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09050009 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21971 COLUMBUS AVE CONTRACTOR:-TED-T BE Tj T1ZNM7ED PERMIT NO:09050009 OWNER'S NAME: GREIF RICHARD K S`fr G DATE ISSUED: 11/06/2009 OWNER'S PHONE: 4089960977 :ZYi5 3H ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG.r ELECT T_ PLUMB IT— License Class Lie.# MECH RESIDENTIAL' COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:ADD 753'-MASTER BEDROOM SUITE ON FIRST (commencing with Section 7000)of Division 3 of the Business&Professions FLR LEVEL, Code and that my license is in full force and effect. WITH MASTERBATH,UTILITY ROOM,AND A KITCHEN EATING AREA-REPLACING LIGHTS&SWITCH IN KITCHEN. 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. 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 Sq.Ft Floor Area: Valuation:$125000 permit is issued. APPLICANT CERTIFICATION APN Number:35614037.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Signature DateIssued Date: OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will 1 certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must O e or'authorize t: forthwith comply with such provisions or this permit shall be deemed revoked. G� _ Date: t( (e APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. a I understand my plans shall be used as public records. Signature Gda ��� — Date t l ! Licensed Professional CITY OF CUPERTINO FF ADDITION/REMODEL CUPEkTINO FEE SCHEDULE APN# � � j ® �7,cD c Date: 15/44 'D ci Building Address: a I q-17 ( To T Mailing Address (if different from building address): Owner's Name: Phone# HOA: (Exterior work only) Yes ❑ No `R] If yes, provide letter from HOA Contractor: Phone#: Fax#: Contractor License#: Cupertino Business License#: Contact: K�— c-ntA GUtL..+.-1 ,&,K5 Phone#: C:,G-7 — Z-44 Fax#: 08 G7`7/- zl Building Permit Info: A Bldg. Elect. - Plumb. ( __ Mech. m.._...... Hillside ❑ Job Description: Addition-What is being added?(Be Specific): 5J 6-r E;. oi-.3 F--i Yz.55, 7� U i '_- L-0--V R-- 5.,T&4 1 What is being remodeled (not including addition)? -�-- ©a-ss��c7 r t+o P�5 5 c C-sf_y d i.3 6-4 A--rt-7- s:� - 'rte. Remodel Includes Re-Roof: Yes DcNo ❑ If yes list number of squares Remodel Includes Structural: Yes ❑ No ❑ Do you have the pre-application planning approval? Yes & No ❑ If yes, please provide a copy of your planning approval letter. Planners name: Lo (z Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen " _ Bath Other Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B ® '` Valuation: Please check this box if the project is a second-story addition ❑ Project Size: Express ❑ Standard [ ---urge ❑ Major❑ Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, Green Building Points Achieved: include in plan set& the sheet index. ***For Office Use Only*** Over-the-Counter 0 Revised 02/05/09 CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type --Sq Ft Group ADDITIONS 1R3 SFDADD 07 ( PLLONGRNGR Long Range PL Planning/Residential 1R31NSP Dwellings Inspections B 1R3PLNCK Dwellings plan check B 1R3REPINSP Dwellings Repeat B Inspection 1R3REPPLNC Dwellings Repeat Plan B Check 1R3HINSP Dwellings Hillside B inspection 1R3HPLNCK Dwellings Hillside plan B check 1R3HREINSP Dwellings Hillside B Repeat Inspection 1R3HREPLNC Dwellings Hillside B Repeat Plan Check 1R3ALTINSP Dwellings Alternate B Materials Inspection 1R3ALTPLNC Dwellings Alternate B Materials Plan Check 1 PCESS Cesspool P 1PPRSEWG Ea. Private Sewage P Disposal System 1PRSEWER Sewers P 1 BP SPRINK Lawn P Sprinkler/Backflow 1BPWSVCS Main Water Service P 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE SeismicResidential B 1REROOFRES Residential Re-roof Each B 100 SF CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Sq Ft Group DECKS 1R3SFDADD OR 1R3SFDREM 