11060065 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10116 LAMPLIGHTER SQ CONTRACTOR:SILICON VALLEY PERMIT NO: 11060065
BUILDERS GROUP
OWNER'S NAME: MICHAEL BAINES 1961 OLD MIDDLEFIELD WAY DATE ISSUED:06/09/2011
'S PHONE: 4082531817 MOUNTAIN VIEW,CA 94043 PHONE NO:(408)627-4177
LICENSED CONTRACTOR'S DECLARATION
n/ / BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class � Lic.# S X` ��(
MECH F RESIDENTIAL r COMMERCIAL r
Contractor l✓� G Date 6
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 260SQFT
1 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.
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 this
permit is issued. Sq.Ft Floor Area: Valuation:$1812
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:34242012.00 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 City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulatio�per pertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. / 7
Signatur Date �7 d l� Issued by: Date:
Li OWNII-BUILDER 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 Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections2 05,25533,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 or au ed
Dat /'//l
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 vork'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
inify 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 ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 24 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34242012 . 00
DATE ISSUED. . . . . . . : 06/09/2011
RECEIPT #. . . . . . . . . : BS000013702
REFERENCE ID # . . . : 11060065
SITE ADDRESS . . . . . : 10116 LAMPLIGHTER SQ
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER MICHAEL BAINES
ADDRESS . . . . . . . . . . : 10116 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, 812 . 00 1. 00 0 . 00 1 .00 0. 00
1BSEISMICR VALUATION 1, 812 . 00 0 .50 0 . 00 0 .50 0. 00
1SIDEOTHER SQ FEET 1. 00 380. 00 0. 00 380 .00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 381. 50 0. 00 381.50 0. 00
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
JJADDRESS: 10116 lamplighter sq. bldg#8 DATE: 06/08/2011 REVIEWED BY: bobs.
PN: BP#: "VALUATION: $1,812
Y°PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair
PRIMARY PENTAMATION 1GENRES
USE: SFD or Duplex PERMIT TYPE:
WORK replace siding due to dryrot damage.
SCOPE
NOTE. These fees are based on the preliminary in ormation available and are onjV an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 09-051f;ff. 'r.-'1 r)1 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.£ Siding
Suppl.PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 $380.00 1SIDEOTHER All Other
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee.e 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 0
Work Without Permit? Yes E) No $0.00
Planning Fee: $0.00 Select a Non-Residential E)
Building or Structure 0
i
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.50 $380.00 TOTAL FEE-T $381.50
Revised: 04/29/2011
� C
CONSTRUCTION. PERMIT APPLICATION-
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
• CUPERTINO, CA 950143255
10300 TORRE AVENUE
CE.lPER,i,f( O (408)777-3228• FAX(408)777-3333 • buildinct0cueertino.or4
❑NEW CONSTRUCTION ❑ ADDmoN ❑ ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS / v/,A+p I-da riA- S A/L e APN# (f�
OWNERNAME/`7l �a E.M�
STREET ADDRESS CITY, STATE,ZIP FAX
CONTACT NAME -x 1ke s f 6r r0�
STREET ADDRESS f CTfY,STA ZiP AX
❑OWNER ❑ OWNER-BUnDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENrINEER ❑ DEvELoPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE HUS.LIC#
�ILG,lO ll7Dl � PS
coI,PANYN� �M� A
44"0 UAci-t-4' /3`Dla
xl. ne ' s bi.f�Crs rov to F �Sa V7 27.43
STREET ADDRESS CrrY,STATE,ZiP � PHO
�,6c.z,L�tfl v�►c�(z .S.r�r vSC
ARCHITECT/ENGIIQEERNAME LICENSE NUMBER BUS.LIC#
COMPANYNAME /•� E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK 7_6 Ad"deb Pt
EXISTING USE PROPOSED USE CONSTR TYPE #STORIES
r;:.:``i rl.i.y-.:...::,.r32'
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA .- ..
BATHROOM KITCHEN OTHER t
REMODEL AREA REMODELAREA REMODELAREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREAGARAGE AREA:❑ DETACH f
❑ ATTACH Exam 4�..
MDWELLING UNITS: DI A SECOND VMr ❑YES SECOND STORY ❑YES
BEING ADDED' ❑NO ADDIIION? ❑NO
>a .. ..xc : F.,Iw ):•sig; r..r°`r>. P ra. .� of ..:_�. ...: ..,....' ,.
PRE APPLICATION ❑ YES 7 YES.PROVIDE CO PLANNER'S NAME:'
PLANNING APPL# [3 NO PLANNING APPROV
By my signature below,I certify to each a following: the p pe 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 ' resentatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INOkMATION REQ
_New SFD or Multifamily dwellings: Apply for demoI permit for 4 ►•"" ""' " t €'
n
nm.
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
i U t Ayab S�
—Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project. '`
to
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application �`... .:. VSA
BldAApp_2011.doe revised 03/16/11