The URL can be used to link to this page

09010071 CITY OF C' 1V0 � �� BUIOF ;G Dl. JN PERMIT PERMIT NO. BUILDING ADDRESS: 10197 ' LINE PERMIT r55uE DATE OWNER'S NAME: A CONTROL NO. TZA (4 0 8) 924 BUILDING PERMIT INFO MECH ARCHITECT/ENGINEER: BLDG ELECTO PLUMB� p LICENSED CONTRACTOR'S DECLARATION IOU Description cwX I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 70(X))of Division 3 of the Business and Professions Code.and my license is RMDL KTC HN(NON-STRUCTRL) INC LD ELEC/L I GHTNG/MEC H/ ;U- in full force and effer,4 L . z License � - fl „S �/- �n„ PLMBNG;NO RE-RF&NO STRCTURAL 160SQ g Date ARCHITECTS DECLARATION tt I understand my plans shall be used as public records 5 d `O Licensed professional OWNER-BUILDER DECLARATION 3 I hereby affirm that 1 am exempt from the Contractors License Law for the p o following reason.(Section 7031.5,Business and professions Code:Any city or county Iwhich requires a permit to construct.liter.improve,demolish,or repair any structure Valuation 4;-- prior to its issuance•also requires the applicant for such permit to file a signed statement S Ft.Floor Area Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q' 15000 Y.I--$ (commencing with Section 70D0)of Division 3 of the Business and Professions Cade)or IQ ., that he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of not mote than five hundred dollars($500) 36909021 . 00 01.as owner of the property,or my employees with wages as their sole compensation, Required Inspections will do the work and the structure is not intended or offered for sale(Sec.7044.Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his owe employees,provided that such improvements are not intended offered for owner- however,the building or improvement is sold within one yearcompletion. builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 1,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractors u- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a comractor(s)licensed pursuant to the Contractors License Law. B&P C for this mason 0 1 am exempt under Sec. Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Workers Compen- -tion,as provided for by Section 3700 of the Labor Code.for the performance of the work for which Nis permit is issued. 01 have and will maintain Workers Compensation insurance,as mquired by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued My Workeers/Co/mpensation Insurance carrier and Policy number are: �7, Carrier.7tG7� �V^d Policy No.: I (��f"I 1 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section creed not be completed if the permit is for one hundred dollars($100) or less) 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 Workers'Compensation Laws of California.Date ApplicantP u should NOTICE 7O APPLICANT:If,after making this Certificate of Exemption,you become subject to the worker's Compensation provisions of the Labor Code•you must ,J'f_, forthwith comply with such provisions or this permit shall be deemed revoked. Z*Z CONSTRUCTION LENDING AGENCY E~•h C*J I hereby affirm that there is a construction lending agency for the performance of 5 the work for which this permit is issued(Sec.3097.Civ.C) W A Lenders Name 04 Lenders Address I certify that I have read this application and state that the above information is LUL� coria.I agree to comply with all city and county ordinances and state laws relating to building construction-and hereby authorim representatives of this city to enter upon the Wabove-mentioned property for inspection purposes Or (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City Date / V U Z in consequence of the granting of this permit ►+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOUR EGULATIONS. /-15-09 Re-roofs Sig of Applicant/Contractor Date T of Roof r HAZARDOUS MATERIALS DISCLOSURE y� Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. 0Yes /' ° If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devi devices all new materials for inspection. it havardous air contaminants as defined by the Bay Area Air Quality Management ,strict? 0 Yes `KNo I have read the havard//°us materials requirements under Chapter 6.95 of the califor- nia Health&Safety Code,Sections 25505.25533 and 25534.1 to that if the building docs not currently haves tenant.that it is my responsibility to notify the mecupan,of theDate rcquimmcn which must be met prior to issuance of a certificate of Occapa7 ��iig_n �eoApplicant - / - 7 57_4 All roof coverings to be Class r'�' 'or better Own authorivcd agent Date' CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36909021 . 