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11070024 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: ;0115 SAICH WAY CONTRACTOR:XL CONSTRUCTION PERMIT NO: 11070024 OWNER'S NAME: ARIE BASH 851 BUCKEYE CT DATE ISSUED:07/05/2011 r)WNER'S PHONE: 4082406053 MILPITAS, CA 95035 PHONE NO:(408)240-6000 v LICENSED CONTRACTOR'S DECLARATIONF_ �� BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# F_ {� y MECH RESIDENTIAL COMMERCIAL Contractor �tr GAIN-��`�l� Date S'/It I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: HAPPY DAYS CDC-REPAIR EXISTING STUCCO WALL& FRAMING DAMAGED BY CAR (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:$8000 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 t APN Number:32632034.00 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 for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED 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 /r granting of this permit. Additionally,the applicant understands and will comply Issued by: —'�" _ Date: with all non-point source ulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date 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. OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of 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) 1,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 perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should 1 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 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 Cod Se�ions 505 25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen Date: 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 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 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 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, q,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. ting 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 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32632034 . 00 DATE ISSUED. . . . . . . : 07/05/2011 RECEIPT # . . . . . . . . . BS000013964 REFERENCE ID # . . . : 11070024 SITE ADDRESS . . . . . : 10115 SAICH WAY SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : ARIE BASH ADDRESS . . . . . . . . . . : 1610 GOSBEAK WAY CITY/STATE/ZIP . . . : SUNNYVALE, CA 94087 RECEIVED FROM . . . . : TOM COPENHAGEN CONTRACTOR . . . . . . . : XL CONSTRUCTION LIC # 21836 COMPANY . . . . . . . . . . : XL CONSTRUCTION ADDRESS . . . . . . . . . . : 851 BUCKEYE CT CITY/STATE/ZIP . . . : MILPITAS, CA 95035 TELEPHONE . . . . . . . . : (408) 240-6000 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 8, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICO VALUATION 8, 000 . 00 1 . 68 0 . 00 1 . 68 0 . 00 1FOUNDREPA EACH 1 . 00 783 . 00 0 . 00 783 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 785 . 68 0 . 00 785 . 68 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 785 . 68 visa --------------- TOTAL RECEIPT 785 . 68 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10115 saich way DATE: 07/05/2011 REVIEWED BY: bobs. APN: BP#: 'VALUATION: 1$8,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY Commercial Building PENTAMATION 1 GENCOM USE: PERMIT TYPE: WORK re air of existing stuuco and wall repair, includes sheetrock etc. SCOPE Lj NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info, FEE ITEMS (Fee Resolution 0.9-051 F;�f. 7-1/10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Foundation Repair Suppl.PC Fee: E) Reg. 0 OT0.0 hrs $0.00 $783.00 IFOUNDREPA PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee4@ Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes (F) No $0.00 Q Work Without Permit? 0 Yes 0 No $0.00 E) Planning, Fee: $0.00 Select a Non-Residential E) Building or Structure 0 Strong Motion Fee: IBSEISMICO $1.68 Select an Administrative Item Bid, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $2.68 $783.00 TOTAL FEE: 1 $785.68 Revised: 07/01/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: J t(� 5!�1L-1 IN PERMIT# OWNER'S NAME: PHONE # GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: ?5`1 C4 *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. 