13060218 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22401 SANTA PAULA AVE CONTRACTOR:BERGEN CHRISTOPHER PERMIT NO: 13060218
D AND KIMBERLY M
OWNER'S NAME:
CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL
License Class Lic.# CONSTRUCT A BAY WINDOW(39 SQFT); REMODEL
POWDER
Contractor Date ROOM&LAUNDRY ROOM(80 SQFT); REMOVE&
I hereby affirm that I am licensed under the provisions of Chapter 9 REPLACE 5
(commencing with Section 7000)of Division 3 of the Business&Professions WINDOWS&2 DOORS; REMOVE WALL IN LIVING&
Code and that my license is in full force and effect. DINING
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:$65000
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:35704007.00 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 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 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
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
e-1�4
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
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
1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
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 9.12 and the
declarations: Health&Safety Code,Section 25532(x)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
25534.
Section 3700 of the Labor Code,for the performance of the work for which this r�'
permit is issued. Owner or authorized agent: Date:
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.
Date
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22401 SANTA PAULA AVE CONTRACTOR:BERGEN CHRISTOPHER PERMIT NO: 13060218
D AND KIMBERLY M
OWNER'S NAME:
CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION-RESIDENTIAL ❑ COMMERCIAL ❑
CONSTRUCT A BAY WINDOW(39 SQFT); REMODEL
License Class Lic.# POWDER
ROOM & LAUNDRY ROOM(80 SQFT); REMOVE&
Contractor Date REPLACE 5
1 hereby affirm that I am licensed under the provisions of Chapter 9 WINDOWS&2 DOORS;REMOVE WALL IN LIVING&
(commencing with Section 7000)of Division 3 of the Business&Professions DINING
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations: REVISION#1-INSTALL 2-6 FRENCH DOORS INSTEAD OF BAY WINDOW,
f have and will maintain a certificate of consent to self-insure for Worker's POSTS TO REMAIN ON DINING ROOM WALLS.ISSD 5/12/2014
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:$65000
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:35704007.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 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 DAYS FROST 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,1 agree to remove all new materials for
inspection.
"J 7OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
1 hereby affirm that 1 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(See.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
�j California Health&Safety Code,Sections 25505,25533,and 25534. I will
1 ereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
1 have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by
/Z
1 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 Taws of California. If,after making this certificate of exemption,1 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
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 1 understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date 2 /
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 22401 Santa Paula DATE: 06/27/2013 REVIEWED BY: SEAN
APN: BP#: 1 3 c) " *VALUATION: 1$65,000
%PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: PERMIT TYPE:
WORK CONSTRUCT A BAY WINDOW ADDITION 39 SQ FT); REMODEL POWDER ROOM AND LAUNDRY
SCOPE (80 SQ FT); REMOVE AND REPLACE (5)WINDOWS AND (2) DOORS; REMOVE WALL IN LIVINGLi
p
env, Lj
14
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'1 info.
FEE ITEMS (Fee Resolution 11-053 Ef' 7.f 1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (F) No $0.00 1 hours Plan Check,Hourly
Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 $133.00 1STPLNCK
PME Plan Check: $0.00 7 # Window/Sliding Glass Door
Permit Fee: Hourly Only? ()Yes Q No $0.00 $400.00 1WINREP Replacement
Suppl. Insp. Fee-0 Reg. 0 OT 0.0 hrs $0.00 80 s.f. Remodel,Bath(<=300 sf)
PME Unit Fee: $0.00 $600.00 1REMRESBAT
PME Permit Fee: $0.00
Work Without Permit? 0 Yes No $0.00 E)
Advanced Planning Fee. $0.00 0 hours Inspections O
(lr�:,t",;c��:`,Nir.<= i�r.�cs- $399.00 1STINSP Inspection,Hourly
Strong Motion Fee: 1BSEISMICR $6.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $3.001 1
SUBTOTALS: $9.501$1,532.001 TOTAL FEE: $1,541.50
Revised: 04/29/2013
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 22401 Santa Paula DATE: 05/12/2014 REVIEWED BY: Mendez
APN: BP#: 'VALUATION: Iso
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex PENTAMATION 1 GENRE
USE: PERMIT TYPE:
WORK Revision #1- install 2-6 french doors instead of bay window, posts to remain on dining room walls
SCOPE
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 Dept-for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. T'I I FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? ®Yes (F) No $0.00 1 hours Plan Check,Hourly
Suppl. PC Fee: (F) Reg. 0 OTp.Q hrs $0.00 $139.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. 0 OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
0
Work Without Permit? 0 Yes E) No $0.00
Advanced Plannim Fee: $0.00 Select a Non-Residential
Building or Structure
Strom 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: 04/01/2014
Milano &Associates Architects
MAA1761 Braddock Ct
San Jose,CA 95125
Ph. (650)271-0538
Email: lili_milanoc yahooxom
May 2, 2014
CITY OF CUPERTINO
Community Development Department
10300 Torre Avenue
Cupertino, CA 95014
RE: CHANGES BY OWNER
Bergen Residence,22401 Santa Paula Ave,Cupertino
Permit# 13060218
Home owner has made changes to the already approved plans; changes include the following:
1. There will be no addition done to the house; remodel only
2. There is no structural work done to the house except for the addition of one header where we are
replacing an existing window by a French door. All additional work is non-structural
3. We are not replacing the center beam in the living room
4. Instead of the previously proposed bay window in the living room, we are now adding two French
doors in the location as the existing windows
5. In the family room, we are re-using the existing framing for the doors and window and replacing them
with new
6. We are keeping the existing powder room as-is and only removing the window and closing off the
wall
7. We are building the new pantry as previously proposed
If you have any questions regarding any of the revisions, please do not hesitate to call me.
Very truly yours,
4L_
Lili Milano, Architect
650-271-0538
lili milanog-q�yahoo.com
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