12100130 ,1
CITI' OF CUPERTINO BUILDING Pit RfMIT
BUILDING ADDRESS: 19765 STFV17NS CREEK 13LVD CONT'RACT'OR:BLACK DIAMOND PAVING 11ICI01ITNO: 12100130
0wN1arS N'AM E: PORTAL.PLAZA LI' 41550 BOSCF.LI,Itll DATE ISSUED: 10/172012
OWNI.R'S PHONE,: 4087200500 V'REMON"I',C.\ 94538 Pl IONENO:15101770-1150
LICENSED CONTRAClrOH'S DIiCLARATION r r
BUILDING 1'IiIL\ll'1' INFO: BLU ELECT' PLUMB
License Class 611 ,L 3 ZI.ic.tl___-_(-1 LS a r r r
�j MECIi 12 ESI DIiN-1'IA I. COi\L\I EI2CL\L
C ntmctorV4i CWITDIAMcaro lAvsg�Date l0/11 /'=OIZ
herby allirm Our llalit licensed under the pnrs'isioru ol'Chapter 9 JOB 1)ESC RI PT]ON:SIb\I.COAT AND RESTRIPH PARK ING ARBA TO MA'I'ClI
ommen iug with Section 7000)of Division 3 of the Business d' Professions 17NIS'rING
Code and that ON license is in fell forceand Creel.
I hereby affirm under penally of perjury one of the following Isvo declarations:
I have and will maintain a certificate ofconsent 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 Sy.Fl Floor Area: \':duction:512000
Section 3700 of the Labor Code,for the performance of the work for which this
Permit is issued.
AI'N N tunber:31620083.19765 Occupancy'1'spe:
APPLICANT CERTIFICATION
I certify that I hare 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 buildingconsnnction,and hercbyauthorize representatives of this city to enter FERMI h EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agrte to save
indemnify and keep harmless the City of Cupertino against liabilities.judgnnenls. NVITNIN 180 DAYS OF PERI' IT ISSUANCE'' OR
costs,and expenses which may accrue against said City in consequence ofthe 180 DAY R NI L A ST CA L L 1,1) 1 N S PIA CTI O N.
granting of this permit. Additionally,the applicant understands air(]will comply
lam
with nln-point source regulations per the Cupertino(Municipal Code,Section
9.18. Issued by: Date: I
Sign. re Dare !o /r9 Z°;2
❑ OW'Nhai-BIIILDFCR DECLARA'T'ION HF-ROOFS:
All roots shall be inspected prior to any roofing material being installed. If a roof is
I hereby affirm that I am cyunpl front the Contraclur's LimiNt,Law for one of installed Mthout first obtaining an inspection.I agree to renove all new materials lin
the rollnwing tan reasons: inspection.
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 far sale(Sec.7044. Signature orApplicant: Date:
Business&Professions Code)
I,as owner ot'the property,ant exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business R Professions Code). AI.1,ROOF COVERINGS TO BE CLASS"A"OIt HE I- EIR
1 hereby affirm under penally of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and(rill maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of Ute
Compensation,as provided for by Section 3700 of the Labor Code•for the California I leclth&Safety Code,Sections 25505.25533.and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Curer lino Municipal Code,Chapter 9.12:rod the I]call[,l
I have and will maintain Worker's Compensation Insurance,as provided for by Safra'Code,Section 25532(:)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of tire work I'nr which this Additionalh',should I use equipmenl or devices which earl hazardous air
pennil is Issued. cunnunin ants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino\I unicipal Code.Chapter 9.12 and the
I certify that in the performnnee of die work for which this permit is issued,I shall I Iealth\Safely Cnde-Sections 2550.,,25533,and 25534.
not employ any person in:ury nwnner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption.I Owner or authorized agent:
become subject to dna Worker's Contpcnsation provisions of the Labor Code,I must Dan•:
forthwith c01111dy with such provisions or this permit shall be deemed revoked.
CONSTRUC-rION LI•:NDIN'G AGENCY
APPLICANT CERTI FICAIION I hereby allirm that there is a construction lending agency for the performance M'work's
I certify that I have read this application;aid state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct. I agree to comply with all city:in(]county ordinances and sone laws retming Lender's Nanne
to building construction,and hereby authorize representatives aphis city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
indemnify and keep harmless the City of Cupcnino against liabilities,judgments,
costs,and expenses which may accrue ngainsl said City in consequence of the
granting of nd
this penmil.Additionally,the applicant understands:aid will comply AltClll'll•:C'I"ST71?CL.\R.\'I'ION
with all non-point source regulations per the Cupertino Municipal Code.Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Dale.
