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13020136 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23200 VIA ESPLENDOR#34 CONTRACTOR:BAY AREA ENTERPRISE PERMIT NO: 13020136 OWNER'S NAME: GORDON GAYLE 2110 MANGIN WAY DATE ISSUED:0226/2013 OWNER'S PHONE: 6505371523 SAN JOSE,CA 95148 PHONE NO:(408)238-5043 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL LJCOMMERCIAL License Class Lie.# q j rT4q)T REPAIRS DUE TO CAR ACCIDENT-REBUILD ARBOR, t Z Zd/-?-0(!:5 �� PARTIAL RE-BUILD FENCE,REPLACE FRONT WINDOW, BsrCc. Contractor M 1cCa. Dau FRAME REPAIR,STUCCO AND PAINT TOUCH UP I hereby affirm that I 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: 1 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:$15000 1 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:34255019.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 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 property£Orin 'act on purposes. (We)agree to save 180 DA ROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Perrino against liabilities,judgments, costs,and expenses which may acc ea t said City in consequence of the Issued by: G Date granting of this. ermit. Addition applicant understands and will comply _ with all no p, or source regulati s Cupertino Municipal Code,Section 74 9.18. - 1 1. y� ,, /,J RE-ROOFS: Sign Date X FTN 710/3 All roofs shall be inspected prior to any roofing material being installed.If a roof is T__T_ installed without firm obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWER-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 1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the sanctum 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 DISCLO E construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements unde C aptcr 6.95 of the California Health&Safety Code,Sections 25505,2553 , d 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal C ,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)shoul I st or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipme or vices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay rea it Q ality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cup ti Man cipal Code,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2 05, 53 nd 25534. Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Owner or authorized agent: Date: 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. If,after making this certificate of exemption,1 CON TRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a concoction 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 hercpy authorize representatives of this city to enter - upon the abovementioned 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 which may accrue against said City in consequence of the I underhand 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 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION (�\ 10300 TORRE AVENUE•CUPERTINO,CA 950143255 B�! CUPERTINO (406)777"3228•FAX(408)777-3333•building co--) \� ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/Tl ❑ REVISION/DEFERRED ✓ORIGINAL PERMIT# PROJECT ADDRESS;3206 APNp\/I#, 1 Qh6�pr 3 G /// ��I SS - �� F 9 f OWNER NAME Pa 4�-r c- 4£/I PHONE �O ^ ('3 / (�2 E-MAIL � �(S�ICO(�` STREET ADDRESS 2 3 yoo V(R a. CITY,S ATE.ZIP CONTACT NAME /Jr� �� PHONW-7 n _` &MAR O f STREET ADDRESS Me ra4h, �An CITY,STATE,�P d" C i/ AX t]G/ 0 ❑OwNER ❑ OwNER-BUacm ❑ owNERAGENr IXONTRACrOR ❑CONTRACTORAOENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR N ' LICENSE BER / LICENS TYPE BUS.LIC M 17 COMPANYNAME c� #� ` &MAIL FAX VeiXyv LN{e-Y [/ S C• r 5�, t.0 L`+ STREET ADDRESSZIlb /4�i'1 lvT C ATE.ZI PHONE �w ;5- Mg ARCHITEUMNGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME &MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK z- J EXISTRIGUSE PROPOSEDUSE CONSTRTYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(f) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODELAREA PORCH AREA I DECKAREA TDTALDECK/PORCHARaA I OARAGEAUA- DETACH ATTACH #DWEL GUMTS: ISASECONDUMT ❑YES SECONDSTORY OYES BEI14GADDED7 ONO ADDITION? ONO PRE-APPLICATION ❑YES UYES,PROVIDECOPYOF ISTHEBLDC AN ❑YFS RECEIV �Y: TOT/1L y�['JATION: PLANNINO ADPL# ❑NO PIANNn1G APPROVAL EICHL oMEt ❑NO V IL Ike/ By my signature below,I certify to each o e f w, a property owner or authorized agent to act on the property owner's behalf. I have read this application and the information 1 have p wr[ect 1 e read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating t ding W (ruction. I dlorize representatives of Cupertino to enter the abov�penlifie property for inspection purposes. Signature of AppliranOAgent: Date: II SUPPLEMENTAL INFO ON QU1RED p CHECKTYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for OVER-TAE-COUNTER BUILDINGP ANREVIEW existing building(s). Demolition permit is required prior to issuance of building- permit for new building. ❑ EXPRESS NNINCPLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIREDEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 23200 VIA ESPLENDOR UNIT 34 DATE: 02/26/2013 REVIEWED BY: MENDEZ APN: BP#: 'VALUATION: $15,000 *PERMIT TYPE: . Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD Or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK REPAIRS DUE TO CAR ACCIDENT- REBUILD ARBOR PARTIAL RE-BUILD FENCE REPLACE SCOPE FRONT WINDOW, FRAME REPAIR, STUCCO AND PAINT TOUCH UP M $F ARNMI Uzi 'd"a+s. Tfz tI Jty '�# '.i`:'„- .F! OR—, rvlech. Plan Check Plumb. Plan Check Dec.Plan Check ,Vlecb. Permil Fce: Plumb.Pcrmil Fee: Elec. Permit Fee: Other b9ech.Insp. Other Plumb Insp. Li I Other Elce.Insp. A1ech,Insp. Fee: Plumb. hap.Fee: Elec.Insp.Fee.- NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District etc). Thesefees are based on the prelhiniina in ormation available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 E . 711/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? O Yes 0 No $0.00 1-7 hours Plan Check,Hourly Supp1. PC Feer D Reg. Q OT 0.0 1 hrs $0.00 $133.00 /STPLNCK PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 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 Cons7ruction Tax Administrative.Fee: O Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee: $0.00 2 hours Inspections 0 Travel Documentation Fees: $266.00 ISTINSP Inspection,Hourly 0 Strong Motion.Fee: IBSEISMICR $1.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $2.50 $399.00aTOi1 fiEE ; $401.50 Revised: 01/01/2013 CD c> b AM W - - _ - fOC I i s yZ� � t� ref0 nV eU��C anrS J.. 7 a - e/r/ 9 r O ~ r� •/` r `S/ nth a � f f 401 °i A/ fid/ Sa STboc < o 0 0 o s e w 01, �7„ dt r•\ Z s I wNIlCt 70 - � wb A � PC tA 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: b 14i ✓ 3 PERMIT#' /302UG3 OWNER'S NAME: PHONE# GENERAL CONTRACTOR: BUSlb4S LIGENSE# ADDRESS: CI / CODE`. . *Our municipal code requires all businesses working in the city to, a aCity of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY SPE ION(S) WILL-BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONCT HAVE OBTAINED.A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: z Z Sig ture I Date Please check applicable subcontractors and complete the following information:. 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 Owner/Contractor Signature Date