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13070052 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21040 HOMESTEAD RD CONTRACTOR`fB' PERMIT NO: 13070052 OWNER'S NAME: HOMESTEAD CUPERTINO LP DATE ISSUED:08/21/2013 OWNER'S PHONE: 4087300808 Uh PHONE NO: 011- LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL LJ COMMERCIAL License Class Lic.# � T.I.FOR OFFICE BUILDING: ADA IMPROVEMENTS �_�,�l INCLUDING INSTALLING(N)WHEELCHAIR LIFT&ADA Contractor/7hV131� �i Date PARKING.PROVIDE ADDITIONAL STRUCTURAL I hereby affirm that I am licensed under the provisions of Chapter 9 SUPPORT TO (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$50000 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 APN Number:32607034.00 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 DAY F M 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 �3 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. f RE-ROOFS: Signature Date ' �< �j All roofs shall be inspected prior to any roofing material being installed.If a roof is / installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,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.I2 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 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: 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 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,1 must 1 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. Signature Date CONSTRUCTION PERMIT APPLICATION O(� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE.AVENUE•CUPERTINO, CA 95014-3255 CUPERTI NQ (40.8).777-3228• FAX(408)777-3333•building(a)cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESSn��/(o APN#7 32 a 0 r7 OWN ERNAME. tioI /� P LPHONE `OQpo p f/ r ft- (�� 3O�o Q d scv mv.Corr STREET ADDRESS r^D CITY, STATE,Zi� `'•, �. � FAX CONTACT NAME Sr �' G� PHONE NIV E-MAM STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER .❑ OWNER-BUBAER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBERLi CENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS . CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME� I LICENSE NUMBER /•� BUS.LIC# 5 COMPANY NAME �(M` �.�. �'rem1 E-MAIL l�/f!Q J,, v a r(�.u 5 FAX STREET ADDRESS 24(oo S 'hIS cam-$►-V P CITY,STATE,ZIP 4G �1 t�1 �ro PHONE 4„p DESCRIPTION OF WORK I� P�. 11,C>Pc Ar-Y—I N G & 19A)4046- 9 )4 46 Jr { 2. INSIAii, t_ lRLIFT � 3. ?RDvim: ��L- STRUC-mm SUPI'�t lb 2ND aR- �- �olv►ll� EXISTING USE PROPOSED USE CONSTR TYPE #STORIES D PEA 4,E I E, V_8t 1 USE TYPE OCC. SQ.FT. VALUATION(S) EXISTAREA GOkla _ l O .AREA FLOOR NEW �I r L� AREA NET AREA 4+ BATHROOM KITCHEN1 OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA F7DECK/PORCHAREA I GARAGE AREA: DETACH []ATTACH #DWELLING UNITS: IS A SECOND UNITYES SECOND STORY YES BEING ADDED? XNO ADDITION? NO PRE-APPLICATIONYES IF YES,PROVIDE COPY OF IS THE BLDG AN YES �`REtwE..IVED TOTAL VALUATION: PLANNING APPL A �NO PLANNING APPROVAL LETTER EICHLERHOME? �NO 50, 000 By my signature below,I certify to each of the following: I am the property owner or au agent t o property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it' accurate. I agree to comply with all applicable local ordinances and state laws relating to u'ding construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent Date: Chi -2L9 SUPPLEMENTAL lNFftMAT10N RE RED a a Q 11 ILA- New ,. RQUiInG�SLTP v' q New SFD or Multifamily dwellings: Apply for demolition permit for d bvER QurrrE � ' �BLai�,D�Ie�P>� ,RE existing building(s). Demolition permit is required prior to issuance of building permit for new building. ' ExpxE car vtEw ' i _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure flsr Agn �x[cs� form if any Hazardous Materials are being used as part of this project. I _Copy of Planning Approval Letter or Meeting with Planning prior to Cly oR � ® rrnx sEwEx TRIG submittal of Building Permit application, EIVVIRONI4IENTAL BEALTAs4 ,6} BldgApp_2011.doc revised 06/2U11 CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION ADDRESS: 21040 HOMESTEAD RD DATE: 07/08/2013 REVIEWED BY: MELISSA APN: 326 07 034BP#: � � *VALUATION: $50,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1B TI USE: PERMIT TYPE: WORK T.I. FOR OFFICE BUILDING: ADA IMPROVEMENTS INCLUDING INSTALLING N WHEELCHAIR SCOPE LIFT &ADA PARKING. PROVIDE ADDITIONAL STRUCTURAL SUPPORT TO 2ND FLR FRAMING OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. B (Tenant Improvements) II-B,111-B,IV,V-B 957 $2,071.77 IBTIPLNCK $1,035.59 IBTIINSP TOTALS: 957 $2,071.77 $1,035.59 MECH,HOURLY ® Yes (F) No PLUNK,HOURLY 0 Yes Q Na kLEC,HOURLY Q Yes Q No �+ t „gin ;._ xr_,. F„Or:,r'-zt � . El Li LJ L NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,eta). Theseees are based on the relimina information available and are onlyan estimate. Contact the Dept or addn'l info. FEE ITEMS (Fee Resolution 11-053 Elf 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $2,071.77 Select a Misc Bldg/Structure Suppl.PC Fee: (E) Reg. Q OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $1,035.59 Suppl. Insp.FeelD Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conz,!rtt,non Tcn'. Work Without Permit? 0 Yes 0 No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) Building or Structure ©i Strong,Motion Fee: IBSEISMICO $10.50 Select an Administrative Item Bld&*Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $3,119.86 $0.00 : TOTAL FEE: 1 $3,119.86 Revised: 07/01/2013