12080004 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10640 MARTINWOOD WAY CONTRACI'OR:TF DESIGN INC PERMITNO: 12080004
OWNER'S NAME: PAUL LYNCH 3957%9A SALICE HATE ISSUED:08/02/2012
OWNER'S PlIONE: 4087778839 CADIPBELL,CA 95008 PHONE NO:(408)438-0432
❑ - LICENSED C(NJ RA(JOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class Lie.9 RO.i d qq r r r
y p1ECFI RESIDENTIAL COMMERCIAL
Tr 6)8-2r4t:N 1, Dateal 1R
I hereby alTrm that 1 am licensed under the pnn'isiuns of Chapter 9 JOB DESCRIPTION:REMOVE EXISTING WOOD SHAKE AND REPLACE WITH
(commencing with Section 7000)of flirision 3 of the Business S ProfessionsLANDNIARK COMPOSITION SHINGLES(2300 SQFT)REhIOVE
Code and that my license is in full force and effect. EXISTING WOOD SIDING AND REPLACE WITH STUCCO(1500
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
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 of the Labor Code,for the performance of Ute work for which this Sq.Fl Fluor Area: Valuation:$25000
permit is issued.
\PPLIC.\\I'CF:R'I'IFIC.\'1'If1N AI'NNumber:36935038.00 Occupancy'ltype:
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 1$U DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. _
Signature Date/tet//pl Issued by: � IY �7l/� Date: 0 ., -fa'
❑ OWNER-BUILDER DECLARATION
RF:ROOFS:
hereby:dTirm that I am exempt from the Contractor's License Law for One Of All cool's shall be inspected prior to my roofing 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 my cnmployces with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered lar sale(Sec.7044,
Business d Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business 8• Professions Code). ALL ROOF COVERINGS TO III.CLASS"A"OR BE,r-EER
hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's II,%Z,\RDOtIS NIA'1'1?RIALS DISCLOSURE
Compensation,as provided for by Scction 3700 ofdme Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance ofthe work for which this permit is issued. California Health S Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance whit the Cupertino illunicipal Code,Chapter 9.12 and the Health S
Section 3700 of the Labor Code,for the perlormanee of the work for which this Safety Code,Section 25532(x)should 1 store or handle hazardous material.
Additionally,should L use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District L will
I cenily 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 any manner so as to become subject to the Worker's Ilealth S Safety Code,Sections 25505.25533,and 25534.
Compensation Imes of Cali forma. 11,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must Usanehorized agent. n 1
forthwith comply with such provisions or this permit shall be deemed revoked. ��— Dale. 6
AI'I'LIC.\N'I'CIiIYI'll IC,\'1'If)N CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indenmity and keep lommless the City ol'Cuperfino against liabilities,judgments, Lender's Address
costs,and expenses which may Electric against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCI I I'1'ECI"S I3ICCLAItA'I'ION
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 Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10640 Martinwood Way DATE: 08/02/2012 REVIEWED BY: Sean
APN: BP#: 'VALUATION: $25,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration I Repair
PRIMARY TA
USE: SFD or Duplex
_2
USE: 1GENRE
WORK Remove existingwood shake and replace with Landmark composition shingles 2300 s ft). Remove
SCOPE existing wood siding and replace with stucco (1500 sq ft).
Mech. Plan Check Phonh. Plan Check Flee.Plan Check
Mech. Penni!Fee: Hand).Permit Fee: F.lec.Penni!bee:
Odtev A1ech.Insp. Other Plumb Imp. Other Elec.Imp. El
Mech.hxsp. Few: Plumb. loop.Fee: Elee.Insp.Fee:
NOTE: This artimtue does not iucludejees clue to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sen'er District,School
District,etc.). These fees are based on the prelitninan information available and are onh,on estiumte. Contact the De ! or tuldn'I into.
