Loading...
15030079F_ CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21040 HOMESTEAD RD OWNER'S NAME: HOMESTEAD CUPERTINO LP OWNER'S PHONE: 4084884965 LICENSED CONTRACTOR'S DEECLARATION License Class Laic. #j_� •f' goo�I Contractor K ,"(Z w,i Date �1 4 --?QT I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busi#ess & Professions Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the folloing two declarations: I have and will maintain a certificate of consent to self-insur for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the ork for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the ab ve information is correct. I agree to comply with all city and county ordinance 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and willcAiion, with all non -point source regulations per the Cupertino Munjcipal Code, 9.18. Signature Date r -d- ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's icense Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. I have and will maintain Worker's Compensation Insuran as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this ermit is issued, I shall not employ any person in any manner so as to become subj let to the Worker's Compensation laws of California. If, after making this cert ficate of exemption, I become subject to the Worker's Compensation provisions f the Labor Code, I must forthwith comply with such provisions or this permit shall a deemed revoked. APPLICANT CERTIFICATIO 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 ordmansand state laws relating to building construction, and hereby authorize representati es of this city to enter upon the above mentioned property for inspection purpose . (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in onsequence of the granting of this permit. Additionally, the applicant unders ds and will comply with all non -point source regulations per the Cupertino Mu iicipal Code, Section 9.18. Signature Date CON RACTOR: PERMIT NO: 15030079 Co, P -0 -44r - DATE ISSUED: 04/29/2015 PHONE NO: JOB DESCRIPTION: RESIDENTIAL COMMERCIAL L] SUITE 201 -CONSTRUCT PARTITIONS(2)DOORS Sq. Ft Floor Area: Valuation: $5000 APN Number: 32607034.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 D T ISSUANCE OR 180 R LED INSPECTIION. ssue Date: RE -ROOFS: 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. Signature of Applicant: Date: _ ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: 15030079 21040 HOMESTEAD RD CUPERTINO CA 95014 (326 07 034) OUTSTANDING CONSTRUCTION 18863 MEEKLAND AVE HAYWARD, CA 94541 OWNER'S NAME: HOMESTEAD CUPERTINO LP DATE ISSUED: 04/29/2015 OWNER'S PHONE: (408) 730-0808 PHONE NO: 510-861-9041 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class a Lic. #900681 Contractor OUTSTANDING CONSTRUCTION Date 04/30/2016 — BLDG —ELECT _PLUMB MECH RESIDENTIAL COMMERCIAL I hereby affirm that I aro 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. JOB DESCRIPTION: SUITE 201 -CONSTRUCT PARTITIONS(2)DOORS 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 REVISION #1 - REMOVE PARTITION WALL AND DOORS FROM `1. Compensation, as provided for by Section 3700 of the Labor Code, for the SCOPE OF WORK - ISSUED 10/27/2016 performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by DEFERRED #1 - 2ND FLOOR BATHROOM GRAB BARS - ISSUED Section 3700 of thc Labor Code, for the performance of the work for which this 10/27/2016 permit is issued. APPLICANT CERTIFICATION Sq. Ft Floor Area: Valuation: $5000.00 I certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 326 07 034 representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point WITHIN 180 DAYS OF PERMIT ISSUANCE OR source regulations per the upe ino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date 10/27/2016 Issued by: PAUL O'SULLIVAN OWNER -BUILDER DECLARATION Date: 04/29/2015 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) i. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 10/27/2016 I hereby affirm under penalty of perjury one of the following three declarations: 1. 1 have and will maintain a Certificate of Consent to self -insure for Worker's ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE z. