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12040062COVERSHEET 12040062-D 10500 N DE ANZA 1ST FLOOR PERMIT # PROJECT ADDRESS PC�sro �4n ,l; .1 e(006, 2 m ^ ,� 1 c C, , /7_-.t__: f -r -."n, _ 1 -.Y� � Y,,� Y`Gar-J�.l �Yrr APPLICANT APM �3 IZ Z;L —d 1- 7 .. RES. (LVNG) (GARAGE) COMM. SQ. FT T.I. SQ.FT. RES. REMODEL CONTACT d-� l7CC � PRONE# 1-(-T- Z2 G( FA Aimce • �('ol&t e e (` VALUATION (Cost of Project) 2 ��r�" g rob N�tH .ep wt / RBQD. PAID NOTES: U CONSTRUCTION TAX (Y) (N) SCHOOL FEES (Y) (N) HOUSINGN9110 (Y) (N) HEART OF THE CITY (Y) (N) ISSUED H ' _ 2 2 -L r �---"� _�.-....--....�.� DATE .S �( 'DOTAL PEES imin rm Old Ed i AMA Mao Emeffummmmmm APM �3 IZ Z;L —d 1- 7 .. RES. (LVNG) (GARAGE) COMM. SQ. FT T.I. SQ.FT. RES. REMODEL CONTACT d-� l7CC � PRONE# 1-(-T- Z2 G( FA Aimce • �('ol&t e e (` VALUATION (Cost of Project) 2 ��r�" g rob N�tH .ep wt / RBQD. PAID NOTES: U CONSTRUCTION TAX (Y) (N) SCHOOL FEES (Y) (N) HOUSINGN9110 (Y) (N) HEART OF THE CITY (Y) (N) ISSUED H ' _ 2 2 -L r �---"� _�.-....--....�.� DATE .S �( 'DOTAL PEES CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10500 N DE ANZA BLVD OWNER'S NAME: BERG FAMILY PARTS LP CONTRACTOR: DEVCON CONSTRUCTION PERMIT NO: 12040062 INC 690 GIBRALTAR DR DATE ISSUED: 05/22/2012 OWNER'S PHONE: 4089961010 I MILPITAS, CA 95035 I PHONE NO: (408)942-8200 LICENSED CONTRACTOR'S DECLARATION •License q.lass�B Lic. # 3 Contractor E ✓cQa Date � / Z 1 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. 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. 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 permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above infomtation 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, 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 4 Cupertino Municipal Code, Section 9.18. pi�,� 1/ VJ:Z Date V % ❑ OWNER-BUILDbU)ECLARATfON I hereby affirm that I am exempt from the Contractor's License 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 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 Insurance, 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 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, 1 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH F RESIDENTIAL r COMMERCIAL I— JOB DESCRIPTION: APPLE -1 ST FLOOR -MODIFY EXISTING RAILING AND METAL STAIR SYSTEM INTERIOR ONLY Sq. Ft Floor Area: I Valuation: $25000 APN Number: 31622017.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by Date:J---�� 2,ri— r 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 1 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 1 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, Sec ' ns 25505, 25533, and 25534. O r author : r Q CO ION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of wrk's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(@cupertino.org CUPERI 114 � F-1 NFW CnN.STRT is-nnNI n AnnTTTnN b AT.TFRATTnN / TI I r� I RF.VTSTnN / nF.FFRRFn nRIGTNAV PF.RMIT N PROJECT ADDRESS I