1DECKWOOD Deck (Wood)-Each B (Each) 1DECKRAIL Deck Railing-Each B (Each) GARAGES 1R3SFDADD OR DETACHED 1R3SFDREM 1 GARDTW<=1 K Wood Frame up to B 1,000 SF (each) 1 GARDTM<=1 K Masonry up to 1,000 SF B (each) BCONSTAXR Construction Tax Res (new detached garage) PATIO'S OPEN 1R3SFDADD OR 1R3SFDREM 1PATIOWOOD Wood Frame up to 300 B SF 1PATIOMETAL Metal Frame up to 300 B SF 1PATIOOTHER Other Frame up to 300 B SF PATIO'S CLOSED 1R3SFDADD OR & SUN ROOMS 1R3SFDREM 1PATIOENCLW Enclosed Wood up to B 300 SF 1PATIOENCLM Enclosed Metal up to B 300 SF 1PATIOENCLO Other Enclosed Patio up B to 300 SF 1 COVPORCH Porch Covered-Each B (Each) REMODELS 1R3SFDREM - 1REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan 300 SF check) 1REMRESBAT Bath Remodel up to 300 B " SF 1REMREOTH Other Remodel up to 300 B SF CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Sq Ft Group 1REMRES2 Remodel Residential B Greater than 1000 sq ft 1REMRES3 Remodel Residential B Greater than 2500 sq ft. 1REROOFRES Residential Re-roof Each B 100 SF REMODEL PLNCK 1 STPLNCK (1-3 for Standard Plan Check B NOT FOR OVER THE remodel) COUNTER PLAN CKS. WINDOW/SLIDING 1R3SFDREM GLASS DOOR 1 WINREP Replacement windows B (ea 8 windows) 1 WINNEWNSTR New Window (non- B structural) 1 WINMEWSTR New Window(Structural B Shear Wall/Masonry) 1 WINBAYSTR Bay Window (Structural) B SKYLIGHTS 1R3SFDREM 1 SKYL<10 SF Skylight less than 10 sf B 1 SKYL>10SF Skylight greater than 10 B sf or structural 1STAIRS Stairs-first flight/ea B addt'1 1EPERMITFEE Electrical Permit Fee E 1MPERMITFEE Mechanical Permit Fee M / 1PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln E Ck (hourly) CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit 'Type Sq Ft Group 1MECPLNCK Stand Alone Mechanical M Pln Ck(hourly 1PLMPLNCK Stand Alone Plumbing P Pln Ck (hourly) 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee / 1BSEISMICRE Seismic Residential B 1 TRAVDOC Travel &Documentation B 1BUSLIC Business License B RM PRE-APPLICATION FORM Community Development Department 10300 Torre Avenue (408)777-3308/Fax(408)777-3333 Cupertino,CA 95014 planning@cupertino.org C U P E RTI N O http://www.cupertino.org/planning PLEASE NOTE: A pre-application. conference. is required . prior to submittal on all applications. The purpose of the pre-application conference is to determine if the application is ready for submittal. Please call your project manager to schedule a time for the review of your application materials. We suggest you allow enough time prior to the application deadline to prepare additional information or make changes in case any are needed. Please bring this form to the pre-application meeting for a signature. Include this, orm in your application submittal. Application R quer : cac c0_ k" ec ' - D e4-- - Comments: Signed (planner) Date ll2� b 00 As a part of the application review process, City of Cupertino employees may visit your site in order to take photographs,slides and/or videotape. These materials may be shown at a city meeting. Page 1 of 4 RM App.doc.doc Revised 7/21/2008 MINOR RESIDENTIAL PERMIT Community Development Department 10300 Tone Avenue (408)777-3308/Fax(408)777-3333 Cupertino,CA 95014 planning@cupertino.org C U P E RT I N O http://www.cupertino.org/planning Property OwnePhone(w) Phone(h) rz t C- 4A-F-4D l� , G I l F C4-5) 9 4(- — 04-t-7 Street Address Fax Cell r4'S? L 1 L —b`- o$ City,State,Zip Code E-Mail P�tZ t r.10 Gf� f a ► `i cl. 9v^e 4' CQ1 Co,vtC�.St Project Contact Person Phone(w) Phone(h) y Street Address Fax Cell City,State,Zip Code E-Mail Project Address APN Z1 �'7 mow►-�$.