FEE ITEMS (Fcc Resolution 11-053 Ell 7/1/11) FEE QTY/FEE D11SC ITEMS
Plan Check Fee: $0.00 FT,500 s.f. Restucco
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $569.00 ISTUCOAPP
PME Plan Check: $0.002,300 s.L Re-roof
Permit Fee: $0.00 $345.00 IREROOFRES
Suppl. Insp. Fee:(D Reg. Q OT 1 0,0 firs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Constrriction Tac:
Administrative Fee: O
Work Without Permit? O Yes Q No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential E)0Travel Documentation Fees: Building or Structure
Song Motion Fee: IBSEISMICR $2.50 Select an Administrative Item
Bide Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $3.50 $914.001 TOTAL FEE: $917.50
Revised: 07/01/2012
)
1 zdOR oocy
CONSTRUCTION PERMIT APPLICATION
Ea COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
(408)777-3228 • FAX(408)777-3333 •buildino(DDcupertino.orn
CUPERTINO -
❑NEWCONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINALPERj�fIT:9
PROJECT ADDRESS10690 I APN A 2
OWNER NAME ?HONE d n 7�l �D�.1 E-MAILSTREET ADDRESS IOL O C� -WoOtd CITY, STATa Z[P 6 V r 6A '75-019 FAx
CONTACT NAME WHHT Q.fA (J 1 PHO 0.0
O 3 o Sj O B-
I e MA .
s RAD°��
325-7 V--µ 5`a-•�tCp•C..Q. I CfiY,STATE, IIPG A 9so o FAX
EI OWNER 13OWNER-BU¢DER ❑ OWNER AGENT -q CONTUCTOR ❑CONTRACTOR AGENT ❑ ARCFBrCr ❑ENGINEER ❑ DEVELOPER ❑ TENANr
CONTRACTOR NAME I R.I.r n
L y LICENSE NUMB7
ER oOCO `, LICENSE TYPE Bus.LICA 0? CI I
COMPANY NAME `^ L I E-MAIL O J FAX
1 (- OI/QnA
STREET ADDRESS3 yS I LA CI S r-e- I CTT,STATE ZIP -
Cd 9soo� PHONE 408 380 3a
ARCHUTEECT/ENGINEER NAME I UCENSE.UMBER I BUS.LICA
COMPANY NAME E-MAIL FAX
STREET ADDRESS CRY,STATE.ZIP PHONE ..
SC"DTION OF WORE
fit. . rL .l a3oo
O" me to �eO s c�Ct, .ei `Y X(Xc-
EXISTING❑Sc PRO USE CONST4 PAST
` L �! . . /L VI-3' J- USE I TYPE OCC. SQ-Fr. I VALUATION(S)
EXIST] NEW FLOOR DEMO TDTAL V
AREA AREA AREA NEr AREA
7ULG0 �p
BATHROOM RMODE Otter
REMODEL AREA REMODEL AREA REMODEI-AREA p
PORCH AREA DEC[ARFw TOTAL OECIVPORCH AREA GARAGE AREA: DETACH )¢
ATTACH lJA}Fj
A DWELLING UNITS: ISASECONDUNIT YES I sECOND STORY YES
BEING"Dec. O Anmtlow. 10
IRIE-APPLIGTtON OYES IF YES.PROVIDE COPY OF I I.a THEBLDGAN ❑YES RECEIV3D BY: TOTAL VALUATION:
PLANNINGAPPLA THNO PLANNTNEI
GAPPROVALLEr:EX CHLERHOME? 1Q-YO G� _ / 75'0'0'0 —
By my signature below,I certify to each of the following: I am the property owner at authorized agent to act on the prrperty owner's behalf. I have read this
application and the information I have provided is corcCL I have read the Descriptionof work and verify it is accuratc. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: e.w,,. .Lt9 Date: $—
SUPPLEN=ALINFORMATIONREQUMED PLAXCEIECKTYPE ROUTING SLIP
New SFD or bfuldfamily dwellings: Apply for demolition permit for OVER-.T HE-COUNTER HUD-°ING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building ,r/-J
permit for new building. El
EXPRESS Cl-PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBucwORKS -
-•IttT if any Hazardous Materials are being used as part of this project ❑ LARGE ❑ Fm Derr
Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. ❑ XUOR ❑ SA.YTTAAYSEWI•R DISTRICT
❑ ENVURONME.YTALHEALTH
B(dgAPP_2011.doc revised 06/21/11