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08110011 CITY OF CUPERTINO 'a ?a^ a +. :,a BUILDING DIVISION PERMIT C, ItA�TQR IN 'URIVIATI BUILDING ADDRESS: - PERMIT NO. 10 OWNER'S NAME: PERMIT ISSUE DATE U CONTROL NO. ARCHIIER/ENGINEER: BUILDING PERMIT INFO BLDG ELECT' PLUMB MECH 0 0 0 0 uQQ LICENSED CONTRACTOR'S DECLARATION Job Description u 1 thereby of inet Nal 1 am Ii¢nsed under provisions of Chapter 9(commencing P with Suction 7000)of Division 3 ofthe Business and Pro(esswru Code,and my license u -ta- full tomeaM REMDL MSTRBDRM(60SQ) ,NON—STRUCTRL, MECH/ELEC/PCMB jn? Lt. 0 IJc.• Ug S2Z- g� Dam cpntnnar INCLUDED — NOTE: JON ANDERS BUILDS PD FOR BSL Q ARCHITECT'S DECLARATION JQ2a�. 1 understand my plans,hall Its,used u"hire records 110408 y g 0� Licensed professional 5 OWNER-B UILDERDECLARATION 1 hereby in.that i am aempi from the Contractors Lu cnm Law ter we p o following mason.(Section 7031.5.Business and Promadons Code:Any city or county I SE! which se,sirq•permit to construct,filer.wprow,demolish,or mpdr any sa'selme °zy prior m its issuance.also requires the applicant for such perediUO Elea signed stammeni ss< Nat he is licensed pursuant to the provisions of the Contractor's licansc Law(Chip=9 Sq.Ft.Floor Area Valuation X51 (commencing wish Section 7030)of Division 3 of the Business and Profusions Code)or Q - that he m aerrpt Nemfrom and the basis for the alleged exemption.Any violation of Section 7031.5 by arty applicant for a permit subjects Ne applinnt m a civil Perulty of APN Number Occupancy Type not mom Nov fw hmdmd Oo1Ws(53001 ❑T,ss owrra ardie psaperty,«my wploy«s wish wage uNe'v sore cmnpentadon, 32649005 . 00 andpr Newick.and Nnie ComanmmLnded«ie,do foraam(Sec.W sec owner Nd PlafeSLON Cade:TIC Cstther ail License,ndwho Law doh or apply lf an aw«t of Required Inspections monam wwwiidaw(mprowch improvements who d«notch work himselrad foreehhf, however. we uiprovided that such improwmens tae not intended mpllepd the ale name. however,Ne building«improvement u told within o« ild w completion,theoneof builder will low the burden of proving that k did tion build w improv for purpose of tale.} 1.u owner of the Property.w encludwly contracting with,Brc"..4 convact«s to companies de pmjca(See 7W4.Business and Professions Cade:)The Commuters U. const law dues not apply w an ow«s of property,who builds Or improve,dement,and who contracts for such projects with,contractur(U licensed pursuant in the Convectors Lkense Law. ❑I an aempt under See ,B h P C for this unser Owner Data WORKERS COMPENSATION DECLARATION 1 hereby aR'um under pcmd,y of perjury ore or the following d"wrodims: - 1 low and"I mdnsin•CestiOeaw ofCmdamt to self-iuum f«Workeh Compete- on,es provided far by Section 3700 of the labor Cade.for two poformarrc of the work fur which this permit is issued. ❑1 have and will maintain Workers Compensation Insurance,as mquip l by Suction 3700 of the Letter Code for the perfarmuce of Ne more for which this permit is issued. ' My Workh'3,J:ompewdo�IPmnnce carrier and Policy meGm�bers ere: rr'� Cartier. >> Policy No.:I O r-y 901—;260 6 CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE . (Thu section need natty canplewd lithe permit u forms hundred dollars(SIM) or kis) 1 certify Nat in we performance of the work for which Nis permit is isssed.I shill nm ampioy,ny person in any mm«ru as to become subjeel m we Worker'Compemadon Laws of California Dam r AppBaw NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should become subject in we WarttYs Compensation provisions of the Lsbw Coo,you must Qfurtbwuh comply with such provision or this permit shill w deemed pwkcd. z C CONsmuc 1ON LENDING AGENCY [-i .4., I hereby affirm that Neu u a cosslnedon landing agency for to perfurmarla of a > Ne work for which Nis permit 1s issued(Sec.3097.Civ.C.) 0.Q Landers Name z Lenders Address U O I ceniry that 1 have read N.application and sum Nu the,bow iMearmon n I, W.t- antra I agora to comply with ill city and county oNinatuv and sum laws plating in 8 SV' building construction.and hereby auN«its mpmunuGveS of Nu city to enter upon tic [17 •hove-mentioned pmpeny for inspersion purphea a (We).