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13090091 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20303 CLIFDEN WAY CONTRACTOR:MICHELLE KIM PERMIT NO: 13090091 OWNER'S NAME: MICHELLE KIM 20303 CLIFDEN WAY DATE ISSUED:09/12/2013 OR'NER'S PHONE: 4086212923 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL0 License Class Lic.tI BATHROOM REMODEL 68 SQ FT,ADD WALL TO TO MASTER Contractor Date SUITE,AND BEDROOM,REPLACE WINDOW ON 2ND I hereby affirm that I am licensed under the provisions of Chapter 9 FLOOR (commencing with Section 7000)of Division 3 of the Business&Professions ADD 50 AMP SUB PANEL Code and that my license is in full force and effect. 1 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:$35000 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:36935040.00 Occupancy Type: permit is issued. 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 80 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DA F OM 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 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 Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this e/ permit is issued. Owner or authorized agent:-Llt,�- tic r Date: 1 certify that in the performance of the work for which this permit is issued,1 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 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 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 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 Dated i Z-/Z--1 3 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20303 CLIFDEN WAY CONTRACTOR:MICHELLE KIM PERMIT NO: 13090091 OWNER'S NAME: MICHELLE KIM 20303 CLIFDEN WAY DATE ISSUED:09/12/2013 OWNER'S PHONE: 4086212923 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL License Class Lic.# BATHROOM REMODEL 68 SQ FT,ADD WALL TO TO MASTER SUITE,AND BEDROOM,REPLACE WINDOW Contractor Date ON 2ND FLOOR ADD 100 AMP SUB PANEL I hereby affirm that I am licensed under the provisions of Chapter 9 REV#1 -MOVE PROPOSED WALL AT BEDROOM#3- (commencing with Section 7000)of Division 3 of the Business&Professions ISSUED 10/9/13 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:$35000 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:36935040.00 Occupancy Type: permit is issued. 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 IT 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 �1G LLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of thet� granting of this permit. Additionally,the applicant understands and will comply s y: Date: lC) / Zz.3 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 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 Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: /%/—. Date:/a-F�3 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,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 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 AI' /bDate �— �� CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20303 CLIFDEN WAY CONTRACTOR:MICHELLE KIM PERMIT NO: 13090091 OWNER'S NAME: MICHELLE KIM 20303 CLIFDEN WAY DATE ISSUED:09/12/2013 OWNER'S PHONE: 4086212923 CUPERTINO,CA 950I4 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL 13 License Class Lic.# BATHROOM REMODEL 68 SQ FT,ADD WALL TO TO MASTER Contractor Date SUITE,AND BEDROOM,REPLACE WINDOW ON 2ND I hereby affirm that I am licensed under the provisions of Chapter 9 FLOOR ADD 100 AMP SUB PANEL (commencing with Section 7000)of Division 3 of the Business&Professions REV#2-SUPPORT DETAILS FOR(E)FULSH BEAM, Code and that my license is in full force and effect. CORRECT(E)WALL LOCATION& ADD PREVIOUS I hereby affirm under penalty of perjury one of the following two declarations: REDLINES-ISSUED 10/29/13 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:$35000 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:36935040.00 Occupancy Type: pen-nit is issued. 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 AS ALLED 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 /0 granting of this permit. Additionally,the applicant understands and will comply 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 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 Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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. 