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous Worker's Compensation laws of California. If, after making this certificate of air contaminants as defined by the Bay Area Air Quality Management District I exemption, I become subject to the Worker's Compensation provisions of the will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Labor Code, I must forthwith comply with such provisions or this permit shall the Health & Safety Code, Se A s 255 , 25533, and 25534. be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION Date: 10/27/2016 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct. I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction, and hereby authorize representatives of this city of work's for which this permit is issued (Sec. 3097, Civ C.) to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 10/27/2016 Licensed CONSTRUCTION PERMIT APPLICATION COMMUNITY DE ELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AV NUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building aacupertino.org CUPERTINQ p� ❑ NEW CONSTRUCTION ❑ ADDITION 1Gy ALTERATION / TI ❑ REVISION / DEFERRED PROJECT ADDRESS 2-10J0 HO o F4 APN 4 OWNERNAME E� `V C' - ` T r P � � 10I PHONE E -MAID STREET ADDRESS � O � J A � I CTTY, STATE, ZIP CONTACT NAME �j� �I `^ '*k P14ONTTE u� w (�� `^ `� e17 E-MAIL f ^n f `'L veao STREET ADDRESS -261 J 45.0er5 7 0 CITY, STATE ZIP ,-,b OWNER ❑ oWTER.BUILDER , ❑ OWNER AGENT ❑ CONTRACTOR— El CONTRACTOR AGEmr ARC�HITE' z -[ ❑ ENGINEER , ❑ DEVELOPER. ❑ TENANT CON i RACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC 0 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAA4E (`^ LICEANSE NUNIBER 6-5-5 Z t J 2 BUS. LIC 4 COMPANY NAME Ade( 1 vt fC.It), _ I- `tk�� moi/' E-MAIL f oAa � Q . u J �+ FAX STREET ADDRESS �y �Y(/��/ -X0111 `�O-` CV 6 CITY, STATE ZIP �pr�;� qS'�j/ PHONE CL, DESCRIPTION OF WORK �p I N� l� I J I to S(�I �t 1 • ZQ C U 7 tet/ a�r444�" "d Aoays EXISTLNG USE PROPOSED USE J7Z� CONSTR TYPE * STORIES 2 USE TYPE '� OCC. SQ:FT. VALUATION (S) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA I REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH Al DWELLING U?,TrS: Is A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED! ❑No ADDITION' ❑No PRE -APPLICATION ❑YES TF YES, PROVIDE COPY OF PLANGAPPROVAL PLA.NNINGAPPL'� NI�NI I IS THE BLDG AN❑YESC,I EICHLERHOA4E? ❑NO , VED ��- ;" "" TOTAL VALUATION: KNO By my signature below, I certify to each of the followi g: I am the property owner or authorized agent to act on the property owaler's behalf. I have read this application and the information I have provided is corr ct 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 buyding construct I au orize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: 1z A 5— SUPPLEMENTAL INFORMATI N REQUIRED �pLAi. ci T�mE xoi3x nc s =: New SFD or Multifamily dwellings: Apply or demolition permit for grequiredg#y� existinQg buildin'�s . Demolition permit is rior to issuance of building OVE THE OLP�TER k C f BUII1n LN7GPL4=F� zg y2 z permit for new building. _ Commercial Bldgs: Provide a completed Hazardous form if any Hazardous Materials are being used Materials Disclosure as part of this project. a U�-- '�Nm��* NEW -Ey�"F sr; DARD�` 11 go! l MINI PUsviRlt� - _ Copy of Planning Approval Letter or Meetin with Planning prior to �€�� ❑ MA70R� fi •: r. eP� S ITARY SE ERDI$TRIC� � N, submittal of Building Permit application.E����� ate. ENS RO 'AIENTA HEARTH B1dg,4pp_2011.doc revised 06/11/11 �,,��,,���E CITY OF CUPERTINO 1\7'AFEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Mgr;ri oto 1 Thoco foot aro hacad nn tho nroliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Ejf 711/13) ADDRESS: 21040 homestead rd DATE: REVIEWED BY: mendez L1ec1=_ 1'ernrrt Fee: APN: BP#: 'VALUATION: $5,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: Commercial Building Civil / Religious activities in BQ zone? © Yes O No PENTAMATION 1 GENCOM PERMIT TYPE: WORK Suite 201: Construct partition and 2 doors. SCOPE 18 l.f. $503.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Mgr;ri oto 1 Thoco foot aro hacad nn tho nroliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Ejf 711/13) afech. Plan Check Plumb. Plan Check Elec. Plan ChHck L1ec1=_ 1'ernrrt Fee: Plumb. Permil Pee: ermit Pee other,11ech. Insp. Other Plumb Insp. UtherElec. Insp. Li :11ech. Insp. Fee: Plumb. Insp. l"", L7ec. In", /cc. NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Mgr;ri oto 1 Thoco foot aro hacad nn tho nroliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Ejf 711/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # $572.00 New Door Opening IDOORNONST Non -Structural Suppl. PC Fee: 0 Reg. Q OT FO.OThrs $0.00 PME Plan Check: $0.00 18 l.f. $503.00 Interior Partitions IPARTICOMM Permit Fee: $0.00 Suppl. Insp. Fee -0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC FA $0.00 (1117llllStrath,,, 1"c'< 1 0 Work Without Permit? Yes 0 No $0.00 Advanced Plannin&lee $0.00 Select a Non -Residential Building or Structure T_ -1 0 � Travel Doetuncenlalion F, Strong Motion Fee: IBSEISMICO $1.40 Select an Administrative Item BldgStds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.401$1,075.00 TOTAL FEE: $1,077.40 Revised: 02/14/2015 ALTERNATE MATERIALS AND METHODS / MODIFICATION FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building cupertino.org CUPERTINO ❑ REQUEST FOR MODIFICATION OF CODE (CBC 104.10) ❑x REQUEST FOR ALTERNATE MATERIAL, DESIGN OR METHOD OF CONSTRUCTION (CBC 104.11, CFC 111.2.4) To annly for this request. comDlete sections 1. 