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12040101 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10571 DEODARA DR CONTRA C1 OR:SEARS HOME PERMIT NO: 12040101 IMPROVEMENT OWNER'S NAME: MORAN DIANE/RICHARD MCGRATH 1024 FLORIDA CENTRAL PKWY DA IT ISSUED:04/18/2012 DOWNER'S PUONE: 4089969819 LONGWOOD, FL 32750 PnoNE NO:(925)245-2000 pfd LICENSED CONTRACTOR'S DECLARATION�7r— r r— '\ BUILDING PER\11'1'INFO: BLDG e.Le.Cf rLlptu License Class J CIS C(, l.ic.q 72— / 3 ? r r r (� , / q / /J/ 1-L_I , .\IECII RFtilI14:S'19AL COMMERCIAL Contractor 7E /hZ'j (-f o7H� Date I I '� 1 hereby affirm that I am licensed under the provisions of Chapter 9 •JOB DESCRIPTION' KI'ICI IEN RI'MOD17I. 180 SQ FI'.NON S'IRUC'I'URAL (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 penally of perjury one of the following two declarations: I have and will maintain a cenificate 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. Sq.Ft Floor Area: Valuation!56029 I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 ofthe Labor Code,for the performance of the work for which this .\PN Number:J 1630042.00 Occupancy Type: permit is issued APPLICANT CERTIFICATION I certify that I have read this application and stale that the above o f tion is PERMIT EXPIRES IF WORK IS NOT STARTED correct- I agree to comply with all city and county ordinances and le laws relmi g W ITH1N 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of is city to enter upon die above mentioned property for inspection purposes, (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments. costs,and expenses which may accrue against said City in consequence of the G granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Mu pal Code,Section 9.18. ry/IZ_ RE-ROOFS: m Signa ore Date `f' IISS All roofs shall be inspected prior to any roofing material being inslSlled If a roof is installed without first obtaining an inspection.I agree to remove all new materials or inspection.O\\' ' BDu,DF:R DECI.AwrnON Signature of Applicant: Date: 1 hereby affirm that I am exempt from the Contractor's License Lew for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California I Icalth&Safety Code,Sections 25505,25533,and 25534. 1 will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the declarations: Ilealth&Surety Code,Section 25532(x)should 1 store or handle hazardous I have and will maintain a Certificate of Consent to stir-insure for Workers material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District 1 performance of the work for which this permit is issued, will maintain compliance with the Cupertino Municipal Codle,_(Jiapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the I lealth&Safety Coda Sections 25505,25533 . Section 3700 of the labor Code,for the performance of the work for which this Owner or authorized agent: Date: permit is issued I certify that in the performance of the work for which this permit is issued.1 shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,a0cr making this certificate of cxemption,1 CONSTRIICHON].ENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code.I must I hereby alirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. w'ork's for which this permit is issued(Sec.3097,Civ C-) Lender's Name APPLICANT CER'TIF'ICATION Lendcr's Address I certify that I have read this application and slate that the above information is correct. I agree to comply with all city and county ordinances and state Imus 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 ARCIII'I'ECI"S DECLARATION and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 3 ITEMS OF 12 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 31630042 . 00 DATE ISSUED. . . . . . . : 04/18/2012 RECEIPT # . . . . . . . . . : BS000016570 REFERENCE ID # . . . : 12040101 SITE ADDRESS . . . . . : 10571 DEODARA DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . ... . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MORAN DIANE/RICHARD MCGRATH ADDRESS . . . . . . . . . . : 10571 DEODARADR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2430 RECEIVED FROM . . . . : PERMIT SERVICES INC CONTRACTOR . . . . . . . : ALFRED NYMAN SR - ASST SEC LIC # 23097 COMPANY . . . . . . . . . . : SEARS HOME IMPROVEMENT ADDRESS . . . . . . . . . . : 1024 FLORIDA CENTRAL PKWY CITY/STATE/ZIP LONGWOOD, FL 32750 TELEPHONE . . . . . . . . : (925) 245-2000 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - - -- -- ---- ------------- ---------- -------- -- —----- -- - - -- 1BCBSC VALUATION 6, 029 . 00 1 . 00 0 .00 1 . 00 0 . 00 1BSEISMICR VALUATION 6, 029 . 00 0 . 60 0 . 00 0 . 60 0 . 00 1REMRESKIT SQ FEET 180 . 00 588 . 00 0 . 00 588 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 589. 60 0 . 00 589 . 60 0 . 00 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333.-buildingecuoertino.org /L U//�\ lo ❑NEW CONSTRUCTION EI ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMITR PROJECT ADDRESS 10521 O52 / I Qv CD 2A /-\ t/ �\ OWNER NAAfE�IL�Mp C- l/ T I/`pH O� ' J EMAIL STREET ADDRESS /057/ OJ // � 1 l� CITY.STATE. PtZZIP7/x' C14 "T 0 I FAX CONTACT NAME PHONE/Q 2? a E-MAIL `-� STREET ADDRESS 106 7 t1�c LN FA% El DINNER ❑ OWNER-BUILDER 13OWNER AGENT CONTRACTOR ❑CONTRACTOR/AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAMELICENSENUMBER LICENSE TYPE BUS,LIC. 2I 7 c17 uv cb CO. PANY NAME E-MAIL FAX STZET ADDRES• �QW I✓� CL-I✓IZWf CI CTT - / �JS� -I1ZL Z�S. ZOI ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC P COMPANY NAME E-MAIL FAX STREET ADDRESS CITY.STATE,ZIP PHONE DESCRIPTION OF WORK l"Ij l r Le--77Z1 C/4- EXISTING USE PROPOSED USE CONSTR.TYPE nSTORIES ;'r'9lM1L:R " _ i.. - - v SOFT LIB EXISTGNEW FLOOR DEMO TOTAL • I{I1.1 r/• [ ' AREA AREA AREA NET AREA I{�{. _ � `,^�I 1 rP I II •� . BATHROOM KITCHEN OTHER nii l5i_t"'•' ice.;•, _ REMODELAREA REMODELAREA REMODELAREA •jlti.����*'i �•r,.._ PORCH AREA DECK AREA TOTAL DECIOPORCH AREA I GARAGEAREA:❑ DETACH _ ❑ ATTACH .B"11jr1rnsnS ISASuX1xDUN1T []vts I sctavnsraly pnv. BEVIGADDE@ _ O Nn ABamore No 10 ' . PNf VFLI i\fIUN ❑YPS Ir y..ii PBOVIIBcm OF PIA\TT.RS NAMr. RECEJVED BYit• PI l\I\Ii APPI.. 0'. PIA\\l\G MPBuvA LLTrIF 11 ) "'1 ) r�) i 1 rl r 1 (��O• By my signature below,l cenify toeach of the following: I am the property owner or authorized agent to act on the property owner's behalf. I ha'e mad this application and the information 1 have provided is coneet. I have read the Description of Work and verify it is accurate. 1 Dgme to comply with all applicable local ordinances and slate laws relating to building construction Drize representatives of Cupertino to enter the above-identifie/d'�pro eny for inspection purposes. Signature of Applicant/Agent: Dale: Zf 1 Z SUPPLEMENTALINF QUIRED Yer PpCtlECK TYPEi l.� [ ROUTING SLIP _New SFD or Multifamily dwe mgs: Apply fordemolition permit for -OVER-THE-COUNTER: IQBUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building .11, -,•;• rt ,��. permit for new building. O'EXPRESSt:•f N'C''.._If1: O FPLANNINGPLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑:•SiANDAR , - .I (O. PUBLIC WORKS Tom if any Hazardous Materials are being used as part of this project. tr I tiD,r ❑1LARCEI,� } ❑%FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ' 4i submittal of Building Permit application. J41 PT'ro.M1IaOR F J , T 16` Fr K }�� SANITARY SEWER DISTRICT -) •r' �•_J II 1� ENVIRONMENTAL IIEALTII BldgApp_20/I.doc reviser)03/I6/I I Mt Jn-L. I-( -T G(-f E (J �l v1vl)c I 10571 T)L;�-a DA Z JDR, APRlg2012 (OvA;l,Jc.` - tJ/157E II,JL ��Z J F/h/c-E7 H e r"— c p . ArDI D Oe tt: niCLJ cx)7 /C r Tn A J L'Zj — JAJy I 1 ,jLzJ �I�z�ZI� ?T) CICZ 7,2 e'>0 nj) Occ;rD COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION-CUPERTINO APPROVED This set of plans and specifications MUST be kept at the Job site during construction. It Is unlawful to make any changes or alterations on same,or to deviate therefrom,without approval from the Building Official. The stamping of this plan and specifications SHALL NOT be held to permit or to be an approval of the violation of any provisions of any City Ordinance or State Law. BAAT N IOFFIPEOIO ®Py .gid �C G ra t�. 1 -3 8Q4+ VLIFiI �, sf G�CW CSO rtsf HDM61MPROVEMENT PRppUCTB LIVERMORE'OFFICE ° N 283 E.Airway Blvd. rw _ O w Livermore, CA 94551 (800)671-3985• C W ;(925)245-2000 Fax,(925).245-2018 •I i JC le c I j CO d � I fPe4` e I IDec c :, :�: �-� orb 1