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12060029 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7893 RObINDELL WAY CONTRAC.TC-- PERMIT NO: 12060029 OWNER'S NAME.: Ii(11:Y 1IIJG0 R AND E-PING S I,GK(AC4 /S �/ A'� �A-C�-� DATE: ISSUED:06/05/2012 OWNER'S PHONE: 4089731461 b hL u PHONE]NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r /// License ClassJin -,.ic.H '70 9 5 85 MECH r RESIDENTIAL r COMMERCIAL r Contractori Q✓•[K Date J �2 1 hereby aRm licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSTALL SIDING OVI7R I-XISTING STUCCO I'OR SINGLE; (commencing with Section 7000)of Division 3 of the Business&Professions FAMILY DWELLING-608 SQFT Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's C'onmpensaii0n,as provided for by Section 3700 of the Labor Code,for the performance of the work lift which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Fluor Area: Valuation:54100 permit is issued. APPLICANTCERTIFICATION APN Number:36219024.00 Occupancy,[)pe: I cenify that I 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 lir inspection purposes. (We)agree tosave PERMIT EXPIRES IF WORK IS NOT STARTED indannif) and keep harmless the City of Cupertino against liabilitics,judgmenls, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply- 180 DAYS FROM LAST CALLED INSPECTION. with all nun-point sour e - atiais per the Cupertino Municipal Code,Section 9.18. Signature Date 6 S '2 Issued by: ❑ OWNER-BUILDER DECLARATION RE:-ROOFS: hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any rooring material being installed.If a roof is the following two reasons: installed without first obtaining an inspection.I agree to remove all new materials for I,as owner of the property,or nmy employees with wages as their sole compensation, inspection. will do the work,mid the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date- I,as owner ofthe property,run exclusively contracting with licensed contractors to cnnSlmC1 the Project(Sec.7044,business&Professions Code), ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penally of perjury one of the following three declarations: IIA%ARDOUS MATERIALS DISCLOSURE: I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided tier by Section 3700 of the Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Ilealth&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code.Chapter 9.12 and the Health& Section 3700 of the Labor Code.for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally.should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the BayArea Air Quality Management District I will 1 certify that in the performance of the work for which this permit is issued.I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in;my nmanner so as to become subject to the Worker's Ilealth&Safely Code,Sections 25505,25533,and 25534. Compensationl;nccof California. If,after making this certificate of exemption.I / become subject to the Worker's Compensation provisions of the Labor Code.I must Owner or 1 6Tized agent: /+� Date: I z- fonh+vith comply with such provisions or this permit shall be deemed revoked. CONSrRUCIION LENDING AGENCY :\PPLICANT CERTIFICATION I certify that I have read this application and state that the above Information is I hereby affirm thin there is a construction lending agency for the performance of work's correct. I agree to compl}'with all city and county ordinances and state laws relating for which this peril is issued(Sec.3097,Civ C.) to building construction,and hereby'authorize representatives of this city to enter Lender's Name Upon the above nncnlioncd property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments. Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCIIITEC'1"S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Dale Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36219024 .00 DATE ISSUED. . . . ... . : 06/05/2012 RECEIPT#. . . . . . . . . BS000017005 REFERENCE Ili # • • • : 12060029 SITE ADDRESS . . . . . : 7893 ROBINDELL WAY SUBDIVISION'S: . . . . . . : CITY CUPERTINO IMPACTAREA . . . . . . . OWNER HUEY HUGO E AND E-PING S ADDRESS 7893 ROBINDELL WAY CITY/STATE/ZIP :. . : CUPERTINO, CA 95014-5076 RECEIVED FROM . . . . : TYEUGENIY CHERNIOGL CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY. ... . . . . . . . . : TBD - TO BE DETERMINED ADDRESS... . . . . . . . . : CITY/STATE/ZIPI. . . : TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------ ----------- --------— ---------- ---------- ---------- 1BCBSC VALUATION 4, 100.00 1. 