D SDU {� / y� A V �� �{'�- q �p�n.ry� APN d o �1/ livIFLOA/ ��j'A/�j OWNERNAME� ev STREET ADDRESS LOop CITY, ST T� E,,/vR_Vk)O FAX CONTACT NAME PHONE O� �/ A (/C' E-MAIL • ' •`L v STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME f LICENSE NUMBER LICENS YPE BUS. LIC N COMPANY NAME Pv� /^„ w 1 ova �/�� /W�V .n� & E-MAIL M� _sO y FAX STREET ADDRESS /_nFay(,(///1,/1 / a q(;5 vl CITY, STATE F PHilp ^ J• lel`, V7vV IZIP (f ` ARCHITECT GINE R NAME M" efflA LICENSE NUMBER BUS. LIC H COMPANY NAME E ^ �aN �A •'9 FAX fgge�ST DRE S ,/ , _ / f►OV C1T STA , Z�/Pnl /J� O/ f^'� L�L PHO DESCRI OOFI V O� / �r + / ��•u Cdr Alh4) C�Ir 1 u l,�i Gc �o�C�-Erb j*D 1r fi- p400y- EXISTING USE PROPOSED USE C'ONSTR TYPE - as TO S USE TYPE OCC. SQ.FT. VALUATION (5) — EXIST Q AREA ( I j NEW FLOOR AREA DEMO AREA TOTAL NET AREA /I • j-� �S BATHROOM KITCREN OTHER REMODEL AREA REMODEL AREA REMODEL AREA ^� PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH �• �` �� []ATTACH H DWELLING UNITS: IS A SECOND UNrr ❑ YES SECOND STORY ❑ YES BEING ADDED? LaN0 ADDITION? .2NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF PLANNING APPL N rNO PLANNING APPROVAL LETTER IS THE BLDG AN ❑YES EICHLER HOME' ONO ;;;a :$,.ri3•�3�(�>>1i;s�lr:�{; `%]a[?.�irfl•�'-`�z {a ''(ri �t =• �j1�Sjj}1'�' TOTAL VALUATION: S fi r' 4� %t 3' 4 z) i, ,� ?i1.') 11510 rY VSsfit':t f 1 , tt_ f 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 providedis rrect. I ha ad the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin ction aut Zze representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicanUAgent: Date: q' SUPPLEME AL INFORMATION REQUIRED SON New SFD or Multifamily dwellings: Apply for Y g PP Y existing building(s). Demolition is required demolition permit for P to issuance of building f�, s ]; ', ;, ti: '`• E f tf 'ri i) �,,�' ffc•j , s�,-• � j3 ``. -r, i ?a ;c; t`. �.`liI N�?{��ij] v y' �{ 3" permit permit for new building. prior I {'/r • s .:clr �< yF, � i E7S } f , ;• , g ]. i;0 .129 , 1 3 tt S �; ,, : f �T Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11- R`•, , t S1O-'• i ?{ =t. „J?; s fj Z �; �fEy1�•li%M LI�� \ {sl£,.. f� 3 r jfs < `•S •i ? °6 Vii:, y MUM �]•;; `'I��jf?. ; y� ✓ s f �ry3 f form if any Hazardous Materials are being used as part of this project. s J }? fs, j ;i?1;; ! , •,f '{,,:};„t?t r •, � s'�l.,. :. =_ i% �>f. (,,-i �•... -J�l f � j':�rn fr'il i )� t.��. k �% r :jA .;.C.j.;;J r1:,,::lS�i {: �:.�%ji.i<.: �.i=-✓ r�4'n!'' "s� ]rte ry'j j', ., f. �'W � •tai<2-� �. � • /r1::1.� r..I.NI%; �.::'�'. • ! ��:.!'n'r? ti:vi•:%•.::5.=)r''11i��1==-ic`fY'�ry1:�.f ' �t ���.-z� .:il.. '[s•,c, Copy of Planning Approval Letter or Meeting with Planning Prior to ; ,•. - �''� ,� : ,;��' s' JY; �'"' '"s�•'''lj � ilr> •Pr< ;r�I.�l: .cif%�i�r]'ir ,I'S. .. !f, � >••, > i rv���i� "•[ . �s iii; submittal of Building Permit application. y�:ti;;ar:,y-;,� ,.>„'%s;•;;.`<,`;:y:,; �.;<c>>=x.: �-�` j.�•]:�Sf/'�:� '<%,:r,f '. r..: ..7'i i�[: �,;�'?':��,�);F;'s;;=: r=cr�;z:�s>��::;f;r;:=;.