12070170CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10182 BILICII PL
OWNER'S NAME: HANSEN ANN E AND BYRON J
OWNER'S PBOINE: 4082578899
❑ LICENSED CON I'RACIOR'S DECLARATION
Licenselclass 901, Lie.4
Contractor/7r�J'l=�o✓(rte rG�atc—i'��( �-.
I herebyaffirm that I am licensed under the provisions of Chapter!)
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
1 hereby affirm under penally of perjury one of rhe fulluwing two declarations:
I have and will maintain a certificate of cmnsrm to self -insure for Worker's
Compensation, 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 provided for by
Section 3700 oflhe Labor Code, for the performance of die work for which this
permit is issued.
APPLICANT CER TI FICA'ION
I certify that I have read this application and state that the above infurnmtion is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and herchy 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 ol'Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understrnds and will comply
with all non -point source regulatint5 per the Cupertino}�'lunicipal Code, Section
9.18. /
Dat p(
❑ / O\\'NE 011 ,I)ER DIiCLARATION
hereby affirm that I am a empt from the Conlraclor's License Law for ane of
the following two reasons:
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 & Professions Code)
I, as owner of the property, ani exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
1 [leech% affirm under penally of perjuryone of the following three
declarations:
I have and will maintain it Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of lie work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the labor Code, I'or the performance of the work for which this
Permit is issued.
I certify that in the performance oldie work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation Imus of California. If, alter making this cenificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code. I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLIC\\ I' CERTIFICATION
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 aid state Imus 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 hamless the City of Cupertino against liabilities, judgments,
costs, and expenses which may aceme against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulatims per the Cupertino Municipal Code, Section
9.18.
Date
CONrRACI OR: r'F.RM IT NO: 12070170
IDA'Z'E ISSUED: 07232012
If ` rDON* E NO:
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB
NIECII r RESIDENTIAL r COMMERCIAL r
J OB 1) ESC R I PT I ON: INSTALLATION OF STUCCO(720 SOFT) AT GARAGE
FRONT,
GARAGE LEFT WALL AND FRONT DOOR WALL-,VITII TI IE
INSTALLATION OF WEEP SCREED AROUND ENTIRE
Sy. Pl Floor-Arra:I Valuation: $16000
APNNumber: 31621066.00 1 occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FI OM LAST CALLED INSPECTION.
L
Issued i / Date:
RR -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Appl is na: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR RGI -TER
HAZARDOUS \IATFRIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Ilealth & Safety Code, Sections 255115, 25533, and 25534. 1 mill maintain
compliance with the Cupertino Municipal Code. Chapter 9.12 and the I lcalth &
Safely Code, Section 25532(x) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Arcu Air Quality Management District I ♦'ill
maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and the
lcalth & Safcty Code. Sections 25505. 25533, and 25534.
ButeT4a90iO
I It r y affirm th er Is a construction lending agency for the performance of work's
fo hich this peri I i issued (Sec. 3097, Civ C)
Lender's Name
Lender's
ARCIII'TECT'S DI'CL,\RATION
I understand my plans shall be used as public records.
Licensed
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
igADDRESS:
10182 Bilich Place
DATE: 07/23/2012
REVIEWED BY: Sean
s
APN: 316-21-066
BP#:
'VALUATION:
$16,000
*PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Restucco
PRIMARY SFDorDuplex
USE:
Lice. Insp. Fee:
PENIANIAIION 1GENRES
PERMIT TYPE: Al
WORK
Installation of stucco at garage front garage left wall and front door wall with the installation of wee
SCOPE
screed around entire residence.
FEE ID WALL AREA
(S.f.)
1STUCOAPP 720
!VOTE: This eviintare doer not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, Schaal
District.etc.). These fees are based on the nrelintinarr information available and are onh, an estitmte. Contact the Dept for addn'I info.
FEE ITEMS (Fee Resolution /1-053 E!f UU11)
Mech. Plan Check
Plumb. Plan Check
Elec. Plan Check
blech. Permit Fee:
Plumb. Permit Fre:
tile-. Permit Fre-
Other Afech. tarp.
Other Plumb Insp.
Other Elce. Insp.
.ldech. Insp. Fee:
Plumb. htsp. Fee:
Lice. Insp. Fee:
!VOTE: This eviintare doer not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, Schaal
District.etc.). These fees are based on the nrelintinarr information available and are onh, an estitmte. Contact the Dept for addn'I info.