— Cwfcn7tction Tai:• — - -
Adinlni trative Fee: 0i-
Work Without Permit? f'1 Yes n No <zn nn
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
C U P E RTI NO (408) 777-3228• FAX (408) 777-3333• buildina0cupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT K
PROIECTADDRESS / 0 OP• -
I/4"1(�$ STEUEJ+S GfaEE�C 31.U��(- i'nr\wro APNq ((/ a?l (>
P61)71a
OWNERNAME Vr{Il/lQ l< Q.e c_ `�t�� � PH N / EMAIL -
STREET ADDRESS O -r'�R CITY, STATE,ZIP Sa�J/IyIla �O o� FAX
�el
CONTACT NAME PHONE E-MAIL
GHRI crr 4o8-12a-o5w (Zly Gup,s01 40lokq. NJer
STREET ADDRESSCITY,STATE, ZIP FAX
s SovM fLVIA Vt: A_2.( S/ PZ? g 64 '14Db
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME ALEx 54n4ti7lWgLICENSENUMBER LICENSE TYPE BUS.LIC0
rOIAcK�lP4rlelt7 -?AV%d INC- �I f'l fy�1 / / ✓
COMPANY NAME E-MAIL �.,�^ -
FAX
u. t eti �Av\B inr-+- LCA �P�LgLk V'Acyl ouo-PNV,e . A CqA -'e --ti Te
STREET ADDRESS CRY,STATE,ZIP PHONE
yr ScJ� Igoxet�"i�n FTL-vi49r CA q-I4S36 5 0 - 7110-IISo
ARCHITECT/ETGTNEERNAME LICENSE NUMBER BUS.LIC k
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
-JI G 61L
EXISTUIG USE PROPOSED USE CONSTR.TYPE :STORIES
USE TYPE OCC. $Q.FT. VALUATION(S)
EXLSTG NEW FLOOR DEMO TOTEr ARAL
AREA AREA AREA NE+
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCHAREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: LJDETACH
❑ATTACH
E DWELLNG UMTS: IS A SECOND UNIT ❑YES I SECONDSTORY ❑YES
BEING ADDED? E)NO ADDITION? [DNO
PRE-A]PPLICATION 01TS T YES,PROVa)E COPY OF IS THE BLDG AN ❑YES - .^T
¢RECTI 'BY; �¢ Ate,' ;. TOTAL VALUATION:
PLANNCIG APPLA ANO PLANINGAPPROVAL LErFjt EICBLER HONE? ❑NO �`, i; y �•�i
T OGU
By my signature below,I.certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. 1 have read this
application and the inforrnation 1 have provided is correct. I have read the Description of Work:and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. 1 authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED Mr.
P44.N.CHEGI:\T]'PEp ' 9 ,ROUTLNG,SEIP ':-
New SFD or Multifamily dwellings: Apply for demolition permit for � N.-Sm
i,,HE-❑ O\ER,TDE-COU\TER` M:REtingbuilding(s). Demolition permit is required prior to issuance of buildingpermit for new building.Commercial Bldgs: Provide a completed Hazardous tvfaterials Disclosure ❑�1E-srANDAnD - oRKs
Corm if any Hazardous Materials are being used as part of this project. ®' LARce ' r t• i ® rIReDEPr
_Copy of Planning Approval Letter or Meeting with Planning prior toi y xi
submittal of Building Permit application. \INJOR ` ,. ,,;p ❑O $ANITAAI$E\\'ERDIST�- +.
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S
CITY OF CUPERTINO BUILDING PERMIT
14UII,UING ADURIiSs: 10536\'I'00'I'HILL BLVD CONTRA CI'01t:DRAIN M.\STI:RS 111,101I'1'NO: 12100129
OWNIIR'S NAME: CA-7A (�t I L-AE6 2 O LL L 2356 LUCRI I'LL AVE S E 3 DA'Z'E ISSUED: 1 011 710 1 2
OWNER'S'PHONE: SAN30SE.CA 95122 I'II0NF,FO:(408)963-7272
❑ LICENSED CON fRAM'OR'S DECLARATION r r r
�7 BUILDINGPERM II' INFO: RI,DC ELECT' PLUMB
License Class Lic.4 '� f 6�� r r—
'
' IN E,CII RPSIDENTIAL COMMERCIAL
Contractor_ - Date I 17 A Z
I hereby:dlinn that I am licensed under the provisions of Chapter 9 .JOB DESCRI PTION:S l3 If-REMOVE AND REPLACE WATER IIIiA' ER 30
(commencing with Section 7000)of Division 3 of the Business S Professions GALLON
Code and that nn'license is in full force and effect.
I hereby affirm under penalty of perjury one of the following loo declarations:
I have and will maintain a certificate of cense t to sell''-insun:for Worker's
Compensation.as provided fur by Section 3700 ofthe Labor Code,for the
performance of the work fin-which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq. ht Floor Arca: Valuation:S900
Section 3700 of the Labor Code,for the perfornnanee ofthe work for%,Inch this
permit is issued.
