09040090 CITY OF CUPERTINO
BUILDING DIVISION PERMIT � ' ` � *
PERMIT NO.
BUILDING ADDRESS:
20661 FORGE WAY JOHN VII)OVICH nqnannqn
PERMIT ISSUE DATE
rNER'S NAME:
SARWAkU.2CONTROL NO.
Fi
ONE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
u p p LICENSED CONTRACTOR'S DECLARATION Job Description
Id,
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
;Z, with Section 70(10)of Division 3 of the Business and Professions Code,and my license is REPAIR WATER DAMAGE AND DRY ROT POSSIBLE FRAMING,
y in full force and effect.
License class Lic.ri SIDING, SHEETROCK, WALKWAY AND LANDIND REPAIR ON
Date Contractor
ntw
D W
ARCHITECTS DECLARATION THE FOL:JOWING UNITS.
< 1 understand my plans shall be used as public records
DyV
L O
or Licensed Professional
OWNER-BUILDER DECLARATION
2<2 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
no following mason.(Section 7031.5,Business and Professions Code:Any city or county
fd which requires a permit toconstruct,alter,improve,demolish,or repair any structure
y"
In prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area
%F_ (commencing with Sec:E Intion 7000)of Division 3 of the Business and Professions Code)or $7500
J1 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 API Number Occupancy Type
not more than five hundred dollars(5500). 3233602D FORGE
❑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.7144,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 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.).
01'A3 owner of the property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's U.
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. -y
❑I amexempt under sec. B&P C for this reason
vner Date
WOR COM ATION DECLARATION
I hereby affirm r penalty of perjury one of the following declarations:
❑I have and will retain a Certificate of Consent to self-insure for workces compen-
sation,as A for by Section 3700 of the Labor Code,for the performance of the
work for w ' this permit is issued.
❑1 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:
Cartier. 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
employ any person iny m
anan r so 'c� ject to the Workers'Compensation
Laws of Cali o ,
Applicant
NOTICE LICA after making this Certificate of Exemption,you should
become subject to the W rker's Compensation provisions of the Labor Code,you must
Z forthwith comply w' h provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
Fr rte.. 1 hereby affirm that there is a construction lending agency for the performance of
LYt the work for which this permit is issued(Sec.3097,Civ.C.)
W QLender's Name
a Z L.endees Address
U 0 1 certify that I have read this application and state that the above information is
IL 0-04 correct.I 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
U above-mcndoncd 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
U Z in consequence of the granting of this permit. Date
APPLICA UNDERS S AND L COMPLY WITH ALL NON-POINT Issued b)
SOU _
Re-roofs —
Signature of Ap licant/Contraclor Date
HAZARDOUS MATERIALS DISCLOSURE Type of I:Oof
*1 applicant or future building occupant store or handle hazardous material
as def, y the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
•�dc,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection, agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r.iaterials for inspection.
District?
❑Yes O1S
1 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
docs not currently have a tenant,that it- y responsibility to notify the occupant of the
roquireroerUTv nreyt be rger no ,ssuanc� a ficate of Ocoapancy. Signaturc of Applicant Date
All roof coverings to be Class'. or better
ner or ihorizr rat Date
y
CITY OF I"UPERTINO
CUPEk INO GENERAL BUILDING
PERMIT APPLICATION FORM o 9a�/00
APN # Date:
23 o
Building Address:
O ® _ 1/
Mailing Address (if dif r t from buflding address):
r i
wner's Name:. Phone#:
Contractor: Phone: �;X61 '72F-q44 Lt C-t