>s A-V jF— Brief Project Description 1 tZ S T 5Tu 1 -A-32 D I T t � A, rz 75 r-F--Tz-- QED fry e')M S v t T4=— V T't L-I T-/ ., kt-3 D N—b PL- (-rte T-A,L-- 75-0 S c¢ t--T> O F� -rt+C Z A-c-le - F M`f' Z -STb 4D lT",z- 'f z'k C-T- I certifij that the foregoing statements are true and correct to the best of my knowledge. I understand that a misrepresentation of any submitted data may invalidate an approval by the City. I have read and understand the ordinances and design guidelines affecting this project in the City of Cupertino: � 3 0 Applicant's Signature Date I declare under penalty of perjunj that I am the owner of said property or have Power of Attorney(attach copy)from said property owner and that I consent to the above-described.application and I authorize City staff to visit the site in order to take photographs,slides and/or videotape that may be shown at a city meeting. X -I G!f l&- (z—D Signature Vrmt.Froperty Uwrner's Name vate Staff use only:(Do not write below this line) Application accepted on by Application type. F-�Extn.LNC F� GabWEnv. F-]R/Y S/b E] 2-d Story Deck F-] Solar Page 2 of 4 RM App.doc.doc Revised 7/21/2008 APPLICATION REQUIREMENTS Community Development Department 10300 Torre Avenue (408)777-3308/Fax(408)777-3333 Cupertino,CA 95014 planning@cupertino.org C U P E RT I N O http://www.cupertino.org/planning Fees Minor Residential Permit $1,077 Non-refundable fee for each request Public Noticing* 200 djacent property owner notice Categorical Exemption '� 213 on-refundable fee Categorical Exemption Filing Fee 50 on-refundable fee *A 'acent neighbors will get notice and copy of pla set Req irements ❑ Application Form ❑ Application Fees and Deposit t 1 ❑ Plan Set Requirements ■ 1 full size 24"x 36"plan set,folded to 81/z"x 11" ■ 3 reduced 11" x 17"plan sets,folded to 81/z"x 11" (Additional copies will be required later for noticing purposes). 0 CD-ROM containing PDF, TIFF or JPEG files of the plan set. In lieu of a CD, the images may be e- mailed directly to the City. See a planner for details. ❑ Public Works Confirmation Pl Set Contents icinity map Site Plan ■ Scale&north arrow. ■ Lot line dimensions,setbacks and dimensions from the building to property lines. ■ Location of existing and proposed building wall and eave lines (including decks and balconies). ■ For extension of a non-conforming wall: Location of existing and proposed building wall_ lines of buildings on adjoining properties. ■ Existing/proposed finished floor elevation of subject property and adjoining lot buildings. ■ Accurate location, size, species type and spread of existing trees on property and in public right-of-way. Mark the ones that are proposed for removal. Floor Plans ■ Fully dimensioned floor plans. ■ Show the first story roof on the second story floor plan. Elevation Plans ■ Building dimensions,first and second floor plate heights and total height. - ■ Indicate the single-story building envelope as described in Section 19.28.060 G (2) of the R1 ordinance. Privacy Protection Planting Plan (for a Second Story Deck) ■ Show entire'site. Show entire building footprint with roof. Page 3 of 4 RM App.doc.doc Revised 7121/2008 PUBLIC WORKS CONFIRMATION Community Development Department 10300 Torre Avenue (408).777-3308/Fax(408)777-3333 Cupertino,CA 95014 planning®cupertino.org C U P E RT I N O • http://www.cupertino.org/planning PLEASE NOTE: A Public Works pre-application is required prior to submittal on all applications. The purpose of this pre-application is to identify preliminary Public Works issues,which may adversely affect this application. Please submit this form and a copy of the site plan to Public Works Department for review. Public Works Department can be reached at(408) 777-3354. Project Address: Email Address: Applicant Name: Phone No: For Public Works Department Use Only Addition: Single Family Dwelling Flood Zone: Dedications Required: Additional Notes and Comments: X Signature Title Date Page 4 of 4 RM App.doc,doc Revised 7/2112008