13020117 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20200 LUCILLE AVE CONTRACTOR:MARK SCOTT PERMIT NO:13020137
CONSTRUCTION
OWNER'S NAME: DB RE CALIFORNIA RESIDENTIAL I 2835 CONTRA COSTA BLVD DATE ISSUED:02/262013
OWNER'S PHONE: 4082579941 PLEASANT HILL,CA 94523 PHONE NO:(925)944-0502
❑ LICENSED CONTRACTOR'S DECLAARAATTION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class .13 Lie.# 8.2 18 / UNITS 47&48**REPAIR FIRE DAMAGE FOR UPSTAIR&
DOWNSTAIRS UNITS,REMOVE&REPLACE BOTH FP
ContmetornJA4:9c;7;�&A)9,14�ate.A—m�6—Z INSERTS,REPAIR TOP PLATE, SISTER DAMAGED FLR
I hereby affirm that 1 am licensed under.the provisions of Chapter 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 theWorkfor which this permit is issued. Sq.Ft Floor Area: Valuation:$11000
1 have and will maintain Worker's Compensation Insurer",as provided for by
Section 3700 of the Labor.Code,for the performance of the work for which this APN Number:31602094.00 Occupancy e:
permit is issued. P y T)'P
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.d agree to comply with all city and county ordinances and state laws relating WITIIIN 180 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 DAYS FRONLASVeXLLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and.expenses which may accrue against said City in consequence of the 'L Z6. 1'3
granting of this permit. Additionally,the applicant understands and will comply Issued ate:
with ail anon-point source.regulations per the Cupertino Municipal Code,Section
9.18.
(� 4E-ROOFS:
Signature Date �a V L,3 All roofs shall be inspected prior to any roofing material being installed.If a roof is
�0 installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am 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
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 offered for sale(Sec.7044,
Business&Professions Code) .
I,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 perjuryone 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 Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S tions 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:��
pernit 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 after'makipg 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 performanceof
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 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
uponthe above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses whichmay 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 sour"regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinG()cuoertino.orG
❑NEW CONSTRUCTION [] ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAALL PJERMIT#
PRO¢IL�AQDRESS�� / e ► APNq ' / OZ 0 / /
OWNERNAME P74 PHONE/6p F7 OZ
-7a0��
STREET ADDRESS CITY,ST ZIP - FAQ
CONTACT NAME Qij Lin
PHONE sr im
/TiE-MAIL54
E.MA
STREET ADDRESS .ter S C .^, y CITY, 'p O/ 1 V ` `\ FA7t �r�� v0708
❑OWNER ❑ OWNER-BUILDER 13 OOWWNER`IAGENr 11 CONTRACTOR AZCOMPACTORAGENT 11 ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ MAM
CONTRACTOR NAME LICENSE NUMBER,n„^I� LICENSE TYPE BUS.LICK
Col
COMPANYNAME E-MAIL (5e 1LJ FAX
90 6, a �2uc�/o la, �l1S, L/Y-O40
STREET ADDRESS ono CITY,STATE,ZIP uT �, II PHONE
9as' Y�!•Csoz
ARCHITECT/ENGINEER NAME ENUMBER I BUS.LI`CCN
COMPANY NAME E-MAIL FAX
STREET ADDRESS 7 ( C(ITY,S�TyATE,ZIP / ' PHONE )
DESCRIPTION OF WORK 00 cJ0 1 o 'Y G' ',./1 M/ /ac -
01� 1,4�/oN Fr-e 9&1*t0>/ ILUATION($)
�i2 til-cis � •ter- �'
EXISTING USE PROPOSED USE CONSTRTYPE ISTORn:S
USE TYPE OCC. SQ.FT. VA
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NETARFA
BATHROOM KRCHEN I/JJ OTHER
REMODEL AREA REMODELAREA `O RFMODELAREA �U
PORCHAREI DECKAREA TOTALDECKIPORCH AREA GARAGEARPA: DETACH
ATTACH
M DWEMU40 UNITS: ISASECONDUNIT YES SECONDSTORY OYES
BEING ADDED? []NO ADDITION? [3NO
PRE-APPLICATION []YES WYES,PROVIDECOPYOF ISTHEBLDGAN ❑YESREC TOTAL VALUATION:
PLANNINGAPPLN []NO PIANNING"PROVALLEITER EICHLERHOMET []NO
By my signature below,I certify to each of the following: I am the property owner or u geiu ct o property owner's behalf. I have read this
application and the information I have provided is correct 1 have read the Description o and verify I a accurate. I agree to comply with all applicable local
ordinances and state laws relating building cotion. I authorize representatives of Cupertino to enter the above-identifiedJJproperty for inspection purposes.
