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11030031CITY OF CUPERTINO BUILDING PERMIT. BUILDING ADDRESS: 22083 BAXLEY CT CONTRACTOR: SIERRA STRUCTURE INC PERMIT NO: 11030031 OWNER'S NAME: MEADOW VISTA, CA 95722 PHONE NO: (916) 275-1971 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # 7-7S 62 Contractor Date 3 2 V 1 hereby a rm th t I am licensed under the provisions of Chapter 9 (comment:(' -with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 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. I have and will maintain Worker's Compensation Insurance, as provided for bv Section 3700 of the Labor Code, for the performance of the work for c this permit is issued. APPLICANT CERTIFICATION / 1 certify that I have read this application and state that the above information is correct. 1 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, costs, and expenses which may.accrue mst said City in consequence of the granting of this permit. Additiianalty, the pplicant understands and will comply with all non -point sour r tuns p the Cupertino Municipal Code, Section 9.18. Date 3- Z C/— / / ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 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 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. certify that in the performance of the work for which this permit is issued, I shall 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 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. 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 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. BUILDING PERMIT INFO: BLDG . ELECT F PLUMB Fi MECH r—_. RESIDENTIAL r7l, COMMERCIAL JOB DESCRIPTION: ADD 270 SQ FT TO STUDY AREA, REMODEL 204 SQ FT TO KITCHEN Sq. Ft Floor Area: I Valuation: $120000 APN Number: 35606025.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date:?`rl� RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should 1 store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safe C e, Sections 25505, 25533, and 25534. Owner LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. Date I Licensed Professional CITY OF CUPERTINO BUILDING PERMIT DAB �� --/ -7— l / BUILDING ADDRESS: 22083 BAXLEY CT CONTRACTOR: SIERRA STRUCTURE INC PERMIT NO: 11030031 OWNER'S MEADOW VISTA, CA 95722 PHONE NO: (916) 275-1971 ❑ LICENSED CONTRACTOR'S DECLARATION F7 License Class 13 Lic. # 2 BUILDING PERMIT INFO: BLDG ELECT PLUMB � / b MECH r RESIDENTIAL COMMERCIAL �' G. contractor S /L%✓�� �7t`d ✓e,%tie-_-1 hereby affirm that 1 am licensed under the provisio s of Ch ter 9 JOB DESCRIPTION: ADD 270 SQ FT TO STUDY AREA, REMODEL 204 SQ FT TO (c mmencing with Section 7000) of Division 3 of the Business & Professions KITCHEN 5/17/2011 -REV#1-REVISE BEAM AT EXISTING KITCHEN LOCATION, ADD 2 o e and that my license is in full force and effect. NEW BEAMS AT NEW ADDITION-REV#1 ISS'D 5/17/2011 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: $120000 permit is issued. APPLICANT CERTIFICATION APN Number: 35606025.00 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 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 e a inst said City in consequence of the granting of this permit. nally, applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non -point sour utations er the Cupertino Municipal Code, Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date �% �/ y'J r" Issued b) Date:�z ❑ OWNER -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, 1 agree to remove all new materials for will do the work, and the structure is not intended or offered for sale (See.7044, inspection. Business & Professions Code) 1, 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. 1 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 b the Bay Area Air Quality Management District 1 will not employ any person in any manner so as to become subject to the Worker's maintaiAcompli nth a Cupertino Municipal Code, Chapter 9.12 and the Compensation laws of California. If, after making this certificate of exemption, I Healh ' s 25505,25533, 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. t // Date: J 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 hereby affirm that there is a construction lending agency for the performance of mrk'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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, 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. understand my plans shall be used as public records. Signature Date Licensed Professional CUPIERTIND CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(Qgugertino.oro ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMITJCJ PROTECT ADDRESS /'• j © APN # .1 O OD ` �—}� OWNERNAME)Ot PHONE ���� E-MAIL 1 STREET ADDRESS , t- J CITY, STATE, ZIP FAX CONTACT NAME ' PHONE9 (b 2� J E-MAIL STREET ADDRESS 7—CIITY STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONIRACTORAGEM' ❑ ARCHITECT ❑ ENGNEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER—,Q LICENSE T E BUS. LIC # G�-2 O 324115 COMPANY NAMEd E / E-MAIL r f J FAX '� I STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECTIENGWEER NAME , Y� / V / LICENSE NUMBER -7 � � � - � t2� n T (/ BUS. LIC # COMP ANY NAME I L7 el E-MAIL FAX STREET ADDRESS CI)VTATF-TF �� r� PHONE O5e�, ZI .7 DESCRIPTION OF WORK -t D O 14e a u✓ S ✓'✓ e 40 2 wiea",77S e D lam 40 EXISTING USE PROPOSED USE CONSTR TYPE #STORIES TYPE'. 