10110163 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10332 CRESTON DR CONTRACTOR:BART&IRIS GACH PERMIT NO: 10 110 163
OW"TFR'S NAME: BART&IRIS GACH 10332 CRESTON DR DATE ISSUED: 11/23/2010
Ok,_.,:R'S PHONE: 4087208026 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG(_ ELECT r— PLUMB
License Class Lie.# MECH r— RESIDENTIAL(_ COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: INSPCTS FOR EXPIRED PERMIT(08030097)NO INSPECTS
EVER DONE-CHANGE 2 PRONG SOCKETS TO 3 PRONG&
(commencing with Section 7000)of Division 3 of the Business&Professions
GROUND RECEPTCL SWITCHESN,LIKF,oYLIKE WINDOW
Code and that my license is in full force and effect. f� J u-
I hereby affirm under penalty of perjury one of the following two declarations: 1 ���G�'►�,�- d40i-
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:$10000
permit is issued.
APPLICANT CERTIFICATION APN Number:32637042.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Issued by: Date:
Sigr-11re Date
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Signature of Applicant: Date:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed c ntractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
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 Own (tor autl riz ager : /
forthwith comply with such provisions or this permit shall be deemed revoked. Date: <<
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
up, 'le above mentioned property for inspection purposes.(We)agree to save
ire fy and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signatur Date �l(2 / Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
tAD]DRESS: 10332 Creston dr. DATE: 11/23/2010 REVIEWED BY: bobs.
: BP#: *VALUATION: $10,000
FPERMITE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex 1f>r.[L PENTAMATION 1GENRES
USE: I'1 C�t1It 1t t. � PERMIT TYPE:
WORK
SCOPE
Elec.Plan Check 0.0 hrs $0.00
Pc,,ln;-!1",2 Elec.Permit Fee: IEPERMIT
Other Elec.Insp. 0.0 hr�$42.00
1 cc'
NOTE. Thesefees are based on the preliminary into rmation available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 09-05I Ef'. 7i1/10) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 13 # Window/Sliding Glass Door
Suppl. PC Fee: 0 Reg. 0 OT 0.0-1 hrs $0.00 $506.00 1 WINREP Replacement
PME Plan Check: $0.00 =1 Electrical
Permit Fee: $0.00 $42.00 IBREMRECEP Recep/Switch/Outlets
Supp/. Insp. Feed Reg. OT
0 --f-00 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $42.00
Acoustical Fee: 0 Yes 0 No $0.00
Work Without Permit? 0 Yes 0 No $0.00 0
Planning I:ee: $0.00 Select a Non-Residential 0
Travel Documentation Fee: ITRA VDOC $42.00 Building or Structure 0
i
Strong Motion Fee: IBSEISMICR $1.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $86.001 $548.00 TOTAL FEE: 1 $634.00
Revised: 11/08/2010
CITY OF CUPERTINO
6 ITEMS OF 14 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32637042 .00
DATE ISSUED. . . . . . . : 11/23/2010
RECEIPT #. . . . . . . . . : BS000012086
REFERENCE ID # . . . : 10110163
SITE ADDRESS . . . . . : 10332 CRESTON DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER BART & IRIS GACH
ADDRESS 10332 CRESTON DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : IRIS J GACH
CONTRACTOR LIC # *OWNER*
COMPANY BART & IRIS GACH
ADDRESS . . . . . . . . . . : 10332 CRESTON DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 10, 000 . 00 1 .00 0. 00 1. 00 0 .00
1BREMRECEP NO. OUTLETS 1. 00 42 .00 0 .00 42 .00 0 .00
1BSEISMICR VALUATION 10, 000 . 00 1. 00 0. 00 1. 00 0 .00
1EPERMITFE FLAT RATE 1. 00 42 .00 0. 00 42 . 00 0 .00
1TRAVDOC FLAT RATE 1. 00 42 . 00 0 .00 42 . 00 0 . 00
1WINREP EACH 8 13 . 00 506 .00 0. 00 506. 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 634 . 00 0 . 00 634 . 00 0 .00
Of CITY OF CUPERTINO
CUPS TING GENERAL BUILDING
PERMIT APPLICATION FORM
APN# : , Date:
Building Address: le of
�i
Mailing Address (if different from buildilig address):
Are Hazardous Materials being used as part of this project? Yes ❑ No
HOA: (Exterior work only) Yes ❑ No If Yes, provide letter from HOA
Owner's Name: Phone#
LILA
Contractor: Phone:
'I I Fax:
Contractor License#:
Cupertino Business License#:
Contact: Phone:
Fax:
Residential Commercial ❑
Job Description: L1 N•K' !? - -, T
1
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A 1-B U/IIJ/V-A II/VI B, IV-HT, 'V-B ❑—� ,` �.
Valuation: Square Footage:
Project Size: Express Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set& the sheet index.
ints Achieved:
For help, contact Build it Green at www.buildit een.or
Revised 07/14/09
s