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13020087 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20580 HOMESTEAD RD CONTRACTOR:SOUTH BAY PERMIT NO: 13020087 CONSTRUCTION,INC OWNER'S NAME: THE SOBRATO ORGANIZATION 1711 DELL AVE DATE ISSUED:02/142013 OWNER'S PHONE: 4084480700 CAMPBELL,CA 95008 PHONE NO:(408)379-5500 13 - LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class 8 Lie.# 3 REMOVAL OF INTERIOR LIGHT FIXTURES Contmcto Dat ll I hereby affirm that I am licensed under the provisions of hapter 9 (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:$500 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 APN Number:32610066.20580 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I 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 1 0 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAY R M LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accme 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 as per the Cupertino Municipal Code,Section 1- 4 9.18. RE•ROOFS: Signature All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,1 agree to remove all new materials for ' inspection. ❑ OWNER-BUILDER DECLARATION I hereby affirm that Iem exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I 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 under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I 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 Ba a it Quality Management District I performance of the work for which this permit is issued. will maintain ompliance with the c Municipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health& afety Code,S c'tl� 5 25533,yadl`t�3 Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized tt. �l� , Dat . permit is issued. I 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 of California. It atter making this certificate of exemption,I CONSTRUCTION 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. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accme 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 Code,Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLICATION 0L�y COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION '1� 10300 TORRE AVENUE•CUPERTINO,CA 950143255 ry,V GUPERTINO (408)777-3228•FAX(408)777-3333•buildinaCdcuDertino.ora \ ❑NEW CONSTRUCTION ❑ ADDITION ja ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRE43 7.9 ATN# owrM.— oV6 O 0/^ -01 71 //A& euoNE ^S1�6''y76 E_MAu, �o STREET ADDR65/50 /✓.I� �7Lj 7�✓� CITY, CONTACT NAM � ngE�s �_ �A1t -7P6-6.56 6 o b f , srRFEt'AD/'C��O� �cr7/J�H��i� CITY r"TE,.zt _ //.lo, A 93i '�Z XOWNER ❑❑ OWNER- UI DM ❑OWMAGENT ❑ OMRACIDR. ❑COCNn ACTORu AGEM 0 ARQD(FLT ❑FNGRNMER ❑ DEVELOPflt ❑rENAW CONTRfM1ZEL Q_ /amu UCENSENUMB� �� ucENSErreEQ BUS.LICK C6 COMPANY NAMED -_y��9j//y�`�9I7� B�H•1'�W4�f�@ �$(3��+-�/�p«� ✓77 P @:��7/'9�[�S� STREET ADDRESS/7Com/CITY,STATE.Zl / /`QO R ARCHECf/ENGDJEERNAI�/+LIo LICEtSENUMBERC g/ p� J BUS.LICM COMPANY NAME K/ grdhls�c6i <�.`'c/rK.GQ FAX STREEFADDRE9y�/tA/A71� TJ �J� f CRY,STATE, PCan PH DESCRIPTIONOFWOjRK ✓9//�qI / ��i V V � r�'T�� G /ris COIaIR.TYff # USE TYPE OCC. SQ.FT. VALUATION(ST EXLSTO NEWFLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODELAREA PORCHAREA I DECKAREA TOTALDBCKMORCD AREA GARAGEAREA: DETACH ATTACH #DWFL.ING UNITS: ISASECONDUNR- ❑YES - 'SECOMSTORY ![]NO YES BEOIC ADD®7 ANO ADDITION?PR&APPLICATION []YES IFYPS,PROVMECOPYOF ISTHERIDGANYES AMCTOT ALUAPLANNDJOAPPL* ❑NO PLAMNGAPPROVALLEITER EICm"HOMErNO O, By my signature below,I certify to each ofthe following: I am thepreperty owner or authorized agentto on property owner's behalf. I have read this application and the information I 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 commlcti I of Cupertino to enter the above#ernfiged property for inspection purposes. Signature of Applicam Ag Date: SUPPL AL INFORMATION REQ <3 ,",'eN CIlAECKTYPRz Rotirwc stu New SFD or Multifamily dwellings: Apply for demolition permit for existingbuilding(s). Demolition permit is required prior to issuance of building � bveRTilzcouxrER,: gannvcPUNREVIEw permit for new building. ❑ EXPRM,-, t.,. ❑ PUNNING FL414 REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure :.❑ STA15oAND ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project -'❑�IARGB 'FIRE DEPT' _Copy of Planning Approval Letter or Meeting with Planning prior to - submittalofBuildingPermitapplication. ❑,M OR W,`SANTIARY SEWERmSTRJCT- .❑rWYIRONMENI'ALHBALTH BldgApp 2011.doc revised 0621111 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 20580 Homestead rd DATE: 02/14/2013 REVIEWED BY: Mendez APN: BP#: `VALUATION: $1,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY Commercial Building PENTAMATION USE: PERMIT TYPE: WORK suites-20580 20590 &20620- REMOVAL OF LIGHT FIXTURES SCOPE t�i4k1 y''," J 4 M1Itl::i i'tiS.la"H 4rr5th. +: ,.i. J�'' - 7 i� wi °� .FF.: Atech. Plan Check Plumb. Plan Check Flec. Plan Check ible(A Perwil Fed: Plumh. Permit Fee' 1,kc. Permit Fee. Other Alech. Insp. - Other Plumb Insp. Other Elec.Insp. ET Alech.Insp. Fee: Plumb. hap.Fee' Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District eta). Thesefees are based on the Prelimin information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS(Fee Resolution 11-053 Eli'.' 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure Suppl. PC Fee: 0 Reg. O OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: Hourly Only? O Yes 0 No $0.00 Suppl. Insp. Fee-.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consiuction Tar: Administrative Fee: Work Without Permit? 0 Yes (j) No $0.00 O Advanced Plannine Fee: $0.00 3 hours Inspections Travel Documentation Fees: $399.00 1STINSP Inspection,Hourly 0 Strong Motion Fee: IBSEISMICO $0.50 0.5 I hrs Admin./Clerical Fee Bldg Stds Commission Fee: IBCBSC $1.00 $42.00 IADMIN I'll �� 4 $1.50 $441.00 a `e�TOT FEE $442.50 Revised: 01/01/2013