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14010128 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10181 FINCH AVE CONTRACTOR:MARVIN DAVIS PERMIT NO: 14010128 CONSTRUCTION OWNER'S NAME: BETHEL LUTHERAN CHURCH 1450 KOLL CIR DATE ISSUED:03/31/2014 OWNER'S PHONE: 4082528500 SAN JOSE,CA 95112 PHONE NO:(408)975-0200 In LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL pp REPAIR FIRE DAMAGE INCLUDING FRAMING, License Class_ Lie.4 uELECTRICAL, HVAC,WINDOWS&ROOF REPAIR Contractor 1!0 Thy it, Date -- 1 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. 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 5ormance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$51900 1 h e and will maintain Worker's Compensation Insurance,as provided for by tion 3700 of the Labor Code,for the performance of the work for which this APN Number:37503022.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIJES IF WORK IS NOT STARTED correct. l agree to comply with all city and county ordinances and state laws relatingWITHISOF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enterupon the above mentioned property for inspection purposes. (We)agree to save 180 DAYLAST CALLED INSP CTION. 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: Dat with all non-point sourAp regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature DateSWIA 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. ❑ NER-BUILDER DECLARATION Signature of Applicant: Date: 1 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 1 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 1 store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 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 1 performance of the work for which this permit is issued. will maintain compliance with the per' o Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this { 11 q—,, permit is issued. Owner or authorized agent: Date? I 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,1 CONSTR CTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,l 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 Date . . O SEECONSTRUCTION PERMIT APPLICATION \ COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION D 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (4013)777-3228•FAX(408)777-3333•build inga-cupertino.orq ❑NEW CONSTRUCTION ❑ ADDITION gg ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS ✓'r • , /A AFN# t 7 p-_ O )2 OWNERNAME•{� HONE s7 GZ„q E•MArL �, r Qr (�% t� 61, STREET ADDRESS o 19'/ n gr �� CrrY.STATE,ZIP FAX CONTACT NAME 1�` ^� �' PHONE ' O�O E-M QYl e STREET ADDRESS TATE [P95oAov664 Sfeld IT , S r 'w E3 owNPR 13 owNERBumzER Z FAX ❑OWNERAGENT A CONTRACTOR ❑CONTRACToAAGENr ❑ ARCHIrecT ❑ENGWEER ❑ DEVELOPER •❑TENANT CONTRACTOR NAME rvin Do �►stns�'. LICENSE NUMBER 3 LICENSE TYPE BUS.LTC W . COMPANY NAME �7S O¢CJh vin,, a/s�. L E-MALL 1 ��_�+ h FAX STREET ADDRESS 5b .�(i1 Cr1Y,STATE,'st J - A ]'Z PHO I' �a ARCHTTEC f/ENGIlVEFR N LICENSE NUMBER BUS.LIC#. COMPANYNAME a E•MAM FAX A yid. 04C �e�bren ire .� W STREET ADDRESS.A r.4 b A It�ev, .. CTTY,STATE.ZIP r+y.. t Its PHON Q-7 Z Z-7 DESCRJVr[CN OF WORK �J �1 d2 ea v/' — l�.a-1� eT Y'o0 2 war o-eN� l EV 'L, C' V 6 o"►r DGSTINGU PROPOSEDUSE CDKSTIL_TYPE #STORIES i USE TYPE OCC. SQ.FT. VALUATION(S) AREA BEA FLOOR DEMa AREANNET MFA BATHROOM KITCHEN OTHER REMODEL AREA K REMODEL AREA REMODEL ARF PORCHAREA DECK TOTALDECKIPORCHAREA I GARAGE AREA: DETACH a— ATTACH W DWELUNGUNTTS: rS A SECOND UM �pYES SECOND STORY YES BBDIGADDEDr 6 ADDMONr NO PRE-APWCAT1ON []YES IF YES,PROVLDE COPY OF IS THE BLDG AN ❑YES *' 1•' f -� '. TOTAL VALUATION: PIANNMADPLW NO PLANNING APPROVAL LETTER ELCHIERHOME! �NO cr .. ., .. .1•' By my signature