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12010110 SION# CITY OF CUPERTINO BUILDING PERMIT DATE BUILDING ADDRESS: 931 NEW HAVEN CT CONTRACTOR:TOM&SYLVIA LEY PERMIT NO: 12010110 01VNER'S NAME: TOM&SYLVIA LEY 931 NEW HAVEN CT DATE ISSUED:04/16/2012 01VNER'S PHONE: 4089960805 CUPERTINO CA,CA 950144023 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r– ELECT r PLUMB r– censC–las –= =L�i a MECH RESIDENTIAL COMMERCIAL Contractor ' ^]7ate�, I hercby..at mrffia am til cased un ew to provistt9li o Chapter 9 JOB DESCRIPTION:ADD 1,365 SQ FT TO 1 ST&2ND FLOOR,359 SQ FT TO (commencing with Section 7000)of Division 3 of the Business&Professions COVERED PATIO,126 SQ FT TO COVERED BALCONY&71 Code and that my license is in full force and effect. SQ FT TO FRON RG•]r 6 1 887 021 1� L7A91 ,. ML7�1 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. 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of die work for which this permit is issued Sq.Ft Floor Area: Valuation:$250000 APPLICANT CERTIFICATION l certify that I.have read this application and state that the above information is APN Number:35611046.00 Occupancy Typc: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source re s per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. jj�� Signature at Issued by:Win/ 144 iG� Date: 7 —Y.— ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: lite following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants ns defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to Elie Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or auth t: forthwith comply with such provisions or this permit shall be deemed revoked, �-.=---a-•� •� - APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of"York's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9,18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 931 NEW HAVEN CT CONTRACTOR:TOM&SYLVIA LEY PERMIT NO: 120 101 10 OWNER'S NAME: TOM&SYLVIA LEY 931 NEW HAVEN CT DATE ISSUED:04/1612012 OWNER'S PHONE: 4089960805 CUPERTINO CA,CA 950144023 PHONE NO: li■ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL L1 COMMERCIALE] cense Class Lic.# 1 ` ADD 1,365 SQ FT TO 1 ST&2ND FLOOR,359 SQ FT TO COVERED PATIO, 126 SQ FT TO COVERED BALCONY&71 Contractor Date Z— SQ FT TO FRONT PORCH,REMODEL 1,887 SQ FT I hereby affirm that I am licensed under the provisions of Chapter 9 THROUGH (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. 8/27/2012-DEF'L#1-DEFERRED TRUSS CALCS-ISSD 11/21/12 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:$250000 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:356I1046.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 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 D 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 r 2 granting of this permit. Additionally,the applicant understands and will comply Issued by: ate: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. �� �` ��L RE-ROOFS: gnatlt _ at, 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 low 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 Ilse work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(See.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 2550 ,25533, 25534. Section 3700 of the Labor Code,for the performance of the work for which this 1�l �,�l Owncr �urrlhoulr!!agetttT _ Dale: 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 ti 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(See.