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11070197 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11672 VINEYARD SPRING CT CONTRACTOR:HIBM CONSTRUCTION PERMIT NO: 11070197 OWNER'S NAME: SAM&NADA GEHA 4250 WESSEX DR DATE ISSUED:07/26/2011 OWNER'S PHONE: 4082558556 SAN JOSE,CA 95136 PHONE NO:(408)315-4663 G LICENSED CONTRACTOR'S DECLARATIONr— BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# 091 r MECH RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE EXTERIOR SIDING LIKE FOR LIKE(1300SQFT) (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 decla 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 Sq.Ft Floor Area: Valuation:$22000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36654010.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18.0 Issued b� Date: Signaf6i d Date C OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 ~ ' ed e become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of Wrk's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, cr and expenses which may accrue against said City in consequence of the € ig of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION wun all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36654010. 00 DATE ISSUED. . . . . . . : 07/26/2011 RECEIPT #. . . . . . . . . BS000014200 REFERENCE ID # . . . : 11070197 SITE ADDRESS . . . . . : 11672 VINEYARD SPRING CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER SAM & NADA GENA ADDRESS . . . . . . . . . . : 11672 VINEYARD SPRING CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : TONY GUIDOTTI CONTRACTOR . . . . . . . : TONY GUIDOTTI LIC # 27139 COMPANY HIBM CONSTRUCTION ADDRESS . . . . . . . . . . : 4250 WESSEX DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95136 TELEPHONE . . . . . . . . : (408) 315-4663 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 1.00 41. 00 0 . 00 41 .00 0 .00 1BCBSC VALUATION 22, 000 .00 1. 00 0. 00 1 .00 0. 00 1BSEISMICR VALUATION 22, 000 .00 2 .20 0. 00 2 .20 0. 00 1SIDEOTHER SQ FEET 1, 300 .00 980. 00 0. 00 980 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 1024 .20 0 . 00 1024 .20 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 1, 024 .20 #3906 --------------- TOTAL RECEIPT 1, 024 .20 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 11672 vineyard spring ct. DATE: 07/26/2011 REVIEWED BY: bobs. APN: BP#: `VALUATION: 1$22,000 "PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK re lace exterior siding like for like. SCOPE 77 1 T I T L_J NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (I'ee Resolution 11-053 1?ff' '-1 1/1 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1,300 s.f. Siding Suppl.PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $1,176.00 ISIDEST/BK Stone and Brick Veneer(Int PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp.Fee4D Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes (j) No $0.00 Work Without Permit? 0 Yes 0 No $0.00 0 1'1 $0.00 Select a Non-Residential 0 Building or Structure 0 Strong Motion Fee: IBSEISMICR $2.20 =hrs Admin./Clerical Fee Bldg�Stds Commission Fee: 1BCBSC $1.00 $41.00 1ADMIN I I SUBTOTALS: $3.20 $1,217.00 TOTAL FEE: I $ 20 Revised: 07/04/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: j/ PERMIT# ! C\ 1 OWNER'S NAME:- -+ ^, PHONE# GENERAL CONTRACTO . ; B - S LICENSE# ADDRESS: CITY/ZIPCODE:c' *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. _ / 1 am not using any subcontractoFg",-- J '� ' - Signature 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 sa� I-7-- C,9".�-I Z� -- , Owner/Contractor Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333• building cDcupertino.orq ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS APN# v CIO OWNE NAME P`ON — _ E-MAIL � L STREET ADDRESS/ CIT STATE,Z1P FAX PHON E-MAIL STREET ADDRESS CITY,STATE FAX G ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 016ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ' ! LICEN E LICENSE BUS.LIC# / COMPANYY— E- L STREET ADDRESS CIT1 STATE,ZI PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NA MFr E-MAIL FAX S T ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK T a5�_ C EXISTING M PROPOSED USE CONS TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) NEW FLOOR DEMO TOTAL AREA J �+� ^ AREA AREA AREA NET AREA S �/J j 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 RECEIVED BY: TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? O'NO By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pr_pperty 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 relating to building cons n. I authoeresentatives of Cupertino to enter the above-id ntified pr erty for inspection purposes. Signature of Applicant/Agen Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for C 4C�RTHE_couNTER LI BUILDING 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 ❑ ME DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ NLUOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11