below,I certify to each of the following: I am the property owner o-6zcd to roperty owner's behalf I have read this application and the information I have provided is co t I have read the Desai Ion of Work and vert curate. I agree to comply with all applicable local ordinances and state laws relating to building authorize representatives of Cupertino to enter the abo e-identified property for inspection purposes. Signature of Applicant/Agent: Date: 1 2'L A. SUPPLEMENTAL ORMATION REQUIRED New SFD or Multifamily d s:'Apply for demolition permit for s existing building(s). Demolition permit is required prior to issuance of building �O x permit for new building. Commeroial Bldgs: Provide a completed Hazardous Materials Disclosure a ; form if any Hazardous Materials are being used as part of this project _Copy of Planning Approval Letter or Meeting with Planning prior to a ` , submittal of Building Permit application. B1dg4pp 2011.doc revised 06/21111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10181 FINCH AVE DATE: 01/22/2014 REVIEWED BY: MELISSA APN: 375 03 022 BP#: *VALUATION: 1$51,900 *PERMIT TYPE: Building Permit PL N CHECK TYPE: Tenant"Improvement PRIMARY PENTAMATION USE: Commercial Building PERMIT TYPE: I E T'A WORK REPAIR FIRE DAMAGE INCLUDING FRAMING ELECTRICAL HVAC WINDOWS & ROOF REPAIR SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID CONSTR. s.f. E (Tenant Improvements) I I-B,I I I-B,IV,V-B 683 $3,430.44 IETIPLNCK. $1,316.50 IETIINSP TOTALS: 683 1 $3,430.44 1 $1,316.50 MECH,HOURLY 0 Yes (D No PLUMB,HOURLY Q Yes Q No ELEC,HOURLY ().Yes Q No :Meeh. Plan CheckT-T Phrmb, Plan CheckT-F Elec.Plan Check Felh.Permit Fee: Phrmb. Permit Fee: Flee. Permit Fee: Other hlech. Insp.. Other Plumb Insp. Lj Other Elec.Insp. Li lelech.Insp.Fee: Plumb. hip. Fee: Elec.Insp.Fee: 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 the prelimina information available and are only an estimate. Contact the De t or addn 7 info. IEE ITEMS (Fee Resolution II-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $3,430.44 Select a Misc Bldg/Structure Suppl.PC Fee: E) Reg. ® OT0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $1,316.50 Suppl. Insp. Fee-0 Reg. 0 OT Q Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consintelion Tax: Adininistrative.Fee: Q Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential O Travel Doc-umentation Fees: Building or Structure 0 i Strong Motion Fee: IBSEISMICO $10.90 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $3.00 SUBTOTALS: $4,760.84 $0.00 TOTAL FEE: 1 $4,760.84 Revised: 01/15/2014 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildingQcupertino.oro ❑NEW CONSTRUCTION ❑ ADDITION MIT ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS el O-n JV-11APN k .a/ -C�' _ 0,5 - 0*7 "V/ OWNERNAME✓ PHONE J E-MAIL ! rp.tf�s- n Z�Z �cj0� o,,3- STREET ADDRESS (f� Ave. CITY,STATE,ZIP ,4 L CONTACT NAME g PHONEE-M�A�tLyy lit D� $ Le,I� q_1'`OZGO CCrrI�S Ganf�•. STREET ADDRESS /[ h 1 �1� �+���b CITY,STATE,ZIP : T A y FAX IJ OWNER ❑ OWNER-BUILDER ❑ OWNER.AGENT S CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME � �o��t S n a'�', 4 Zfl LICENSE NUMBER LICENSE TNTE BUS.LIC 9 �V l � COMPANY NAME d� U E-MAIL �t� " r�A FAX p T_vb STREET ADDRESS � -G r CITY,STATE. IP PHO 2(Ln `Y ^iLI )Z 0 ARCHTECT/ENGINEERN LICENSE NUMBER BUS.LIC# COMPANYNAMEr' E-MALL FAX A ni�r 5 t3L�f e„b f'2 r) C. STREET ADDRESS jc"d CITY,STATE,ZIP (- d�, 1 Is PHON7�L�0'7 Z 2--7 DESCRIPTION OF WORK re >(0 0 2 VV t V-4 g e�\e-e— GC n' r4--P—L(--5 Vora Y 6 L t^ ETTSTINGUSE PROPOSED USE CONSTRTYPE I k STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA ® AREA NETAREA y q D BATHROOM KITCHEN OTHER / t, REMODEL AREA REMODEL AREA t