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14020160CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20705 VALLEY GREEN DR CONTRACTOR: NOVO CONSTRUCTION PERMIT NO: 14020160 OWNER'S NAME: BERG FAMILY PARTNERS, L.P. 1460 O'BRIEN DR DATE ISSUED: 02/27/2014 OWNER'S PHONE: 4153105791 MENLO PARK, CA 94025 PHONE NO: (650)701-1500 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ ADDITIONAL ELECTRICAL POWER OUTLETS, (N) PANEL License Class/- r Lic. # %C%� Z 2- UPGRADE AND TRANSFORMER Contractor bVo „tST#z_W_- 7 -4 Date 2 �N, I hereby affirm that I am licensed under the provision of C apter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 1 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: $12000 1 have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 32610046.20705 Occupancy Type: section 3700 of the Labor Code, for the performance of the work for which this 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 DAY M L ST 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 Issued by: Date. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signat Date b2 2 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 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(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 Co e, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505 5533, a 25 4. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agar Date: 2 2 7 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 CONSTRUCTION LENDING AGENCY 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 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION � U� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION /�, p ` 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 N Y (408) 777-3228 • FAX (408) 777-3333 • buildina(d_)cupertino.org ❑ W ONSTRUCTION ❑ADDITION ❑ ALTERATION / TI ❑ RESION / DEFERRED ORIGINAL PERMIT r NE C PROJECT ADDRESS 0 ^7 OS \ AGt,! C n � ' � • t ''.tic^ APN R �h fQ 0 4/ I PROD (415) V C - y � Iq OWNER NAME �(N! ! Nvc • !/G E-ntiA ?Mot IO ft• �o �+�t STREET ADDRESS CITY, STATE, ZIP FAX R So I �{ I (sJFi � I rt P .10 C.� CONTACT NAME PHONE E MAIL Ion — S t 2- nov0 Cons fr uu�o/�.co toR Nt re 7 4+bvl STREET ADDRESS l K AX �v ❑ Oq+NER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE 02 Z L3 BUS. LIC r 38 9 I COMPANY NAME %6 ya a1�1e.7g tow E-MAIL FAX STREET AD RESS /� CITY STATE, ZIP �4� ,41TK PHONE ARCHITECT/ENGLNEER NAME LICENSE NUMBER BUS. LIC COMPANY NAME / F'n h.vgp Ft L�aT7tl� <=J2ovI� E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK s �e �►-► E2 EXISTING USE PROPOSED USE CONSTR. TYPE d I f STORIES USE TYPE OGC. SQ.FT. VALUATION (S) n � J, � �l � EXIS'tG AREA NEW FLOOR AREA DE.i0 AREA TOTAL NET AREA B /�� /2 OOo BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGE AREA: DETACH ❑ ATTACH m DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BELNGADDED? ❑NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: , ' - / TOTAI,�LI]lA�I4' "t / PLANNING APPL T NO PLANNING APPROVAL LETTER ( EICHLER HOME? ❑ NO !/ %' C//Y'/C/ 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 co ect. I havIrea the De .ption ofWork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to ing cons etion. utr�pr ntatives of Cupertino to enter the above -identified property for inspection purposes. Signature ofApplicant/A,e Date: 0Z Z SU��TAL IINTFORA4ATION REQUIRED PIA\ CHECK TYPE ROUTING SLIP ovER-TIC COL vTER Bnu DING PLAN RENIEw' New SFD ory dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLA.N\LNGPLAN REVIEW _ 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 ❑ FIRE DEPT . _ Copy of Planning Approval Letter or Meeting with Planning prior to ElrLAJOR ❑ s.ANITARY SEWER DISTRICT submittal of Building Permit application. ❑ EN'VIRON'TiENTALHEALTH BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ' ADDRESS: 20705 Valley Green Dr DATE: 02/27/2014 REVIEWED BY: Mendez APN: BP#: I �� /(L�� *VALUATION: $12,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1 REAP8 PERMIT TYPE: WORK additional electrical power outlets n anela and transformer SCOPE Elec. Plan Check 10.0 1 firs $0.00 Elec. Permit Fee: IEPERMIT Other Elec. Insp. 1 1.0 1 hrs 1 $47.00 1 Elec. Insp. Fee: JELECINSP $139.00 NOTE. This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Di.Qtrirt. PtC_ )_ The.@e feet/ arP ha.Qed an the nrPliminary hifni'ination availahlP and arP a"Iv an ovtin9atP_ f nntlyrt the nant fnr adds'I Jnf. FEE ITEMS (Fee Resolution I1-053 E f. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1� # $174.00 Electrical 1BREMP01 ER Other Power Devices Suppl. PC Fee: Reg. 0 OT f 0.0 firs $0.00 PME Plan Check: $0.00 1� amps $47.00 1 Electrical IBELEC2007 Services Permit Fee: $0.00 Suppl. Insp. Fee:0 Reg. 0 OT 0 0 firs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $186.00 Administrative Fee: 1ADMIN $44.00 0 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 Travel Documentation Fee: 1TRAVDOC $47.00 Strong Motion Fee: 1BSEISMICR $1.20 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $279.20 $221.00 TOTAL FEE: $500.20 Revised: 01/15/2014 Building Department CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: ,t�� 6C,,J �i�s� PERMIT # ©Z0 W OWNER'S NAME: A 'cc "� PHONE # foci 53 °- Sri 1 'z GENERAL CONTRACTOR: Aly,, BUSINESS LICENSE # '79102`Z ADDRESS: lybo C 113e.[ &^fLc CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature :1- [ ate