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12060130COVERSHEET 12060130-D EXPIRED 20605 LAZAN EO DR /�lanska/!eJ) PERMIT # _ PROJECT .2 ADDRESS APPLICANT l a'0 0�zn :I (fzvmlvL, 2 OG CO r % �z DATE .y►eM f� cam- ,� 00 m0 m0 min A �- �J 6T4' RES. (LVNG) (GARAGE) COMM. SQ. FT. (Nm T.I. Sur. PM. REMODEL CONTACT Arai^-� PHONE# l4 �ly' G. f��/ FAX VALUATION (Cost of Project) . RBQD. PAID NOTES: CONSTRUCTION TAX (Y) (N) SCHOOL FEES (Y) (N) HOUSING MTTIG (Y) (N) HEART OF THE CITY (Y) (N) ISSUED B ��� DATE TOTAL FEES I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 20605 LAZANEO DR OWNER'S NAME: BOYER FAMILY PRTNERSHIP I LP CONTRACTOR: DEVCON CONSTRUCTION PERMIT NO: 12060130 INC 690 GIBRALTAR DR DATE ISSUED: 06/21/2012 OWNER'S PHONE:. 4089745062 1 MILPITAS, CA 95035 1 PHONE NO: (408)942-8200 1 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. H Contractor Date 2 / p C�bt/� I 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. 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. 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. 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 re lions per the Cupertino Municipal Code, Section 9.18. Signature Date__���/y`�� ❑ OWNER -BUILDER DECLARATION 1 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 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 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, I become subject to the Worker's Compensation provisions of the Labor Code, 1 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. BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH r RESIDENTIAL r COMMERCIAL (— JOB DESCRIPTION: APPLE-TI EXISTING LAB SPACE NON-STRUCTURAL, INCLUDE ELECTRICAL & MECHANICAL, CEILING MODIFICATION Sq. Ft Floor Area: I Valuation: $38000 APN Number: 32633096.00 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 2/'// I - 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 I 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 I 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, Sections 25505, 25533, and 25534. Owne rf`iorized . Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Add ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Sign Date Licensed Professiona CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 •FAX (408) 777-3333 • build i ng(a-)cu pertino.org IOWO%,V) ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / Tl ❑ REVISION / DEFERRED ORIGINAL PERMIT N In] PROJECT ADDRESS ,fl O(00!5 �bjb ^VIV APN q 33 -69 OWNER NAME E-MAIL STREET ADDRES '�[i / / T , ZI Or �?7 CONTACT NAM PHONE �&�Ir +. STREET ADDRESS 1 Y,ST E, ZIP F ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAM LIC B R LICEN YPE BUS. LIC N 0 91 COMPANY NAME 1 E-MAIL F `771 v Ir�Z. e rJ - �-, M STREET ADDRESS 9 C , ST ZIP PHONE ARCHITECT4ENGINEER NAME 1 r IIrT� LICENSE NU BUS. LIC N COMPANY NA -MAIL _ F /3 STREET ADDR E ZIP PHO DESCRIPTION OF WORK 1 U1 Ji�J \ � l ~ EXISTING USE PROPOSED USE CONSTR. YPE H ST USE TYPE SQ.FT. VALUATION (S) AREA NEW Ot—� AREAS T AREA O TOTAL NEr AREA ` �OjCC. BATHROOM REMODELAREA KITCHEN REMODEL AREA / OTHER REMODEL AREA PORCH DECK AREg J TOTAL DECK/PORCH AREA GARAGE AR A: DETACH ATTACH p DWELLING UNIT IS A SECOND uNrr ❑ YES SECOND STORY ❑ YES BEING ADDED? 1NO ADDITION? JkNO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED BY: ^ TOTAL VALUATION: PLANNING APPL # IWO PLANNING APPROVAL LETTER EICHLER HOME? O J 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 ead this application and the information I have provided ' correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local v' ordinances and state laws relating to bull nstruction. I auth ' representatives of Cupertino to enter the above-id�rtified pryperty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMEN AL ATION REQU1 - ' PLANCHECKTYPE : ROUrINGNLW ` �/y_ &�_W New SFD or Multifamily i.ngs: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building OUNTER IMNGPLAN REVIEW permit for new building. ❑ EXPRESS ❑ PLANNING PLAN 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 El MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEAL'rHf BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 20605 lazaneo dr. DATE: 06/21/2012 REVIEWED BY: bobs. APN: BP#: �Q 3 d 'VALUATION: $38,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building USE: PENTAMATION 1 B TI PERMIT TYPE: WORK U. comm existing labs ace non structural include E. SCOPE OCCUPANCY TYPE: TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID B (Tenant Improvements) II-B,III-B,IV,V-B 0 $0.00 $0.00 TOTALS: 0 $0.00 $0.00 MECH, HOURLY Q Yes v No PLUMB, HOURLY Q Yes 0 No ELEC, HOURLY n Yes 0 No W. ch. flan Check plumb. phw t hec A FT IBev, Plan Ci7Cr;r 1111 h. Fee: Nr�-n1>. Pi /'c'c: GICc.Pe±'+ni!%';•: Olho- ,tech. Insp Other Phimh h; Lj Other E(-,( Insh. ile(.h. Irzsp. Fero: Plnnrh. h).Sp. IJcc. Insp. /;ce. NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). These fees are based on the nreliminary information available and are only an estimate. Contact the DeDt for addn'l info. FEE ITEMS (Fee Resolution 11-053 Ef. . 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? Q Yes 0 No $0.00 F--27 hours Plan Check, Hourly $260.00 1STPLNCK Suppl. PC Fee: Q Reg. © OT ro.01hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? Q Yes 0 No $0.00 $0.00 Suppl. Insp. Fee-0 Reg. Q OT o .01 hrs PME Unit Fee: $0.00 PME Permit Fee: $0.00 (:nf,sn7�clion TUX. �1:�=ni,ristrauve Fee: Q 0 Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Fee: $0.00E--57 hours Inspections $650.00 1STINSP Inspection, Hourly 0 i Travel Uocnmctttation h Strong Motion Fee: 1BSEISMICo $7.98 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $2.00 U "T0'1':�LS: $9.98 $910.00 TOTAL FEE: $919.98 Revised: 06/30/2012