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/Wallpapers Paving Plastering rtvu'fS (L-✓t,,, Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile er/Contracto Signature Date PROJECT DATA - COMMERCIAL COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISIOtUY�� .- 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•building (cDcupertino.or4 CU:PE.RTINO PROJECT ADDRESS t O l 45�/�1 'V-'! t q L/ APN OWNER NAME 6v/t'� PHONE:40 / E-MAIL J� / 'VAS STREET ADDRESS CITY, STATE,ZIPFAX tons �1 APPLICANT NAME \ PHONE E-MAIL t G 1(9\i s�D Z '�e, z7 C,1,�F�S� C, STREET ADDRESSCITY,STATE, ZIP FAX �1L�1 -21w_ 'l ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT TENANT CONTACT NAM PHONE E-MAIL L1 (� C �z� o� ��Lt•-t'.�� �C G� •Cove BUSINESS NAME FAX 1 6� r > � DERIPTICzN OF W©RK - EXISTING USE(S): y 1 Cr PROPOSED USE(S): c� C i11Z OCCUPANCY(S): �/►�� ► /� OCCUPANT TYPE OF 5•� �S 7�PARCEL LOAD: TCONSTRUCTION (_ AREA: AREA OF FLOOR(S) HAZARDOUS Y N REMODEL SPACE: c OF REMODEL SPACE: TERIALS? FIREY N WUI Y CN FLOOD Y N SIESMIC Y N SPRINKLERS: AREA: / AREA: AREA: NUMBER OF CHILDREN<2 YRS OLD: LEARNING CENTERS AND 24 HOURS CARE? Y CN NUMBER OF STUDENTS—2 YRS OLD UP TO 12'x'GRADE: EDUCATIONAL OPERATIONS: NUMBER OF ADULT CLIENTS: Governing Codes: 2010 California Building Code(based on the 2009 International Building Code) 2010 California Residential Code(based on the 2009 International Residential d")®5 al" 2010 California Plumbing Code(based on the 2009 Uniform Plumbing C 2010 California Mechanical Code(based on the 2009 Uniform Mechanic ►1 2010 California Electrical Cby4*Wrnational Electrical Code) 2010 California DNISiON-CUPERT 2010 California Gree,-rTTu—iT00tAr&&0Pde Cupertino Municipal Code ZhIs set of plans and spec Mt1STtl�kept�th� t is untew` any job site during construction. to devlatD to make changes or altarationon same,01 vat from the Bud g O��' therefrom,without aPP ecifications SHALL NOT 'nte stamping of this pian and sp knit or to be an approval of the violation be held to P Ci Ordinance or State Lam• of any provisions r�y � PrqjectData-Commercisl.doc revised 03/01/11 P�Aw NU. k� 3 u a �• * t c,. k <t� o •r r { . � ��r � � ; i , =: �" .��` x � �,z � � 'in. t , ,�: f,,. + w.� .. t _ a� G .� }�. �f _ �: ' � r 41. .- a � } � P i, �, ���. ��' �xS:•, Y i ��� � ,.._:tea r� � i . � I f.� �' S t 4 k {� i i i ,- �:. z E�. �� -� (` �,,- *� �� !. } ����r ►<� � a: � � �� � , ���. .� s �, .� r+�y N y iVly rj I�" d '"' r• O� O p O �-' O C� o 0 Cl t� a W W r to a . r i I1 ,p y N CA N .P W /v C.0 11" m co to Cil N W a' O � -P \� w Nom. �' ,H—,3'-10" °' ii /_" % tz o CA C� o i I • C: � r ft o� �• 0 a r ME O b b 0 z r � z n I a z tz r .P O �o w 0 MEm 4y` i O O W A .P CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333• buildingCcDcupertino.org 110`7 00 Z!-/ ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS ++ / �� C /' APN# /1Z O OWNERNAME �Y1� S I^ PHONE � - 0Q E-MAIL �� lc�s STREET ADDRESS r I CITY, STATE,ZIP FAX CONTACT NAMELr PHONE _[n,/ 1�1 E-MAIL yY esi S�C STREET ADDRESSCITY,STATE, ZIP Zv G20 �f1h-�-�-`( tea.' ��T,rw C� ` !5o( ��� 2 40,6et� ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# (kc 00V COMPANY NAME � ` / E-MAIL 'G FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK C - ISTING USE P POSED USE CONSTR.TYPE #STOI�S Ccs /+ USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR �. DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER U 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 RECEIVED BY: TO(,��L VALUATION: PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO By my signature below,I certify to each of llowing: 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 ha e provi d correc 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 uilding co structi n. I authorize representatives of Cupertino to enter the above-ident'fied property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL 0 ATION REQUIRED PLAN CHECK TYPE �ROUTING SLIP New SFD or Multifamily dwelli : Apply for demolition permit for Er OVER-THE-COUNTERBLJ UII DING 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 ❑ PUBLIC WORKS form 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 ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11