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 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 permit is issued. Owner or authorized agenif � Date 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,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 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. / Signatur _c_>/ j Date ` � CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE -CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333- build ingCa.cupertino.org CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION © ALTERATION/TI EVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS C I , clL n IN o� APN a �Z6 �S -O L ONRJER M IAME G{���I e 1 � PFl4aONE r � 6 Z r-z q Z3 E-MAIL e I �M1� 0-h .c.Q+r] 5TRM ADDRESS CITY, STATE,ZIP FAX ZO 303 CONTACT NAMEPHONE all- W kle IZ C_ o6 37o-mad ,� s earl STREET ADDRESS CITY,STATE, ZIP FAX 8a N 411-v) At fr wo 408 370- 971(, 17b�c,n�iz ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AG ENT I( C'I- ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE AMELICENSE NUMBER /�/� BUS.LIC# COMPANY NAME E-MAIL FAX S af+7�irttif0 t/1M eD��l 0 370 STREET ADDRESS CITY,STATE,ZIP PHONE i YF .zt2 R• e— 408 370 3.1" DESCRIPTION OF WORK flTH 0.-1 NO la AM 5u N 3r,P",Vm -ro sTdlSE Sim& F i6-f 1ZV5; &Jk-G EXISTING USE PROPOSED UCONSTR.TYPE #STORIES s " I-,,l M V6 () 2 USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA ` AREA 3�d[�.I L AREA NET AREA BATHROOM KITCHEN OTHER REMODEL ARL-L o 3 / REMODEL AREA REMODEL AREA � PORCH AREA DECK AREA TOTAL DEC ORCH AREA GARAGE AREA: DETACH .4#1. 91 p ATTACH #DWELLING UAYTS: IS A SECOND UNIT ❑YES SECOND STORY []YES BEING ADDED? ®NO ADDITION? ®NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES 'EIV E-D ON: PLANNING ADPL# [5�NO PLANNING APPROVAL LETTER EICHLER HONIE? ®NO By my signature below,I certify to each of the following: I am the properly owner or authorize agent to ac on the property owner's behalf. 1 have read this application and the information I have provided is correct. 1 have read the Description of Work and verify itis accurate. I agree to comply with all applicable local ordinances and state laws relating to buil ns r ction I utI presentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: �f7 P SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW existing bwIding(s). Demolition permit is required prior to issuance of building permitfor new building. 1:1 EXPRESS El PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 1:1 STANDARD El PUBLIC N'ORKS To—mi 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 ❑ mt WOR ❑ SANITARY SEN ER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doe revised 06121111 CONSTRUCTION PERMIT APPLICATION 12 COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228• FAX(408)777-3333•building(a)cupertino.org �-7 /� ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI REVISIO DEFERRED ORIGINAL PERMIT tl �(/ (/o PROJECT ADDRESS ZO 3 D 3 CU,r ' )(/A r APN H OWNF,RNAME 1l / e—l" PHONE 44- /Zl— �a E-MAIL STREET ADDRESS S�aM r C,T S]'fjTF,.�l�(,�NO CONTACT NAME �i �PHOONNE`/ E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �j 9LICENSE NUMBER LICENSE TYPE BUS.LIC d COMPANY NAME ( f> E-MAJL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCFBTECT/ENGNEER NAME LICENSE NUMBER BUS.LIC d COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK �1-6)444;rtl l (OF A jiveniavi tv4.4— bag nAu.7 �Slo.AN EXISTING USE PROPOSED USE CONSTR.TYPE d STORIES USE TYP OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA �! BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDETACH ❑ATTACH k DWELLING UMTS: IS A SECOND UNIT ❑YES SECOND STORY ❑VES BEING ADDED? []NO ADDITION? ❑NO PRE-APPLICATION OYES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES TOTAL VALUATION: PLANTING APPL N n NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO r00 By my signature below,I certify to each of the following: I am the property owner or authorized o act on t e property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work nd verify it is accurate. I agree to comply with al I applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. S40mm;t3'fApplo-eaDVAS-t~ -� � Date: /D— 9— Z.Ol_3 SUPPLEMENTAL INFORMATION REQUIRED PLAN CnECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building OVER-THE-COUNTER El BUILDING PLAN REVIEW permit for new building. ❑ EXPRESS ❑ PLANNING PLAN RENEW 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 Cl FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SERER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH- B1dMpp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20303 CLIFDEN AVE DATE: 10/09/2013 REVIEWED BY: MELISSA APN: 369 35 040 BP#: 13090091 `VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION USE: PERMIT TYPE: WORK REV# 1 - MOVE PROPOSED WALL IN BEDROOM # 3 - ISSUED 10/9/13 SCOPE IV('al c'ri<.ck lVe0 ib. Puri chccr', i_lec. 0co(Cheek �fech. Pernjit Fee Plumb. "r rmit lee: Elec. Permit Fee: Other Meeh.Insp. Other Plumb Insp. :%.;=cr`Elea. Insp. Li i9<ech.Insp.Fee: Phimb. hasp. Fe Elec.Insp, Fee., NOEL: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District etc.). Thesefees are based on the re[imina information available and are only an estimate Contact the Dept or addn'!in o. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C"onso-action Tax Administrative Fees: 0 Work Without Permit? Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential E) Travel Documentation Fees. Building or Structure 0 Strom Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 1 F- SUBTOTALS: $0.00 $0.00 TOTAL FEE: $0.00 Revised: 10/01/2013 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: Zp 3 O 3 � l�t-t DATE: REVIEWED BY: APN: BP#: 3 �O J "VALUATION: Iso *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK SCOPE Ak A V � .1Z x"01. Plo, /'boob. Plan UFiec! Elec. Plan Chet;k Permit fe". Plumb. Permit Fee: Plec. Permit Other Mec'h. Insp, F Other Plumb Insp. Other Glee. Insp Meeh. Insp. Fcx Plumb. hisp. rec. Glue_Insp. Fee NOTE: This estimate does not include fees due to other Departments(4e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These ees are based on the prelfiinmdinar information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? ©Yes Q No $0.00 1 hours Plan Check, Hourly Suppl. PC Fee: C) Reg, Q OT 0.0 hrs $0.00 $139.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.-O Reg. Q OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: 77— ,4dministrative,Fee: Work Without Permit? 0 Yes Q No $0.00 E) Advanced Planning,Fee: $0.00 Select a Non-Residential Travel Documentation Fees. Building or Structure Strong Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 SUBTOTALS: 1 $0.001 $139.00 TOTAL FEE: $139.00 Revised: 10/01/2013 CONSTRUCTION PERMIT APPLICATION PCOMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION " Y 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINQ (408)777-3228• FAX(408)777-3333• building@cupertino.org 1� ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/T1 ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS :,0303 CL1 FiJr-:--.v4 \..A./ 7APA �/ _�jV040 OWNER NAME oo PHONE (® / E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX (,'Li F Q6)4 W TTN O1 CONTACT NAME PUONE E-MAIL A � 7� 40 z C401-1 STREET ADDRESS CITY-STATE,ZIP FAX E30 u Avb sc6 2g e r_1AEu LA civ 0E) 37Q-ci796, 0e51e„erVA- ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR 1:1 CONTRACTOR AGENT 1R,.,W4UTEe4 ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE Alte.lfffEe4� NGMEE AME LICENSE NUMBER ` ,1 BUS.LIC M D,-544N614; i� GIG r�i COMPANY NAME E-MAIL FAX FySI��P c +7 6 sra (21 . �a� L5,-0-9,% STREET ADDRESS y�J ) /1',L�IA�) j�YG ��' �'`�� CITY,STATE,ZIP PHONE k/L/ (9 CAM 36u C, a8 I 370--33U DESCRIPTION OF WORK �GV� '�ItCI-� oo n•�-� l fli-i7 900M 12 000GL STO-*L4c C 9yo CG ti vSiY�N 7"' A a 1�DYl CLOS Mo CL 7D a t n . RGr1e t, W r—)X-& 102.4& $ 9-6MODCi— Or— A A s:,'FQ tis ZU(al,'1 0 7WO SMICY Si"4,,6 I 2 Es i o 6w cE. EXISTINGUSE PROPOSED USE CONSTR.TYPE 1 9STORIES USE TYPE OCC. SQ.FT. VALUATION(S) - EXISTG NEW FLOOR DEMO TOTAL AREA36&,q.,)1AREA +:55i 4 I AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA r,11C PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH J[(4'4(41,11 [.ATTACH A DWELLING UMTS. IS A SECOND UNIT ❑YES SECOND STORY []YES I BEING ADDED? fRNO ADDITION? CaNO JL PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES WC EJWDY: d r_T95, AL VALUATION: PLANNING APPL O ®NO PLANNING APPROVAL LETTER EICIILER HOME? ®NO �V, / Ow`0.f' -.&J 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 have read this application and the information I have provided is correct, I have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating to 4i1chng construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature ofApplicanUAgenC Date: 0a1i:Z/'_3 SUPPLEMENTAL INFORMATION REQUIRED PLAN CIIECK TV PF ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ER-THF-COUNTER I3inLD►NG PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of build' permit for new building. ❑ EXPRESS ANNING PLAN REVIEW ___Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ElSTANDARD ElPUBLIC 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. ❑ ENVIRONMENTALIIEALTII BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 9580 