12100198 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10086 LAMPLIGHTER SQ CONTRACTOR:SEARS IIOME PERMIT NO: 12100198
IMPROVEMENT
OWNER'S NAME: RAVI ILANGO AND LATHA 1024 FLORIDA CEYI'RAL PKN'S' DA'Z'E ISSUED: 10262012
OWNER'S PHONE: 4088930661 LONG WOOD,FL 32750 PROSE No:(925)245-2000
LICENSED CO\fRACI'OK's 171iC1,A RATIONBUILDING PERMIT INFO: BLDG IJ ELECT IJ PLUMB
.�
License Class G� Lic.d -772- 3 ) 7
:M ECH rI RESIDENTIAL(J COMMERCIAL
Contractor /P4 - Date
I herebyaffirm that l am licensed under the provisions of Chapter JOB DESCRIPTION: REINSTALL KffCUI:N SINE Ah7ER CABINETAND
(commencing with Section 7000)of Division 3 of the Business& Professions 'IOUNTI;
Code and that my license is in full force and effect. 'I'OI'REPI,ACIiMI'sN'f
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 Sq.Ft Floor Area: Valuation:5250
permit is issued.
API'I,ICANI'CF,R"I'IPIC,1'1'ION APN Number:34233003.00 Occupancy Type:
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 mid state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property forinspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,.Section
9.18. JE�/✓ / Gf7
D • 1 Issued by: �r Date: 16 •pOlp'/a
Signature DateZ
❑ 21LSER-Bl�R DECLARATION
Kb;ROOFS:
I hereby affirm that 1 am exempt from the Contractor's License Law fur one of All roofs shall be inspected prior to wly roofing material being installed. If a roof is
the following tom reasons: installed without first obtaining-an inspection.I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Dale:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code).
ALL ROOF CO\'ERINGS'I'O 13E CLASS",\"OR BETTER
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 IU\ZARDOUS\L\TERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I lore read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code.Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by time Bav Area Air Quality\lanagement District I will
1 certify that in the performance of the work for which this permit is issued,1 shall maintain compliance with the Cupertino dl unici pal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's I Zeal th&Safety Code,Sections 25505,25533,and 25534.
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 owner or authorized
forthwith comply with such provisions or this permit shall be deemed revoked. Uarc `�Z
,\['PLIC,\N"1'CER'1'IF]G\'I'IO\ CONS'IRUCI'ION LENDING ACIiNCY
I certify that I have read this application and state that the above information is I hereby affirm than there is a construction lending agency for the performance of work's
correct. 1 agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Nano
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of true
granting of this permit.Additionally,the applicant understands and will comply AKCI I1'I'I:CI"S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
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CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10086 Lamplighter Scl DATE: 10/26/2012 REVIEWED Bl': Sean
` APN: BP#: a D 8 -VALUATION: $250
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARYPENTAMATION
USE: SFDorDuplex PERMITTYPE: 1RPFIX
IVORK Re-install kitchen sink after cabinet and counter top replacement.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Fixture or Trap 16PFIXTURE 1 # $10
TOTALS: $10.00
A/ech. Plan Check Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check
Mech. Pernnh Fee: Plumb. Permit Fee: IPPERMIT Elec•.Permit Fee:
Other life,h. Insp. Other Plumb Insp. 0.0 hrs $45.00 Other Elec•,htsp.
,Mech.Iup.Fee: Plumb. Insp. Fee: Flce.bap.Fee:
NOTE: This estimate does not include jeer due to other Departments(i.e. Planning, Public I Porks, Fire,Sanilaty Sewer District,School
District,etc. . These ees are based on the prefintinan information available and are onh•an estinmte. Contact the Dept for addn'l into.
