0901105 CITY OF CIJPERTINO
BUILDING DIVISION PERMIT
PERMIT NO.
BUILDING ADDRESS: ,
20063 LA RO A CT PENINS U L_A _HD_MB_1N23DyEMENT-S- 0"0"'0"
PERMIT ISSUE DATE
OWNER'S NAME:
SA CONTROL NO.
PHO
BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH
REMODEL 472 SQ FT TO GARAGE C O O D
u O c LICENSED CONTRACT'OR'S DECLARATION MINOR STRUCTRUAL TO Job Description
UI hereby affirm that I am licensed under provisions of Chapter 9(commencing _
Z with Section 7000)of Division 3 of the Business and Professions Code,and license is
n`4 a- in full force and effect.
j ? License Class Lle.R Z
r t- Date
L— 3 Contractor
� ARCHTFECTS DECLARA ON
I understand my plans shall be used as public records
�yU
tr.y Licensed Professional
y OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
K which requires a permit to construct,alter,improve,demolish,or repair any structure
4 prior to its issuance,also requires the applicant for such permit to file a signed statement Sq,Ft.Floor Area Valuation
Z< that he is licv'=d pursuant to the provisions of the Contractor's License Law(Chapter 9
YtS G (commencing with Section 7000)of Division 3 of the Business and Professions Codc)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars($500).
0 I,Is 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 Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or thmugh his
own employees,provided that such improvements arc not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
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 Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law. B&P C for this reason
0 I am exempt under Sec.
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 I have and will maintain a Certificate of Consent to self-insure Cor Worker s Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need 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
emp n in any man r_ be c svb'ect the workers'Compensation
Laws o al ia.
Applicant
NOTICE TOA ANT:If, r making this Ccrtificae of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J Z forthwith comply with such provisions or this permit shall be deemed revoked.
z 2 CONSTRUCTION LENDING AGENCY
Hrte- I hereby affirm that there is a construction lending agency for the performance of
(x> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
0.Z Lender's Address
V C) I certify that I have read this application and state that the above information is
LL E"' correct.I agree to comply with all city and county ordinances and state laws relating to
V building construction.and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
W (We)ag<JA
ntaiLy an harmless the City of Cupertino against
to liabilities,judgmexpenses which may y way accrue against said City
U Z in consequencef this permit. Date /! � (/
P- APPLICANT S NO WILL COMPL ITH ALL NON-POINT Issued by:
SOURCE REG -'Z j-ZOv
� Re-roofs �
Signature of Applicani/Con or Date Type of Roof
HAZARDO MATERIALS DISCLOSURE YP
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Muniei odc,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
0 Yes No
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes L
1 have readmaterials requirements under Chapter 6.95 of the Califor-
nia Health& ty Code,Secd 25505,25533 and 25534.1 understand that if the building
docs no ndy have a t,that it is my responsibility to notify the occupant of the Date
requi les which must met prior to issuance of a Certificate of Occupancy. Signature of Applicant
`7+ All roof coverings to be Class'A.'or better
Owner or authorized agent Dalc
CITY OF CUPERTINO
5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN 36934028 . 00
DATE ISSUED. . . . . . . : 01/23/2009
RECEIPT # . . . . . . . . . BS000007034
REFERENCE ID # 09010105
SITE ADDRESS 20063 LA RODA CT
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SANDMAN LEONARDO AND MONIKA C
ADDRESS : 20063 LA RODA CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4410
RECEIVED FROM . . . . : PENINSULA HOME
CONTRACTOR . . . . . . . : KURT URRUTIA LIC # 22506
COMPANY . . . . . . . . . . : PENINSULA HOME IMPROVEMENTS
ADDRESS : 203 KENNEDY AVE #D
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408) 374-1516
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------------
---------- ---------- --------
1BCBSC VALUATION 8, 900 .00 1 . 00 0 .00 1 . 00 0 . 00
1BSEISMICR VALUATION 8, 900 .00 0 . 90 0 .00 0 . 90 0 . 00
1BUSLIC FLAT RATE 1 .00 114 . 00 0 .00 114 . 00 0 .00
1REMRESOTH SQ FEET 472 . 00 428 . 00 0 . 00 428 . 00 0 . 00
1SIDEOTHER SQ FEET 1 . 00 367 . 00 0 . 00 367 . 00 0 . 00
---------- ---------- ---------- -------
TOTAL PERMIT 910 . 90 0 . 00 910 . 90 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 910 . 90 8514
---------------
TOTAL RECEIPT 910 . 90
CITY OF CUPERTINO
k ` ADDITION/REMODEL
CUPEI�TINO PERMIT APPLICATION FORM
APN #
p. Date.
