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11060058 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10076 LAMPLIGHTER SQ CONTRACTOR:SILICON VALLEY PERMIT NO: 11060058 BUILDERS GROUP OWNER'S NAME: STEFAN KOTES 1961 OLD MIDDLEFIELD WAY DATE ISSUED:06/09/2011 IER'S PHONE: 4082528285 MOUNTAIN VIEW,CA 94043 PHONE NO:(408)627-4177 CJS LICENSED CONTRACTOR'S DECLARATION I /1 BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class 2 Lic.# s79llGG l MECH[_ RESIDENTIAL� COMMERCIAL � Contractor �V CL Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE SIDING DUE TO DRYROT DAMAGE(460SQFT) (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: 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:$1437 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:34233004.00 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. Issued by: Date: Signatur DatZ,211,61 V 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. 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, 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 Owner o zed 7 become subject to the Worker's Compensation provisions of the Labor Code,I mus Dat . �J 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%ork'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 i nify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with 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 3 ITEMS OF 24 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34233004 . 00 DATE ISSUED. . . . . . . : 06/09/2011 RECEIPT #. . . . . . . . . : BS000013702 REFERENCE ID # . . . : 11060058 SITE ADDRESS . . . . . : 10076 LAMPLIGHTER SQ SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : STEFAN KOTES ADDRESS . . . . . . . . . . : 10076 LAMPLIGHTER SQ CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : MICHAEL INOUYE CONTRACTOR . . . . . . . : FRANCISCO BERRUETA LIC # 30850 COMPANY . . . . . . . . . . : SILICON VALLEY BUILDERS GROUP ADDRESS . . . . . . . . . . : 1961 OLD MIDDLEFIELD WAY CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94043 TELEPHONE . . . . . . . . : (408) 627-4177 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 1,437. 00 1. 00 0. 00 1. 00 0 . 00 1BSEISMICR VALUATION 1,437. 00 0.50 0. 00 0 .50 0 . 00 1SIDEOTHER SQ FEET 460 . 00 570. 00 0. 00 570 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 571.50 0. 00 571.50 0. 00 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION TADDRESS: 10076 lamplighter square bldg I DATE: 06/08/2011 REVIEWED BY: bobs.PN: BP#: "VALUATION: 1$1,437 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK replace siding due to dryrot damage. SCOPE Lj Li I--------------- NOTE: Thesein-fees are based on the relindnar information available and are onlyan estimate. Contact the De t or addn'[ o. FEE ITEMS (Fee Resolution 09-051 F;ff1.-'10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 f 460 s.£ Siding Suppl.PC Fee: G Reg. 0 OT 0.0 hrs $0.00 $570.00 ISIDEOTHER All Other PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee: ' 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 0 Work Without Permit? 0 Yes (D No $0.00 Planning ree: $0.00 Select a Non-Residential Building or Structure i Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg,Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS $1.50 $570.00 TOTAL FEE: $571.50 Revised: 04/29/2011 CONSTRUCTION PERMIT APPLICATION- COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•building(M-cuaertino.orct CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/n ❑ REVISION/DEFERRED ORIGINAL PE/REMIT# PRO TtDDRESS / / , `�G TFiI\. J QLey�/Z L APN# [ 7— OWNER NAME C`lJ� 0 E-MAIL �J STREET ADDRESS CITY, STATE,ZIP/ ' FAX CONTACT G6-1,�t� �vc� E-MAIL kC S �4t r rota STREET ADDRESS ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRAcTORAGENT ❑ ARCHITECT ❑ENGINm ❑ DEVELOPEi ❑ TENANT CONTRACTOR NAME 2 '10 `0 y C/� LICENSE NUMBERO //'O/ LICENSE TYPE BUS.LIC# Q �� COMPANYNAIMA !rI44 t4 UA61f* & Itf. el�� &eosu roG• .ZO FAX C6SO)177'2ZZ-7 STREET ADDRESSCITY,STATE,ZIP PHONE t,6e-a01AAl r .d vew�� S.r� J�s� Lit < S/Z! gra S`10-X1 ARCHITECT/ENGINIM NAME 1 // LICENSE NUMBER BUS.LIC# COMPANYNAME ,v E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE dSCRIPTION OF WORK A,/e CPA EXISTING USE PROPOSED USE CONSTR TYPE F;70RMS EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA . ., BATHROOM KnrHEN OTHER REMODELAREA REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA:❑ DETACH ❑ ATTACH MDWELLING UNITS: 15 A SECOND Mr ❑YES SECOND STORY ❑YES BEINGADDED! ❑NO AMMON? ❑NO t .w v PRE APPLICATION [3 YES IF YES.PROVIDE COP PLANNER'S,NAIvIIi: PLANING ADPL# [3 NO PLANNING APPROV By my signature below,I certify to each a following: the p p owner or authorized agent to act on the property owner's behalf I have read this application and the information I have vided is correct. ve read Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin 'to ding constructio I autho ' esentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Dater49 SUPPLEMENTAL TION REQ New SFD or Multifamily dwellings: Apply for demo permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. x _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �' y form if any Hazardous Materials are being used as part of this project Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application f' BldgApp_2011.doc revised 03116/11