09040144 CTTY OF CUPERTINO
BUILDIIY.G DP ISION PERMIT
PERMIT NO.
BUILDING ADDRESS:
10204 S PORTAL AVE SIGMA CORPORATION09040144
PERMIT ISSUE DATE
OWNER'S NAME:
MR & MR q ('I Z1 1 Z1 43353 A 0-SQ-991) RP
S A CONTROL NO.
JNE:
(510) 6138-1817
BUILDING PERMCI'INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
a 0 a o
u o c LICENSED CONTRACT'OR'S DECLARATION Job Description
U I 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 my license is KT C H RM-D L(12 0 S Q)NEW C BNT S,CNTR TOPS,RC S D LTNG,
�y in full force and c L_ (� Lic.N
.�z License Class
Date ( Contractor '' -( ELEC,CO?PR REPIPE,WTR HTR;NO STRCTRL;NO RF**SIGMA
Lt f—, � '
ARCHITECTS DECLARA N CORP RE:�IWD BSL 4/27/9
< I understand my plans shall be used as public records
�yU
4 UO y Licensed Pmfcssional
OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
K m which requires a permit to construct,alter,improve,demolish,or repair any structure
prior to its issuance.also requires the applicant for such permit to file a signed statement ]~t.Floor Area Valuation
?< that he is licensed pursuant to the provisions of the Contractor's Licensc Law(Chapter 9 3q
Y.H G (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $15000
a 5 a that he is exempt themfrom 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). 36909003 . 00
0 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
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
9ns
.).
I,as owner of the property.am exclusively contracting with licensed contractors to
truct 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 conuractor(s)licensed pursuant to the Contractor s
License law.
0 I am exempt under Sec.. B&P C for this reason
Owner / Dare
WO KER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
L]1 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.
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 Workees_Compensationnsur
Insurance carrier and Policy number are:
_ c
Cartier.`J 141 's iltil; Policy No.:.CCI
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 in any man so as to become subject to the Workers'Compensation
Laws of California Date
Applicant
NOTICE TO APPLIC :If,after making this Certificate of Exemption,you should
become subject to the orker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z►' CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
fY+ the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lenders Name
z Lenders Address
V 0 1 certify that 1 have read this application and state that the above information is
LL. � comes[I agree to comply with all city and county ordinances and state laws relating to
0U building construction.and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes
Q. (We)agree to save,indemnify and keep harmless the City of Cupertino against
rA liabilities,judgments,costs and expenses which may in any way accrue against said City
V z in consequence of the granting of this permit. Date v 1
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS.
Li1 I n`' Re-roofs —
Signature of Applicant/Contractor Date Type Of Roof
MATERIALS DISCLOSURE
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.
fi
0 Yes ly No
T If a roof:s installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
.ait hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
DYes &No
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,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 issuance of a certificate of occupancy. Signature of Applicant Date
Owner or authorized agent rl� �1� Date All roof coverings to be Class`
'�.'r or better
o U ( qI
G, CITY OF i-UPERTINO
ADDITION/REMODEL
CUPEkTINO FEE SCREDULE
APN # Date:
�(�q � 0 CD8 ti a lei,
Building Address:
Mailing Address (if different from building address):
Owner's Name: nAr 4 Nkrs .C—(:, Phone# : �. � - S C
HOA: (Exterior work only) Yes ❑ No ❑
If yes, provide letter from HOA
Contractor: Phone#: �-
`S16-1vi A L-ci�i�r�k-�i i uiv Fax #:
Contractor License#:
Cupertino Business License#: J
Contact: Phone#: tJ I u
�, z 1 NVA L-- i Fax #:
Building Permit Info:
Bldg. Elect. Plumb. Mech. ❑ Hillside ❑
Job Description:
Addition-What is being added?(Be Specific):
What is being remodeled (not including addition;?
YXIv-Ic��� lZ��.��ac13 � �CPttVvC-_, l-�iiR �ra �
t -N L L- ri
co,
C'F- _lam p - -tub�3 1(�`kfitrt
Remodel Includes Re-Roof. Yes ❑ NoEN] 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 plann!Rg approval letter. Planners name:
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen ( ►-aC �s.A4I3ath Other iz : P,,2t_- 1*,us r1 , L`:r�;
tL
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ IUIII/V-A ❑ IUIII B, IV-HT, V.B [' �,"3
Valuation: `{6 PS) eer c,-u Please check this box if the project is a
second-story addition ❑
Project Size: Express [q4tandard ❑ 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 plan set& the sheet index.
***For Office Use Only***
Over-the-Counter ❑ Revised 02/05/09
CITY OF ,CUPERTINO
ADDITON/REMODEL
FEE S(:HEDULE
Quantity Fee ID Fee Description Fee Permit Type
Sq Ft Group
1MECPLNCK Stand Alone Mechanical M
Pln Ck I hourly
1PLMPLNCK Stand Alone Plumbing P
Pln Ck i hourly)
1 BCBSC Cal Bld; Standards B ALL PERMIT TYPES
Commi;;sion Fee
1 BSEISMICRE Seismic Residential B
/ 1 TRAVDOC Travel & Documentation B
1BUSLIC Business License B
D Lj
:RESIDENTIAL PRO JECTER'COYSHEET
Assessor's Parcel Number: G cr
Name of owner. M tz- tYA f-s t)NY f�
Project address. I b2.0 Li �oi�li rt
Contact person. Prsc-Ha V- IY IN ct e&(Li Ph ane. S 1
Fa:c.
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor: /
Garage:
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces in:ide the garage?
is privacy protection planting required for the project?
On what floor(s) is work being done?
Brief description of work.i4-F c'�-1 G rJ �E'vn u I)E� . J .�eC.Lb kWJ-I , car.;;_—(,er-v &-i1-�
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2008 CPC -1)2008 NEC �-N)
Effective 1/1/08
, SSESSOR COPY -
Plan Review Process Work Book Page-8-Revised 1/1/08
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RESIDENTIAL PHOJECT�COY" SHEET
Assessor's Parcel Number: - _ U
Name of owner. M 9- o tv FF
Project address. I ba 0 Zi �� tt 14,(2- rN t- Ay� , C"t ��M NLS
Contact person. PtSc-Ham tY1A t&sizA Ph)ne. S u L-k - S Li 2C
Fa:(. ►u C�t�-� - ��19
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor:
Garage: /r —
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces in:ide the garage?
Is privacy protection planting required for the project?
On what floor(s) is work being done? n�
N N��
Brief description of work.K 1"F-0
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Code editions:2008 CBC -N)2008 CFC 69-N)2008 CMC O N) A� vl t;ov$ MUS'
2008 CPC N)2008 NEC -N)
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Plan Review Process Work Book Page-8-Revised 1/1/08
114
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204CUPIFkTIO
1
Sc�4F : N 1 S
— Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CIT1f OF
„UPEt�TINO Fax(408)777-3333
Building Department
JOB ADDRESS: PERMIT # Q D�
OWNER'S NAME: at�w +�1�; LY. PHONE # �►c (-�4' - i�;
GENERAL CONTRACTOR:S. -r h ,r` ✓; FAX # S
I am not using 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
Tile
� �a -4 1 �
Owner/Contactor Signature Date