='}�';t �1�i�.)?..ii.�Ct-���.;;ti�.:iJ��(y'�a,,.:�ij/•'•rr lv C.f%:. '•:<�.., a.�f;-t �,sc.,k'r��!iI'IR.rFFT14%i.A�'?'?c�- :I:;•:?,�,;. •-J�.'-�.;.-Yr,.; c•'•i BIdg4pp2011.doc revised 06/21/11 a CITY OF CUPERTINO FMIN FEE ESTIMATOR - BUILDING DIVISION /f .7.. .J.-a••S •. ..>,.... �.: t..;:��,::.isi::;fj':.i��'F.;i..i...r;. ,.i.•.::...•.:.'-:.: �:.:�.. .,I.1./> ->J`<:/. ,f.f •i%ii i'i:i'rr. � / i?+i �:ii= ii ii i ii i i%/ � r;:J:•_: •,�'ii�•.•'�.! ��;'i ADDRESS: 10500 n. de anza blvd. DATE: 04/11/2012 i APN: 311 a (�� BP#: ��� (�d�� REVIEWED BY: bobs. `VALUATION: 1$25,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY Commercial Building USE: F-47 hours Plan Check, Hourly $520.00 ISTPLNCK PENTAMATION 1GENCOM PERMIT TYPE: 'Al WORK modify existing railing and metal stairs stem interior only. SCOPE PME Plan Check: /f .7.. .J.-a••S •. ..>,.... �.: t..;:��,::.isi::;fj':.i��'F.;i..i...r;. ,.i.•.::...•.:.'-:.: �:.:�.. .,I.1./> ->J`<:/. ,f.f •i%ii i'i:i'rr. � / i?+i �:ii= ii ii i ii i i%/ � r;:J:•_: •,�'ii�•.•'�.! ��;'i ;': �. .. 1';:Ni �. •... :: J. , i.rn;,ri'. ��� ,: a f�'.,. a 1'-, . �. .. ,.' �,'.�'6:; Plan Check Fee: Hourly Only? Q Yes 0 No $0.00 F-47 hours Plan Check, Hourly $520.00 ISTPLNCK Suppl. PC Fee: Q Reg. 0 OT 0.0 Li $0.00 PME Plan Check: $0.00 F__17 # Stairs $327.00 ISTAIRS (Specify # of Flights of Stairs) Permit Fee: $0.00 Suppl. Insp. Fee -0 Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 .! Crtvj E) Work Without Permit? © Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Q Building or Structure i �jrf A--- :•,, r... Biu.' r%:':r A'lr: ri::::�, M1, yk /f .7.. .J.-a••S •. ..>,.... �.: t..;:��,::.isi::;fj':.i��'F.;i..i...r;. ,.i.•.::...•.:.'-:.: �:.:�.. .,I.1./> ->J`<:/. ,f.f •i%ii i'i:i'rr. � / i?+i �:ii= ii ii i ii i i%/ � r;:J:•_: •,�'ii�•.•'�.! ��;'i ;': �. .. 1';:Ni �. •... :: J. , i.rn;,ri'. ��� ,: a f�'.,. a 1'-, . �. .. ,.' �,'.�'6:; Plan Check Fee: Hourly Only? Q Yes 0 No $0.00 F-47 hours Plan Check, Hourly $520.00 ISTPLNCK Suppl. PC Fee: Q Reg. 0 OT 0.0 Li $0.00 PME Plan Check: $0.00 F__17 # Stairs $327.00 ISTAIRS (Specify # of Flights of Stairs) Permit Fee: $0.00 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These Pees are based on the preliiminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 ff. 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes 0 No $0.00 F-47 hours Plan Check, Hourly $520.00 ISTPLNCK Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 F__17 # Stairs $327.00 ISTAIRS (Specify # of Flights of Stairs) Permit Fee: $0.00 Suppl. Insp. Fee -0 Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 .! Crtvj E) Work Without Permit? © Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Q Building or Structure i 7•i. .,::+ [3�7i ,7;, ,�.,rE>i �" Strong; Motion Fee: IBSEISMICO $5.25 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 ; '...: ':..::i;:......„'....._,;. `..�;, $6.25 $847.00 , ..,., 853.25 Revised: 04/01/2012