Ve- .� 6- ct.� 6�X/r� ae n 4I Fax:
Contractor License#: w UJ e-/L
Cupertino Business License#:
Contact: Phone:
J Fax:
4-
ResidentUl Commercial
Zvi /(os; 2&3*1 3&'6
Job Description: u � �
/57 25-17X57 /S� ZSR 2�'i -3 ls�/
3�� / ,253' 3��/ 1692 .2lvZ 102 /S/c Z 5_ ,7 L3
3�`� � , 5lo ZScv i i
Building Permit nfo: 5; i,,��c S[1e�f ✓dc-I[� I�I�ui(!L a�Y a-�t� ����j
Bldg Cr' Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
IUIII/V-A IUIII B, IV-HT,V-B [� A' j 6
— 2
1-A, I-B ❑ ❑
Valuation: O Square Footage:
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:
lFor help, contact Build it Green at www.bufldklteen.org
Revised 01/07/09
CITY OF C.UPERTINO
CM Of GENERAL BUILDING APPLICATION
CUPERTINO
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
ACOUSTICAL
REVIEW
IACOUSFDW SFDWUDuplex New B
IACOUSRESAD SFDWL/Duplex-Addition/Alteration B
l ACOUSCOM Multi-Family/Commercial B
CHIMNEY'S
1 CHIMNEY Chimney B
1 CHIMNEYR Chimney Repair B
FENCES
1FENCE>6FT Non-masonry, over 6 ft in height B
1FENCEMAS>6 Masonry, over 6 ft in height B
FIREPLACES
1FIREPLMAS Fireplace Masonry B
1 FIREPLFAB Fireplace-Pre-Fabricated/Metal B
1FLAGPOL>20 Flag poll; (over 20 ft in height) B
1 MODUSTRU Modular Structures B
FOUNDATIONS
` 1 FOUNDREP Foundation Repair B —
1PILECAST Pile Fouldation Cast in place concrete B
1PILEDRIV Pile Fou:idation Driven (steel,pre- B
stressed concrete)
3 of 5
11 SWk411_.1 CITY OF (�UPERTINO
CITY
E TGENERAL BUILDING APPLICATION
CU � ING FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications (up to 400 sf) B
additiona: stucco application
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows)
1WINMEWSTR New Window-structural shear B
wall/masonry (includes plan ck fee)
1 EPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing;Permit Fee P
1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E
1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M
1PLMBLNCK Stand Al)ne Plumbing Pln Ck(hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check (when no E/M/P) B
when not over counter) hourly-sl and alone
f 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1BSEISMICR Seismic Residential B
1 BSEISMICO Seismic Commercial B
y 1 TRAVDOC Travel &:Documentation B
1 1BUSLIC Business; License B
5 of 5
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Assessor's Parcel Number: j
Name of owner.
Project address. T_TQrl', P_
Contact person. YPaone. j7 /
Fax.
vCCORDANCE WITH THE CRY UI
Net square footage of lot. _ ` aJDFRImo ('.ODES AND ORDINANCES t
Existing SATE
k5 t:i
Square footage: First floor: ;ICS
Second floor: chis set Ations�fOS
r
Garage:
as kept cn � 'eur'
TOTAL:
m on
,no building bap'., upertino.
re there at least two 10 foot by 20 foot clear spaces ir..side the g *mpinyut h N ' OJ s
;HALL NOT be rie.0 PeAlt C6'be a�
Is privacy protection planting required for the project? Y I of the violation of en ity R.
,t'�,i�y COrdinance ance or � �l��`t
On what floor(s) is work being done? IJ _A6b r
Brief description of work. i c
�,�,� rd roc�� r rA4 ILI
Code editions:2008 CBC (Y -N)2008 CFC 0--N)2008 CMC (Y-N)
2008 CPC (Y -N)2008 NEC 0--N)
36.o, 163),2,&3,363, 1 , �L , 3&
Effective 1/1/08oZs�,3,57 16"C>) -Z(d�)J 560
157157, 357, /S�i aStr, S5s-�
rvt;j I ✓- C4"a 40 b C'
�v✓Iv;�C\I I.F�p`i��. F
Plan Review Process Work Book Page-B-Revised 1/l/08
De Anza Properties
Monday, March 16, 2009
Building Official
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014
Dear Building: Official
I am the owner of Forge Homestead Apartments. This letter is to notify you that
as the owner we are in the process of repairing minor dry rotting due to water
intrusion. Your cooperation with any f ermits, inspections and ancillary services
in this matter will be greatly appreciate I. Craig Crandall will be the person in
charge. He can be reached directly at 408 605 7747.
Sincerely,
John Vidovich
A '
Y...
920 West Fremont Avenue Sunnyv,ile, California 94087 Phone: 408/738-4444