13030089I `CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11128 SUTHERLAND AVE
OWNER'S NAME: KOPP ROGER G AND RIENA
OWNER'S PHONE: 4082557009
01 LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor F C MX Date At
I hereby affirm thati 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 the work for which this'permit is issued.
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
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this applicatiotyand 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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point sourc egulations rthe Cupertino Municipal Code, Section
9.18. 2
Signature
O OWNER - BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044i Business &'Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions • or thispermit shall be deemed revoked.
APPLICANT CERTIFICATION
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. (Wejagree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
CONTRACTOR: ANTIQUE TERMITE & PERMIT NO: 13030089
PEST
1913 STONE AVE DATE ISSUED: 03/I,8/2013
SAN JOSE, CA 95125 PHONE NO: (408)995 -6300
JOB DESCRIPTION: RESIDENTIAL u COMMERCIAL
REMOVE & REPLACE (E) STUCCO TO EXTERIOR
PORTION OF
FRONT, RIGHT SIDE PORTION OF HOUSE (BEHIND
GARAGE). REPAIR & REPLACE ANY TEMITE DAMAGE
Sq. Ft Floor Area: I Valuation: $1350
APN Number: 35617058.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF ERMIT ISSUANCE. OR
180 DAYS FRO ALLED INSPECTION.
Issued Date: i e ;
RE- ROOFS:
All 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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous. .
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Sections 505,25 , and 25534. /,G�
Owner or authorized agent: Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CUPERTINO
I
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building0cugertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS , / / �/ (y ('u/ O /� �h , �p
APN # [r —/ 1 O C X
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PHONE
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STREET ADDRESS
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CITY, SATE, ZIP A �S `
FAX
CONTACT NAME
PHONE
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STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT )�(,CONrRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME .erm` i.r(:F.NSE NUMBER �-,,, p LICENSE
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BUS. LIC " L/
FAX
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COMPANY NAME
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E-MAIL
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STREET ADDRESS
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CITY, STATE ZIP
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
C42iO C `4e l" " C C
EXISTING USE
PROPOSED USE
ONSTR TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
[]ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY []YES
BEING ADDED? []NO
ADDITION? []NO
PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES T TAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO fib.
w .01A
a nt wner's behalf. I have read this
By my signature below, I certify to each of the following: I am the property owner or author to act on a pro a
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 relating to buil ' g c ction . orize representatives of Cupertino to enter the above - identified property for inspection purposes.
Signature of Applicant/Agent: - Date:
SUPPLEMENTAL INFORMATION REQUIRED
.N
2124" oU ciriG�u4�
x ,"
_ New SFD or Multifamily dwellings: Apply for demolition permit for
m
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
;Te$I�II3ARD
woRKS
_
form if any Hazardous Materials are being used as part of this project.
_ Copy of Planning Approval Letter or Meeting with Planning prior to
ao
i
submittal of Building Permit application.
BldgApp_2011.doc revised 06121111
gtAr3
7"�
wo CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
Lfech. flan Check I I Plumb. Plan Check I I Elec, Plan Check
Llech, Permit Fee: Plumb. Permit Fee: tiles. Permit Fee:
Other- alcch. Insp. Other Plumb Insp. Other Elec. Insp.
,11ech. Insp. Fee: Plumb. Insp. Fee: Elee. Insp. Fee:
)TE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, Scho
District, etc). Thesefees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'l info.
FEE ITEMS (Fee. Resolution 11 -053 E . 711112)
11128 SUTHERLAND AVE
DATE: 03/18/2013
REVIEWED BY: MELISSA
11alADDRESS:
APN: 356 17 058
BP #:
*VALUATION:
1$1,350
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair .
PRIMARY
USE: SFD or Duplex
$0.00
PENTAMATION
PERMIT TYPE: 1 GENRE i
WORK
REMOVE & REPLACE E STUCCO TO EXTERIOR PORTION OF FRONT RIGHT SIDE PORTION
SCOPE I
OF HOUSE (BEHIND GARAGE). REPAIR & REPLACE ANY TEMITE DAMAGE BENEATH.
Lfech. flan Check I I Plumb. Plan Check I I Elec, Plan Check
Llech, Permit Fee: Plumb. Permit Fee: tiles. Permit Fee:
Other- alcch. Insp. Other Plumb Insp. Other Elec. Insp.
,11ech. Insp. Fee: Plumb. Insp. Fee: Elee. Insp. Fee:
)TE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, Scho
District, etc). Thesefees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'l info.
FEE ITEMS (Fee. Resolution 11 -053 E . 711112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= s.f Restucco
$467.00 ISTUCOAPP
Suppl. PC Fee: 0 Reg. Q OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg: Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction :Tax:
�\ • Revised: 01/01/20
CUPERTINO
JOB ADDRESS: 111 S v
PERMIT # O O.O 1? 9
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR:
BUSINESS LICENSE #
ADDRESS: G,�? ,nom ✓� r, �S{. c. ►2
CITY /ZIPCODE''
*Our municipal code requires all businesses working in the city:to have a City ofCupertmo: business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL, ,•BE S.CIIEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL UBCO TRACTO HAVE OBTAINED A, CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following informationt
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