AVN Number:32613069.00 OccupancyType:
.\I'1'LICA�"f CI?12'1'1 FICA'IION
I certify that I have read this application and state that the above inlbnnation is
correct.I agree to comply with all city and county ordinances:aid state laws relating
to building construction,and hereby authorize representatives oflhis city to enter PERMIT EXPIRES IF WORK IS NOT STARTED
the above mentioned property for inspection purposes. (We)agree to save
indemnify;aid keep harmless the City of Cupertino against l iabilities,judgments, WITHIN HIN 180 DM'S OI' PERIMI I ISSUANCL OR
costs,and expenses which may uceMC against Said Cit).in C11115taplunce of the 180 DAYS FROIINI LAST CALLED INSPECTION.
granting offlos permit. Additionally,the applicant understands laid will connpl}•
with al non-pointmow %gat a it . per the Cupertino Municipal Code,Section
9.18. /// Issued by: /�� / /�li fl Date: �'�7." 1
Signatu4.. +t O
❑ O\\'NEIt-Ii III LDl'R DECLARATION Rh:ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a root'is
hereby affirm that 1 am e%empl from the Contractor's License La, for une of installed without first obtaining-an inspection,I agree to remove all new materials lbr
the fallowing Iwo reasons: inspection.
I,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 offerer)for sale(See.7044. Signature ol•ApplicanC Date:
Business K Professions Code)
I,as owner ofthe property,out exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business R Professions Code). AI.[,ROOF CO\'ERINGS'I'O ISE CIASS"A"OR 131CI-I'P;It
I hereby affirm under penalty of perjury one of lire following torr
HAZARDOUS)h\TIC It MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consem to self-insure for Worker's I have read the hazardousmaterials requirements under Chapter 6.95 of the
Compensation,as provided lin by Section 3700 of the Labor Code,for the California Health&Safety Code.Sections 25505,25533.and 2,534. 1 will maintain
performance ofthe work for which this permit is issued. c... pli:nce with the Cupertino Municipal Code Chapter 9.1'_and the l lealth\ ,
I have and will maintain Worker's Compensation Insurance.as provided for by Safety Code.Section 25532(x)should I store or handle hazardous mulrrial.
Section 3700 of the Labor Code,for doe performance of the work for which this Additionally.should 1 use equipment or devices which emit hazardous air
cuntamin:mts as defined by the Ifap Arca Air Qualily Management District I will
permit is issued ntnintain compliance wish the Cupertino Municipal Code.Chaptnr9.12:uu1(lie
I certify that in the performance ofthe work for which this permit is issued I shall Ilealth&Safely Curie.Sections 25505.25533,and 25534.
not employ any person in any manner so as to become subject to the Worker's
Compensation law's of California. If after making this cenificatc ol'e.yelool0n.I ' 0wn• r and zed or,
become subject to the Workers Compensation provisions ofthe Labor Code,I must U: r: 10&Zz
forthwith comply with such provisions or this permit shall be deenned revoked
CO,NSTB teff ON LENDING AGENCY
AI'I'LICANT MITI FICATION I hereby affirm that there is a constuction lending agency for the performance ofmork's
I certify that I have read this application and state that the above intornution is for which this permit is issued(Sec,3097.Cie C.)
correct. I agree to comply with all city and county ordinances and state laws relating Lender's Nature
to building construction,and hereby authorize representatives of this cit•to enter
upon the above mentioned propeny for inspection purposeS.(We)agree to Saye Lender's Address
indemnify and keep harmless the City o'Cuperlinn against liabililics,lodgments,
costs,:aid espenses which may rectae against said Cit•in consequence ofthe
granting of this permit.Additionally;the applicant understands and will comply AltClll'1'ICGI"5 DECLARATION
with all non-point source regulations per the Cupertino Municipal Code Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
ax� �Sa/7/ hm-61 9-
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 R w I
CUPERTINO (408)777-3228• FAX(408)777-3333 • buildinac cuoer-ino.ora \v/' v\
IC
lam,(
Q'}P -MBING ❑MECHANICAL ❑ELECTRICAL ❑MISCELLANEOUS
PROs--Cr ADDRS$ — 3� 0 L'7
t 1 J
OWNER NAME PHONE E-MAtL
STREET ADDRESS CRY. �S 1. S I FAX
C ONTACT NAME n(-t- N \�^ PHO E-MAIL
r� '�Sb 2 �4�4 \
STR-.cam'-f ADDRESS GP) S FAX
❑ OWNER ❑ OWNER-BUIDER ❑ OWNAGENT 'I!,54LNTRACfOR ❑CONTRACTOR AGENT ❑ ARC!MrE r ❑ENGINEER ❑ DEVELOPER ❑p TEYANT
CONTRACTORN LICENSE NUMBER UCENSETYPE BUS.LICA
COWANYNAME ^- E-MAIL FAX
ITREEF ADDRESS I ICIN,STA iT_,ZIP 9So PH !S C
Z
ARC=--Cf/FNaa'EER NAME I LICENSE NUMBER I BUS.LIC a
COWANYNAME' I E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF mDUPiFX ❑ MIRTIFAMILY PRmF2TNK^J-DLWD ❑ �S I FRO=IN I IS THE BLDG AN ❑ YES
BUILDING ❑COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE NO EIOD_R HOME? NO
DESCRIPTION OF WORK
TOTAL VALUATION: DD ^- RECEIVED BY:
By my signature below,I certify m each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the imormadon I have provided is CCL I have. ascription of Work and verify it is accurate. I agree m comply with all applicable local
ordinances and suits laws relating m bui '.,cons ction. or,'ze re esentatives of Cupertino to enter the above--id ti5ed>&perry for inspection putposes.