00 DATE ISSUED. . . . . . . : 01/15/2009 RECEIPT # . . . . . . . . . . BS000006983 REFERENCE ID # . . . : 09010071 SITE ADDRESS 10197 COLD HARBOR AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER KASOF MADELEINE L ADDRESS 10197 COLD HARBOR AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3326 RECEIVED FROM . . . . : JASON B CLINE CONTRACTOR JASON CLINE LIC # 30079 COMPANY CLINE CONSTRUCTION ADDRESS 330 B LINCOLN AVE CITY/STATE/ZIP SAN JOSE, CA 95126 TELEPHONE . . . . . . . . : (408) 924-0204 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ------ 1BCBSC VALUATION 15, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 15, 000 . 00 1 . 50 0 . 00 1. 50 0 . 00 1REMRESKIT SQ FEET 1 . 00 429 . 00 0 . 00 429 . 00 0 . 00 1STPLNCK HOURS 1 . 00 122 . 00 0 . 00 122 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 553 . 50 0 . 00 553 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 553 . 50 MC --------------- TOTAL RECEIPT 553 . 50 `)9ol o 7/ CITY OF CUPERTINO ADDITION/REMODEL CUPEt�TINO PERMIT APPLICATION FORM APN # 3 f 0 D o2 /, U o Date: Building Address: Mailing Address (if different from building address): Owner's N e: Phone# � ( to - S -17-e1 o tractor: Phone#: C0Fax#: Contractor License#: 96Z35'-1 Cupertino Business License#: 00 1 Con act: Phone#: Fax#: q09' 92--1 020' Building Permit Info: Bldg. ❑ Elect. Plumb. Mech. Hillside ❑ Job Description: Addition-What is being added?(Be Specific): � What is being remodeled (not including addition). Remodel Includes Re-Roof: Yes ❑ No If yes list number of squares Remodel Includes Structural: Yes ❑ No Do you have the pre-application planning approval? Yes ❑ No If yes, please provide a copy of your plannin 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, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT,V-B Valuation: 5 t oc C Please check this box if the project is a second-story addition ❑ Project Size: Ex ress ❑ Standard Large ❑ Major❑ Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, Green Building Points Achieved: include in lan set& the sheet index. ***For Office Use Only*** Revised 01/07/09 Over-the-Counter ❑ CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft DECKS 1R3SFDADD OR 1R3SFDREM 1DECKWOOD Deck (Wood)-Each B (Each) 1 DECKRAIL Deck Railing-Each B (Each) GARAGES 1R3SFDADD OR DETACHED 1R3SFDREM 1 GARDTW<=1 K Wood Frame up to B 1,000 SF (each) 1 GARDTM<=1 K Masonry up to 1,000 SF B (each) BCONSTAXR Construction Tax Res (new detached garage) PATIO'S OPEN 1R3SFDADD OR 1R3SFDREM 1PATIOWOOD Wood Frame up to 300 B SF 1 PATIOMETAL Metal Frame up to 300 B SF 1PATIOOTHER Other Frame up to 300 SF B PATIO'S CLOSED 1R3SFDADD OR & SUN ROOMS 1R3SFDREM 1PATIOENCLW Enclosed Wood up to 300 B SF 1PATIOENCLM Enclosed Metal up to 300 B SF 1PATIOENCLO Other Enclosed Patio up B to 300 SF 1COVPORCH Porch Covered-Each B (Each) REMODELS 1R3SFDREM - L 1REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan /V 6 300 SF check 1REMRESBAT Bath Remodel up to 300 B " SF 1REMREOTH Other Remodel up to 300 B " SF CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft 1MECPLNCK Stand Alone Mechanical M Pln Ck(hourly 1 PLMPLNCK Stand Alone Plumbing P Pln Ck (hourly) 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1 TRAVDOC Travel &Documentation B 1BUSLIC Business License B x Assessor's Parcel Number: I f/ Name of owner. All�C I 41 zf a 5 d Project address. C O I at r''bo IZ U Contact person. S o C �� Phone. q 4 K q10 07S-) Fax. Net square footage of lot. 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 privacy protection planting required for the project? On what floor(s) is work being done? / Brief descri tion of work. Z-l �t X11 G` `o kifh y1 14h f i'ti KI C U Code editions:2008 CBC (2008 CFC -N)2008 CMCJ-N) 2008 CPC 1)2008 NEC N) WrI4 Effective 1/1/08 RF C F,I.V F-1-1 IF) LUPWATE ` -I'S 5o" f keOFFmICE COPY i" 1VVfLJ1 to, Plan ReviewMocssk Book Page-8-Revised 1/1/08 r • i i FI Y y� ura a�pa+l ea ® • la, rA rA �• �� (I� • 0 go IS �.. • ts� o ® .g ��4 �\ • • 1• •1 1 • • /�:. 4 • • INe .. v ! R 10mmmwi 11,01, _ '� \ al �` • 00 0. 00 rA 0. 0 v® • n •e •r • 1 • ` • in • Os NJ 4'As 1 1. t