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13080205 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 101 ION DE ANZA BLVD CONTRACTOR:HOUGH CONSTRUCTION PERMIT NO: 13080205 CO INC OWNER'S NAME: ROMAN CATHOLIC BISHOP OF SAN JOSE, 303 LINT)A DR`-■ DATE ISSUED: 12/10/2013 O : NER'S PHONE: 4082527653 HOLLISTER,CA 95023 PHONE NO:(831)636-5827 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COhIM11ERCIAL p/ / REMOVE(E) CONCRETE SLAB. CONSTRUCT(N)ADA License Class_ Lic.# -V!p O 6 8 - RAMP, Contractorp4uL 0uq Date 3 aeyq (m BASTISMAL FONT(LESS THAN 16" DEEP)COMPLETE ri WITH PLUMBING,HEATER,FILTER&PUMP.MODIFY I hereby affirm that I am licensed under the provisions of Chapter 9 � r (commencing with Section 7000)of Division 3 of the Business&Professions REVISION#1-REP.41!1f2r1F16NELL-ISSD OTC 3/26/2014 Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 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. DA - -F or Area: Valuation:$25000 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:31626096.00 Occupancye: permit is issued. Type: APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.1 agree to comply with all city and county ordinances and state laws relating WITHIN 18Q D YS OF PERNIIT ISSUANCE OR to building eonstruction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 1$0 DAYS F OM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, I costs,and expenses which may. crue ainst sai yin consequence of the granting of this rmi. Additi l , e appli E nderstands and will comply Issued by: Date: III with all non- int s rce reg io § er the up ino Municipal Code,Section 9.18. RE-ROOFS- Si ttu ..a^•. Date 7 All 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 I hereby affirm that I am exempt from the Contractor's License Lawfor one of Signatrue of Applicant: Date: the following two reasons: ALL ROOF COVERMGS 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 tinder 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 . Ar r Qualit,Management District 1 performance of the work for which this permit is issued. will maintain compliance with a per unic' al ode,Chapter 9.12 and I have and will tnaintain Worker's Compensation Insurance,as provided for by the Hcalih&Salpty Code,Se ' ns 25 533, t 5534. Section 3700 of the Labor Code,for the performance of the work for which this 0 "er••or aulft�o V agent Date permit is issued. certify that in the performance of the work for which this permit is issued,l 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 certify that 1 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 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION W"PERMIT DDRESS: 10110 n de anza DATE: 03/2612014 REVIEWED BY: MENDEZ PN: BP##: 13080205 `VALUATION: $2,900 PE: Building Permit PLAN CHECK TYPE: Alteration 1 Repair PRIMARY SFD or Duplex PENTAMATION 1GENRE USE: PERMIT TYPE: WORK revision#1- repair d well SCOPE VVLI) Plan['hur6 Pluarh Plan('11et6 Flea. Platt Check Aleclr. Per'nrit!i+e' F'lnmh. Perrnir Fee: Llcr Permit Fee: Urhe•r•afech. Insp prltrr Plumb Insf). Other Fler.Insp. Hoch Lisp. F,'P' Phanh. lwp. Fee- Elec Insp.Frac" NOTE.This eslitnale does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sever District,School District,etc . Thesefees are based on the prefindna ir: ornration available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS free Resolution 11-053 Eff 711113) FEE QTYIFEE MISC ITEMS Plan Check Fee: Hourly Only? O Yes Q No $0.00 1 hours Plan Check,Hourly Suppl. PC Fee: Q Reg. Q OT LLhrs $0.00 $139.