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12060129 (2)COVERSHEET 12060129-D 22249 HAMMOND WAY PERMIT # / Z c7 6, O ( 2- 9 DATE 9 -2) - ' -I— PROJECT PC-z-k , All 16D lz , 3 a ; �ou.0 `41►:f �� d ou1201900- F, it c ez.scr ADDRESS 22 Z %4 S ffA MM 0 Nv cJ APPLICANT f J E JON\ OWNER JR*4)t s +Al o M g y T prAC00— ®■tea» s�� s��® mWAS) SA 114Z AM 3 yz- sd- OoS US. (LVNG) pEcsc. IS'o ' (+26AR /.SS' (GARACM COMM. SQ. FT. (NEW) T.L SQ.FT RES. REMODEL CONTACT(�,E,pM�f►rnl PHONE# lv L2-2-00 3t- PAX '�i M Lif"A#.N- VALUATION (Cos of Project) 3 E, D do NOTES: (,. mi0scAfff.., C-vn S CONSTRUCTION TAX (Y) (I) SCHOOL FEES (Y) (N) HOUSING bl]MG (Y) (I) HEART OF THE CITY (Y) (I) ISSUED B'Y� ��--�— DATES Li�l'L- TOTAL FEES CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22249 HAMMOND WAY CONTRACTOR: ELEMENTS LANDSCAPE PERMIT NO: 12060129 INC OWNER'S NAME: MAY TOPPER 329 BARTON PL DATE ISSUED: 08/14/2012 OWNER'S PHONE: 6509651581 MENLO PARK, CA 94025 PHONE NO: (650) 847-1252 LICENSED CONTRACTOR'S DECLARATION BLDG ELECT PLUMB License Class Lic. 4 BUILDING PERMIT INFO: MECH RESIDENTIAL COMMERCIAL /�� Contractord 446* 1 �— Dateah pt I hereby affirm that I am licensed under the provisions of Ch f 9 JOB DESCRIPTION: BACKYARD PATIO, DECK 180 SQFT, ARBOR 155 SQFT, (commencing with Section 7000) of Division 3 of the Business & Professions FIREPLACE, BBQ AND FOUNTAIN 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 Sq. Ft Floor Area: Valuation: $35000 Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APN Number: 34258005.00 Occupancy Type: 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 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. Issued by: Date: Signature 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 1, 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: 1, 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: l 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. Additionally, should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I 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 caner aut oriz t- forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that [ 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 %ork'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. I understand my plans shall be used as public records. Signature Date Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION -9 ALTERATION / TI ❑ REVISION / DEFERRED 1)D� D/A ORIGINAL PERMIT # PROJECT ADDRESS /f rj �I7 i- (-• APNiT� - r rDO� ,J1 OWNER N4A �% PHONE E-MAIL STREET ADDRES%}` 7a!t1 hkjkl�!! CITY k') 09C CA FAX CONTACT N PHO �1w MAII STREET ♦ FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR D) t" TLI pl BUS. LIC a J5 COMPANY y • W FAX g P 2ZZ d0 ARCHrI'ECr/ENG LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK d lT R Q i s5 0 EXISTING E PROPOSED USE CONSTR. TYYPE II STORIES R 3 (,/ — i S A M� p ( USE TYPE SQ17. VALUATION (S) EXISTAREA AREA ARENEW FLOOR AREA DEMO TOTAL AREA NET AREA 0 L(T Do to /i /�OCC. R - 3Z 3 J, t-)-orj BATHROOM KITCHEN OTTER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ATTACH q DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? WO ADDITION ENO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF G APP� ❑ NO PLANNING APPROVAL LETTER 18 THE BLDG AN ❑ YES EICHLER HOME? WO RECEIVED BY ROD TOTAL VALUATION: O 35 IUD ,60 By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the prpperty owner's behalf. I have mad this application and the information I have provided is cgpwov, I have read the Description of Work and verify it is accurate. I agree to c ly with all applicable local ordinances and state laws relating to building trio a orize representatives of Cupertino to enter the abov -id fled p , erty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENT ORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER -.TIE -COUNTER ❑ BUILDING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance ofbuilding permit for new building. El PLANNINGEl PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD El 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 HEALTH ow B1d&4pp_2011.doc revised 06121/11 CITY OF CUPERTINO Iil FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 22249 Hammond Way DATE: 06/21/2012 REVIEWED BY: RDW IMN APN: BP#: *VALUATION: 1$35,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PENTAMATION 1GENRES PERMIT TYPE: WORK Addition to existing deck - 180 s /ft. new arbor - 155 s /ft. new outdoor fireplace, new fountain and SCOPE BBQ. t.fzaa+: Nan Check Plumb. Plan Check 0.0 1 hrs $0.00 Elec. Pkur Che,�rk Akf h. 1,crwa Fee_ Plumb. Permit Fee: IPPERMIT 1_fec 1,c-ruw l:. . +.k,c.h. ht)p Other Plumb Insp. 0.0 hrs $44.00 Or/wr Clec, ln.rh, NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta). These fees are based on the oreliminary information available and are only an estimate. Contact the Dent for addn'l into. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =# $457.00 Deck / Deck Railing IDECKwooD Deck (wood) Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 F--17 # $65.00 Plumbing IPGASRES Piping, Gas <=4 Outlets Permit Fee: Hourly Only? ()Yes 0 No $0.00 Suppl. Insp. Fee-0 Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $44.00 c ), ; '; 7fcfion TaX. Administrative Fee: IADMIN $41.00 0 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 2� hours $260.00 Inspections ISTINSP Inspection, Hourly 0 0� Travel Documentation Fee: ITRAVDOC $44.00 Strong Motion Fee: IBSEISMICR $3.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC 1 $2.00 ,SUBTOTALS: 1 $134.50 $782.00 TOTAL FEE: $916.50 Revised: 06/30/2012