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.1 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 ARCIi1TEC 1'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 " CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 931 NEW HAVEN CT CONTRACTOR:TOM&SYLVIA LEY PERMIT NO: 12010110 OWNER'S NAME: TOM&SYLVIA LEY 931 NEW HAVEN CT DATE ISSUED:04116/2012 OW NER'S PHONE: 4089960805 CUPERTINO CA,CA 95014-4023 PHONE NO: LICENSED CONTRACTOR'S DECLARATION r BULLRING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that 1 am licensed under the provisions of Chapter 9 ,JOB DESCRIPTION:ADD 1,365 SQ FT TO IST&2ND FLOOR,359 SQ FT TO (commencing with Section 7000)of Division 3 of the Business&Professions COVERED PATIO,126 SQ FT TO COVERED BALCONY&71 Code and that my license is in full force and effect. SQ FT TO FRONT PORCH,REMODEL 1,887 SQ FT THROUGH I hereby affirm under penally 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. 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 Arca: Valuation:$250000 permit is issued. APPLICANT CERTIFICATION APN Number:35611046.00 Occupancy Type: I certify that l have read this applieation 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 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 4.18. issued Dater / /J Signature Date O%VNER-BUILDER DECLARATION Of 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(See.7044, Business&Professions Code) Signature of Applicant: Date: 1,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 fallowing three declarations: HAZARDOUS MATERIALS DISCLOSURE have and will maintain a Certificate of Consent toself-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements uuder 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. conlamivants as defined b the Bay Arca Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,[shat[ maintain a as cc wit 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 Uca1.h& c ode, ctions 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,I must Owner u ent: f forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is 1 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 whicli y accrue against said City inconsequence of the granting of this permit. di Tonally, a applicant understands and will comply ARCHITECT'S DECLARATION with all non-point sou a re ulations er the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature R rT �� Licensed Professional CONSTRUCTION PERMIT APPLIC II 10N COMMUNITY DEVELOPMENT DEPARTMENT• BUIL DIN I In 10300 TORRE AVENUE• CUPERTINO, CA 55014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333• building Qcupertino.orq ❑NEW CONSTRUCITON ❑ ADDITION ❑ ALTERATION 1 T[ REVISION I DEFERRE r ORIGINAL PERMIT PROIECTADDRESS 6'�L APN2 �l y �� OWNER NAME ^ ( PHONE -�� E-MAIL STREET ADDRESS CITY, STATE,ZIP FAX w ';�TDC_(A '=�61 CONTACT NAME PHONE E-MAIL \ C� w 01 1 -. `6CY� ins:0-od yl�+'I.cat STREETADDRESS ^ � CTTY,STATE• ZIP c^� C FAX ❑OWNER 0-OWNER-BUILDER ❑ OwNERAGENr ❑ CONTRACTOR CI CONTRACTORAGENT ❑ ARCHITECT ❑ENGENM ❑ DEVELOPER ❑TENANT CONTRACTOR NAME � , LICENSE NUMBER LICENSE TYPE BUS.LIC a lC-loY ILt�j(JY COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHI ECTIENGINEER NAME LICENSE NUMBER BUS.LIC a tiG ��TC COMPANY NAME E-MAIL FAX STF=ADDRESS CITY,STATE,ZIP PHDNE a c, �'-n U nESCRDTI70N OF WORK \AIL-We a bu �c� EXISTING USE PROPOSED USE CONSTR-TYPE J STORIES USE TYPE OCC. SQ1T. VALUATION(S) EXISTG K- NEW FLOOR ,r DEMO TUTAL ARF.A AREA G i AREA NET AREA BATHROOM I KITCHEN OTHER REMODEL AREA RErIODELAREA REMODELAREA PORCH ASIA DECKARIA. TOTAL DECKIPORCH AREA GARAGEARFA DETACH ATTACH d DWELLING UNITS: ISA SECOND UNIT YES SECOND STDRY ❑YES BEING ADDED? RNO ADDITION? 