11080040CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10700 STOKES AVE I CRESTORATION RA INC CONSTRUCTION & I PERMIT NO: 11080040 I
OWNER'S NAME: MILLS THEODORE J AND LINDA M 1573 PATTON AVE i DATE ISSUED: 08/04/2011 I
R'S PHONE: 4087420838
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # 3\(-f/t%
Contractor w L �I� jt'���' Date
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.
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
1 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 m y accrue against said City in consequence of the
granting of this pe nally, the applicant understands and will comply
with all non-po' s ce r ulaNVns per the Cupertino Municipal Code, Section
9.18. _. _. e v/
Signature Date 'l
L_ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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
1 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
' -nnify and keep harmless the City of Cupertino against liabilities, judgments,
and expenses which may accrue against said City in consequence of the
6: _,ting 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
SAN JOSE, CA 95128
PHONE NO: (408) 355-4238
BUILDING PERMIT INFO: BLDG ELECT F PLUMB f—
MECH r RESIDENTIAL COMMERCIAL F
JOB DESCRIPTION: REPLACE I 1 WINDOWS & I SLIDING GLASS DOOR,
REPLACE
EXISTING SIDING WITH 500SQFT OF STUCCO
Sq. Ft Floor Area: I Valuation: $18530
APN Number: 32649012.00 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 & SafvU Code, Sections 25505, 25533, and 25534.
Ow r au 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
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
NOTE: These fees are hated nn the nreliminary infarmatinn availahle and are nnly an o0imato_ Cnntnrt tho Dont fnr addn'1 info_
FEE ITEMS (P" e Resolution 11-053 lief, ';'1.-"11)
ADDRESS. 10700 stokes
DATE: 08/04/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION: 1$18,530 -1
°PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Suppl. PC Fee: E) Reg. 0 OT
PENTAMATION 1GENRES
PERMIT TYPE:
WORK
re lace 11 windows and 1 sliding lass door, replace exisitnq siding with 500 sf ft of stucco.
SCOPE
NOTE: These fees are hated nn the nreliminary infarmatinn availahle and are nnly an o0imato_ Cnntnrt tho Dont fnr addn'1 info_
FEE ITEMS (P" e Resolution 11-053 lief, ';'1.-"11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
12 #
$522.00
Window / Sliding Glass Door
IWINREP _-]Replacement
Suppl. PC Fee: E) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
= s.f. Restucco
$490.00 ISTUCOAPP
Permit Fee:
$0.00
Suppl. Insp. Fee -0 Reg.
0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Acoustical Fee:
0 Yes (D No
$0.00
Q
Work Without Permit? Yes G) No
$0.00
Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
i
Strong )Motion Fee:
IBSEISMICR
$1.85
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.85
$1,012.00
TOTAL FEE:
$1,014.85
Revised: 07/04/2011
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(c7cupertino.org
F7 Xr=11r (-nX1 Z772T TC-r'Tr)M F7 A 1lflM(-)N
❑'ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PRO]ECT ADDRESS . 4-o t /
AFN # H D 1'2—
ZOWNER
OWNER NAME �I IJ
PHONE cf�23 , ! T 22 - 0 8 `�
E-MAIL
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CITY, STATE ZIP: { .^� A{ ��
FAX
CONTACT NAME I ' �,�/h +• s `
PHONE L108 -if
Z 30
E -MAIL
STREET ADDRESS /I 1 ,c
CITY, STATE, ZIP (r' 1 7 if
FAX r_
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME /, f 1
If�p L- �V
LICENSE NUJMBER 9 j ,T tf 1
LICENSE TYPE
BUS. LIC #
COMPANY NAME J� I` ^
E-MAIL �._
FAX
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STREET ADDRESS
CITY, STATE, ZIP
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ARCI=CT/ENGWEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
S T RZEEI' ADDRESS
CITY, STATE, ZIP
PHONE
�ESCRIPTIONOF WORK rl e � �G rf i 10 1 5 -0T -L r G� � K
ofS c cv
EXISTING USE
PROPOSED USE CONSTIL
TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
AREA
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
9/�
I�
9 7
BATHROOM
REMODEL AREA
KITCHEN
REMODEL AREA
OTHER
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKRORCH AREA
GARAGE AREA DETACH
ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
BEING ADDED? []NO
SECOND STORY ❑ YES
ADDITION? []NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPL # []NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
RECEIVED BY:. ZSZ
I TO VALUATION:
By my signature below, I certify to each of the following: the property owner or authorized agent to act on the pr_rperty owner's behalf. I have read this
application and the information I have provided i I ve read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building c e representatives of Cupertino to enter the above-ided�foperty for inspection purposes.
I `
Signature of ApplicandAgent: Date: 1
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for
�R-1HE-COUNTER
-
[T- U ING 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
11 STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ Fns DE1-r
_ Copy of Planning Approval Letter or Meetin; with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
B1dgApp_2011.doc revised 06/21/11
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CUPERTINO
r-nVTR ACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
- - l� �"
JOB ADDRESS: 0'7 42Ps'%w e �T��- PERMIT p _ �-5-_ y2.3
OWNER'S NAME: "—(r, ��� PHONE # -
GENERAL CONTRACTOR$4-r"( BUSINESS LICENSE #
ADDRESS: S"7 o o CITY/ZIPCODE:
... ., r;*., "f f..nPrtinn husiness license.
*Our municipal code requires au imsmesses worKlllg ,n till, cl■y •� ••» • -- - - -_ _ _
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) CTORS HAVE OBTAINED AHCITY OF CUPER INO
UNTIL THE
GENERAL CONTRACTOR AND ALL SUB O
BUSINESS LICENSE.
I am not using any subcontractors: Signature Date
_■_ -_■_ _:,..•IIIhnnntrartnrR and comnlete the following information:
r1CilJG
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
n
EFlooring
Carpeting / Woodlazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
Date