Signature of Applicant/Agent: Date: Ily 1 7/ 1 Z
SUP EN EN-T INrF MON REQUIRED OFFICE USE ONLY
OVER-THE-COUNTER
Y
F ❑ EXPRESS
t
U
m ❑ STANDARD
U
Z ❑ URGE
❑ MAJOR
rigp:NucApp_201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
:91 ADDRESS: 10536 B Foothill Blvd DATE: 10/17/2012 REVIEWED BY: Sean
APN: BP#: Z O 162 'VALUATION: $900
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY SFD or Duplex PENTARIATION PRWHEATR
USE: PERMIT TYPE:
WORK Remove and replace water heater 30 gallon).
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 1 # $27
TOTALS: $27.00
Mech. Plan Check Plumb. Plan Check 0.0 hrs $0.00 Elec.Plan Check
,tlecb.Permit Fee: Plumb. Permit Fee: IPPERMIT I 6lec. Pennir Fee:
Odrer Mech.Insp. Other Plumb Insp. 0.0 hrs $45.00 Other Elec.Insp.
Mech.hasp. Fee.: Plumb. lay. Fee: Elec. hasp.Fee:
NOTE: This estiuune does not includejees due in other Departments(i.e. Planning, Public Works, Fire,Sanitary Server District,School
District, etc. . Thesefees are based on the prelintinan information availahle and are on&an estinuue. Contact the De t or addn'I info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Snppl. PC Fee
PME Plan Check: $0.00
Pennir Fee:
SuppL hasp Fee
PME Unit Fee: $27.00
PME Permit Fee: $45.00
Conswuction Tar:
Administrative Fee: IADAfhv $42.00
Work Without Permit? 0 Yes Q No $0.00
Advanced Planning Fees:
Travel DOClllneiltatiOn Fee: ITRA n'DOC $45.00
Strong Motion Fee: IBSEISAIICR $0.50 Select an Administrative Item
131c1g Stds Commission Fee: IBCBSC $1.001 1
SUBTOTALS: $160.501 $0.00 TOTAL FEE: $160.50
Revised: 10/01/2012
1
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL
CUPERTINO
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228 • FAX(408)777-3333• buildinana cuoertino.oro
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PROJECT ADDRESS I APN Y
OWNER N PHONE / E-MAIL
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I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled un to one business day before the requested inspection date.
Please call (408) 777-3228 from 7:30-3:30pm (Mon-Thurs) or 7:30-2:30pm (Friday) to schedule
inspection. For Tear-Off and Nailing Inspections, you must also call on the day of the inspection only
after that phase of the work is completed. The building inspector will be available within one hour.
Final Inspections will be given a two hour window.
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3. Tear-Off inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspection.
Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either
complete])' knocked-down or removed prior to this inspection.
4. If plywood is installed, a plywood Nailing Inspection is required.
5. Roofing shall not be applied without first obtaining all prior inspection and written approvals from the
building inspector. Any roofing which is applied without first obtaining an approved inspection will
require the removal of all new material down to the sheathing so a proper inspection can be performed.
6. A Final Inspection and approval shall be obtained from the building inspector when the re-roofing is
completed. To receive a final sign-off, the following items will be verified:
a. Flat roofs shall have a minimum of/4" per foot of slope and demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre-manufactured products used shall be
available on-site to review at the time of the inspection.
c. Proper spark arrestor installation, vents painted, gutter/downspouts installed, debris removed.
7. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be
charged a re-inspection fee. The re-inspection fee shall be paid before another inspection can be
scheduled.
By my signing below, I certify each of the following is true: i am the property owner or authorized agent to act on the
property owner's behalf. I understand and agree to comply with the re-roof policy stated above. I also understand that
smoke detectors and carbon monoxide de ciors are required to be installed in accordance with Sections R314 and R315 of
the 2010 California Residential C �!
Signature of Applicant/Agent: Date:.
Rerog1Po1ity_2012.dcc revised 10/7112