4NO PRE APPLICATION ❑YES IF YES,PROVIDE COPY OF tS TME BLDG AN ❑YES RLE BY: TOTA T V ar.ttAIION: PLANNINGAPPL# ❑NO PLANNINGAPPROVALLETTER EICHLERHOME? RNO ���a• ` � G'f�Q 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 bile read this application and the information I have provided is correct. I have read the Description of Worst and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildiu s tion. I authorize representatives of Cupertino w enter the above-identified property forinspection purposes. Signature of Applicant/Agent. Date: (�-' —I la . ' SUPPLEMENTAL INFO QUIRED PLAN CHECK TYPE ROUTIxGSLD New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-TILE-COUNTER BIM,DING PLAN REVIZW existing building(s). Demolition permit is required prior to issuance of building permitfor new building. ❑ EXPRESS yn-PLANNJNGPLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD /❑ PUBLIC woRxs form if any Hazardous Materials are being used as part of this project. ❑ r-IRGE1 FM DIS _Copy of Planning Approval Letter or Meeting with Planning prior to CPT SEWER DISTRICT submittal of Building Permit application. El zmAicR S ❑•ENVIRONI?=- ALHEAITH BldgApp 1011.doc revised 06/21/11 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDINCEX 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 PRES CUPERTINO (408)777-3228 • FAX(408)777-3333 • buildincl(a)cugertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI "VISI0J!Z:f:):E:�FEDORIGINAL PECRMIT#_J2-0 Q PROJECT ADDRESS e APN k OWNER NAMEPHONE E-MAIL STREET ADDRESS2 CITY, STATE,ZIP FAX CONTACT NAMEy PHONE E-MAIL u enc , STREET ADDRESS t e CITY,ST TE ZIP QS ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 9CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE ER LICENSE TYPE ( BUS.WC k COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE __7ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORKM1 u EXISTING USE PROPOSED USE CONSTR.TYPE h STORIES USE TYPE OCC. SQ.FT. VALUATION(5) EXISTO NEW FLOOR DEMO TOTAL AttEA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DUACH ❑ATTACH 9 DWELLING UNITS: is A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? []NO ADDITION? [:]NO PRE-APPLICATION []YES IF YES,PROVIDE COPY OF ISTHEBLDGAN DYES "RECEIVED BY? TOTAL VALUATION: PLANNINGAPPL4 ❑NO PLANNING APPROVALLETIER EICIILERIIOMIE? []NO By my signature below,I certify to each of the following. a property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided i correct. hav read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin o thorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature ofApp]icandAgent: Date: l SUPPLEMENTAL INFORMATION REQUIRED PLAN cliEcic TYPE-, IibUiING SLIP_. —New SFD or Multifamily dwellings: Apply for demolition permit for El OVER-THE=COUrrUR BUILDING PLAN REVIEW- existing building(s). Demolition permit is required prior to issuance of building �� permit for new building. D Ei;REss" ' ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a eompleted Hazardous Materials Disclosure ❑ STANDARD- ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIREDEPT _Copy of Planning Approval Letter or Mceting with Planning prior to p MlndoR j ❑, SANITARY SEWER DISTRICT submittal of Building Permit application. _ENVIRONMIENTALHEALTIU, ., B1dgRpp_2011.doc revised 06121111 CONSTRUCTION PERMIT APPLICATIONrd NJ is COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 Cl3PERTIriO (408)777-3228• FAX(408)777-3333 • building(�cupertino.org ) O 0 ❑NEW CONS'T'RUCTION © ADDITION ❑ ALTERATION/TI ❑ REVISION I DEFERRED ORIGINAL PIERMIT# PROJECT ADDRESS APN it 3 y I. OWNER NAME PHON � �a0� E-MAIL SRL \ STREETADDRESS ig, CITY,STATE,ZIP FAX .5 CONTACT NAMEPHON E-MAIL e � STREETADDRESSITY,STAATEE,,ZIP rI ❑OWNER ❑ OWNER-BUILDER ❑ OWNFRAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NANIE LICENSE NUMBER L]CENSE TYPE BUS.LIC k COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE / ARCHITECTIENGTNEER NAME LICENSE NUMBER BUS.LIC k COMPANY NAM E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHON scokk { S1t , 105 a A 9So 1 4C3S 5SCI-OS 0 DESCRIPTION OF WORK wtka 5 utw ac. x� oY� an Qg"A IgfFS v. EXISTING USE PROPOSED USE CONSTR.`TYPE 4 STORIES ` 'OFF[ r;,USE ONLY V-1%1 d - TY F ON 5 VAL I TIO`] S EXISTG NEW FLOOR ` DEMO G-y TOTAL ' AREA AREA !