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: Hourly Only? Q Yes Q No $0.00 Suppl. Insp. Fee-.Q Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C'orisirrtrtion Tax: flchninistrolive Fee: Q Work Without Permit? O Yes Q No $0.00 0 Advanced Planning-Fee: $0 00 Select a Non-Residential Q Travel Dounmentation Feces: Building or Structure O i Strong-Motion Fee: IBSEISMICR $0.50 2.0 hrs Inspections Bldg Stds Commission Fee: 1BCBSC $1.00 $278.00 1STINSP Inspection,Hourly SUBTOTALS: $1.50 $417.00 TOTAL FEE: Revised: 01115/2014 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILOLNG DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUP>=RTINO (408)777-3228• FAX(408)777-3333•building(ftugertino.ora ❑NEW CONBTRI_ICTION ❑ ADDITION ❑ ALTERATION 1 TIREVISIO 1 DEFERRED ORIGINAL PERMIT PROJECT ADDRESS, APN tl �do 31(- --� (r, -o (t6 ER NAMEPktO - E•MA1L �kt� oi„�. x:54 a rata 5�5 "33! 6 z� STREET ADDRESS CITY, STATE,ZIP FAX w"2/A- v c '7`-r; c, CO N �E 0 (Lk�` E-MAIL STREET ADDRESS C TY,STATE,ZIP U �n FAX 6-13 ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCH= ❑ENGINEER ❑ DEVELOPER ❑ TENANT RACT AME LICENSE NUMBER LICENSE TYPE BUS.LIC 9 MPANY NAME EMAIL FAX C 1 rel STREET HDRESS CITY,STATE,ZIP QNE (03 ARCHITECT/ENGrNEER NAME LICENSE NUMBER BUS.LIC H COMPANY NAME EMAIL FAX STREET ADDRESS (r' CITY,STATE,ZIP PHONE D PrIO OFWORK��S?� QW DJ_ W" L W Lt— EXISTING USE PROPOSED USE CONSTR,TYPE I I STORIES USE TYPE OCC- SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KTTCHEN OTHER REMODELAREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: LJ DETACH []ATTACH 4 DWELLING UNITS: ISASECONDUNIT ❑YES SECONASTORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION []YES IF YES,PROVIDE COPY OF ISTEIEBLDGAN ❑YES RECEIVFD,RY-' T .AI T[ON: PLANNFNGAPPL k []NO NO PLANNING APPROVAL LETTER EICHLER HOME? IJ NO �. C) By my signaturc below,I certify to each of the following: I am the property owner or authorized age o act on theTAperty owner's behalf. I ave read this application and the informatiopgdu�ildiii ed i correct I have read the Description of Work and verify it is accurate, I agree to comply with all applicable local ordinances and state laws relac tructio . out rize representatives of Cupertino to enter the above-identified property for inspection purposes. Signatur g nUAgent: Late. z� '� L 6 C> ELEMENTAL INFOItMATI N IRED PLAN CIIECK TYPE ROUTING SLIP - _New SFD or Multifamily dwellings: Apply for demolition permit for 1OIIIr VER-TCOUN1'ER - El BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building I - - permit for new building. ❑ EaPRESS ❑ PLANNING PLAN REVIEW- _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STAND ❑ PUB_LICWO_RKS form if any Hazardous Materials are being used as part of this project. '- 0 LARGE, ;`' ��ElFIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior toEl MnroR ❑ SANITARY SEINER DISTRICT ' submittal of Building Permit application. ❑' ENVIRONMENTAL HEALTH BldgApp 2011.doc revised 061W11 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10110 N DE ANZA BLVD CONTRACTOR:HOUGH CONSTRUCTION PERMIT NO: 13080205 CO INC OWNER'S NAME: ROMAN CATHOLIC BISHOP OF SAN JOSE, 303 LINDA DR DATE ISSUED:17/10/2013 OWNER'S PHONE: 4082527653 HOLLISTER,CA 95023 PHONE NO:(831)636-5827 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL License Class } ` Lic.N L REMOVE(E)CONCRETE SLAB.CONSTRUCT(N)ADA RAMP,(N) BASTISMAL FONT(LESS THAN 16"DEEP)COMPLETE WITH PLUMBING, o[�� Contractor N � "h .L,�^ Date J� a.:. ( HEATER,FILTER&PUhIP.MODIFY SURROUNDING AREA :J „w�r � I 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 perjnry one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's ompensalion,as provided for by Section 3700 of the Labor Code,for the crfonnance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:525000 Lr' 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:31626096.00 Occupancy e: permit is issued. p y Typ . 