00 0. 00 1 .00 0. 00 1BSEISMICR VALUATION 4, 100 .00 0 .50 0 .00 0. 50 0 .00 1SIDEOTHER SQ FEET 608 .00 588 . 00 0. 00 588 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 589. 50. 0 .00 589 .50 0 .00 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 MY OF Fax(408) 777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAyffi: PHONE # yCg- %?3 -/9G/ GENERAL CONTRACTOR: n . Cl,e:,-„of o FAX # 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 er/Contractor Signature Date CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 7893'robindell way DATE: 06/05/2012 REVIEWED BY: bobs. APN: BP#:, VALUATION: $4,100 *PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK install siding over exisitin .stucco for sfd. SCOPE 11rch, Plan Check PLurrb. Plan Check Flee. Plan Check ,llveh, 1'ermil Fee: Plranh. Permil F,c•: l:lec. Permit hire: Orher,lh,ch. bnT. 011ier Plumb Ince. 011ier 1,Icc. hIs :lhrelr. hi,p. Fec: Plumb. hr.cp. Fee' dike. heap. Fer: NOTE: This estimate does not fecludejees due to other Departments(i.e. Planning,Public Works, Fire,Sanitary Sewer District,School District,etc.). Thesefees are based on the Prelimina information available and are only an estimate Contact the De f or addn'!info. FEE ITEMS(Fee Resolution 11-053 EIT 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 608 s.f. Siding Suppl. PC Fee: Q Reg. 0 OT F0,0Thrs $0.00 $588.00 ISIDEOTHER I All Other PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. FeeQ Reg. 0 OT 0.0 1 hrs, $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction liar: it rbnhnslrative Fce: 0 Work Without Permit? 0 Yes (F) No $0.00 0 Advanced Planning I7ce: $0.001 Select a Non-Residential E) Truce!DoclunenruNrnd Ices: Building or Structure 0 A Suone Motion Fee IBSEISMICR $0.50 Select an Administrative Item Blde Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $588.00 TOTAL FEE: $589.50 Revised: 05/01/2012 ZO(o OcU2-(9 rCHECKED By p s PAST CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION PLANNING per,' 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333• buildino(okuoertino.ora OAS CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED�j 0 PROIECr ADDRESS J IJq 'j RIIblIt �1'E�J lyryt, - A 7-- L l — 0 OWNER NAME 7 C �I PHONE E-MAB. H�:�•z yb,t� lCITY, yC8-973-/46/ , STREETADDRESS 7b /6�L.[ CITY. STATE ZIP �.. I FAX P, �:.k &/) CONTACT NAME PHONE E-MAB. STREET ADDRESS CITY,STATE ZIP FAX ❑OWNER ❑ OWNER-BUTIDER ❑ OWNEitAGENTC�R ❑CONTRACTORAGENT ❑ ARCHITECT ❑MNGNEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME EL44J LICENSE NUMBER LIC SE TYPE BUS.LIC4 COMPANY NAME A��l�u,.,s Ad�H. . ,t lµ'lvrvl�P,"n E-MAIL , AR elmde h, N[o,,7 9/6 -731-06 9'6 STREET ADD RE�s CRY.STATE ZIP PHONE _ /1i qJdz- � -fig - ARCH1TECf/ENGINEER �7�'S�Zi• NAME LICENSE NUMBER BUS.LIC p COMPANY NAME E-MAB. FAX STREET ADDRESS CRY.STATE ZIP PHONE DESCRIPTION OF WORK �n a_ �riA Sfdinc 0/I w'ef ,•c� L��/l. �rKlc{f=6o8- . � EXISTING USE PROPOSED USE CONSTRTYPE tl5TORxs USE TYPE OCC. SQ-FT. VALUATION(S) EXLSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET.AREA BATHROOM KITCHEN OTHER REMODET.ARFA REMODELAREA REMODEL AREA PORCHAREA DECKAREA TOTALDECK/PORCNAREA GARAGEAREA DETACH ATTACH a DWELLING UNRS: 15 A SECOND UNIT YES SECONDSTORY YFS BEING ADDED? ❑NO ADDITION? []NO PRE-APPLICATION ❑YES T YES,PROVIDE COPY OF IS TRE BLDG AN El YES RECEIVED BY: / TOTAL VALUATION: PLANNNGAPPLA ❑NO PLANNING APPROVAL LETTER EICHLER NOME? ❑NO By my signature below,I certify to each of the following: 1 am the property owner or authorized agent m act on the prppertyowner's behalf. If have read Ibis application and the information I have provi e(CS lcorreeL I have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating to bui nstroction. I anthori c representatives of Cupertino to enter the abo a-i lentified property for inspection purposes. Signature of Applicant/Agent Daze: S SUPPLEMEM ORMATIONREQUIRED PLAN CHECK TYPE RGUMGSLEP _New SFD or Multifamily dwellings: Apply for demolition permit for ovP.R-'reE-coDnTER soaomc PLA. REVIEWexisting building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ ExPRESs ❑ PIANNING PLAN REVIEW _ComDisclosure Commercial Bldgs: Provide a completed'Hazardous Materials Disclose ❑ sPDB rANDARD ❑ ucwORKS Tom if any Hazardous Materials are being used as part of this projecL ❑ LARGE ❑ FIRE Deer Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B/dgApp_2011.doc revised 06121111