-`�• AREA 116 NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA31 RFMODELAR ' T. PORCH AREA ^-��PIF!MT7t TOTAL DECKIPPORCH AREA GARAGE AREA:❑ DETACH Y F-• 1 7 tiIo ATTACH R OWOJINC.MTTS ISASCCONDUNrr ❑YoSLCO.YDSTOAY J&yus ' DLINOADOCD7 No ADDITION': ❑N'D # PRF-ArPUc'%TSo.N YFS IFYMPROMECOPYOF PL�NIFx's\,%\7C RECEWFDBY: 7b' `Y�1t; -q PLAWNG APPI.a ❑ I'M PU.NMNO APPROVAL +TTER COyC v v By my signature below,I certify to eF-�z t<hV ng: I am the property owner or authorized agent to act on the property owner's heha]C I have read this application and the information I havvidrect. T have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating toi tion. I authorize representatives of Cupertino to enter the above-iden if'lied property for inspection purposes. Plr sena yt t: �, 12, SUPPLE MENTA' NFORMA ION REQUIRED - PLAN CHECK TYPE ROUTINGSLIP _ New*SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-TTIE-COUNTER ❑ RUILBING Pt AN REvim existing building(s). Demolition permit is required prior to issuance of building permit for ncty building. ❑ EXPRESS ❑ PLANNING PLAP!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. ❑ EiNVIRONNIENTAL.HBALTtI Cuh'�ey4-rNb1174 ,�� � , Bldgr4pp_2011.doc revised 03116/11 `�' 'max - CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 931 new haven ct DATE: 0111712012 REVIEWED BY: larrys APN: -� (p BP#: 1;,,O/ O/w '"VALUATION: 1$250,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or DU lex 2nd Unit? Yes • No PENTA141ATION 1 R3SFDADD USE: P OTC? O Yes (j)No PERMIT TYPE: WORK addition 1365 sq ft plu 430 sq ft porch/patio. remodel existing 2138 sq ft SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC PC FEE ID BP FEES BP FEE ID CONSTR. s-G R-3 (Custom) II-6,111-B,IV,V-B 1,921 $2,608.10 IR3PLNCK $2,192.80 IR3INSP TOTALS: 1,921 $2,608.10 $2,192.80 MECH, HOURLY O Yes (D No PLUMB,HOURLY O Yes Q No ELEC,HOURLY Q Yes Q No 1''h4od] "'ran Clic(k L-fPC Alta Ce, t, f'; ' f m:f, Pc?1Tl+l£Y P7=e f.r:P. 6th-' r, (am"',f;--sp 01110-f 1,G lo)p3 E37-- I 1 Pfu",I" Fee Elf:( Irz,p 1 r'r. NOTE: This estimate does not include fees due to other Departmettts(I e.Planning,Public{Yorks,Fire,Sanitary Sewer District,School District,etc). Thesefees rtre based on the erelinina information available and are on!y an estimate- Contact the De t or addii't info, FEE ITEMS(Fee 12esolution 11-053 gE 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,608.10 1,887 s.f. Remodel,Other Suppl.PC Fee: Q Reg. Q OT 0.0 1 hrs $0.00 $4,712.00 IREMRES2 PME Plan Check: $0.00 Permit Fee: $2,192.80 Suppl. Insp.Fee-.0 Reg. Q OT 0.0 1 lirs $0.00 PME Unit Fee: $0,00 PME Permit Fee: $0.00 0 Work Without Permit? O Yes Q No $0.00 0 Advanced Plannine Fee: PLLOA'GRNGR $249.73 Select a Non-Residential G Building or Structure O Strom Motion Fee: IBSEISMCR $25.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCESC $10.00 SUBTOTALS: $5,085.63 $4,712.00 TOTAL FEE: 1 $9,797.63 Revised: 1/01/2012 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 931 New Haven Ct DATE: 06/0712012 REVIEWED BY: Sean APN: 356-11-046-000 BP#: 12010110 *VALUATION: 1$15,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY 2nd Unit? Yes No PENTAMATION USE: SFD or Duplex OTC? DYes (F)No PERMIT TYPE: 1R3SFDADD WORK Revision#1: Construct a 91 sq ft bathroom addition and structural revisions to previously approved SCOPE plans. OCCUPANCY TYPE: TYPE . s.1:FLR AREA CONSTR. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) 11-B,111-B,IV,V-B 91 $994.00 IADDPLCK $963.00 IADDINSP TOTALS: 91 $994.00 $963.00 MECH,HOURLY 0 Yes No PLUMB,HOURLY O Yes Q No ELEC,HOURLY Q Yes Q No Mech. Plan Check Plumb.Plan Check Elec.Plan Check lrfech. Permil Fee: Plumb,Permit Tee: Llec•.Permit Fee: F Ocher -t- Riec'h. Insp. Ocher Plumb Insp. Lj O11rerGlec Insp. ET klech.fa5p.1-ee: Phdi)A lush. Fre: Elee.Insp.Fee: NOTE: This estimate does not include fees due to other Departments(i a Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). These ees are based on the prefintina information available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (Fee Resolulion 11-053 Eff 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $994.00 Select a Misc Bldg/Structure Suppl. PC Fee: (D Reg. Q OT 1 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $963.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0,00 PME Permit Fee: $0.00 Constrnclian Tax: ,ldinh istrative Fee: Q Work Without Permit? © Yes Q No $0.00 G) Advanced Planning Fee: PLLONGRNGR $11.83 Select a Non-Residential Q Travel Documentation Dees: Building or Structure i Strom Motion Fee: IBSEISMICR $1.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $1,971.33 $0.00 TOTAL FEE: 1 $1,971.33 Revised: 06/05/2012 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 931 new haven ct. DATE: 08/27/2012 REVIEWED BY: bobs. APN: BP4: "VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration 1 Repair PRIMARY SFD or Duplex PENTAMATION (GENRE USE: PERMIT TYPE: WORK deferred truss talcs. SCOPE Mcch.Plan Chea[ Phrnib.Phm Check Elec.Plan Check ,Wech.Permit Fete: Plumb.Permit Fee: Elec.Pennir Fee: Orher hfech. Insp. Odle?.Plumb Insp. Orher Elce.Insp. Lj ,1lech. Insp.Fee: Plumb.Insp.Fre: Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etr-). These ees are based on the prelinzina information available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes Q No $0.00 ® hours Plan Check,Hourly Suppl. PC Fee: Q Reg. Q OT 0.0 1 hrs $0.00 $532.00 1STPLNCK 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 CO)IS11710iOn TeU: Administrative Fee: O Work Without Permit? 0 Yes Q No $0.00 G Advanced Planning.Fee: $0.00 Select a Non-Residential G Travel Documentation Fees: Building or Structure � i Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.001 1 SUBTOTALS: $0.00 $532.00 TOTALFEE-T $532.00 Revised: 07/01/2012 per' -1 Building Department cV r--t Lyc . 7-0�-4 / City Of Cupertino `� 10300 Torre Avenue 4 08 -7 G$ 4zi 3 3 Gf e c. Pho;-.,cL01 Cupertino, CA 950I 4-3255 �c) Telephone: 408-777-3228 CUP ERT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 31 N Et'/ 14AV F CI PERMIT# 12 01 OWNER'S NAME: : L-t/I 9 PHONE# D -443-3 GENERAL CONTRACTOR: HC;t -e Lo,-j G0 7fZVrl"rr BUSINESS LICENSE# ADDRESS: r14 CITY/ZIPCODE: —[ 0-S 6 C49 1 "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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 6/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork r-1 rz-� Lam,0 Ccs r-,5700C a/ C,,— �9A 1141 Cement Finishing OR-e Lvz:�H 0 C Ti C 84 04 Electrical t—( p1ZL(-- G'-Or—t'S Z VC I04 2A 114 Excavation rl 0 ILF(¢Q-rq C-0 j 2V?T,G 41 1 4 Fencing P`f Flooring I Carpeting 1`1 p fz-C LY2� C� .� {z vz%�,.� �'La' 111.1 Linoleum/Wood Gy Glass/Glazing Heating Insulation M 0 fL.0 Lrq-r 14,it Lr Landscaping (A/L-5 j Ltx� 1 e Q2z:573 - Lathing Masonry Painting/Wallpaper /`�uM�L � !�2✓c�//�� d!� 11 Lr Paving r� Plastering Plumbing ct o t^--q fCc7 T?V6- 0.--4 8ZI1141 Roofing � �(� �> fz,/L j res 81111,4 Septic Tank Sheet Metal Sheet Rock Tile f z-C Cl'lq 0 GQ VZiQ Ll t/l7,J r� S'r2i�—�1�� Ow�er/ ont•actor Signature Date UTILITY RELEASE REQUEST FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL �V" GUPERTINO 10300 TORRE AVENUE -CUPERTINO,CA 95014-3255 (408)777-3228- FAX(408)777-3333•building aecuoertino.org PURPOSE For residential single family or duplex construction, there are cases where gas and electric utilities are requested to be released prior to the issuance of the certificate of occupancy. Upon approval from the building inspector, the City of Cupertino is allowing both utilities to be released prior to the final sign-off of the building. INSTRUCTIONS 1. Download this form at: ht!p://www.cupertino.orylindex.aspx?i)age=297. 