12080089 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: 10062 SCENIC BLVD CON'TRACT'OR:AMERICAN KITCHENS PERMITNO: 12080089
BATH
OWNER'SNAME: CARLTON ALEXANDER E D AND NADINE E 1758 JUNCTION AVE UNIT D DATE ISSUED:08/088012
OWNER'S PHONE: 4088651136 SAN JOSE.CA 95112 PHONE NO:(408)436-8151
❑ LICENSED CONTRACT'OR'S DECLARATION BUILDING PERMIT INFO: BLDG F- ELECT F- PLUMB r
License Class Lie.N / 343F r' (-
r� / / ,n MECH RESIDENTIAL COMMERCIAL
Conlmclo r !� /J die
hereby affirm that I ant licensedunder the provisions of hapter9 JOB DESCRIPTION: REPLACE SIDING(520 SQFI)DUETOTERMITE DAMAGE,
(commencing wilh Seeiim 7000)of Division 3 of the Business S Professions ADD ELECTRICAL SWITCH AT DINING AREA,NEW LIGHTAT
Code and that my license is in full force:aid effect. ATTIC SPACE,REPLACE PORCH COVER,AT PORCH AREA
I hereby affirm under penally of perjury one of the fullua ing 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 pemtit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the labor Code,for die performance of die work for which this Sq.Ft Floor Area: Valuation:$14000
permit is issued.
AI'1'LICAN'I'Chlt'1'I1-'ICA'I'ION APN Number:3570904 Loo Occupancy,T)lie:
I cenif'y that 1 have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state Imes relating
to building construction,and hereby authorize representatives of this city to enter
upon die 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 liabilides,judgments,
costs,and eNpenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit, Additionally,the applicant licant understands and will coni h'
with all non-poit source eregulations per Ell Cupertino Municipal Code Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. 7
Signature Date ` Issued In Date:
Date:
❑ O\VNI.R-BUILDER DECLARATION
RE-ROOFS:
hereby affirm that I ani exempt from the Contractor's License Linv for otic of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the fulkoOng two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
L as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,tad the structure is not intended or offered for sale(Sec.7044,
Business S•Professions Code) Signature of Applimnl: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to -
conslrnd the project(Sec.7044,Business:Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BEITI'ER
1 hereby affirm under penalty of perjury tine of the following three
declarations:
I have and will maintain it Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Conipcnsation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 0.95 of the
performance of the work for which this permit is issued. California I leakh S Safe[ Code.Sections 25505,25533.and 25534. 1 will maintain
1 have and will maintain Worker's Compensation Insurance,as provided I'or by compliance with the Cupertino Nlunicipal Code.Chapter 9.12 and the Ilealth S
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 1 use equipment or devices which emit hazardous air
permit is issued contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which(his 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 Health S Safely Code.Sectio _9 25533,and 25 34.
Compensation laws of Cal ifania. If,after making this cerlilicale of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I most 19
forthwith comply with such provisions or this permit shall be devoted revoked. Date°
\1'I'LIG\NI'CPR'I'I FTC.\'PION CONSI'RIICI'ION LENIIINC ACP:NC%,
1 certify that I have read this application and state that the above information is I hereby affirm that(here is a construction lending agency for the performance of work's
correct.1 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
indemnifyand keep harmless the City ofCuperinoagainst liabili(ies,JUdgmeats, Leader'sAddress
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ,\RCII I'I'IiCI"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 Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 10062 scenic blvd DA'Z'E: OS/OSI2012 REVIE LVED BY: bobs.
APN: 13P#: 'VALUATION: $14,000
*PERINUT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD Or Duplex PE M"IT AlPE: 1GENRES
USE: PER��II"PTl'PE:
WORK re lace siding520s.f. due to termite damage, add electrical switch at diningarea new light at attic
SCOPE space, replace porch cover, at porch area add new skylight.
btech. loan Check Plumb.Plan Check Elea Plan Check 0.0 hrs $0.00
blech. Permit Fee: Plumb.Permit Fee: Elec. Permit Fee: IEPERAHT
Other,tfech.Insp. Other Plumb Insp, Ll I Other Elec. I nsp. 0.0 hrs $45.00
Meeh. Imp. Fee: Plumb. /nsp. Fee: Elec.Imp.Fee:
NOTE: This estimate does not include jeev due m other Departments(i.e. Planting, Public Works, Fire,Sanitary Server District,Schaal
District, etc.). These ees are baser/on the treliminam information available and are onbv an estimate. Contact the De t or addn7 info.
FEE ITEMS (Fee Revohdion 11-053 Ef. 7/1/11) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 520 s.f. Siding
Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $600.00 ISIDEoTF/ER All Other
PME Plan Check: $0.00 1 # Skylight
Permit Fee: $0.00 $400.00 1 ISKS'6<IOSF <= 10 s.f.