Signatureof Applicant/Agent: Date: 1-a6—/13
SUPPLEME RMATION REQUIRED PLANCRECKTYPE ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit forOVER-THF-COUNTER ❑ BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD 11PUBLIC WORKS
Tom if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. ❑ MAJOR ❑ SANITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
BfdgApp_201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 20200 LUCILLE AVE#47&48 DATE: 02/26/2013 REVIEWED BY: MELISSA
APN: 316 02 094 BP#: VALUATION: $11,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY Building is PENTAMATION
USE: Multi-Family Dwelling >3 Stories O Yes 0 No PERMIT TYPE: 1R2REM
woRK UNITS 47 &48"*REPAIR FIRE DAMAGE FOR UPSTAIR& DOWNSTAIRS UNITS REMOVE &
SCOPE REPLACE BOTH FP INSERTS, REPAIR TOP PLATE, SISTER DAMAGED FLR JOIST& CONFIRM p
eX a_
}j�r f b
,Meth. Plan Check Plumb. Plan Check Dec. Plan Check
Meda Permit Fee: Plumb.Permit Fcc: [,,lee. Permit Fee:
Other Meeh. Insp. Other Plumb Insp. Li I Odter Dec.Insp. Li
;1a`ech.Insp. Fee: Plumb. Insp.Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,Sehobl
District etc-. These fees are based on the prelfutin in ormadon available and are only an estimate. Contact the Dent for addn'1 info.'
FEE ITEMS (Fee Resolution 11-053 Eff 711/12) FEE QTY/FEE I MISC ITEMS
Plan Check Fee: $0.00 F-7-07 s.f. Remodel,Other
Suppl. PC Fee:, Q Reg. Q OT 0.0 hrs $0.00 $400.00 1REJV 2ESOTH
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.FeelD Reg. Q OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tex:
Administrative Fee: o
Work Without Permit? O Yes 0 No $0.00 G)
Advanced Planning Fee: $0.00 Select a Non-Residential (E)
Building or Structure O
Travel Documentation Fees: A
Strong Motion Fee: 1BSE1SAHCR $1.10 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
02.10$2.10 $400.00 $4` T
'\, Revised: 01/01/2013
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BUiLD:ivG DI`.;,_SON-CUr nIli`:O
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This set of pians and spr�cif!cc,?ions MUST he kept at the
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Th simn.no f1. !in ificntions SHAT L NO
0' iP F W I t b.h_I„ ,o p 0,t� se an a,,proval of the violation
/IZ �� _/ `� 1 -- --- --- — of any provisi any City Ordinance or State Law.
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IVANHOE-RESIDENTAL 1/10/2013 Page: 16
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IVANHOE-RESEDENTAL 1/10/2013 Page: 17
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
C U P E RT I N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: OO LuUII6 Vco AK 1117-418 PERMIT#
OWNER'S NAME: ar- PHONE# --65ZQ
GENERAL CONTRACTOR: c6l �►p ~C- BUSINESS•LICENSE;# 4 ,2
ADDRESS:a 39 p CITY/zIPCODE: S
*Our municipal code requires all businesses working in the city to have'a City of;Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. n -
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
6/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
caner/ ntractor Sig ure Date