FEE ITEMS (Fee Resolution /1-053 E!f UU11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Sttppl. PC Fee
Plumb./Aleck/Faec
Permit Fee:
$501.00
Supp/. lnsp Fee
Phrenb.1Afech./E1ec
PlunhhJMech./Elee Permit Fee:
Consmhction Tor:
Administrative Fee:
Work Without Permit? O Yes (j) No
$0.00
Advanced Planning Fees:
Travel Docmnentation Fees:
Stron, Motion Fee: IBSF-ISMICR
$1.60
Select an Administrative Item
131de Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$503.60
$0.00
TOTAL FEE:
$503.60
Revised: 07/01/2012
CCUPERTINO
7 NFW rONGTRitf'
L Zv"1 u t -1 v►61 N�
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (4f008) 777-3333 • buildiinng( cuoertino.org
TON F-1 ADDITION YCI ALTER4TION/TI F1 REVISION/DEFERRFD ORI(;MAi.PFRM7T0-
PROTECT 4DDRSS -
I r
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OWNER NAME PHONE E-MAII.
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STREET ADDRESS
CITY, STATE ZIP
FAX
IUIY72 It l ,
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CONTACT NAME -
PHONE E -MAB.
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STREET ADDRESSCRY,
STAFAXE ZIP
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CoN CTIOR ❑CONiRACTORAGENT ❑ ARCHITECT ❑ ENGINE-]. ❑ DEVE1.0PE2 ❑ TENANr
CONTRACTOR NAME LICENSENUMH E2��I�� LICENSE7� BUS. tiCR
COMPANY NAME
E-M�- I f I.Q I'fiE%5;[ Vl1al/GGICSJ FAX
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STREET ADDRESSCITY.
STATE, ZIP PHONE
It l
ZME rA e=— )-3 057 ' I 55"
ARCHITECT/ENGINEER NAME I LICENSE NUMBER Bus. UC #
COMPANY NAME
STREET ADDRESS • .STATE. ZIP PHONE
DESCRD•T'ION OF WORK
�-
OM r Orx>z IAT (N3r41-f-. wLZY •u 6 OfedGN0
E'rr"Y- a� NONE .
FXSTING US'c
PROPoS-c�USE
CONSTR TYPE
fST0AIF5
USE
TYPE
OCC I
SQ -FT.
VALUATION(S)
EJGSTG
AREA
NEW FLOORDEMO
AREA
ARSA
T9rAL
NET.AR�A
BAreiROOM KRCHE OTHER
REMODELAREA REMODEL AREA REMODa AREA
PORCH AREA DECK AREA
TOTAL DECKTORCH AREA GARAGE AREA DETACH
❑ATTACH
M DWELLING UNTIE:
IS A SECOND UNIT YES
SECOND STORY ❑YES
BENGADDED' []NO
ADDITIONT - ❑NO
PR-APPUCA TION ❑YES IF YES. PROVIDE COPY OF
5 THE ELDC AN ❑YES
RECEIVED
TOTAL VALUATION:
PLANMNGAPPLd []NO PLANMNGAPPROVALLETTER
MCRLER HOME" ❑NO
By my signature below, I cermy m each of the foilowing I am the property owner or authorized agent to act on the prpperty owner's behalf. I have read This
application and the information I have provided is conecL I have read the Description of Work and verity it is accurate. I agree m comply with all applicable local
ordinances and stat laws relating to buil ' .g constr�+tJcdcut. I authorize r-presentaaves ofCuperdno w enter the above -i deed pmpe ry for inspection purposes.
Date:
Signare ofAppRcanr/Agenc % li' d//
tu
SUPPLEMEITAL 1NFORMA-MONREQUIRED
PLAN CHECK TYPE
R9trrcvc sT.s
j OVER_.TH !-COGNTZR
la.• BMWivG Puv REVIEW
_ New SFD or Multifamily, dwellings: Apply for demolition permit for
existing building(s). Demolition permit is requited prior to issuance of building
permit for new building.
❑ EXPRESS�[J
NNItiG PLty REVw
AAA❑�- Purn
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
El STANDARD
PVBUC WORKS
fornt if any Hazardous Materials are being used as part of this project.
❑ LARGE
-
❑ FIRE DEPT
_ Copy of Planning Approval Letter or' eeting with Planning prior to
❑
'
❑
submittal of Building Permit application.
atAioR
SANITARY SEWER DISTRICT
❑ ' ENVmONMEYT.AL RZA r TH
31do,App_2011.doc revised 06/21/11