0;a F.Tx�r s,.��aWArr1'ATION= :? FICSTG NEW FLOOR DEMO TOTAL z . N �' + M AREA AREA AREA NET AREA T` BATHROOM KITCHEN OTHER �.• u[I° a '� REMODEL AREA REMODEL AREA REMODEL AREA �; POACH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑DETACH '. r:.� - . ' :• - -s '3 ON 9 [IATTACH ,tea,. u"._ `' r�ks3 «`` 0 DWELLING UNNIS: IS A SECOND UNIT ❑ YES SECOND Sl'ORY ❑ YES �y �y.n BEING ADDED? NO A MON? NO tin PRE -APPLICATION ❑YES ffYES,M20VIDECOPYOF PLANNEVSNAB RECEIUED•BY ,; '.'� py '!'4TAL`YAT?U`e@ ' yf PLANNING APPL 0 NO MANNING APPROVAL LSITER _ � By my signature below, I certify to each of the follo I the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided ' ect, ave read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin cti . I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. SignatureofApplicanr/Agent: Date: SUPPLEMENT TI REQUIRED n :'x , P,Le1F>.CHECICzT7�PEs5,?.r�-:» U,I � ..rest .� �®�PiG 5-._ . .M� .-2:'�t: New SFD or Multif ' dwellings: Apply for demolition permit forte, g _ existing building(s). De lition permit is required prior to issuance of building permit for new building. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure BHE-CQYIIYTER �; EXPRESS scalvnAx ®PLANMNG ELdN RFi4IRW ❑ pria a form if any Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or Meeting with Planning prior to aS � z _ submittal of Building Permit application. aoR �sAEilFnRxsLKwERDsTRrcr 6--7 B1dgApp_2011.doc revised 03116111 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - building(c cupertino.org ❑ NEW CONSTRUCTION �l0D1--3 ADDITION / ALTERATION ❑ REVISION / DEFERRED SUBMITTAL PROJECT ADDRESS o v(- 7APN # ,� r ` U 6 A () ^ r• �( OWNER NAME ' / i Pgrl1111A 1 KC �1G' PH0 Q , i ��— J-7 _757 E-MAIL STREET ADDRESS 5 AmC. C Y, STATE, ZIP (u C FAX e! 1 Z, + APPLICANT NAME U e I b_L , '� PHO G , _ z / 5� 1 E-MAIL H I STREET ADDRESS -3 Ss[&VW4; CITY, S ATE, Zl `. '7 L x2 J(✓ -�'AJ ✓ w Vt A ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ,Z'CONTRAcTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME - 5 i er r 5'�,*.� c-+�Ir e- LICENSE NUMBER .-7.-7,S i p I v LICENSE TYPE �" BUS. LIC # COMPANY NAME E-MAIL .T I�J7 I F p �7 .7U - 9 J �� 7 J STREETADDRESS Z L43 5 /_ yn CITY, STATE, ZIP ✓Jt✓E 7 5' ,7 r T �` -7 d ARCHITECTIENGINEER NAME /��v � 10ENSE NUMBER "I BUS. LIC # COMPANY NAME 17 110 E-MAIL FAX n STREET ADDRESS 1*7 J CITY, STATE, ZIP �� "�� 5, <l PHONE AIl43p.-.q D�YSCRIPTIONOF;WORK ` al / J. 'qS AMv .k �, Rn Amu t EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES UM `. M` - OFFICE SE O1V T ,Ya1 ^J r lJ1-� I 004 8* TYPE DESCRIPTION �+ : F�FI' '!>` WALUATI N EXISTG NEW FLOOR DEMO TOTAL - AREA AREA AREA NET AREA BATHROOM KITCHEN k4 OTHER t REMODELAREA REMODEL AREA REMODEL AREA PORCH AREA 7DECKAREA TOTAL DECKIPORCH AREA GARAGE AREA: ❑ DETACH • a ❑ ATTACH p DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES a ' rg�+% A BEING ADDED? �NO ADDITION?f0 t PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNER'S NAME: CELyED BY� T TAL U LUAT[ON - PLANNING APPL N PLANNING APPROVAL LETTER By my signature below, I certify to each of the follo ing: am t�Ie property owner or authorized agent to act on the property owner's behalf. I have rea this application and the information I have provided ' corr I l se•reTld"tttp Description of Work and verify it is accurate. I agree to comply with all applicable local laws relating to buildin onst tion�I'authorizg,I/epresentatives of Cupertino to the above -identified for inspection ordinances and state enter property purposes. -/ - - . Signature of ApplicanUAgent: Date: RMATION REQUIRED SUPPLEZaV y:;; ..-OFFICEUSE'ONLY-,_„. _New SFD or Multillings:Apply for demolition permit for LAxcHEcx ZYPE. , d qll,.., ROUTING sLIP� _ .. existing building(s). Demolition permit is required prior to issuance of buildings ' 0 O THE couNTER ❑ BUILDINGREVIEW permit for new building. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Ei�ss ❑ ,I�LANNr�GPLAN�IiEw _ folTn if any Hazardous Materials are being used as part of this project. 0 sTANDnaD :x, ❑ , rusLlc woRxs ; Copy ofPlarming Approval Letter or Meeting with Planning Prior to of Buildingapplication. Permit s 0 LARCE� � � + �" W�g ❑ r••IxE DEPT.' � ���; ' "- submittal yea s I;❑:MPiJOR „�,.�„:- �CI�`iP' y❑..ENVIRONytENTAL=tIEALTH, B1dgApp_1011.doc revised 03103111 Building Department CUPERTINO , City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: �20l�3 PERMIT # 6O OWNER'S NAME: Ar,rv►a l Ko :at�.4 kAr PHONE # GENERAL. CONTRACTOR: SI�.',�c, S'7✓c�'u e. BUSINESS LICENSE # ADDRESS: 3S $/��f;,,;t t: U��5+A 64 CITY/ZIPCODE: `i5-" z 2. *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. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V 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 Owner / Contractor Signature Date