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 DAYS F 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 by: Date: Z 10 with all non-point source regulations pe the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signat Date ; 0.. } All roofs shall be inspected prior to any roofing material being installed;if a roof is installed without first obtaining an inspection,l 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 of4'ered for'sale(See.7044, Business&Professions Code) 1,as owner of the property,am exclusively eontraeting with licensed contractors to HAZAIJDOUS MATERIALS DISCLOSURE construct the project(Sce.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 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&Safcty Code,Sections 25 O5,25533,an 25534. Section 3700 of the Labor Code,for the per of the work for which this Owner or authorized agent: Dal permit is issued. I certify that in the performance of the work for which this permit is issued,l 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 LEMQING 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 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 to building construction,and hereby authorize represenratives 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 1 understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date l CONSTRUCTION PERMIT APPLICATION O l/ COMMUNITY DEVELOPMENT DEPARTMENT' BUILDING DIVISION O� 10300 TORRE AVENUE'CUPERTINO, CA 95014-3255 CUPERTINO 1 (408)777-3228' FAX(408)777-3333'buildinciftcutiertino.ord l ❑NEW CONSTRUCTION� .096❑ ADDITION ALTERATION/TI ❑ REVISION I DEFERRED ORIGINAL PERMIT 4 MP15RTv1 PiiQA• _ E-h1AlL' { IC a w W� 27 3 5 C T 5 >r ST tT ZiER 8 �"-'- C[TY,STAT ,ZIP FA �1` © N . C �I'�aM- 252-52 3 N 4 4N VNLT Pti6NE (, SZ1 CMA^- Y�1 civl a tri STREET ADDRESS CITY,STATE,ZIP FAX )5I-CvLQ os G� s 13Wloq-2 Lv G G.-L4s C -T50 ❑OWNER ❑ OWNER-BUILDER 1�0OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT 4 ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT C� CENSE NUMBER LICENSE TYPE HUs.LIC 71 ?�b)Of,- (TOO�lt bC5740 COMPANY NAM pE-MAIL FAX IJ STREET ADDRESS CITY,STATE,ZIP PHONE ARCHTTECTIENGINEER NAb1E LICENSE NUMBER BUS.LIC k COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE D oatit: V1 ?1 itit 91lm 1 � its l 0+'I-- t " c "x lj�y USE PROPOSED USE^ CON �E 4 ST (/'`l S V USE TYPE OCC. SQTT, VALUATION(S) ]tSS7G OR DEMO TOTAL AREA ! a �REA AREA AREA NET AREA IPJI'wwt 1 i/X/.�1 f BATHROOM KFICHEN OTHER REMODELAREA REMODEL AREA REMODEL AREA ORCHAREA DECK AREA TOTALDECKIPORCHAPEA GARAGE AREA: DETACH Ll ATrACH lybWELLING UNITS: ISASECONDUNrr []YES SECONDSTORY LYES :f REINCAODED? []NO ADDITION? []NO L�J PRE-APPLICATION []YES IF YES.PROVIDECOPYOF IS THE BLDG AN [I YES ''RECEIV _ �POTAlibA.l4A�f'Ifdi7} PLANNINGAPPLN ❑NO PLANNING APPROVAL LETTER EICHLERHOMS? NO By my signature below,I certify to each of the following: 1 am the property owner or authorized agent to act on thefitperty 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 is accurate. I agree to comply with all applicable local ordinances and state laws relating to b ilding con c ion. l authorize representatives