08110102 CITY OF CUPERTINOxsx+ k+$ pr; (se ,xi 'x„': •, ''�?
BUILDING DIVISION PERMIT aCtl1 rRAGTO ANF0Rn'IA'TION '
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BUILDING ADDRE SI PERMITNO.
22330 HOMESTEAD RD 120 CENTRAL A
R'S NAME: PERMIT ISSUE DATE
4844 QT.YPEE3hB AVE
NE: - SA Y CONTROL NO.
ARCHTfECr/ENGINEER: BUILDING PERMITINFO
HLI ELECT PLUMB MECH
REMODEL 70 SQ FT TO BATHROOM D O D O
.Gp LICENSED CONTRACTORS DECLARATION NON—STRUCTURAL Job Description
r��Zt 1 oA 70ra of that1amsensedunderpmvidonso!Chapw9(eay If--is
n< wiNSmtian]IXIU)of Oiviaon3ofW Buanessud Prolessiom Code.cera mylicuaseu
<� in full Iota and effech
� p Damnssa — `ARCNTECTSOECLj i
-
—
�3q3q''7W<< I uMctaplansand my plans mail W used u pubo oNa
yU
e G G Licensed Professto..1
'' 3 OWNER-BUILDER DECLARATION
qyI hereby 31TIM Nal 1 am ecmpt from ftConuacto's License Law for ft
i a O following tetion.(Section 7851.5.Busims and Hofuaions Code:My city or county
$(Li which require a permit n cnruuueL aur.improve,demolish,or repair any sweture
pHwmila umc,alaan'qu1113Neappl6NtfofsuChper111111oRICasigwdsmWmcnl Ft.Floor Area Valuation
—Z< Nat he is licensed puru sdhol W to pmvisimof the CanuncturS Lim.Law(Chap=9 Sq.
y� (camnc.6.,with S.Ww 700M.f Division Sof the Been.and Professions Cade)Or
Q —g tha he Or Among,tbenfrom and the basis for the alleged eaempdata MY violaoan of
Section 7131.5 by any applicant fora permit aubjec s the applicant u A civil Penalty of APN Number Occupancy Type
out mart said fie hundred dollars($500).
L u owek.nd property,m my employee with wage a tWtr se.cam.BAAIO n,
wife buduworts Code: swtsumiaoutinutdcd or offered Imsale tapply M An Bnsituv Required Inspections
Am my at ore Cade:The Co.uace i,Cdvnse Law doe not apply u an owe of q p
NosrstY who buiWouided rowsthmmporna who doesohtrek aroffeordsvu,h his
own cm.me building
uip ing ar l that slashai ,I,mid nu sae rmt esssor c moQetW the Owners-
Wilder,
wn E,
h older, in e,Ab{mien o`pro proving
cold within ane lessor compktian,ase owe-
Wilder will haw mu Marden of paovini that K did not bulk or impamm fm purpose of
uk.4
❑1.u atom of the property.Business
and confession,with licensed Am uacross m
caruut�Y Ude es not
(Sec.Asan,urne of.and Pnofesproperty
who
CodeI The fonheman,Li-
sue Law doe not ippon u es ownu of property who Wilds or Improve COAMICred,
who se LAW.far such pmjew with acontratsom(¢)liaised pumsummthe ConuatsMa
L aamlaw.
❑lav eempr undo Sec .B dtPC fm mtis reasost
Dau
WORKER'S COMPENSATION DECLARATION
1 hemby aRino under Nodty of perjury,one of du following deluauattc
1 hzw,and will manor.a Cestiluau of Consent u self-inavn for Worlacra Compere
tion,u ptwidW foe by Section 5700 of du labor Cede,for dm No..of Ne
wmk for which Nis permit is famed.
O 1 Ww and will maintain Wor mem Comp,,mmo Insmrta,u tm7dred by Smuon
5700 of ase Labor Code,for the performance of du work for which Nu permit is issued.
My Werke/f)�Cc IOSati/op lnsu{p .ear icr and Policy nu Wr am:
Carrier. r-"Yl^ Policy Na.: —
c6neICATE OF E%FA3PnON Fl um WORKERS
COMPENSATION INSURANCE -
maiAscmlon stem tutbecomplee d if Ne permitu fame hundW tloBua(SIM)
or inu)
1 Canary that In Ne performance of the work for which this Permit Is issued.)shall not
employ anypersen in any manocran As u Wcome subject to mm Workers''Compenu8on
laws of CaBrmdL Data
Applicants
NOTICE TD APPLICANT:IL afar making Nu Ccrtlrem:of Eaemption.Yam ahould
become subject in du WarluYa Compcukdem provisions or tW lahm Code.yeti muss
.J O roMwith comply will such provisions o Nu permit mall m
l W decetl wkrA
n
Z y CONSTRUCTION LENDING AGENCY
[-n Ihermy.111.Nn there iso consuuctimn lendingagene,for Ne perfmmamn of
amoi Ne work for which this pmsnit Mre
oad(Sec.5097,Civ.C.)
[T] LcndcYs Name
Address;
Z Lenders .
U 0 1 cmtify mut I lura mail Nis application and sum tha do abut information is
ty, r' comets.I aims to comply with all city aM county on ina en,s and sum laws relating An
.C) rV' building construction.and hereby amardse npmsemuuws of Nu city to enter upon Ne
CWve-mentioned property for inspection purposes
(We)gree to caw,indemnify um kebaamlrss the City of Cupertino against
tiHmilims.judgmeno.cnsts and cape.ell' may Is my way acenuaganst said City ^
U Z in co uerue of du granu W
^' Date
A IC UNDER COMPLY WITH ALL NON-POINT Issue
d by:
5 URGER ULA —
—of
Re-roofs
Si o Apt t a ffkwrRDOU Dow
AZAran.b MATE RIALSDISCLOSURE Type of Roof
aPCupemor fmuni Wilding e.Chantmom m handle hvudou material
defied y the Cupertino Mumci Cade.Chaptm 9.1;and tW HW N and Safety
Section M3zp)A All roofs shall be inspected prior to any roofing material being installed.
