10100215CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19140 STEVENS CREEK BLVD
OWNER'S NAME: STEVENS CREEK VILLAGE, INC
OWNER'S PHONE: 4082797673
❑ LICENSED CONTRACTOR'S DECLARATION
License Class rye 1j,Y'�!, �Lic. # q1341
Contractor Si I I i LO N ) J� 6/ Date �� }
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:
1. 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.
2. 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 _Date J
cagiw�
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1. 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)
2. 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:
1. 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.
2. 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.
a. 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.
Date
CONTRACTOR: SILICON VALLEYI PERMIT NO: 10100215
BUILDERS GROUP
1961 OLD MIDDLEFIELD WAY I DATE ISSUED: 01/27/2011
MOUNTAIN VIEW, CA 94043 PHONE NO: (408) 627-4177
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REPAIR DRY ROT DECK 150 SQ FT LIKE FOR LIKE
Sq. Ft Floor Area: I Valuation: $24000
APN Number: 37507060.00 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: -7�
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, Sections 75505, 25533, and 25534.
Owner or authorized agent:
Date:
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 Ad
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed P
CITY OF CUPERTINO
FEE SCHEDULE
~`.
APN#6.� O ✓
%� d
Date: �.�2 /0
/
Is a 2nd unit being added? Yes ❑ No °iC If yes, please fill out the permit application for 2' unit.
Building Address.
Mailing Address (f different from building address):
Owner's Name:
Phone #
Contractor: _ t \ (.V S!�
j�..
Phone #: Z /� � � ` 6f `�
Fax #:y
Cupertino Business License: State Contractor License #: -4 i f.32 t
Contact:
Phone #:����
eve, e _-5' "C"A
Fax #:
Landscape Ordinance Compliance:
Landscape area in sq. ft. (includes all irrigated areas): �' .
If 2,500 sq. ft. or less, compliance with the Landscape Water -Efficiency Checklist is required.
If more than 2,500 sq. ft., a complete Landscape Project Submittal is required.
Compliance Method: ❑ Plant Type ❑ Water Budget
Building Permit Info:
Bldg. Elect. ❑ Plumb. ❑ Mech. ❑ Hillside ❑
Job Description:
Addition -What is being added?(Be Specific): -
What is being remodeled (not including addition)?
Remodel Includes Re -Roof. Yes ❑ No If yes list number of squares
Remodel Includes Structural: Yes No
Do you have the pre -application planning approval? Yes ❑ No ❑
If yes, please provide a copy of your planning approval letter. Planners name:
v
Square Footage: `
°
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen Bath Other
Type of Construction (Usage Class):
Occupancy Type: (2---(
1-A, 1-B ❑ II/IHN-A ❑ II/III BJV-HT, V -B
Valuation: _ ' '-// CoC-)
Please check this box if the project is a
Project Size: Ex ress Standard Large ❑ Major ❑
second -story addition ❑
Please complete relevant portion of the Green Building
Checklist & attach it to the application or if applicable,
Green Building Points Achieved:
include in plan set & the sheet index.
-
Revised 05/18/10
CITY OF CUPERTINO
WON FEE ESTIMATOR — BUILDING DIVISION
NOTE. These fees are based on the Preliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 09-051 E '. 7/1/10)
ADDRESS:
DATE:
REVIEWED BY:
FTPerntil Fee:
APN:
BP#:
*VALUATION:
1$24,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi -Family Dwelling
USE:
Buildina is
>3 Stories 0 Yes 0 No
PENTAMATION 1GENRES
PERMIT TYPE:
WORK
PNM Plan Check:
SCOPE
$0.001=
NOTE. These fees are based on the Preliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 09-051 E '. 7/1/10)
lfech. Plan Chec)r
Phuub. Plcnr Chea/,
Elegy:. Plan Checlt
FTPerntil Fee:
Phtinb. Penni/ Fece:
Vec. Pei mit Fee:
Other Alech. hi p.
01hef. Phrrnb Insp.Lj
Other Elec. lisp.
111cch. hap. Fee:
Plrnrrb. hzsp. 1`ee:
Elec.Irup. fce:
NOTE. These fees are based on the Preliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 09-051 E '. 7/1/10)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 #
$443.00
Deck / Deck Railing
IDECKWOOD Deck (wood)
J
Suppl. PC Fee: 0 Reg. 0 OT
Mhrs
$0.00
PNM Plan Check:
$0.001=
#
$886.00
Deck / Deck Railing
IDECKWOOD Deck & Deck Railing
Permit Fee:
$0.00
Suppl. Insp. Feed Reg. 0
OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Constritction Tax
Acoustical Fee:
0 Yes) No
$0.00
0
0
Work Without Permit? 0 Yes) No
$0.00
Plamju Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
Tiwvel DoctnmPntcttion Fees:
Strong Motion Fee:
IBSEISMICR
$2.40
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
1 $3.401$1,329.00
TOTAL FEE: 1
$1,332.40
Revised: 10/17/2010
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION,
ADDRESS: DATE: REVIEWED BY:
APN: BP#: EVALUATION: 1$24,000 —�
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY Multi -Family Dwelling Buildina is PENTAMATION 1GENRES
USE: >3 Stories (D Yes E) No PERMIT TYPE:
WORK
SCOPE
- vs
A7l1'PV Tt,,...,, F „ .. ., k..o.,d ., o. ff,., mrnilnhla "rill hro nnh) nsf PctimatP_ Cnnftl!'f tho IIPnf fnr ntltlif'1 hifn_
FEE ITEMS (Fee Resolution 09-051 E . 7/1/101
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
ETD—#
$443.00
Deck / Deck Railing
1DECKWOOD Deck (wood) .
Suppl. PC Fee: E) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
0 #
$886.00
Deck / Deck Railing
1DECKWOOD Deck & Deck Railing
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0 OT
0.0
hzs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax
Acoustical Fee: 0 Yes G No
$0.00
8
E)
Work Without Permit? 0 Yes E) No
$0.00
Planning Fee:
$0.00
Select a Non -Residential
or Structure
E)
0
7'rT r, �l Dc�s �.rirtei�lativrr Fees:Building
Strong Motion Fee: IBSEISMICR
$2.40
Select an Administrative Item
332.40
Bldg Stds Commission Fee: 1BCBSC
SUBTOTALS,
$1.00
$3.401$1,329.001A
Revised: 10/17/2010