Suppl. Insp. Fee@ Reg. 0 0'1' 0.0 hrs $0.00 1� Electrical
PME Unit Pee: $0.00 $45.00 IBREAIRCEP
ERecep/Switch/Outlets
PME Permit Fee: $45.001= # Electrical
Consn-nclion Tay.- $67.00 IBREdIFIXT Fixtures, Lighting
Administrative Fee: 1nDMIN $42.00 0
Work Without Permit? 0 Yes Q) No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential t)
Travel Documentation Fee: ITRA t'DOC $45.00Building or Structure 0
A
Strong Motion Fee: IBSEISdIICR $1.40 Select an Administrative Item
Bldg Sids Commission Fee: IBCBSC $1.00
SUBTOTALS: $134.40 $1,112.001 TOTAL FEE: $1,246,40
Revised: 07/01/2012
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION-CUPERTINO
APPROVED
This set of plans and specifications MUST be kept at the
Job site during construction. It Is unlawful to make any
changes or alterations on same,or to deviate
therefrom,without approval from the Building Official. CUP IRTINO
Building apartment
The stamping of this plan and specifications SHALL NOT�.
be held to permit or to be an approval of the violation o
of any provisions of any City Ordinance or State Law. AUG 0 7 2012
BY REVIEWED FOR CODE COMI IANCE
DATE --- Reviewed By:
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CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 Nkomo
(408) 777-3228• FAX (408) 77 333 • buildingicDcupertino.oro
GUPERTINO
❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION//DD7/EF��JERRED //nORIGINAL PERMIT#
OTECT ADDRES
PRS _ APN M 2{�• 'I 9 DLI
ONtNOR'NEtR'N`AME ^ _ L- 0 -1 1 ap E-MAIL
STREET ADDRESS�1 CITY. TAT ,ZIP FAX
5
/4 G LVD Ir4o
c acT N E _ _ L4(::)(2> tq —�I E-MAIL
STREET AD REBS CTY.ST TE, ZIP FAX
o VES s 5E IIZ
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ID CONTRACTOR O:TRACTORAGENT 0 ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NA 1E, - I LIC ENS'N,S1MBaER3 g LICFrN�E TYPE 'b
C N I
kte
COJAPA;YNAI1E VV ` E-MAIL ,(� FAX
RIAITH
STREET ADDRESS I CITY,STATE.ZIP PHONE L4 NO
�K:lcT aAVE CI- C(1511?— (40 I S
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC Of
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DE RIPTION OF WORK 5-20 5� ,
A cE �ZM14 Dn c jS --51 w 636 li2l tNt{e
DD oPrLeT 1N kt�chei c1<cak<a 4s i o D I IC,147"
lvtov r 6 ,FE'ONT (brcN -Aie-W $ leil~T A/V 0) /?oot/
EXISTING USE PROPOSED USE CONSIR.TYPE I #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NETAREA /`j--
BATHROOM XHCHEN OTHER / •/
REMODEL AREA RENODELAREA REMODEL AREA
PORCH AREA I DECK AREA TOTALDECKIPORCH ARG GARAGE AREA: DETACH
❑ATTACH
4 DWELLNG UNITS: ISASECOFDUNIT OYES SECOND STORY ❑YES
IIEINCADDEII' E]NO ADDITION' ONO
PRE-APPLICATION OYES IF YES,PROVIDE COPYOF ISTHEBLDGAN ❑YES ':RECEIVED BY:" - - 7AL VALUAT
PLANNINGAPPL# ONO PLANNING APPROVAL LETTER EICHLER HOME
By my signature below,I certify to each of tire following: I am the rope o mer or authorized agent to act on the property owner's behalf. 1 have read this
application and the information I have pr •ided is correct. I have ead the sEription of Work and verily it is accurate. I agree to comply With all applicable local
ordinances and state IaN•s relating to uildi g construction. u orize reprelives of Cupertino to enter the abo -id ntified property for inspection purposes.
SignawreofApplicant/Agene Date: �z
SUPPLEMENTAL INPORvIATION REQUIRED -- - - - - - _ -
'ROVI'ISC SLIP. _
New SPD or Multifamily dwellings: Apply for demolition permit for I vr:u=rivacuuxreR riuD.bisG rias RE-VIE •
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. -- ❑',Exrnr-SS ^❑ r%Lta:�INc ri;�N.lie4i Etd
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD - ElPUBLIC%ORKS
Tom if any Iiazardous Materials are being used as part of this project. •p iavice ❑ F'IRt.DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to 71,MAJOR - ❑' SANITARY SEN'r.R DISTRICT
submittal of Building Permit application. -
.,❑ .ENVIRO\'M T:\TAh IIF V:I'll�-_
BldgApp_1011.doc rerised.06/11/11