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09030010CITY OF CUPEKITNU BUILDING 31VISION . PERMIT UILDING ADDRESS: JER'S NAME: ARCHITECTIENGINEER: u o p LICENSED CONTRACTOR'S DECLARATION m I hereby affirm that I am licensed under provisions of Chapter 9 (commencing Z with Section 7000) of that 3 of the Business and Professions Code. and my license is < a in full forte and ec U i _Md� -Z Z License CI Lic• M fr'�'' F p Date 3 e Contractor .M /. , .f sa.. ARCHITECTS DECLARATION 1 understand my plans shall be used as public records 7yU y o y Licensed Professional n n -1 OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractors License law for the a O following reason. (Section 7031.5, Business and Professions Code: Any city or county K m P which requires a permit to construct, alter. improve, demolish. or repair any structure y Z prior to its issuance, also requires the applicant for such permit to file a signed statement SEthat he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 yt— (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 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 not mote than five hundred dollars (5500). ❑ 1, 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 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 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 Contractors 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 Contractors License Law. I am exempt under See B & P C for this mason ner Dare WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: .7 0 Z 0-4 rr a Q �z UO wH 0U Uz ❑ I have and will maintain a Certificate of Consent to self -insure for workers compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. have and will maintain Workers Compensation insurance, as required by Section 37 of the Labor Code, for the performance of the work for which this permit is issued. My Workers Compe a . insurance carrier and Policy number are: Carrier. •7 ` C °ri' ('i Policy No.: f el oc-2- . CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foe one hundred dollars ($100) or Icss.) 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 at to become subject to the Workcrs' Compensadon Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Wotkces Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097. Civ. C.) L.endces Name Landers Address I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws 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, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REGULATIONS. S�ure of Applicant/tractor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material le0ned by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Ac, Section 25532(a)l t n' ❑ Yes ,Ayre 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 District? Yes u I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Cade, Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant. that it is my responsibility to notify the occupant of the requirements which must be met prior to' of a Certificate of occupancy. Date INC �WIM Job Description RMV &REFLC WTR DMGD CARPORT BEAMS(12)LOCS LIKE4LIKE q. Ft. Floor Area 32609064.04 Issued by: Re -roofs Type of Ro Valuation Type Required Inspections All roofs shall be inspected prior to any roofing�)aterial being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature e f Applicant Date All roof coverings to be Class ')W' or better 0 PERMIT NO. PERMIT ISSUE DATE S Agtt CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB Job Description RMV &REFLC WTR DMGD CARPORT BEAMS(12)LOCS LIKE4LIKE q. Ft. Floor Area 32609064.04 Issued by: Re -roofs Type of Ro Valuation Type Required Inspections All roofs shall be inspected prior to any roofing�)aterial being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature e f Applicant Date All roof coverings to be Class ')W' or better 0 Assessor's Parcel Number: Name of owner. Project address. Contact person. %C�� .� �Rione. S�jC . � S" 7. 71- y' F, x. C,—c? T r, All's Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: Garage: �' TOTAL: ' ire there at least two 10 foot by 20 foot clear spaces in,,,idee the -garage? � -- Is privacy protection planting required for the project? Y On what floor(s) is work being done? Brief descri tion of work. �j v / j -.� /.vcl1iL ry- � cif Code editions: 2008 CBC 2008 CPC Effective 1/1/08 (Y - N)2008 CFC (Y - N)2008 NEC (Y - N)2008 CMC (Y - N) Plan Review Process Work Book Page -8-Revised 1/1/08 (Y - CITY %iF-r.' Y kc u` -yer I AW O�v3 od�� CITY OF CUPERTINO CUPEI�TINO GENERAL BUILDING PERMIT APPLICATION FORM r C) �p r Date: AYN # 2>9 Building Address: ZOg7r //,q��G �rG� ,dr.✓.� Cv �Ko C Mailing Address (if different from building address): Aq 5-6 d,,illlillll, 11 a 2Z Owner's Name: Wa A" 1 l rIr AA Phone #: HOA: (Exterior work only) Yes No ❑ /• S7-4- $'o 2—,,l 4-L y If yes, provide letter from HOA Contractor: A-lG All j lf+p. Coms>L�r�iai Phone: p, GT J, G 7e, r Fax: Sip . G 7• !e Contractor License #: (, 00� 9 Z Cupertino Business License #: Contact: eevr..._ e,�,�,,�� Phone: Fax: o • G f . G �G Residential ❑ Commercial Job Description:l Gltiplir, � ��D� c -c- lair �G✓ Ot ot � Car�i►r� f � ,�° cam- $' • to cc-� p^- S / K- � � %t •. l � �y l �-- Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/IIIN-A ❑ II/III B, IV -HT, V -B ©� — 3 Valuation: `g/j/ / Square Footage: / Project Size: Express ❑ Standard ❑ Lar e [l Maj or ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it Points Achieved: to the application or if applicable, nclude in plan set & the sheet index. For help, contact Build it Green at www.buildit reeji.or Revised 02/05/09 CITY OF CUPERTINO CUPEI�71N0 GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1GENCOM PARTITION WALLS 1PARTICOMM Partition Interior Commercial B 1PARTICOMM IPARTIR Partition Interior Residential B 1PARTIR<=30 RETAINING WALL(CONCRETE OR MASONRY 1RETSTN Standard (up to 50 ft) B IRETSP310 Special Design, 3-10' high (up to 50 `) B 1 RETSP 10 Special Design, over 10' high (up to 50' B 1RETCRB< Gravity/Crib Wall, 0-10'high (up to 50 ft B 1RETCRB> Gravity/Crib Wall over 10' high (up to 50 ft B SIDING 1 SIDEST/BK Siding, Stene & Brick Veneer interior/ea:terior B 1 SIDEOTHER Siding all ether B SKYLIGHTS 1 SKYL<10 SF Skylight lE ss than 10 sf B 1SKYL>IOSF Skylight greater than 10 sf or structural B 1STAIRS Stairs -first flight/ea addt'1 B STORAGE RACKS 1SRACKS<=8 Storage Ricks 0-8' high (up to 100 sf) B 1 SRACKS>8 Storage R icks over 8' high (up to 100 st B �Doc--c- C:T /ILj z of Lj CITY OF CUPERTINO GENERAL BUILDING APPLICATION FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Group Permit Type 1GENRES or 1 GENCOM 1STUCOAP Stucco Applications (up to 400 sf) additional stucco application B 1 WINREP Replacement windows/sliding glass door ea .3 windows B 1 WINMEWSTR New Window -structural shear wall/masc n includes plan ck fee B 1 EPERMITFEE Electrical Permit Fee E IMPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P IELCPLNCK Stand Alo le Electric Pin Ck (hourly) E 1 MECPLNCK Stand Alo ie Mechanical Pin Ck (hrly) M 1 PLMBLNCK Stand Alone Plumbing Pin Ck (hrly) P 1 STPLNCK-(3 Hr Min when not over counter) Standard Ilan Check (when no E/M/P) hourl -staid alone B 1BCBSC Cal Bldg 'tandards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic Residential B IBSEISMICO Seismic Commercial B 1 TRAVDOC Travel & Documentation B 1BUSLIC Business License B 5 A 5