ASTER LN DATE: 09/92/2093 REVIEWED BY: MELISSA jail APN: 36616 039 BP#: zji 'VALUATION: 1$25,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1R3SFDREM USE: PERMIT TYPE: WORK REMODEL MASTER & HALL BATHS NO STRUCTURAL CHANGES. NEW VANITY TILE SHOWER SCOPE TUB, OUTLET RECEPTACLES & LIGHTING I iun(hC;J Nfech. Pe:rnrit Fee Plumb, Permit Fee: -lec. Permit Fee. Either Afech.Insp. E]_L_ EJther Plumb InspE17-- 0'':' %:'c. hu'r) Li Alex-h. bzsp.Fee Plunth. htsp. Fee. Eler. Imp,Fee: NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works, Fire,Sanitary Sewer District,School District,etG). Theseees are based on the prefimina in ormadon available and are only an estimate. Contact the De t or addn'l info, FEE ITEMS (Fee Resolution 11-053 Gff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 108 1 s.f. Remodel,Bath(<=300 sf Suppl. PC Fee: (j) Reg. 0 OT 0.0 1 hrs $0.00 $626.00 IREMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.0 Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conswitetion Tax: , dininistrative Fee_ 0 Work Without Permit? 0 Yes (F) No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential 0 Travel Doewnentation Fees: Building or Structure 0 Strong Motion Fee: IBSEISMICR $2.50 Select an Administrative Item Bldg Stds Commission.Fee: IBCBSC $1.00 SUBTOTALS: $3.50 $626.00 TOTAL FEE.-T $629.50 Revised: 08/01/2013 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20303 clifden way DATE: 09/12/2013 REVIEWED BY: Mendez APN: BP#: 'VALUATION: 1$35,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1R3SFDREM USE: PERMIT TYPE. WORK bathroom remodel 68 sq ft add wall to to master suite and bedroom replace window on 2nd floor add SCOPE 50 amp sub panel 1`amb. Plan Check Elec. Plan Check 0.0 1 hrs $0.00 p_ Permit Fer: PTumh.Permil Fee: Elec.Permit Fee: IEPERMIT OzheF a9erh. Insp Plumb Insp. Li Other Elec.Insp. 0.0 hrs $47.00 Ilech. In.,p. IF,tie: Pl:mtb. Insp. Fee: Elec.Insp. NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Thesefees are based on the preliminar information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 ETf 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 L_L8_j s.f. Remodel,Bath(<=300 sf) Suppl. PC Fee: Q Reg. Q OT0.0 hrs $0.00 $626.00 IREMRESBAT PME Plan Check: $0.00 105 1 s.f. Remodel,Other Permit Fee: $0.00 $418.00 1 1REMRESOTH Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 50 amps Electrical PME Unit Fee: $0.00 $47.00 1BELEC200 Services PME Permit Fee: $47.00 Construction Tar: Administrative Fee: IADMIN $44.00 0 Work Without Permit? 0 Yes (E) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) Travel Documentation Fee: ITRA VDOC $47.00 Building or Structure 0 i Strong Motion Fee: IBSEISMICR $3.50 Select an Administrative Item Bldg Stds Commission.Fee: 1BCBSC $2.00 SUBTOTALS: $143.501$1,091.00 TOTAL FEE: F$1,234.50 Revised: 08/01/2013 OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333•building(d_cupertinc.crg 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: SITE ADDRESS APN BP# :2030,r C I d w e er-tvt- OA OWNER NAME OWNER ADDRESS LLI l( � K VY s O YJA s i e� DESCRIPTION OF WORK: i yl{` r 0— of O t— S o .5�� � a—a-►�%+ tLtd 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 (DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.) A X11. I 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 own 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. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. /vAk- 2. I 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. 14—a I understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. ( AIL 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 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 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. ttT 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. NAL-- 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. OwnerBuilderForm 2010.doc revised 04/14/10 mak`— 9. 1 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 (CS LB) at 1-800-321-CSLB(2752)or www.cslb.ca.gov for more information about licensed contractors. r�k`'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. \L-11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. 2. 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 issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. 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: 7 - - ------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authodzation 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: OwnerBuilderForm 2010.doc revised 04114110