2. & 3 (ink or tvoe) SITE 21040 HOMESTEAD RD ADDRESS APN 326-07-034 DATE 03/11/2015 Owner. Homes.tead..Cupe..rtino..LP ....................................................................................................................... PC #: ..................................�.. V -B Type:..................................... 20111 Stevens Creek Blvd., Suite 250, Cupertino, CA 95014 Address............................................................................................................................. 79 rr �r��..............r.... 2 Stories: Reviewed I By: ..................................................... Date: ........................... Permit #: .................................. Email. virgng3333@gmaiLcom 408-873-8090 x114 Phone. ��3 � B ............ PLN #:................................... Dept./Div................................ Occupancy: 6,690 SF Floor Area:............................. JANICE YEH ARCHITECT Applicant...................................................................Title................................................ 20111 Stevens Creek Blvd., Suite 270, Cupertino, CA 95014 Address............................................................................................................................. Job Status: ............................ OCC. Load:............................. anice ada tivearch us 408-865-1089 Email........@..... p....................................................Phone.......................................... OFFICE Use of Bldg: ............................ 2 REQUEST: For code modifications, please state the applicable code requirement and the extent of relief desired. For alternate requests, state the type of system proposed and design methods. Submit plans if necessary to illustrate request. Additional sheets or data may be attached. To indicate the tutoring center use in Suite 202 as Group B occupancy rather than Group E occupancy. The 2015 CBC Supplement, to be effective on July 1, 2015, lists tutoring center under Group B occupancy, Training and skill development not within a school or academic program. 3 JUSTIFICATION/FINDINGS OF EQUIVALENCY: For code modifications, applicant shall demonstrate that special, individual reasons exist that make compliance with the strict letter of the ordinance impractical and that equivalency is provided. For alternate requests, applicant shall demonstrate suitability, strength, effectiveness, fire resistance, durability, safety and sanitation that is equivalent to the code for a similar use. Code Section(s): 304.1 Attach additional sheets if necessary. The 2015 CBC Supplement, to be effective on July 1, 2015, lists tutoring center under Group B occupancy, Training and skill development not within a school or academic program. Petitioner's Signature: ..... ..... Position: ,Architect 3 j 2 / .......................... .................... Date:................ Reviewed I By: ..................................................... Date: ........................... The Request is: O'GRANTED ❑ DENIED I Dept. Comments: hiodi CONDITIONS OF APPROVAL: No. of Items: .............................. Fee Due: $................................. DatePaid: ................................. Receipt No.: .............................. Processed by:.........1.................... Buildin Official: .... .. .................. � ..... ............. Print:.... / LI Jv:....0 Y. !(:'......... Date:... .................. ..... Fire Marshal: ........ 4/— ..........................................................Print:..... d...