of Cupe the above-identifieddproperty for inspection purposes. ;S rug ute_o# 15 11�a t�A� n:t p7ut ' r 9-7 , SUPPLEMENTAL INFO ATION REQUIRED PLASCHECK.,TYPE 1tOUTING'SL1P New SFD or Multifamily dwellings: Apply for demolition permit for "El. OVER-rHE-COUnTER 0,-BUILDINGrLANREV-IEW existing building(s). Demolition permit is required prior to issuance Of building F permit for new building, In ETPRESS. ,r 0� PLANNIHG`1AN,AEVIEV � � •! _Commercial Bldgs: Y`Provide a completed Hazardous Materials Disclosure STAIVDAlkh" �a form if any Hazardous Materials are being used as part of this project. Z7. ❑,S.ARGE-1 -Q"%FIRE'IIEPT, 'iI _Copy of Planning Approval Letter or Meeting with Planning prior to ,= I submittal of Building Permit application. aIAIOSL D SANITARY•SEI- D15TRICTJ [1+,ENV1FCdWFNTAL HEALTH. ,. BldgApp_2011-doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10110 N DE ANZA BLVD DATE: 08127/2013 REVIEWED BY: MELISSA APN: 316 26 096 BPtI: 47D&�Q� 'VALUATION: $25,000 *PERMIT TYPE: Building Permit PLAN CHECKTYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1ATI USE: PERMIT TYPE: WORK REMOVE E CONCRETE SLAB. CONSTRUCT N ADA RAMP N BASTISMAL FONT LESS THAN SCOPE 16" DEEP) COMPLETE WITH PLUMBING, HEATER, FILTER & PUMP. MODIFY SURROUNDING 13 OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. A (Tenant Improvements) II-B,III-B,IV,V-B 511 $2,369.56 1ATIPLNCK $615.14 IATIINSP TOTALS: 511 1 $2,369.56 1 $615.14 MECH,HOURLY 0 Yes 0 No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY Q Yes Q No Mech, Plan Chcek Phuarb, Plun Check Elec.Plan Check Mech. Per•nalr Fee: Plumb. Perna!1-cc: (Tec.Permlr Fee: Orlro-Mech. Insp. other Phimb Insp, Orher•Fice.Insp. 11cch.hasp.here: Phanrb.hap. Fee: Elev.Insp, Fere: 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 flee prefindna information available and are only an estimate Contact the De t or adain'1 info, FEE ITEMS(Fee Resolution 11-053 Eff 7/1/121 FEE QTYIFEE MISC ITEMS Plan Check Fee: $2,369.56 Select a Misc Bldg/Structure Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $615.14 Suppl. Insp. Fee-.Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construclior Ten-: A din iniso-afive Fee: Q Work Without Permit? 0 Yes Q No $0.00 (D Advanced Planning,Fee: $0.00 Select a Non-Residential G) Travel Doemnenlation Fees: Building or Structure O A Strong Motion Fee: 1BSEISMICO $5.25 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 7 SUBTOTALS: $2,990.95 $0.00 TOTAL FEE: $2,990.95 Revised: 07/01/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT 1 N O Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: 1 D11 p /U . PERMIT# 3og o Zo OWNER'S NAME: R )"gy C L e. ONE# 2 3 — GENERAL CONTRACTOR: lac• s— BUSINESS LICENSE# ADDRESS:3d3 411L,,t9,4 D F 9�s CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL 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: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing FIooring/ Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting 1 Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile �-=��� Owner/ ntractor 'gnature Date C Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Lo C U P S RT I N O Telephone:408-777-3228 Fax:408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: "j p I pp, Q_ p PERMIT# 1Z0 OVVNER'S NAME: (0L5 9,0 r7 p ,S' , PHONE# 3l�G 3G-- GENERAL CONTRACTOR: UG Citi& BUSINESS LICENSE# ADDRESS: 3ba L 02,g b CITY/ZIPCODE: "Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION{S} WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL 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: fjPIZ> ✓ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE# Cabinets & Millwork 448 u C'-r¢ �"D SUS -(_'n .E; a ? j/ Cement Finishing �], & A. Tv ZZ j --e r Electrical jlG C s' V Excavation ti '3 Fencing Flooring/Carpeting Linoleum/Wood Glass /Glazing Heating Insulation Landscaping Lathing C0)- 2rLT r C. _ rY Sn L, a U r L o m o D oA) 1 q L Painting/Wallpaper 1—�o u 6 14 Zvtt-&' Paving Plastering Plumbing (�A Roofing Septic Tank Sheet Metal Sheet Rock a f* Cb fir- " �v -.c S Tile 4 o L4, e o AJL7. hq4j je. egt�n'� — 3/ 2©tom Owner/tonfiracior Sign re ill, Date UNREASONABLE HARDSHIP EXEMPTION FORM-1' =� 1� , COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E.,C.B.O.,BUILDING OFFICIAL 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255': CUPERTINO �. (408)777-3228•FAX(408)777-3333-buildingf@cupertino.org For Tenant Improvements where the Cost of Construction does not exceed $136,060.00 SITE ADDRESS APN 316-26-096 BP# _ 10110 North De Anza Blvd. 1:7�1060205 CITY CU ertino zip 95014 TOTAL CONSTRUCTION COST A $...0.!0.0.0........ DESCRIPTION OF WORK: INTERIOR MODERNIZATION OF THE CHURCH'S BAPTISMAL FONT AND ALTAR The following Is a list of costs to provide access features in order to comply 100%with the current State Title-24 Disable Access Standards.(All costs to be documented by actual bids or other information accepted by the Bul ding Official. Accessible Features Complies with If not,list required upgrades in order for Cost to make feature current standards? features to fully comply? fully accessible? 1.Path of travel to accessible entrance. No Addition of Truncated Domes between $ 27,120 vehicular and pedestrian traffic 2.Cost of providing a primary entrance. (Including but not limited to,thresholds,landings,door hardware, Yes $ max.door pull,etc. 3.Cost of providing the primary path of travel to the specific area of alteration,structural repair,or Yes $ addition. 4.Cost of providing accessible restroom facilities. Yes $ 5.Cost of providing an accessible drinking fountain. (If Yes $ required or if a drinking fountain Is provided.) 6.Cost of providing accessible public telephones(if Not Required $ provided) 7.Cost of providingiot 6.,accessible features,including but not limited 10,prjtng,�storge�;=al.�rSnSslc. Yes 0 $ ■ a ji� TOTAL COST OF ACCESS FEATURES(B): $ 27,120 L;U 'YY . Jf Has the same tenant performed work in the Yes � ° same tenants ace within the last three ears? ; Calculate(B!A)x 100/0 30 /o Description of access features to be provided: none x �p TOTAL COST OF rT PERCENTAGE (20%minimum ° PROPOSED UPGRADE $ expenditure is re uired) 0 /° ARCHITECT OR ENGINEER OF RECORD INFORMATION: I certify that a above n d information is true and correct. Name(print): Tanya Guerrera Signature: Date: 2 �� Firm address: 15466 Los Gatos Blvd.#109-260,Los Gatos,CA 9503?itie: Ar h tec Phone: 408�f58 0852 ------_— ----------- — FOR DEPARTMENT USE ONLY -----------_.__---------- �_-,._ ❑ The above named project has been denied an unreasonable hardship exemption under 2010 CBC Section 1134B.2.1. ❑ The above named project has been granted an unreasonable hardship exemption from the requirements of the State of California CCR-Title 24 (Regulation for the Accommodation of the Disabled)pursuant to 2010 CBC Section 1134B.2.1. COMMENTS:SIT151 S V l!&La .. 54PX7 AL01 &4OWS;S L) I0-� 650 s' OST oa at4iL sr GL,& IT t- S '1- 200 a� I 0 Ca Building Official Designee(print): Ar�LZ> Signature: Date: �� f3 HardshipExemptionFonn 1012,doc revised 06/15/11