2. Complete the form and obtain signatures from both the owner of the property and the primary contractor. 3. Fax, E-Mail,Mail or hand deliver the original signed form to: City of Cupertino Building Division Attn: Utility Release Request Forin 408-777-3228 office 10300 Torre Ave. 408-777-3333 fax Cupertino,CA 45014 buildin @cupertino.ore. 4. Schedule a Gas Meter Release inspection (4403)and/or Electric Meter Release inspection(4404). Please note, a Gas Test inspection (4506) is required prior to or at the same time of the Gas Meter Release inspection: BUILDING INFORMATION (Please complete the following information): APN , -//__ BLDG PERMIT#; DATE _ �3� l i t� r 1 31Gt/ CLI 3 SITE )I ' ADDRESS: 9 �-+-�1 I r r 1 r_'- L "L f 7/ /1� ''vl ^� "� ` 4 OWNER'S NAME:� ! PHONE M -768 // ` ' u S,l L W' I Jts FAX#: A o l' ; � MAILING ADDRESS(if different from site a dress): /� CONTRACTOR: I d '1i�\U 011 h e l i FAX# PHONE #: �I f) } ^Vr92 CONTACT: I -oil FAX#PHONE#: I1 I request the City to eleas my utily' 6s prior to obtaining a final inspection approval for the building. I fully understand the occupants of the building cannot ove(nto the f sidence until they receive all of the required final sign-offs and the City has issued a certificate of occu anc forth 'uildi , l Owner:........... ...... �...... . ......_..................... ........Print:.... /G7/......LQ ..Date:... fl pp Contractor:..........: ............. .'je.jYP...... Date:.17.4i.613.. UdliryReleasel7orm_2011.doc revised 08/09/11 CITY OF CUPERTINO BUILDING PERMIT INSPECTION CARD _ 1BIIILDINGADDRESS:931 iTEW HAVEN CT CONTRACTOR:TOM 6c SYLVIA LEY PERNHTNO:12010110 OWNER'SNAME:TOM & SYLVIA LEY 931 NEW HAVENCI' DATE ISSUED:04/16/2012 i WYNER'S PiJONE:40 a 9960 805 CUPERTINO CA,CA 95014AO23 PRONE NO: 1N�YECT;(rNS DATE IRSPI: r• r— - FL%g1JV I10NlP[F:RSIH.D.S. 7 BUILDING PERMIT INFO: BLDG ELECT' PLUMB MECH r'zr-'trtf GRa11ND � •i RESIDENTIAL COMMERCIAL r PA 1S13TBACK-CERT JOB DESCRIPTION: ADD 1,365 SQ FT I'0 IST F 2ND FLOOR, 359 SQ FT TO _ „OVERED PATIO, 126 SQ Fr TO COVERED BALCONY & 71 AUS1� J6ARAGI SLRCGUNIIE J� �� Q FT TO FRONT PORCU, REMODEL 1,087 SO FT THROUGH POUR NO GONCIArTE UNTIL A'BONT HAS 13EEN/SIGNED UNDERGRO'J1:DISLAB .ell UNDERGROUND PLUMBING v�+[fir. rJ i UNDMOROUND El,F.CTRICAL jDry\OT POUR I-LOOlk tJNTI1„180Vr.HAS BIi1:iti SIGNET] LINDERE.00RPLUMBING (j) l <_ .� Y''?y'_ •r'Y•:S ri UN -RFL00RMECHANICAL ; UNDERFLOOR r::.FCTRICAL 2 WILDLAND URBAN INTERFACE FIRE AREA r ERN UNDERFLOOR FRAMING VENTS TO ARRANGE.INSPECTION UNDERFLOOR INSUI AT ON I _ _ Call 777-3228 between 7:30 am and 3:30 pm Monday through Friday,at least 34 hours I1Ie1C1:itiUStJIIr'LOOIt UttiTILr1RU1cF:t1etS BEIENSIGNI'sD before required inspection.Job address and Permit Numbers are needed when ROOF SHFF PHTNG requesting a it inspection. RGllGIT FLl1M8MG � 3 CUPERTINO SANITARY DISTRICT 1 JBS I FHOWER PAN Closed circuit video inspection of property line cleanout,point of connection InciwolI MITRANICA[ and street lateral required prior to passing FINAL CITY"PLUNKING INSPECTION. Call the District(408-253-7071)far nn appuinttuent. 7.WtJGI I E-LI:C.rRI(':ALlP(7QL,L'�� Sli'ILIT<ilIR0.57AI sor,I:GRtwSS �[ ! NO BUILDING FINALS INSPECTIONS UNTIL ALL REQUIRED rn.i:1,�Tic�,.I,Vi N•ttA'f[nN I 1 BUSINL''SS LICENSES ARE OBTAINP:D �i;•�L ti;:v�,c:a�t i��t•rli.uu_.I,Il.as ttt:r•.0::ICNEn �m = - — ----•----- — -- - PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PF.HMIT ISSUANCE OR 180 DAPS FROM LAST CALLED INSPECTION. �Ir11'tit{I():�HEARRH'OLI)1)aWN _ �sttr.L:rP.e:.t:rsll�trtOCl:sHIiAR IMPORTANT I ii4�i i Vhen a permit has expired,a charge totaling one-half the fees to obtain anew permit vie FYTERIOR LATHAV-SCREED ��;I/IC,t�lC��1 be paid in order to reactivate the permit.if a permit has Leto es,ii art for more a'IIN OR 1-,%T14 t- 3 �/ than one year,a charge totaling the full fees to obt:+in a new permi! must�Ie paid _i?,a pp- lam L'W � ( 77 to reactivate the permit. ,NGT,AI'li OR PLASTER Uti r[I.A MI.HAS BEEN SIGNED SCIZA71 Fi COAT J, NOTES.A T•nr.Izrtvtr:CnreLrcrntlovtE cEtL -1 ALS tr":LNCTI,tcMETER RIaLEnsr: SPTCIALINSPEC711ONS Inspcetor: GAS7Ii5 I.