`� O... 1Z4 ............................................... Date:—J-2—L.". / � DEPARTMENT ACTION: After determination, copies to: 1) applicant, 2) permit file Altform 2010.doc revised 06/11/10 USE AND OCCUPANCY CLASSIFICATION 303.4 Assembly Group A-3. Assembly uses ii ship, recreation or amusement and other ass classified elsewhere in Group A including, but Jed for wor- ily uses not limited to: Amusement arcades Art galleries Bowling alleys Community halls Courtrooms Dance halls (not including food or drink consumption) Exhibition halls Funeral parlors Gymnasiums (without spectator seating) Indoor swimming pools (without spectator eating) Indoor tennis courts (without spectator seat ng) Lecture halls Libraries Museums Places of religious worship Pool and billiard parlors Waiting areas in transportation terminals 303.5 Assembly Group A-4. Assembly viewing of indoor sporting events and act for seating including, but not limited to: Arenas Skating rinks Swimming pools Tennis courts intended for with specta- 303.6 Assembly Group A-5. Assembly use intended for participation in or viewing outdoor activities 'ncluding, but not limited to: Amusement park structures Bleachers Grandstands Stadiums 303.7 Fixed guideway transit systems. [SFM Fixed guide- way transit system buildings shall conform t the require- ments of this code for their occupancy cl sification in addition to the provisions set forth in Section 4 3. 303.8 Subterranean spaces for winery facUities in natural or manmade caves. ISM For fire and life s fety require- ments, see Sectio: 436. SECTION 304 BUSINESS GROUP B 304.1 Business Group B. Business Group occupancy includes, among others, the use of a building or tructure, or a portion thereof, for office, professional or servic type transac- tions, including storage of records and accounts. Business occupancies shall include, but not be limited to, t ie following: Airport traffic control towers Ambulatory care facilities serving five or,l (see Section 308.4.2 for facilities serving j patients) Animal hospitals, kennels and pounds Banks Barber and beauty shops patients than five Car wash Civic administration Clinic, outpatient [SFMJ (not classified as Group 1-2.1) Dry cleaning and laundries: pick-up and delivery stations and self-service Educational occupancies for students above the 12th grade Electronic data processing Laboratories: testing, research and [SFMJ instruction Motor vehicle showrooms Post offices Print shops Professional services (architects, attorneys, dentists, physicians, engineers, etc.) Radio and television stations Telephone exchanges Training and skill development not within a school or academic program (this shall include, but not be limited to, tutoring centers, martial arts studios, gymnastics, and similar uses regardless of the ages served, and where not classified as a Group A occupancy) 304.2 Definitions. The following terms are defined in Chap- ter 2: AMBULATORY CARE FACILITY. CLINIC, OUTPATIENT. SECTION 305 EDUCATIONAL GROUP E 305.1 Educational Group E. Educational Group E occu- pancy includes, among others, the use of a building or struc- ture, or a portion thereof, by more than six persons at any one time for educational purposes through the 12th grade. Exception: [SFM] A residence used as a home school for the children who normally reside at the residence. Such residences shall remain classified as Group R-2, or Group R-3 occupancies. 305.1.1 Accessory to places of religious worship. Reli- gious educational rooms and religious auditoriums, which are accessory to places of religious worship in accordance with Section 303.1.4 and have occupant loads of less than 100, shall be classified as Group A-3 occupancies. 305.2 Group E, day care facilities. This group includes buildings and structures or portions thereof occupied by more than six children 2 years of age and older who receive educa- tional, supervision or personal care services for fewer than 24 hours per day. Exception: [SFM] A Day-care facility not otherwise clas- sified as an R-3 occupancy, where occupants are not capable of responding to an emergency situation without physical assistance from the staff shall be classified as Group 1-4. SECTION 306 FACTORY GROUP F 306.1 Factory Industrial Group F. Factory Industrial Group F occupancy includes, among others, the use of a building or structure, or a portion thereof, for assembling, disassembling, 92 JULY 1, 2015 SUPPLEMENT 2013 CALIFORNIA BUILDING CODE BLUE CONS- Mv COt\/,Iv1U I N FE�Rf��I�APPLIGATION O�� AR ENT • BUILDING DIVISION C _,. 10300 TORRE VENUE • CUPERTINO— C� A 9 014-3255 Is (408) 777-3228 FAX (408) 777-3333 • buildino a0cuoert RRED CUPERTEt\!O rAan& ❑ NEW CONSTRUCTION ElADDITIO [:1 ALTERATION / TI REVISI R o I ? Plv n 2 Z-6 _ O /� ^ O'� — PROJECT ADDRESS n 1 n/1 11 �-�{yM OW? ER NAM4E PHONF 4 6f- E-Mi0.IL STREET.ADDPESS1e - 1 r�k cyri�r^ r I CITY, STATE, ZIP m -k � qrr t ¢�- r s�, CO?