and will comply with all non-point so a regulatio the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date EVISION# CITY OF CUPERTINO BUILDING PERMIT DATE 1" - t z BUILDING ADDRESS: 21750 RAINBOW DR CONTRACTOR:BRUCE STEAKLEY PERMIT NO: 11060003 OWNER'S NAME: CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG f— ELECT f— PLUMB r License Class Lic.# _3o D6j, r— f— f— �IMECH RESIDENTIAL COMMERCIAL Contractor i - 'Date,/ I hereby affirm that I a licensed under the provisions of Chapter 9 JOB DESCRIPTION:NEW TWO-STORY SFDWL(5,702SQFT),PORCH(98 (commencing with Section 7000)of Division 3 of the Business&Professions SQFT), Code and that my license is in full force and effect. DECK(467 SQ FT)& ATTACHED GARAGE(493 SQ FT)ON EMPY LOT NO DEMO REQUIRED. TOTAL SQ FT 6,760 REVISION#2-REVISE I hereby affirm under penalty of perjury one of the following two declarations: PAD,RETAINING WALL AND ADD WATER TANK-REV#2 ISS'D 10/23/12 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 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 permit is issued. APPLICANT CERTIFICATION Sq.Ft Floor Area: Valuation:$1205000 1 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 APN Number:36603064.00 Occupancy Type: 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, costs,and expenses which may accrue against said City in consequence of the PERMIT EXPIRES IF WORK IS NOT STARTED granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section HIN 1 DAYS OF PERMIT ISSUANCE OR 9.18. 1DAY ROM LAST CALLED INSPECTION. Signature Date Issu/etb t'i Date: ❑ OWNER-BUILDER DECLARATION U I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: RE-ROOFS: 1,as owner of the property,or my employees with wages as their sole compensation, All roofs shall be inspected prior to any roofing material being installed.If a roof is will do the work,and the structure is not intended or offered for sale(Sec.7044, installed without first obtaining an inspection,I agree to remove all new materials for Business&Professions Code) inspection. I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). Signature of Applicant: Date: I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(x)should I store or handle hazardous material. I certify that in the performance of the work for which this permit is issued,I shall Additionally,should I use equipment or devices which emit hazardous air not employ any person in any manner so as to become subject to the Worker's contaminants as defined by the Bay Area Air Quality Management District I will Compensation laws of California. If,after making this certificate of exemption,I maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the become subject to the Worker's Compensation provisions of the Labor Code,I must Health&Safety Code,Sections 25505,25-533,and 25534. forthwith comply with such provisions or this permit shall be deemed revoked. Owner 11�1�uthorizma Date:-a3 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with al I city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter I hereby affirm that there is a construction lending agency for the performance of work's upon the above mentioned property for inspection purposes.(We)agree to save for which this permit is issued(Sec.3097,Civ C.) indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Name costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply Lender's Address with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ARCHITECT'S DECLARATION Signature Date I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 21750 rainbow dr. DATE: 06/01/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$1,200,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: New Construction PRIMARY SFD or Duplex 2nd Unit? 0 Yes No PENTAMATION 1 R3SFDW USE: 7 PERMIT TYPE: WORK construct new 2nd story sfd. Empty lot no demo required. SCOPE 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 6,760 $3,417.28 IR3PLNCK $4,595.28 IR37NSP TOTALS: 6,760 $3,417.28 $4,595.28 NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the Detfi- or addn'l info. FEE ITEMS (Fee Resolution 09-051 1 ': 7/1;10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,417.28 Select a Misc Bldg/Structure Suppl.PC Fee: G Reg. 0 OT 0.0 1 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $4,595.28 Suppl. Insp.Feer Reg. 0 OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Constr.Tax: 1BCONSTA R 1 units $569.36 Acoustical Fee: ® Yes E) No $0,00 Q Work Without Permit? 0 Yes E) No $0.00 Nlannin Fee: PLLONGRNGR $878.80 Select a Non-Residential G Building or Structure �J Strong Motion Fee: 1BSEISWCR $120.00 Select an Administrative Item Bldg�Stds Commission Fee: 1BCBSC $48.00 SUBTOTALS: $9,628.72 $0.00 TOTAL FEE: 1 $9,628.72 Revised:04/29/2011 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21750 rainbow dr. DATE: 01/03/2012 REVIEWED BY: bobs. APN: BP#: r'VALUATION: Iso PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK revise 1 bedroom and bath winery, enclose carport. SCOPE Li 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 prefinina information available and are oidy an estimate. Contact the De tfi or addn'1 in o. FEE ITEMS (Fee Resolution 11-053 Efi/1.-11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure Suppl.PC Fee: Q Reg. ® OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Feer Reg. C)OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? ® Yes No $0.00 Advanced Planning;Fee: $0.00 Select a Non-Residential Q Building or Structure 0 Strong Motion Fee: $0.00 1 # Revision BldgStds Commission Fee: $0.00 $783.00 1REVSFDWL SFDWL SUBTOTALS: $0.00 $783.00 TOTAL FEE: $783.00 Revised: 12/0412011 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 21750 Rainbow DATE: 06/20/2012 REVIEWED BY: jsg APN: BP#: *VALUATION: 1$5,000 FPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Rep PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: woRK Roof trusses deferred submittal I `~— SCOPE rEl---------L_ LJ I NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS jLge Resolution 11-053 E . 7/1!11) FEE QTY/FEE I MISC ITEMS Plan Check Fee: Hourly Only? Q Yes E) No $0.00 2 hours Plan Check,Hourly Suppl. PC Fee: (j) Reg. OT 0.0 hrs $0.00 $260.00 1STPLNCK PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:(j) Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? Yes (F) No $0.00 Advanced Planning I:ee: $0.00 Select a Non-Residential Building or Structure Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldy,Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $260.00 TOTAL FEE: $261.50 Revised: 06/30/2012