REMODrL ARF.L PORCH AREA DECK A TOTAL DECKiPORCH AREA GARAGEAREA: DETACH �— — ❑ATTACH r B DWELLTNGUNRS: IS A SECOND LJN[7' ❑YES SECONDSTORY ❑YES RETNGADDED? WO ADDITION? NO PRE-APPLLCATToN ❑]'ES IF YES,PROVIDE COPY OFF IS THE R1DG AN ❑YES REC£(VED.BY '" TOTAL VALUATION: PI.ANNMG APDL p 13NO PLANNING APPROVAL LETT-ER EICHLER HOME? ;WO r ,{ , y r y. r` ^� l]b-b By my signature below,I certify to each of the following: 1 am the property owner or authorized agcnt to act on the property owner's behalf. I have read this application and the information I have provided is c t. 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 building oWe authorize representatives of Cupertino to enter the abo e-identified property for inspection,purposes. Signature of Applicant/Agent: Date I, SUPPLEMENTALORMATION REQUIRED ?VAN,Cl ECKTYPB,r: :rl oi)ir�c'siiP "' New SFD or Multifamily dw ugs:'Apply for demolition permit forVER-a Tt o UN t� [£'Buri nLNc piAn AE tii ` existing building(s). Demolition permit is required prior to issuance of building' permit for new building. © IaaPxESn x �t ALvtmc rtvAr uEvrEw'r _Commercial Bldgs: Provide a completed hazardous Materials Disclosure �0-$rnnoaxD 3J �'" puB>rcoxrs �r a form if any Hazardous Materials are being used as pan of this project. 1'rkE DEPT- _ Copy of Planning Approval Letter or Meeting with Planning Prior to G 1MAJOtt�' �t submittal of Building Permit application. ti s Lkrt LRY stER ArsTALc7 r $ BldgApp_ Ol I.doc revised 061-21111 UNREASONABLE HARDSHIP EXEMPTION FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR,P.E.,C.B.O.,BUILDING OFFICIAL 10300 TORRE AVENUE>CUPERTINO,CA 950143255 CUPERTINO (408)777-3228^FAX(408)777-3333^building(a.cupertino.org For Tenant Improvements where the Cost of Construction does not exceed $139,934.00 SITE ADDRESS APN 7`70/0/2-s",- a®e 81 -F«,� e' , 3-t 5 -o T.-o2'L CITY (2,3r¢- �d�� ZIP '7 TOTAL CONSTRUCTION COST A $......5..� ... .Qin..................... DESCRIPTI N OF WORK: vv-o- Ir ,nor Y 4 r YD OF The f lowing is a list of costs to provide access features in order to comply 100%with the current State Title-24 Disable Access Standards.(AII costs to be documented by actual bids or other information accepted by the Bui 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. /� S cC� wr.1�r rn b+.��L� 2-7-310 2.Cost of providing a primary entrance. (Including butv-9 K ► +Ixfe ' not limited to,thresholds,landings,door hardware, l $ 5 max.door pull,etc.) re, 2^cjb a/Cr 3.Cost of providing the primary path of travel to the twte-W-%YL specific area of alteration,structural repair,or w f dJ1Ae1 I- addition. r-ml 4.Cost of providing accessible restroom facilities. $ 5.Cost of providing an accessible drinking fountain. (If $ required or if a drinking fountain is provided.) 6.Cost of providing accessible public telephones(if �1 $ provided) Yet 7.Cost of providing other accessible features,including (� Qerl 5 s $ v2 ep but not limited to,parking,storage,alarms etc. I 7 TOTAL COST OF ACCESS FEATURES(B): 7$ -1OL b-O Has the same tenant performed work in the same tenants ace within the last three ears? P-s 0 Calculate(B i A)x 100% Zm. 5 /o Descrip ion of access f atures to be provided: , yy d%r X4G .L t .e Gba r b TOTAL COST OF I �9 PERCENTAGE (20%minimum PROPOSED UPGRADE $ ( -Y 0O expenditure is required) % ARCHITECT OR ENGINEER OFR ORD INFORMA/TION: I certify that the above nformation is true and correct, Name(print): , L( ^-r Signatur Date: Firm address: 3 /oel/ br �� /p�Cf Phone: I*Z�g'ZO�'��� ------------------------------------- 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: Building Official Designee(print): Signature: Date: HardshipExemptionForm_2012.doc revised 10/17/13