&me m saw,indemnify and kap harmless Ne City of Cupenino against rte liabilnaus,WZ .f tus which may in any way accrue agduat said City Uz into permit �soul AND WILL COMPLYW1TH ALL NON-POINT Issued by: 62� DateSOU • Id 6 Re-roofs �- Signet fApp tlCa Totter Do N tDOUS MATERIALS DISCLOSURE Type of Roof _ Will Ne applicant or fuwm building ecoupsew Tom whatew,heandons maerid as deRm'd by she Currents.Municipal Cuda.Chip.9.13,and the Halw and Safety code.Section 25532(a)7 Ya All roofs shall be inspected prior to any roofing material being installed. Will the appbcanl or mum wilding occupant use weipment or dcwps which If a roof is installed without first obtaining an inspection,I agree to remove II hvaNnus air concealments a defined by Nr Bay Am Air Quality Management all new materials for inspection. vitt? Ya 24--- 1 have mad the hvaNaua mamridsrtquiumems undue CNPvs ti.93ofNe Calilm- wlicd"S lyCa-!k5n ss505.35533and25534.1u.&-mWthatifdehuikwg duh Out carte dy haw.s ar Nu b u my pspondbllily m rwtiry the occumm,of the reguirem rl khmuiW tri a rmissuarccef.Cvtifcateaf Ocap 08 Signature of Applicant Date / All roof coverings to be Class'ni'or better Owner 6sohmi.Q jl;eoJDam' 0 CITY OF CUPERTINO ,• 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32649005 . 00 DATE ISSUED. . . . . . . : 11/04/2008 RECEIPT # . . . . . . . . . : BS000006535 REFERENCE ID # . . . : 08110011 SITE ADDRESS . . . . . : 10630 STOKES AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : BOB & JULIE GOODMAN ADDRESS . . . . . . . . . . : 10630 STOKES AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1237 RECEIVED FROM . . . . : JON ANDERSON BUILDS CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . , TELEPHONE . . . . . . . . : • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 15, 000 . 00 1 . 50 0 . 00 1 . 50 0. 00 1BUSLIC FLAT RATE 1 . 00 110 . 00 0 . 00 110 . 00 0 . 00 1REMRESBAT SQ FEET 60. 00 429 . 00 0. 00 429 . 00 0 . 00 1STPLNCK HOURS 1 . 00 122 . 00 0 . 00 122 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00 --------- ---------- ---------- ---=------ TOTAL PERMIT 703 . 29 0 . 00 703 . 29 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER -------------- --------------- -------------------- CHECK 703 . 29 #1781 --------------- TOTAL RECEIPT 703 .29 O RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number: Name of owner. Project address. fo1 161:7C im_ Contact person. vp S(P Phone. 20 Fax. Net square footage of lot. T� Existin¢ Proposed Square footage: First floor: Second floor: Garage: TOTAL: —� Are there at least two 10 foot by 20 foot clear spaces inside the garage? r ri� \ *privacy protection planting required for the project? Y 1 On what floor(s) is work being done? Brief description of work. FM1AkVA &t"1 Q AIDE ! C:X {tWL (° 00, ] uM&Arn 4 Code editions: 2008 CBC „y �N)200$,CFC N)2008 CMC 2008 CPCfII R ^.t,008 �Dt� 1q N) C DFS AND ORDINANCE; LI Effective 1/1/08 3MW — %set of pt f apt on the j._} et aspecification`s MUS. v LI 1 to make - c,,.�riimes and it is , try@ inWrth'o Pe or alteration 'The Ora DcP,. C v I mission fror NOV 0 4 7UU8 *44 s<Bm 8 of,h, Pertino. , WOT P n .n., SPacrficatior ORIftl pt a void t_ Pc mit or to be r. �pCltyOrtlmanceor ,d jaProvrsin . Plan Review Process Work Book Page-8-Revised 1/1/08 z 7. CY gtT I�fr'bv./ T1 NOVO 410O8 o � S�oP—oF iNare Al,�S)OC ( ✓Ioc�&t__ 10630S7� SS vim, j v�7z�In/o _ r J SCoNcF �-t�,tfT q�eEuJ �I � �l�o(z/ ZZ 5w(ITA VAp vJl PRaw� G¢rJ �> s h T b2Eina� Ne►J -T ('E 6 ftyiSTPrz- 6474 f P17- 011D DE • �R4Jr� s: ��1.ZoFZ /o C) � I CITY OF CUPERTINO ry(C� ADDITION/REMODEL CITCUPEI�TINO PERMIT APPLICATION FORM APN # 3� (� // ! C) V U J Date: 7 L O Building Address: 3 S v C Mailing Address (if different from building address): Owner's Name: Phone # 2-s7— q_- Contractor: Phone#: p$ -SS(,6--7 17.57 S Fax #: K Contractor License #: cgc'q S� Z Cupertino Business LicensseD#:l Contact: �( Phone #: 1 .2L(^ ZD9F5 SJ4 Fax #: Building Permit Info: Bldg. [P/ Elect. D;--- Plumb. [ __ Mech. Hillside ❑ Job Description: Addition-What is being added?(Be Specific): What is being remodeled (not including addition)? EWC4W Uhl S / Remodel Includes Re-Roof: Yes ❑ No ©/]f yes list number of squares Remodel Includes Structural: Yes ❑ No Ejtt.�. Do you have the pre-application planning approval? Yes ❑ No ❑ If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached ` o Remodel: Kitchen Bath 90 Other Type of Construction (Usage Class): Occupancy Type: I-A, 1-B ❑ II/III/V-A ❑ 11/III B, IV-HT, V-B Ej- -�L 3 Valuation: L<-,4,1,9 Please check this box if the project is a I second-story addition ❑ Project Size: Ex ress ET Standard ❑ Large❑ Major❑ Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, Green Building Points chieved: include in plan set & the sheet index. ***For Office Use Only*** Over-the-Counter ❑ Revised 10/01/08