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09030098 CITY OF CUPERTINO BUILDING DIVISION PERMIT 1 10ro.lROMTx N• BUILDING ADDRESS: PERMIT NO. 20142 PACIFI A DR WESTHILL CONSTRUCTION CC) OWNER'S NAME: PERMIT ISSUE DATE 0017 mv ''-LONE: S A CONTROL NO. (408) 395-4361 ARCHITECI7ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 200 LICENSED CONTRACTOR'S DECLARATION mI hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description U r, with Section 7000)of Division 3 of the Business and Professions Code,and my license is '"4 in full force and effect Q -7 p RMV RPLC EXTNG MSTRBTHRM TILE STONEW/FIBGLS .=,n n? License Class Lic.M —0 Datca Contractor PAN&FNL FLRNG;RPLC DRYWAL&INSTL WIRELTH,FLT WALLS AR HITECr DECLARAT N �aI understand myplans shall beused aspublicrec W/MORTR, SET FIBRGLSPAN INSTL WIRELTHOVR �ulU 4 O y Licensed Professional y 3 OWNER-BUILDER DECLARATION qqy I hereby affirm that 1 am exempt from the Contractor's License Law for the LOO following mason.(Section 7031.5,Business and Professions Code:Any city or county 429 which requires a permit to construct,alter,improve,demolish,or repair any structure y Zy prior to its issuance,also requires the applicant for such permit to file a signed statement < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation yh$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 4 O O 0 y .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). 36928021 . 00 ❑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 Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q P property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are 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.). ❑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 contractors)licensed pursuant to the Contractor's License Law. C]I am exempt under Sec. B&P C for this reason 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 Worker's Compen- -ion,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑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 am: Carrier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be complete the permit is for one hundred dollars($100) or less.) I certify that in th %J15- f rm c f for which this permit is issued,I shall not employanype i-' y r conic to Warkcr� mpensatian Laws-11—r- r�r (� Applicant NOTICE TO NT:I,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z''' CONSTRUCTION LENDING AGENCY Fr I hereby affirm that there is a construction lending agency for the performance of a the work for which this permit is issued(Sec.3097,Civ.C.) WW A Lender's Name Lender's Address V 0 I certify that I have read this application and state that the above information is correct.1 agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. W W (We)agree to save,ind if nd armless the City of Cupertino against 0. ,Ft to liabilities,judgments,c Us ex ns hic ay in any way accrue against said City U Z in consequence of g this it r"t APPLICANT U E S N COMPLY WITH ALL NON-POINT Issued b y: Date SOURCE REGU Tf0 Re-roof., Signature of Applicant/Contractor Dare HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant store or handle hazardous material as defined by the Cupertino Munici odc.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roof:;shall be inspected prior to any roofing a en''a eing insta e . ❑Yes - Will the applicant of future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove 't hazardous air contaminants as ncd by the Bay Arca Air Quality Management all new materials for inspection. strict? —//,1� ❑Yes VIVO have read the a re s remcnts under Chapter 6.95 of the Califor- nia Health&S Se ons and 25534.1 understand that if the building does not cu ntly a a an y responsibility to notify the occupant of the requircmcn w'1. p' r once of a Ccnifica of Occupanry. SlgnatuI°of Applicant Date 23^0 All roof coverings to be Class or or better Owner or authorized agent Dam 03 CITY OF CUPERTINO CITY OF CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM APN # f Date: Building Address: - Mailing Address (if different from building address): Owner's Name: C,-Vvluoc l3C)d'1A)Aq Phone#: q-7-3 182-9 HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA Contractor: n Phone: 2,q wfs41, Fax: Contractor License#: t'3 ov© o Cupertino Business License#: Contact: C-4lPhone: � wl 'F— 4-�, 4000F, Fax: Residential Commercial El Job Description: P—>"oJ E ��, l�-t'E- C 1V S-+�� +�/� 5 �� E S�U,,,J,E✓ 'C �,� u`'A4I 1 wtnr, JM-LA . ttoA4 u� t,1s �> nnr� �'" ... Sof -- 4DCrlj - " U)1:rLr_ Jg Building Permit Info: Bldg R Elect ❑ Plumb L7' Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B E] II/III/V-A F] II/III B, IV-HT, V-B fzE:S c de�4-1 A— Valuation: Square Footage: L45 Project Size: Express Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion. of the Green Building/LEED Checklist& attach it to the application or if applicable, include in plan set& the sheet index. Points Achieved: For help, contact Build it Green at www.buildits -een.or Revised 02/05/09 CITY OF CUPERTINO Cin Of GENERAL BUILDING APPLICATION CUPEkTINO FEE SCHEDULE Quantity/Sf Fee ID Fee Des cription Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco applications (up to 400 sf) B additional stucco application 1 WlNREP Replacement windows/sliding glass B door (ez 8 windows) 1 WINMEWSTR New Wi Zdow-structural shear B wall/ma:;onry(includes plan ck fee) 1 EPERMITFEE Electricz l Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand A:one Electric Pln Ck (hourly) E 1 MECPLNCK Stand A:one Mechanical Pln Ck (hrly) M 1 PLMBLNCK Stand A one Plumbing Pln Ck (hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B when not over counter) hourly-stand alone r 1 BCBSC Cal Bldj; Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B 1BSEISMICO Seismic Commercial B r 1TRAVDOC Travel 6., Documentation B / 1 BUSLIC Busines, License B �r r Ppr PE_ 5 of 5 SO RE WE-- 2 01 ;. .;3,e���•-'�`2�'> ..i,.z4,::. 'r tea^.-�'��`i� .r-r. -. •- x ,- � „k;_ ,",`� FY'; �._,2M:, — .-'lr a�'�`-: -���,Y .��- `� �- � •" Assessor's Parcel Number: Name of owner. Project address. 2- 1`4 2- Contact person. CJI I Vb F hone. 3 g S—Lf 3 b� F ax. 3 Sb (S S Net square footage of lot. Existing Proposed Square footage: First floor: _ Second floor: Garage: TOTAL: Are thereat least two 10 foot by 20 foot clear spaces inside the garage? T privacy protection planting required for the project? On what floor(s) is work being done? Brief description of work. fL j aXew I, brA a i 4C5�, s� r�4►,��� c.�;� 16&h -CD v,\ dw�f v�'i1 art wl (n•.Oft f�(z • S-4,o'l1 w (Ve,IJ I01-'k Code editions:2008 CBC N)2008 CFC -N)2008 CMC (Y-N) 2008 CPC -N)2008 NEC -N) /uo Effective 1/1/08 4- Plan Review Process Work Book Page-8-Revised 1/1/08 RES ?-•.u-'-sz-` '- ., +- as7'�'-s`'Y �; ` sx Assessor's Parcel Number: Name of owner. Project address. �-01 L4 2- pre-- t—L,I, Q' Contact person. t F'hone. 3 blj Fax. 3 Sb (oS S Net square footage of lot. Exist Proposed Square footage: First floor: _ Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? 1-1� privacy protection planting required for the project? On what floor(s) is work being done? r Brief description of work. �-�%� Dom. &E Lo a I SS_ r h ( c.; A I LS o,\ "t V�AA"( -to4-(- wl jM D(L{ � �u S-y�o-i( w i 1�L. t'l� ©,� S VdoA. Code editions:2008 CBC N)2008 CFC (�'-N)2008 CMC (Y-N) 2008 CPC )-N)2008 NEC ()' -N) P-Ai 1-tn't Effective 1/1/08 Plan Review process Work Book Page-B-Revised 1/1/08 VIEW - Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 cff OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: 701 L4 2 ����� 7� , PERMIT # 0q 03 o09 2 OWNER'S NAME: 6kz> Cc. PHONE # q-7 S2-1 GENERAL CONTRACTOR: s{� l (o,,.� FAX # 3 S g 6 S I am not using any subcontractors: `signature Date Please check applicable subcontractors and cora lete the following information: 60 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 a t 4-a ?[ rA CC>e),41 Roofing Septic Tank Sheet Metal Sheet Roc 23 —0 Owner/Contractor Signature Date