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12100057
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21327 GLEN PL CONTRACTOR:STEVE PLEVANCIC PERMIT NO: 12100057 CONSTRUCTION OWNER'S NAME: AVERY CONSTRUCTION 528S MATIIILDA AVE STE 2 DATE ISSUED: 10/092012 OWNER'S PHONE: 6509618330 SUNNYVALE,CA 94086 PIIONE NO:(408)806-9145 ❑ LICENSED CON'TRACTOR'S DECLARATION •JOB DESCRIPTION: RESIDEN'TIALU COM\IF,RCIA1 License Class Lie.# g(o 5 APT 4- DECK REPAIR Contractor Date 9 hereby affirm 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. 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 Compensation,as provided for by Section 3700 of the Labor Code,for the Performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$5000 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 ANN Number:32627036.21327 Occupancy Type: permit is issued. API'LICAN'T CIiR'1'IFICA'I'ION 1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned properly for inspection against liabilities,( Vey agree g sane 180 DAY OM LAST CALLED 1NSPEC-- indemnify and keep harmless the City of Cupertino against (We)agree 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 Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature DatAll 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. ❑ ONVNF,R-BUILDER DECLARATION Signature of Applicant: Date: hereby affirm that I am exempt from the Contractor's License how for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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,am exclusively contracting with licensed contractors to HA-LARDOUS NIATF,RI L S DISCLOSURE construct the project(Sec.7044,Business&Professions Code), 1 have read the hazardous materials requirements under Chapter 6.95 of the California health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm ander penalty of perjury one of the following three maintain compliance with the Cu pertina Nlu nicipal Code.Chapter 9.12 and the declarations: health&Safety Code,Section 25532(a)should Istore or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District performance of.the work for which this permit is issued. will maintain compliance withthli5 (hertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the health&Safety Code,Seeti ,-5533,and 25534. Section 3700of the Labor Code,for the perfommnec of the work for which this permit is issued. Owner or authorized agenv= Date: 1 certify that in the performance of the 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 laws ofCalifomia. If,after making this certificate of exemption,1 CONSTRUCI'ION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked w'ork's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANTCERTIFICATION Lender's Address I certify that I have read this application and state that the above information is cr rem I agree to comply with all ciy and couny ordinances mid 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 indemnify and keep harmless the Ciy of Cupertino against liabilities.judgments, ARCIIITECI"S DECLARA'T'ION costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Cade,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 21327 Glen Place DATE: 1010912012 REVIEWED BY: Sean A PN: BP#: 'VALUATION: $5,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIDIARISFD or DuPENTAIIATION USE: Duplex PERMITTYPE: Al 1GENRE WORK Deck Repair 224 sq ft). SCOPE Hech.Plan Check Plumb.Plan Check Flee. Plan Check Mech. Permit ree: Plumb.Permit pee: Elec.Permit Pee: Other Afech.Insp. Other Plumb Insp. Ll I Other Elec.Imp. A4ech.hap.ree: Plumb. !rap. pee: F,fec.Insp.rec: NOTE: This estinutte does not includejees clue to other Departments(i.e. Planning. Public !forks, Fire.Sanitary Server District,School District, etc.). These fees are based on the prelitninarl information available ant/tire only an estimate. Contact tine De f or audit'I into. FEE ITEMS (Fee Resolution 11-053 111' 7/1/11/ FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # Deck/Deck Railing Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $467.00 IDECKIVOOD Deck(wood) PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.0 Reg. 0 OT O.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cmtsawction Tax: Administrative ree: O Work Without Permit? 0 Yes (j) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential Travel Documentationru'.+•: Building or Structure 0 Strong Motion Fee: IBSEIS,HICR $0.50 Select an Administrative Item Bldg Sids Commission Pee: IBCBSC $1.00 SUBTOTALS: $1.50 $467.001 TOTAL FEE: 1 $468.50 Revised: 10/01/2012 CONSTRUCTION PERMIT APPLICATION N COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DMSIONEl 10300 TORRE AVENUE r CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333• buildina(7a cuoertino.ortl ❑NEW CONM. ADD[lFSS UU-CTION El ADDMON TERATQOIYN./TI TE1-1 REVISION/DEF ID{/ ORIGINAL PER IT S PROJECT ADDRESS V ,32L%Ie� `32te ZI 0'5L0 Ems¢ , s OWNER NAME LULy�- Y �Ci �Foojc L � FE"6j_o-961-a- gAV.fal. STTir 7( 3O �R,uR sf' ©v.�L,nA../ IIA•,j GoxrncrNArdES�-(;'JI- 7 @"UArJC.uL. YOis-$06- Cr74)� STI- rj& LL G Al ft � 4c. STREET ADDRESS Y� et 'J yA N Cr i1 e CA Ur-G F - 4f(014 ❑OWNEa 0OWNET4HtInDEt ❑ OWNER AGENT G7�tsxrtaAQaa ❑cmrtaAcroa AGENT ❑ ARcHmE:T ❑ENGnizu ❑ oEvEioFER 11 TENANT tbtmucTOR t+AN¢ e , ' �G LICENlSE NrJNm . r p� uca+sE tree Hua tier a 'i 1qC -732^ I WAawrrcNASD: .re. oh E.tAA¢S, Qu EU hilaI,cv�'TI E STREET ADDRESS QTY.STATE.ZIP S TT vu Is,L14 2'falf. no6- S ARCH=T/ETIGINEEANAME UCENSENUNmER Ms.uca COMPANY NAME E-KAM FAX STREET ADDRESS QTY.STATE ZIP PHONE DESQtn•TfON OF WORK wau'WD USE I PROPOSED USE CONSnLTYPE ASIOa65 LL�� S `� USE TYPE OCC SQFT. VALUATION(S) �VOTTO NEW TTDOR DEMO TOTAL AREA AREA AREA NET AREA - BATHROOM I W=IEN OTHER REMODELARFA REMODELAREA R1240DEL AREA PORCHAREA DE AREA TOTALDE(MPORCHAAEA GARAGE AREA DETACH ATTACH DR'EI.tJNG tnftlS: B A SaWNn m.TT UYES SECOND STORY LJYES ' RCDIG ADDRDT ONO ADDMOW.. ❑NO t o RMN LIVESIF YES,PROVIDE COPY OF rRTiizsO ❑YES gECQSWg iL OGArri.# ONO QLE1Oa(V 0 zzrr; + By my signs below,I ratify to each of the following: I am the property owner or aphorized agent m act an the prpperty owner's behalf. I have read this application and the infocmaiou.I vided is carred I have read the Dvsciptim of Work and verify it is arcpatD. 1 agree to comply with all applicable local ordinances and Stam laws relating sting Or. 1 aDdioria representatives of Cupertino to enter the above-identified tprroperty for inspection patposes. Signature ofAppliap/Ageut Dam: A/O - SUPPLII.fENTALINFORMATIONREQUIRED PUN CRICK TYPE ROUMC SLIP New SFD at Multifamily dwellings: Apply for demolition Permit for OvmTTn;comrr� Hvnauac FUN RKVRw ml casting bdmg(s). Demolition permit is required prior to issuance of building PI permit far new building. ❑ MWEuiss ❑ PUNMGPLAN REVIEW Commercial Bldgs: Provide a wmpleted Hazardous Materials Disclosure ❑ srwrmwaD ❑ w Cwoaro form if any Hazardous Materials are being used as part of this project. ❑ rAHGa ❑ Pmanvr Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY sKwnt DISTRICT of Building Permit application. ❑ ttNVTROrY,WUNTAL w.r TH. dldgApp_1011.doc revised 06/71/11