11060064 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10077 LAMPLIGHTER SQ CONTRACTOR:SILICON VALLEY PERMIT NO: 11060064
BUILDERS GROUP
OWNER'S NAME: COUCH JOE H AND JO B 1961 OLD MIDDLEFIELD WAY DATE ISSUED:06/09/2011
/:ER'S PHONE: 6509413128 MOUNTAIN VIEW,CA 94043 PHONE NO:(408)627-4177
uk LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT PLUMB r
License Class 67 Lic.# (�4I JJe� j"
G(f[� Date /3 MECH RESIDENTIAL COMMERCIAL
Contractor
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SIDING REPAIRS TO REPLACE SIDING DAMAGED BY
(commencing with Section 7000)of Division 3 of the Business&Professions DRY
Code and that my license is in full force and effect. ROT PRIOR TO PAINTING COMPLEX 80SQFT
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
permit is issued. Sq.Ft Floor Area: Valuation:$250
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:34242001.00 Occupancy Type:
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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said C'_1 in consequence of the
granting of this permit. Additionally,the applic nderstands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per t u rtino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Date v ! J ! ` Issued by: Date:
LJ OWNE - ILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
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
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cuper'no Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 5,25533,and 25534.
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. Owner uthoriz ent:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
i -nify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the Lender's Address
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. ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10077 lamplighter sq. bldg#7 DATE: 06/08/2011 REVIEWED BY: bobs.
APN: I BP#: "VALUATION: $250
°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
NOTE. Theseees are based on the preliminary in ormation available and are only an estimate. Contact the Dept-for addn7 info.
FEE ITEMS (Fee Resolution 09-051 tiff. '%'1.-10) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.£ Siding
Supp/.PC Fee: Reg. OT 0.0 hrs $0.00 $380.00 1SIDEOTHER All Other
PME Plan Check: $0.00
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 0
Work Without Permit? 0 Yes G No $0.00
Planning_Fee: $0.00 Select a Non-Residential E)
Building or Structure 0
Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.50 $380.00 TOTAL FEE:- $381.50
Revised: 04/29/2011
0C:)(-4) �
CONSTRUCTION PERMIT APPLICATION-
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
eURER, ,I O (408)777-3228• FAX(408)777-3333 •buildingdW-cuoertino.or4
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT#
A mcT ADDRESS � APN# 3112-
� 412- - 6 f
OWNERNAME , / HONE �/ , �_ E-MAIL 7�
STREET ADDRESS CITY, STATE,ZIP`r /� FAX
lOb72 Lac i-L 4 rtx--� C1.P�K,7lr.✓D Q.SOI
CONTACT NAME�L`��t L PHONE 9 23 /7 nt kC S t ✓ r'cc.�
STREET ADDRESS ' , CITY,STA ZIP AX
41711 s,�wE ca 4�lZd �• z�3
❑OWNER ❑ OWNER-BULDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME Cv`D �� C/� LICENSE NUMBER 8 P /v O/ LICENSE TYPE / BUS.LIC# Q ��
coMPANYNA�4 4"r4 641,1-9i' /31, XJ• e7 A*"P E-MAIL So A"ldrr'S L4:%4.z o& "f bra► TY 7-2 ZZY
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECTIENGIIIEER NAME 1 '/ LICENSE NUMBER BUS.LIC#
COMPANYNAME ,v E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ESCRIPTION OF WORK AxC ` `R vJ
EMSTING USE TZ�USE CONSTIL TYPE #STORES :•. !
y 5
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA ...'
BATHROOM KITCHEN OTHERS
REMODEL AREA REMODELAREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑ DETACH
A s
❑ ATTACH
#DWELLING UNITS: _ IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDEr ❑NO ADDMON7 ❑NO
PRE APPLICATION ❑TES IF YES.PROVIDE COP PLANNER NAME:
+ Y
PLANNING ADPL# [3NO PLANNING APPROV },. x.... + ...;
... ., E:. .. ..;.
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.
SignatureofApplicant/Agent: Date:
SUPPLEMENTAL TION REQ "y s
_New SFD or Multifamily dwellings: Apply for demo permit for
existing building(s). Demolition permit is required prior to issuance of building a zR63�" x
permit for new building.
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure e
form if any Hazardous Materials are being used as part of this project ' k
r
_ ZU
Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application ti
B1dRApp_2011.doc revised 03116/11