FEE ITEMS fFee Resolution 11-053 Elf UUl3) FEE QTY/FEE MISC ITEMS
Plan Chcck Fee •
Suppl. PC Fee
PME Plan Check: $0.00
Permit Fee:
Suppl. Insp Fee
PME Unit Fee: $10.00
PME Permit Fee: $45.00
Consn-uction Tax:
Administrative Fee: 1ADAHN $42.00
Work Without Permit? O Yes Q No $0.00
Advanced Planting Pecs:
Travel Documentation Fee:. ITRAVDOC $45.00
i
Strone Motion Fee: /BSEISLIICR $0.50 Select an Administrative Item
Bide,Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $143.501 $0.001 TOTAL FEE: $143.50
Revised: 10/01/2012
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO,CA 95014-3255 MIA
CUPERTINO (408)777-3228•FAX(408)777-3333• buildina(GDcuoertino.oro J
PLUMBING ❑MECHAN'ICCAL [—]ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS 100 Il l` S - APN R 3el q 33 va 3
OWNER NAME PHONE -06O I E-MAIL
TLAAC KA Id
STREET ADDRESS CITY. STATE,ZIP FAX
100q6 t/-fjj 'IGT((Clz pl
CONTACT NAME BERNIE MATHESON PHONE925-245-2013 E-MAIL
S 2833 E.AIRWAY BLVD. CITY,STATE ZIP LIVERMORE,CA 94551 FAX 925-245-2017
❑OWNER ❑ OWNER BUILDER ❑ OWNMAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONI'RACTORNAME LICENSENUMBER 721379 LICENSE TYPES,CID BUS.LIC. ?7 �j
BERNIE MATHESON C17 C6 OC /
COMPANYNAME SEARS HOME IMPROVEMENT EMAIL FAX 925-245-2017
STREET ADDRESS 283 E. AIRWAY BLVD. CITY,STATE.ZIP LIVERMORE, CA 94551 PHONE 925-245-2013
ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC R
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ❑SFD.DUPLEX ❑ MULTI-FAMILYPROTECT IN N'IIDIANDEA ❑ YES PROJECT IN ❑YES ISTHEBIDGAN ❑ YES
BUILDING'. ❑COMMERCIAL URBAN LYTFRFACEAR ❑ NO FLOOD ZONE Cl NO EICHLER HOME? ❑NO
DESCRIPTIONOF WORK M _ /
I.JaZ 1-7G —tMG1I L A^-j) C,*)A)7a2.—
�7U D1 5Slt7— r tGE e7 /JE75
f �tJ N1 I nr — 7 I n� K- /TNI f—ihlGt l �I
-j LJ3
ELS 2 G�1
TOTAL VALUATION; (� 5�_� RECEIVED BY;
By my signature below,I certify to tach ofthe following: 1 am the property owner or authorized agent to act on the property owner's behalf. 1 have read This
application and the information 1 have provided is correct. I have rea Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building conslNe' w orize r resentatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
�SUPPLEME ATION REQUIRED OFFICE list:ONLY
OYER-THE-COUNTER
❑ 4.XPRF65
1
❑ SLNTIARD
❑ LARGE'
❑ MAJOR
A4EPh1iscdpp_20I1.doc reviser/06121111
I� Cupertino; CA 95014-3255
u Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 842 S STELLING RD CONTRACI'OR:' /e22`� ) h! [PPrRMITNO: 12100194
OW'NER'S NAME: WEBER JAMES I AND PAT M 0 '1'F: ISSUED: 10262012OWNER'S PHONE: 4086622481 &,175ONE,10, _ O
❑ LICENSED CON_rR AC`rOR'S DECLARA'T'ION
7�KOd BUILDING PERMIT INFO: BLDG [ ELECT CiPLUA16
License Class l —3 Lie.9nn/� r, t
Gau _�Z IDI ECII RESIDENTIAL 0 COMMERCIAL r
Contractor /� 1� /�v> Date
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMOVE EXISTING SHARE ROOF AND INSTALL 25
(commencing with Section 7000)of Division 3 of the Business S Professions SQUARES
Code and that my license is in full force and effect. N17W OSB AND NEW COMPOSITION ROOFING
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 Sq.Ft Floor Area: Valuation:$9950
permit is issued.
APPLICANT CERTIFICATION AKN Number:35920026.00 Occupant)Type:
I certify that I have read this application and state that the above infor ation 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. (��''"/)//�/ s/
Signature d •� / Date )p ^d,� Issued by: - /��•/✓ �(j� Date: lQ •aZ, •/
❑ OW'NF-R-BUILDER DECLARATION
RE-ROOFS:
hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons: installed without first obtaining an inspection 1 agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection. _
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: O Daie:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code).
ALL ROOF COVIiRIN'GS TO BE CLASS"A"OR BE I-1'IiR
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 HA'LARDOUS MATER1AIS DISCLOSURE
Compensation,as provided for by Section 3700 critic Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the
performance of the Work for which this permit is issued. California I lealth S Safety Code.Sections 25505,25533,and 25534. 1 will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the CupertinoMunicipal Code.Chapter 9.12 and the l lealth S
Section 3700 of the Labor Code,for the performance of the work for which this Safeh.Code.Section 25532(a)should I store or handle hazardous material.
Additionally,should 1 use equipment or devices which emit hazardous air
permit is issued. contaminants as defined be the Buy Area Air
Quality ode.Ch Ater District 1 will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Il callh S Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,1 must O"'n�3 or au1It d a /J
forthwith comply with such provisions or this permit shall be deemed revoked. 5J➢Zu J °y Date: /0
,\PI'I.IC,AN'I'CER'I'IFIC TION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is 1 hereby affirm that there is a construction leading agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ,\RCII I'I'FCI"S DECLARATION
all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand nn),plans shall be used as public records.