Iv? o�d ®v .1 AiJ. � —1�DZv0�
Building Address:
Mailing Address (if different from building address):
Owner's Name: Phone#
LFA iv✓t i'LD
Contractor: Phone#: ko a 3-1 ti-
t4nLAk� 44,P .0Vo 4u Fax #: tion ?l`i�fl 31
Contractor License#: it-t LtIl'17-71—
Cupertino Business License#:
Contact: Phone#: if po 8 P,8-��Y8
V"A-7- �1_ t,2E?.vr��A- Fax#:
Building Permit Info:
Bldg.
Elect. Plumb. [� Mech. Hillside ❑
Job Description:
Addition-What is being added?(Be Specific):
t
What is being remodeled (not including addition)? i'f I'Z 0
A4)ckf-, (Q, re�te� r' h� ,
Remodel Includes Re-Roof: Yes ❑ No Er/1"If yes list number of squares
Remodel Includes Structural: Yes ❑ No 9-"
Dopou have the re-application planning approval? Yes [:] No
Y
If yes, please provide a co of yDur 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, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT,V-B '
Valuation: &,q�,n,-,) Please check this box if the project is a
second-story addition ❑
Project Size: Express ❑ Standard ❑ Large❑ Ma'or❑
Please complete relevant portion of the Green Building
Checklist& attach it to the application or if applicable, Green Building Points Achieved:
include in plan 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)
1GARDTM<=1K 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
1PATIOMETAL Metal Frame up to 300 B
SF
1 PATIOOTHER Other Frame up to 300 SF B
PATIO'S CLOSED 1R3SFDADD OR
& SUN ROOMS 1R3SFDREM
1PATIOENCLW Enclosed Wood up to 300 B
SF
1 PATIOENCLM Enclosed Metal up to 300 B
SF
1 PATIOENCLO Other Enclosed Patio up B
to 300 SF
1 COVPORCH Porch Covered-Each B
(Each)
REMODELS 1R3SFDREM —
1 REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan
300 SF check
1REMRESBAT Bath Remodel up to 300 B "
SF
r� 1 REMREOTH 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
1PLMPLNCK Stand Alone Plumbing P
Pln Ck (hourly)
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
L 1BSEISMICRE Seismic Residential B
1 TRAVDOC Travel &Documentation B
1BUSLIC Business License B
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
,XPERTINO
BuildinDe artment
JOB ADDRESS: 2.00(9 3 Cir: PERMIT #
OWNER'S NAME: PHONE # &{d "
GENERAL CONTRACTOR: , , FAX # &l o ti 37 Ai
am not ing any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank _
Sheet Metal
Sheet Rock
-e—
Owner/Contracto
Owner/Contractor Signature Date
RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number: `� (o
Name of owner. Li oAga-2i1Jo
Project address. O O 3 L.4 N A
1L.s-?-� u 22c.,
Contact person. Phone.'�LL a�,� 3`7�-G U
Fax.
square footage of lot. �..
Net sg g
Existing Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
"re there at least two 10 foot by 20 foot clear spaces inside the garage? N
Is privacy protection planting required for theproject? 1
On what floor(s) is work being done?
Brief description of work. �r4_0AA-£_AJJKW— 1LP6r/L. =6 i-S /!-u i.krn
Code editio 008 (Y-N)2008 CFC -N)2008 CMC (Y-N)
008 CPC 08 NECIZ
-
Effective 1/1/08 . r
Plan Review Process Work Book Page-8-Revised 1/1/08
' 20063 LA RODA CT. CUPERTINO
PENINSULA HOME IMPROVEMENTS
203 KENNEDY AVE- STE. D
CAMPBELL CA 95008-4114
(408) 374-1516
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i � i G?fJistS�rs-STSG
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mo,ALLa0Ar4 =��n X4 AL SarrsM `
E�P T-o Lr-�
IN ACCORDANCE WITH THE C1 t 3
GUPERTINO CODES AND ORDINANCES �.
SATE _ — C�� dna cam;L-P\i
1GIVEira rations
This set P u ! V ; s and it is un
t„ti i nc
ue kept on nr alteratto
o lawful to m;ssion iron
` .
)n same C.El: �LDi+La E iLc 2-4” o,c-. /
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M w .(3 X 3 �
re bu. 4,, � _:L specificatan`
of 8 1 he stamp-119 ,rift or to be ar
HALL NO-1 be ' a
i 4,RrpN81 of the v►ola�iori��{fratPYi aw"�on �
n,minwirp
AO
EXISTING GARAGE FLOOR PLAN;
472 SQ. FT.
+[.*-
► 20063 LA RODA CT. CUPERTINO
PE jai :)
203 KENNEDY AVE,, J
CAMPBELL CA 95008-0, 114
(408) 374-1516
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PROPOSED GARAGE FLOOR PLAN
472 SQ. FT- _ �< "
2c L CS 2411
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