•:TL R ItE M5L _ _ ROOF INSPECTIONS GRADE-PUBLIC, RKS PRE-INSPECTION:laspecinr- 0ate- IFIRE-CAI•i.(403)37h-:0I0 TEAR-OFF: ]nspmlor. Date —^-,--- PLANNING(408)777-3303 PLYWOOD: ]nspector: D,rrc• ]ANITARY NOR)253-7071 BA•[-GENS: Inspector: Date. rI ECTTRIC.AI._ — —` -- -- '4tGCI IANICAL IN PROGRESS: Inspector:_ Dale-_ •, 4 1?I.UM13fIJO FINAL: Inspector: — Date_ HANDICAP NOTE.NOTE:OSHA APPROVED ACCESS TO HOOF SIIALLBE PROVIDED FOR INSPECTION. f•.NERIiY •OCCUPANCY OF BUILDING NOT PERMY17ED UNTIL BUILDING FINAL IS SIGNED BY r1l Ill r1"ZG 1N51'FCI'Oit 'F771-11 ICA FEE 01;OCCUPANCY OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildina(cDcuoertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: 51 DRESSY r APN zz` r BP# OW�NAME t. O NEER ADDRESS l� e r Cif `i .t 1AtO DESCRIPTION OF WORM! ?r!! ?.1 7&'Z o L We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you,the property owner,obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIREONS:Please read and initial each statement below to signify you understand or verify this information.) IL 711. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Builder'building permit that erroneously implies that the property owner is providing his or her awn labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. 1 am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. TL'2. 1 understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 'iL 3. 1 understand as an "Owner-Builder" 1 am the responsible party of record on the permit. 1 understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit fled in his or her name instead of my own. K�4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. �5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors,and the total value of my construction is at least five hundred dollars($500), including labor and materials, I may be considered an "employer" under state and federal law. I–U I understand if I am considered an "employer"under state and federal law, I must register with the state and federal government,withhold payroll taxes, provide workers'compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. . I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. �—8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. Ownw1 BuilderForm1 2010.doc revised 04114110 L)_9. I understand I may obtain more information regarding my obligations as an "employer"from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors'State License Board (CSLB)at 1-800-321-CSLB (2752)or www.csib.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide y all applicable laws and requirements that govern Owner-Builders as well as employers. '12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint.Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property,you may be held liable for damages. if you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be isrel lo must be completed and signed by the property owner and returned to the agency responsiblng a permit. Note:A copy of the property owner's driver's license, form notarization, or other verificationle the city may be required to be presented when the permit is issued to vert the ro ert owner's si natu Property Owner's Signature: Date: .. --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OsrnerBuildeiFornr 1010.doc revised 04/14/10