10120121I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 6793 CLIFFORD DR IDEVELOPMENT NTRACTOR:MCCLELLAN I PERMIT NO: 10120121
OWNER'S NAME: BLANEY VENTURE LLC 11448 ENTRADA VERDE PL I DATE ISSUED: 03/10/201 1 1
OWNER'S PHONE: 9259449108 I ALAMO, CA 94507 I PHONE NO: (925) 944-9108 I
❑ LICENSED R'S DE LARATION
License Class Lic. #
Contractor /'lC 21M Date 12 1- 0 l�
I hereby affirm that I am licensed under the provisions of Chapter 9
(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.
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.
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 sour regulations per the Cupertino Municipal Code, Section
9.18. 22
Signature DateC7 �� l
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, 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).
I 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.
I 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, 1 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 r ELECT r PLUMB I
r— r— r—
MECH RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: LOT 3-CONSTRUCT 2 STORY 2,399 SQ FT SFDWL W/
ATTACHED 428 SQ FT GARAGE-(ADDR CHANGED FROM 790 S
BLANEY)
Sq. Ft Floor Area: I Valuation: $282700
I APN Number: 36911063.00 I Occupancy Type: I
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date:
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
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I 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 & Safety Code, Sectio 25505, 25533, and 25534.
Owner or authorized agent: Date. /� l
CONSTRUCTION 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
I understand my plans shall be used as public records.
Licensed Professional
Signature Date
REVISION
CITY OF OF CUPERTINO BUILDING PERMI'DATE �� - i t—
BUILDING ADDRESS: 6793 CLIFFORD DR CONTRACTOR: MCCLELLAN PERMIT NO: 10120121
DEVELOPMENT
OWNER'S NAME: BLANEY VENTURE LLC 1448 ENTRADA VERDE PL DATE ISSUED: 03/10/2011
OWNER'S PHONE: 9259449108 ALAMO, CA 94507 PHONE NO: (925) 944-9108
❑ LICENSED CONTRACTOR'S DECLARATION F r
� BUILDING PERMIT INFO: BLDG " ELECT PLUMB
License Class —I Lic. # _ M84
�t
II _ r ^! , MECH � RESIDENTIAL F COMMERCIAL F
Contractor R, c44l I a A �� Date 5" 2-J �(
I hereby affirm that I am licensed under the provisions of Chapter 9
(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
Section 3700 of the Labor Code, for the performance of the work for 111ich this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above informatio s
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 against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non- oint source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date
❑ O R-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
I, 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).
I 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.
I 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.
JOB DESCRIPTION: LOT 3-CONSTRUCT 2 STORY 2,399 SQ FT SFDWL W/
ATTACHED 428 SQ FT GARAGE-(ADDR CHANGED FROM 790 S
BLANEY)
4/7/11 REVISION #1- REMOVE FIREPLACE BETWEEN DINING & FAMIL.Y-
5/26/2011 REV#1 ISS'D
Sq. Ft Floor Area: I Valuation: $282700
APN Number: 36911063.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS YROM LAST CALLED INSPECTION.
Iss b : Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material berg installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or au th 'z agent: S — 2 /
Date: f
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of Hork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
Date
1 understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO BUILDING
BUILDING ADDRESS: 6793 CLIFFORD DR
CONTRACTOR: MCCLELLAN I PERMIT NO: 10120121
DEVELOPMENT
OWNER'S NAME: BLANEY VENTURE LLC 11448 ENTRADA VERDE PL I DATE ISSUED: 03/10/2011 I
OWNER'S PHONE: 9259449108 1 ALAMO, CA 94507 I PHONE NO: (925) 944-9108
0 LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # 4-igfsA
Contractor P e. 1 >ZA 1-6,4 tkV, Date
I hereby affirm that 1 am licensed under the provisions of Chapter 9
(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
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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.
Signature Dated
❑ OW UILDER DECLARATION
1 hereby affirm that 1 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)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I 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.
l 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 T_ ELECT I— PLUMB r—
MECH T_ RESIDENTIAL r— COMMERCIAL T_
JOB DESCRIPTION: LOT 3-CONSTRUCT 2 STORY 2,399 SQ FT SFDWL W/
ATTACHED 428 SQ FT GARAGE-(ADDR CHANGED FROM 790 S
BLANEY)
4/7/I I DEFERRED #1- TRUSS CALCS-ISSD 5/24/2011
Sq. Ft Floor Area: I Valuation: $282700
APN Number: 36911063.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS YROM LAST CALLED INSPECTION.
I4ss1ed by Date:
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
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I 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 I 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 & Safety Code, Sections 25505, 25533, and 25534.
Owner or auth � d age t: L 1 /
Date:
UCONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of %ork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Signature Date I Licensed Professional
CITY OF CUPERTINO
FM__7_ FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 6793 clifford dr.
DATE: 04/07/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION: $100
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1GENRES
PERMIT TYPE:
WORK
revise fireplace location from dining to family room.
SCOPE
-I-
f1!iti°i' .i1rc"!1. 17,.i',
l"1tE,1'IaereiiE3
E3
NOTE. These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn't info.
FEE ITEMS (Pee Resolution 09-051 Efi' 711110)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee: Hourly Only? Q Yes
(F) No
$0.00
hours Plan Check, Hourly
$252.00 ISTPLNCK
Suppl. PC Fee: E) Reg. 0 OT
0.0 I
hrs
$0.00
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
Con.vtrwrif'o" Tav
Acoustical Fee: 0 Yes (F) No
$0.00
Q
Work Without Permit? Q Yes G No
$0.00
Plannin Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
CI
i
Travel Dor:7rrnrrmailon l t ;
Strong Motion Fee: IBSEISMICR
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1,
SUBTOTALS:
$Y*
$252.00
TOTAL FEE:
$2
50
Revised: 01 /15/2011