\'T.ACT NAME 'v ' [ QC �C ^�J 1 ) PHO\= j�l E-hiA 1L b STREET.ADDRESS CITY, STATE, ZIP F.A3 OIANTR ❑ O\i'N-EM-BUILDER ❑ OANMRAGM\ ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGL'\MR ❑ DE\LIOPER ❑ TSA -r CONMACTORNAME I LiCZN'SEI\7MBER LICENSE TYPE BUS. LIC COMPANY NAME E-)kIWM FAX STREET #MDRESS CITY, STATE, ZIP Pi- CKEE ARCiISTECT/F-NGN-EER?\.A.A;E -JQ• 11� LICENSE /\'UMBER G 3 z Z /(3 1 BUS. LIC r COMPANY N4M E ��• t I E-MZAIL FAX STREETADDRESS - 1 I L p� p�S / ,moo �I v� CITY, ST.AIE, ZiP}-t I PHONE - - DESCRIPTION OFWORK d S�bmi�1 � ��J�i1 �i�►% �✓�' J ott, EX1snvG USE PROPOSED USE CORSTR TYPE STORIES USE TYPE OCC. SQ.FT. I VALUATION (S) EXISTG NSA FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEl. OTHER REMODEL AREA REMODEL AREA RB40DEL AREA PORCH AREA DECK AREA TOTAL D=_CX?ORCH -TA GA1tAGE AREA: 0 DETACH ❑ ATTACH I D\4ELLr-GL'�9T5: ISA SECONDL'NIT ❑YES SECONDSTORY ❑YES BEIING.ADDED? NO ADDITION? ❑NO PRE-.42PUC.ATMN ❑ YES IF 17FS, PROVIDE COPY OF PL-A-KNTGAPPL []NO PLk\-\1NGAPPROV.ALLETTER I 1S THE BLDG AN ❑ YES EICHLERHOME? ❑ � �..-= f 9 `� � � � �� �`��,,,:�4�, TOTAL 'ALLATlOiNO By my signature below, I certify to each of the followin : I an the property om-ner or authorized agent to act on the property owner's behalf I have read this application and the information I have provided is core a t. I have read the Description of Work and verify it is accurate. I aT,-ee to comply with all applicable local ordinances and state MNN,s relating to kuil I g c rs-aucti n. I authorize representatives of Cupertino to enter the above-identi5ed property for inspection purposes. Signature of Applicant/ gent: Date: O 14 SUPPLEMENT kL INFOn4ATI0 t New SFD Multifatrrily &vellings: Apply f REQUIRED Q demolition A h .A \ CRECK TYi �'� RO or r pennit for O\ERTH;=C'OCiTiR existing building(s). Demolition pennit is require prior to issuance ofbuildina .�iLD1\G 2 . pernit for new buildin;. " Qi D E�Px�S A � Bldgs: Provide a completed Haz rdous Materials Disclosure � . C3 s �� RDS �,, _Commercial conn if any Hazardous !rater ials are being used as art of this project. F k _ Copy of Planning Approval Letter or Meeting vith Planning prior to�_ v s '' submittal of Building Permit application. EN-VIRONMENTALF_EAL' Bld.a1pp_2011.doc revised 06/21/11 CUPERTINO UNREASONABLE HARDSHIP EXEMPTION FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building cDcupertino.org (For Tenant Improvements where the Cost of Construction does not exceed $139,934.00) 1503 x"791 SITE ADDRES S�O TO fliuhu oa � STC APN 3 LG - C � _ O 3q 13P#�� 03 CITY A'`�h6 ZIP TOTAL CONSTRUCTION COST A $ ........ ....v0 DESCRIPTION OF WORK: ;-, Z 0 /)S r �5�3T�4 -t (� 'tf P,r�� (A�+vL ��•,7 i3��o 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 Building Official.) Accessible Features Complies with If not, list required upgrades in order for Cost to make feature Description of access features to be provided: current standards? features to fully comely? fully accessible? 1. Path of travel to accessible entrance. ✓ TOTAL COST OF PROPOSED UPGRADE $ 2. Cost of providing a primary entrance. (Including but / 70 not limited to, thresholds, landings, door hardware, V $ max. door pull, etc. 3. Cost of providing the primary path of travel to the specific area of alteration, structural repair, or $ addition. 4. Cost of providing accessible restroom facilities.? ¢ �I $ 60, '000 5. Cost of providing an accessible drinking fountain. (if d $ 2 required or if a drinking fountain is provided.) / 6. Cost of providing accessible public telephones (if AW $ provided) 7. Cost of providing other accessible features, including / 1/ $ but not limited to, parking, storage, alarms etc. L F OF- ESS FEATURES (B): $ Zf (Ia O MW _�i Has the same tenant performed work in the same tenants ace within the last three ears? Calculate (B / A) x 100% ° � -775— ' Description of access features to be provided: TOTAL COST OF PROPOSED UPGRADE $ ' PERCENTAGE (20% minimum expenditure is required)`Z� 70 ARCHITECT OR ENGINEER OF RRECOD INFORMATION: I certify that the above noted information is true and correct. Name (print): �J a� / Signature: ��- Date: Firm address: �ll� S-}��"ehS G{GQ,k$1Vd-*?-ZTitle: AI, 2+ -PV' Phone: / FOR DEPARTMENT USE ONLY ❑ Tfto above named project has been denied an unreasonable hardship exemption under 2010 CBC Section 1134B.2.1. p'' 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: �� p� t ao,v Ct- S&9 rJrO t--AU,,C LJD O C> F ROB- CaNP,:. i zz r" �1.5✓YLcJGr1 � COS -r a� r � 1✓�?A-t,.�r� `� f'I �.J 1�i4/y i e W S Building Official Designee (print):` Signature: Date: S HardshipExemptronForm_2012.doc revised 10/17/13