11080010CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19608 PRUNERIDGE AVE
CONTRACTOR:
) I PERMIT NO. 11080010
OWNER'S NAME: SFERS REAL EST CORP UU �� � et)ESr`&(t nd DATE ISSUED: 08/01/2011 I
C—NER'S PHONE: 9259634177
Ll LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # tq 105 J ' %
ContractorDate (
I hereby affir 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 declare * ns:
I have and will maintain a certificate of consent to self -insure for Worker's UC
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 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,
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.
Signate / Date
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)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, 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 this permit 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. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
and expenses which may accrue against said City in consequence of the
.ng of this permit. Additionally, the applicant understands and will comply
wrttt all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
PHONE NO:
BUILDING PERMIT INFO: BLDG I— ELECT I— PLUMB r—
MECH F RESIDENTIAL f— COMMERCIAL r—
JOB DESCRIPTION: UNIT 9205 & 9105- STOVE FIRE IN UNIT
9205,SPRINKLERS IN 9205 WERE SET OF DAMAGE TO
DRYWALL & INSULATION IN UNIT 9205&9105.UNIT 9205
Sq. Ft Floor Area: I Valuation: $30000
APN Number: 31645016.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date:
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 25505, 25533, and 25534.
O er or rth gent:
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of vork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Date I Licensed Professional
rCUPERTINO 1
—�
I I NFW ('nNSTRTT('TTON
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408))777-3228 • FAX (408) 777-3333 • buildinq(d�cupertino.org
1
I I ADDTTTn1
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PROJECT ADDRESS
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OWNER NAME -,SFF `C E I $rcrr C01,✓_
PHONE
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STREET ADDRESS
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CITY, STATE, ZIP
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FAX
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CONTACT NAME
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PHONE
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E-MAIL
STREET ADDRESS
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CITY, STATE, ZIP _
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT (;'CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME ' i ,
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
Be iB
COMPANY NAME
E-MAIL
FAX
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STREET ADDRESS
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CITY, STATE, ZIP <
Sc�►, o5c
PHONE
41eF 714 J0�5-
ARCHITECT/ENGINEER NAME
LICENSE NUMBER j
BUS. LIC # f f
COMPANY NAME
E-MAIL /
FAX
STREET ADDRESS if
CITY, STATE, ZIP Al/ 4-
PHONEY
')ESCRIPTION OF WORK
C
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4f�Y �'�'lt (`l: �'r�.. i a�taG"r.'c•. �L"CJ��.. T1,,.1��i :h.yr,+c>,c..
/C'G FT ;.I( :n51)<<T'C
EXISTING USE'PROPOSED
USE CO
sTR. TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKRORCH AREA
GARAGE AREA: 0 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 ❑ YESRECEIVED
BY: -
TOTAL VALUATION:
PLANNING APPL # []NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the praperty 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 relatin uildi cskVtnon. I authorize representatives of Cupertino to enter the abboo7ve-'dentified property for inspection purposes.
�—
Signature of Applicant/Agent: A ".'/ Date:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
_ New SFD or Multifamily dwellings: Apply for demolition permit for
❑ OVER-THE-COUNTER
❑ BUMDING 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
11 PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ I= DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to
MAJOR
❑ SANITARY SEWER DISTRICT
mittal of Building Permit application.
F
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doe revised 06/21/11
CITY OF CUPERTINO
Fw--_M7 FF.F. FCTIMATOR — RITII.DING DIVISION
ialREVIEWED
ADDRESS: 19608 pruneridge ave
DATE: 08/01/2011
BY: larry s
PC FEE ID
APN:
BP#:
„VALUATION: 1$30,000
°PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration'/ Repair
PRIMARY Multi -Family Dwelling
USE:
Buildina is
3 Stories Yes (F)No
PENTAMATION 1 R2REM
PERMIT TYPE:
WORK
1 hrs
SCOPE
PME Plan Check:
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-2 (Apartment)
II-B,111-B,IV,V-B
= s.f.
$522.00
$0.00
$0.00
1 0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg.
0 OT
FO.01
hrs
$0.00
PME Unit Fee:
$0.00
TOTALS:
0
$0.00
$0.00
1 $0.00
MECH, HOURLY 0 Yes E) No PLUMB, HOURLY Q Yes Q No ELEC, HOURLY Q Yes Q No
1VnTF• Thoco %ac Oro hncod nn tho nroliminary i"Mrmatin" availahlo and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (14'ee Resolution 11-053 F f 7/f,"I1)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
= s.f.
$522.00
Remodel, Other
1REMRESOTH
Suppl. PC Fee: 0 Reg. 0 OT
1 0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg.
0 OT
FO.01
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Acoustical Fee:
0 Yes (F) No
$0.00
0
Work Without Permit? 0 Yes G No
$0.00
Planning, Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
0
Strong Motion Fee:
IBSEISMICR
$3.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$5.00
$522.00
TOTAL FEE -.T
$527.00
Revised: 07/04/2011
NT
COMMUNITY IN
G DIVISION CUPERTENT
NO
I
APPROVED
This set of plans and specifications MUST be kept at the
job sire during construction. It is unlawful to make any
chaeic;e_ or alterations on same, or to deviate
therefrom, vvithout approval from the Building Official.
The stam;aing of this plan and specifications SHALL NOT
be held to permit or to be an approval of the violation
of any provisions of any City Ordinance or State Law.
BY
DATE
PERMIT NO.
* Square footages and room dimensions are approximate
N �1'
i
yi
r
OFFICkLm
COMMUNITYBBING DIVISION DEVELOPMENT ET
UPERTINO
APPROVED
This set of plans and specifications MUST be kept at the
job site during construction. It is unlawful to make any
changes or alterations on same, or to deviate
therefrom, without approval from the Building Official.
The stamping of this plan and specifications
the violation be held to permit or to be an approval
of any provisions of any City Ordinance or State Law.
BY
DATE
PERMIT NO.
UN15 a c� a a�
* Square footages and room dimensions are approximate
Duck / Patio
WH
Dining
Master
Bedroom
Area
Q
t4
s 7x13
14x14
_
kitchen
�1/�I114
13x 13
}
a..
`�
rb.
k
w
linen t
-
y
13x13
iii. RR /yl'
3jT
Bedroom
W.I.C.
...: ,
w.i.c.
;storage
��-----
* Square footages and room dimensions are approximate
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION - CUPERTINO
APPROVED
Ibis set of plans and specifications MUST be kept at the
jots site during construction. It is unlawful to make any
changes or alterations on same, or to deviate
therefrom, without approval from the Building Officlal.
ho stamping of this plan and specifications SHALL NOT
be held to permit or to be an approval of the violation
of any provisions of any City Ordinance or State Law.
DATE , -
PERMIT NO.
JcLvi
t
* Square footages and room dimensions are approximate