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10100013
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10640 MARTINWOOD WAY CONTRACTOR:TF DESIGN INC PERMIT NO: 10100013 OWNER'S NAME: PAUL LYNCH 3957 VIA SALICE DATE ISSUED: 10/01/2010 NNER'S PHONE: 4084380432 C,+MPBELL,CA 95008 PHONE NO:(408)438-0432 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class 50 Lia# 905-O REPAIR DRYROT AND TERMITS,REPLACE WOOD ,[, S1 DING ON Contractor TA d+,-.M At t �C Date t �� U GARAGE BUILDING TO STUCCO INSTALL NEW GARAGE I hereby affirm that I am licensed under the provisions of Chapter 9 DOORS (commencing with Section 7000)of Division 3 of the Business&Professions AND(8) WINDOWS REPLACE RAINGUTTERS AND Code and that my license is in full force and effect. 1 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. Sq.Ft Floor Area: Valuation:$5000 t 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 A N Number:36935038.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section _ 9.18. .------- RE-ROOFS: Signature Date 0/0-0 A I 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 in spection. OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three m aintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(x)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's it aterial. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this pen-nit is issued. w ill maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by d a Health&Safety Code,Sections 25505,, .33,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this L Date permit is issued. C wrier or authorized agent: 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I iereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. m ork's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 oe to building construction,and hereby authorize representatives of this city to enter 3.3 7d' upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION '-1emnify and keep harmless the City of Cupertino against liabilities,judgments, s,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. ;sting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. , d Signature �'` Date M y 17 r /0 ACORD_ CERTIFICATE OF LIABILITY INSURANCE OP TFD DATE(MM/DD/FDES-1 09/22/1/1 0 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION First Service Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE c. #OC13473 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Estates Dr. Ste. 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Roseville CA 95678 Phone: 800-591-9692 Fax:800-591-1845 14SURERS AFFORDING COVERAGE NAIC# INSURED I:JSURERA: James River Insurance Co. IJSURER B: Everest Rational Insurance Co. T F Design Incorporated 1 4SURER C3957 Via : Campbell CA195008 IJSURER D: IJSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE =OR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AI.L THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 114JECYEFFECTIVE POLICY EXPIRATION LTR NSRd TYPE OF INSURANCE POLICY NUMBER DAl E(MM/DD/YY) DATE(MMIDDIYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 00043378 (5/19/10 05/19/11 PREMISEStEaoccurence} $50,000 CLAIMS MADE X❑ OCCUR MED EXP(Any one person) $Excluded PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 }{ POLICY PEa LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED ALTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F-1 CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND X TO LIMITS ER B EMPLOYERS'LIABILITY 7600005695101 1)8/01/10 08/01/11 E.L.EACH ACCIDENT $ 1,000,000 ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT'SPECIAL PROVISIONS *This certificate is issued as Proof of Insurance only and is valid as of date issued. For a more updated confirmation of coverage, please contact our Certificate Department at 800-591-9692. CERTIFICATE HOLDER CANCELLATION PROOFXX SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO$O SHALL TF Design Incorporated IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) ©ACORD CORPORATION 1988 CITY OF CU PERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: I DATE: REVIEWED BY: APN: BP#: *VALUATION: $5,000 R*PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY PENTAMATION 1GENRES USE: SFD or Duplex I°l_(;Ot .1,, PERMIT TYPE: WORK SCOPE h, -. c. ir!I c'c t 7, 1'£'rmif F"'; YEJ. h:", �t(7f'i �.1£`C_If?5��. �], k b ,/,, PCC P,hMh NOTE: Thesefees are based on the preliminary in ormation availtible and are only an estimate. Contact the De t or addn'l info. FEE ITEMS ,(Fee Resolution 09-051 ff. T,1/10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1,000 s.f. Restucco Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 $507.00 ISTUCOAPP PME Plan Check: $0.00 ® # Window/Sliding Glass Door Permit Fee: $0.00 $380.00 1 WINREP Replacement Suppl. Insp. Fee-.0 Reg. 0 OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes (F) No $0.00 Work Without Permit? 0 Yes (E) No $0.00 1 E) Planning l ee: $0.00 Select a Non-Residential 0 Building or Structure 0 �r-tn°el 1�cac rttr�L°trtE.rtitx, 1�G��.�'_ � Strongy Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.0C SUBTOTALS: $1.50 $887.00 TOTAL FEE: $888.50 Revised: 9/29/2010 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBI�ONTRACTOR LIST JOB ADDRESS: 1064-0 '69,n/ PERMIT# OWNER'S NAME: I?a AXLA PHONE# tf CR 0SO 9-3oo &- GENERAL CONTRACTOR: 7-f � BUSINESS LICENSE # t000-6-0 ADDRESS: .3 5- Vt-rkio� u csz CITY/ZIPCODE: ,SDO? *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY IVTECTION(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: Signal ure Date Please check applicable subcontractors and complete the following information: 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 Qc) (0 Owner/Contra or Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36935038 . 00 DATE ISSUED. . . . . . . : 10/01/2010 RECEIPT #. . . . . . . . . : BS000011615 REFERENCE ID # . . . : 10100013 SITE ADDRESS . . . . . : 10640 MARTINWOOD WAY SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : PAUL LYNCH ADDRESS . 10640 MARTINWOOD WAY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : TF DESIGN CONTRACTOR . . . . . . . : THOMAS FEULT LIC # 29516 COMPANY . . . . . . . . . . : TF DESIGN INC ADDRESS : 3957 VIA SALICE CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (408) 438-0432 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 5, 000 . 00 1. 00 0 . 00 1 . 00 0. 00 1STUCOAPP SQ FEET 1, 000 . 00 1014 . 00 0 . 00 1014 . 00 0. 00 1WINREP EACH 8 1 . 00 760 . 00 0 .00 760 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 1775 . 00 0 .00 1775 . 00 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 1, 775 . 00 9685 --------------- TOTAL RECEIPT 1, 775 . 00 ino Cupert v Basemap Labels �. Abc Street Names Secondary Address Labels Primary Address Labels Freeway Basemap =c= Street Centerline County Freeways County Major Roads •' -- Right-of-Way Parcels uvmmunity Development 0 City Boundary ® Aerials-2006 = N SCALE 1 : 527 20 0 20 40 60 FEET http://gissvr/cupertinointranet/home/mapFile.aspx Friday, October 01, 2010 11:56 AM _ar ..5M - - CITY OF CUPERTINO .,carr OF CU PEKTINO GENERAL BUILDING ILDING f ��- PERMIT APPLICATION FORM APN # S 03ss (-0 Dater "67 � _ Building Address: 1000 tJL( •�..'�soeo�-us�c �/-�I rL�J�OG� bjqj Mailing Address (if different from building 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 #: Contractor:.r� T, .0, ---, Fax: / 3.� 7 Fax: Contractor License#: C),5-0 Cupertino Business License#: Contact: Phone: �4& Sc�s Fax: .esidential Commercial ❑ Job Description: —,-"t (3, @+.L r 1 O V O '"' O Y... V V /1/lQ.i1,Vc t{Ull doc, Building Permit Info: Bld .�9 Elect ❑ PlunLb ❑ Mech ❑ Type of Construction (Usage Class): Occupanc Type: 1-A, 1-B ❑ U/MN-A ❑ IUIII B, IV-HT, V-B Valuation: _5_0 0 O o Square Footage: Project Size: Express 2Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of th,: Green BTuilding/LEED Checklist & attach it to the application or if applicable, inc:.ude in plan set & the sheet index. points Achieved: - jr help, contact Build it Green at www.builditg reen.o • Revised 07/14/09 3