Oyer o
Will the applicant or future Wilding Occupant use,equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
'it haudnas air canamimana u recd by the Bay Area Air Quality Management all new materials for inspection.
avicO
❑Yes u
I haw n:aJ mu hasadausmauria urcmenaunderClupurG95aftheCilifor-
nuHdth Mty Cade, m'ns255 535am125531.1 unMmuud thuifdu Wilding
does contend) hate l e ti y resp.ndbdiiy,m mufy dr e¢upant of du
aqui C.aWah e or ssuanccOra cm"euo capon Signature of Applicant Date .
owner roma a>' asemt Dare All roof coverings to be Class'W'or better
CITY OF CUPERTINO
7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32659999 . 120
DATE ISSUED. . . . . . . : 11/26/2008
RECEIPT #. . . . . . . . . : BS000006705
REFERENCE ID # . . . : 08110102
SITE ADDRESS . . . . . : 22330 HOMESTEAD RD 120
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HOMEOWNERS ASSOCIATION
ADDRESS . . . . . . . . . . : 444 FIRST ST #1
CITY/STATE/ZIP . . . : LOS ALTOS, CA 94022
RECEIVED FROM . . . . : CENTRAL COASE
CONTRACTOR . . . . . . . : JEFF ROBBINS LIC # 30477
COMPANY . . . . . . . . . . : CENTRAL COAST CONSTRUCTION
ADDRESS . . . . . . . . . . : 4844 CLYDELLE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95124
TELEPHONE . . . . . . . . : (408) 858-6417
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ----------- - ---------- ---------- ---- ----
1BPFIXTURE NO OF FIXTURE 1 . 00 8 . 16 0 . 00 8 . 16 0 . 00
1BREMFIXT NO. FIXTURES 1. 00 61 . 19 0 . 00 61 . 19 0 . 00
1BREMRECEP NO. OUTLETS 1 . 00 40 . 79 0 . 00 40 .79 0 . 00
1BSEISMICR VALUATION 9, 000 . 00 0 . 90 0 . 00 0 . 90 0 . 00
1EPERMITFE FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
1REMRESBAT SQ FEET 70 . 00 551 . 00 0 . 00 551 . 00 0 . 00
1TRAVDOC FLAT RATE 1 . 00 40 . 79 0 . 00 40 . 79 0 . 00
TOTAL PERMIT 743 . 62 0 . 00 743 . 62 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
-----------------
CREDIT CARD 743 . 62 visa
---------------
TOTAL RECEIPT 743 . 62
•
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Assessor's Parcel Number: V2-G--_f'
Name ofowner. 6 (20&T Tit ) e4 :S
Project address. 0 e-
LEI)=
Contact person. Phone. --//,
Fax.
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor:
Garage: R-n,
TOTAL:
c there at least two 10 foot by 20 foot clear spaces inside the,garage?
Is privacy protection planting required for the project? Y
On what floor(s) is work being done? ,
Brief description of work. 6-464f- -T,&_t Al-lak— t1-4 0,01,eg_ L01�51
Ale4v 0AA 1_ Zltc _�L DoT (r-eC62t, X.au, vat-r -6+-h -1-a c 1�I
Code editions: 2008 CBC N)2008 CFC - N)2008 CMC N)
2008 CPC N)2008 NEC BY -N)
v�y7- -b to — e i, e- 4v b w�5yy_ 4- va h)e- i A-Owc-
Nt-ovrbo 419& )-,se-A -be-tr Lz
Effective 1,�I
A
MIGNO'
(I** Sat Of pans En—d�sW—ific�-0--M�
A kept Oft the jobat afitimagaditile
4wful to make any changes or t
:)n SUM Without written penmWo *a. NOV 262008
no building Dept., city of cup tj fl.
• % SWAft Of this P0 and OPKWAWM BY.
)HALL NOT be held to perMk or to 1A at,
)PPM of ft*bft 61
,f any CO OMMM at M bw
Plan Review Process Work Book Page-8-Revised 1/1/08
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CITY OF CUPERTINO
CCr� ADDITION/REMODEL
COF
• CUPERTINO PERMIT APPLICATION FORM
08 O/D
APN # 2-Lp 59 n q . 1 r12J) Date:
Building Address: -1
933D #ia-o
Mailing Address (if different from building address):
Owner's Name: Phone# : •a —773 -1
Contra or: Phone#:
T Fax #: 44f--t'? 0
Contractor License#: 3 (Q a
Cupertino Business License#:
Contact: (� Phone #: Vol YS C/ 7
-L}} toy 'L Fax #: G — — O 0
Building Permit Info:
Bldg. Elect.. [tom Plumb. ❑--' Mech. 0' Hillside ❑
Job Description:
Addition-What is being added?(Be Specific):
What is being remodeled (not including addition)?
Remodel Includes Re-Roof: Yes ❑ No ff" If yes list number of squares
Remodel Includes Structural: Yes ❑ No 2
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
Remodel: Kitchen Bath_ Other
Type of Construction (Usage Class): Occupancy Type:
1-A, I-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B ❑� —3
Valuation: 0,90'.
DO Please check this box if the project is a
second-story addition ❑
Project Size: Express [9--Standard ❑ Large ❑ Major❑
Please complete relevant portion of the Green Building
Checklist & attach it to the application or if applicable, Green Buildin oints Achieved:
include in plan set & the sheet index.
***For Office Use Only***
Over-the-Counter ❑ Revised 10/01/08