Signature Date Licensed Professional
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE -CUPERTINO,CA 95014-3255
CUPERTINO
(408)777-3228• FAX(408)777-3333•buildincecuoertino.orG
1 / / 7/
PROJECT ADDRESS e_U,'M1�l APNp o\o - a.--z
OWNER NAME 1 J I VIO d,(` J PHONE
G6 2 1(/1L/� E4-MA'�11IL
STREET ADDRESS CITY, STATE,ZIP
CONTACT NMIE 1 't�V--F� PHONE�t ` �rS, `'�� E-AlA1L
STREET ADDRESS t-1 " n C .STATE.ZIP /x -
SSe� 1. t l ew s` , 7G
❑ OWNER ❑ OWNER.BUE DER111 ❑ OWNER/ASGEM ;CONTRACrOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEN'FIAPER ❑TENANT
CONTRACTOR NAME f/� / l� LI EWE ^C LICZE TYPE BUS.LIC.9
COA1PANl'NAAfE //L'RI sLLGB i E-A4(A,LL L FAX/7 // �t� J Co�c�sr�,n"t_
STREETADDRESS '� CIrr��STATE,ZIP /� J PH NE
- — ---- - .'br-�-1-ur-r�•..x �3.�. .,3 M -
ARCHITECTRNGINEER NAME LICENSE NUMBER BUS.LIC.M
COMPANY NAA(E E-MAIL FA%
STREET ADDRESS CT',STATE,ZIP PHONE
USE OF SFD or Duplex ❑ blulti-Family, ROOF.AREA: VALUATION:`
STRUCTURE: ❑ Commercial .�� 5 I✓ls � %•Jd ,
EXISTING ROOF TYPE ❑BUILT-UP ROOF ❑ASPHALT SHINGLES AW'OOD SHARES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOTE REPLACE ®❑ S ERE PLYWOOD AH SS' ❑ pt y OSB PITCH: (' ROLOF
' aIFLAOYI. D ❑ MASS
PROPOSED ROOF TYPE: ❑BUILTUP ROOF )OASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC FS REPORT M
DESCRIPTION OF WORK: -
tt•^44d- 5l,4C loin 1,,,,4 r Gs/3
By my Signature below,1 certityto each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and ate information I have provided is correct. I have read the Description ofR'ort:and verify it is accurate. 1 agree to comply with all applicable local
ordinances and state laws relating tp buildir 1n5 coon. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature 0fApplicaat/AgMI: //y1 � �rr1�UDate: � 6
SUPPLEMENTAL INFORMATION REQUIRED OFFICE USEONt•v
_If building is associated with a Home Owners Association,provide letter rLAN CHECK*rVPE ROUTING SUP
of approval from HOA. -OVER.THE-COUNTER BUILDING PI:eN REVIEW
_Provide Planning approval to veriN,if there any restrictions. ❑ IIXPRESS ❑ PLANNING PLAN REVIEW
_Provide copy of Afanufacturer'S Installation Specifications. ❑ STANDARD ❑ naE DEPT
Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER: -
ReroojApp_2011.doc rerised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 842 S. Stelling DATE: 10/26/2012 REVIEWED BY: Sean
APN: BP#: L VALUATION: $9,950
*PERMITTYPE:' Minor Building Permit PLAN CIIECK I'\'PE: Re-roof
PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF
USE: PERPIIT T\'PE:
\\'ORK Remove existing shake roof and install new OSB and new composition roofing.
SCOPE
FEE ID ROOFAREA
s.f.
1REROOFFRES 2,500
dkmh.Pan Check Plumb.Plan Check Elec.Plan Check
Mach. Permit Fee: Plumb.Petmtim Fec: Elec. Permit ree:
Other Much.Insp. Other Plumb Insp. Other Elec.hasp.
Heck hrsp. Fee: Plumb. htap. ree: Elea•.Insp.Fec:
NOTE: This ertinmle doer not include jeer clue to other Departments(i.e. Panning, Public Work's, Fire,Sanitary Sewer District,School
District,etc). These ees are based on the reliminat) in ormation unvailable and are onh,an estinmte. Contact the Dept for atl(Iit7 info,
FEE ITEMS (Fee Resolution 11-053 E2. 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check ree:
Suppl. PC ree
Pbunb.hWechAlec
Permit Fee: $375.00
Suppl. btsp Fee
Plumb.lHech./Elec
Plumh.lMech./Elec Permit Fee:
Const mction Tac:
Administrative Fee:
Work Without Permit? O Yes Q No $0.00
Advanced Plmvting Fees:
Travel Documentation Fees: A
Strom Motion Fee: IBSEISMICR $1.00 Select an Administrative Item
Blde Sids Commission Fee: 1BCBSC $1.00
SUBTOTALS: $377.00 $0.00 TOTAL FEE: $377.00
Revised: 10/01/2012