10090161 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10421 E ESTATES DR CONTRACTOR:SMITHSON ROBERT C PERMIT NO: 10090161
AND SUSAN D
f"x'NER'S NAME: SMITHSON ROBERT C AND SUSAN D 10421 EAST ESTATES DR DATE ISSUED:09/16/2010
.NER'S PHONE: 4082573689 CUPERTINO,CA 950144505 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB
License Class Lic.# MECH r RESIDENTIAL r COMMERCIAL
Contractor Date
JOB DESCRIPTION:REPLACE ROTTEN PORCH POST WITH NEW 4"X6"
I hereby affirm that I am licensed under the provisions of Chapter 9
REDWOOD
(commencing with Section 7000)of Division 3 of the Business&Professions HEART POST MILLED TO SIZE OF ORIGINAL SAWN LUMBER
Code and that my license is in full force and effect. POST.SEE DRAWING
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
Sq.Ft Floor Area: Valuation:$70
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:36913046.00 Occupancy Type:
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 accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
—P
Signature Date Issued bye"- Date---'`� l �
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,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contract
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:
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. I will maintain
compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this 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 by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must 1
O
forthwith comply with such provisions or this permit shall be deemed revokedDate: < l6 2�l o
41.
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
atin;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 rel
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
v the above mentioned property for inspection purposes.(We)agree to save Lender's Name
mify and keep harmless the City of Cupertino against liabilities,judgments,
L. s,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 regulati s per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18. � —
I understand my plans shall be used as public records.
Signature e
Licensed Professional
REPLACE ROTTING PORCH 10421 EAST ESTATES DRIVE
EAVES SUPPORT POST 9/16/2010
SCALE: 0.5" = 1'
1 FOOT
77 Acc.R4 f,01 I N(iWr r1�PPPORT BEAM
• ct.l�AIk81�� r,�t�t ;ar,l
23" DATE- �� d/
Ey SIGNED/` , —�
M DETAIL A this set of plans ani specifications MUS'
be kept on the lob at all times and it it
j VIEW nlawful to make any changes or alteration
M on same without wr tten permission from
the Building De artrr ent, City of Cupertino
_ rhe stamping of this Llan and specifications
!A SHALE. NOT be held to permit or to be ar,
'U approval of the viol+ nn of any provisions
OCf) nt:any CY Y t?r;ire; ��r�r„ `;t:;i�, 3W
5 3/8" 7'
= CENTER TO CENTER dt I TO GARAGE
1019" 13' 8"
O
O
0
D ' . DETAIL B
-VIEW
3"
9„ PORCH CONCRETE SLAB
GRADE
DETAIL A = T, B
VIEW
VIE
3 5/8" EAVE CROSS SECTION OF POST:
3.625 x 5.375= 19.484 SQ. IN.
SUPPORT
9 1/8 BEAM 3 E/8° MAXIMUM CRUSHING STRENGTH
SECOND GROWTH REDWOOD:
216D NAIL INTO 5220 PSI @ 12% MOISTURE CONTENT
` BEAMTOENIL INSIDE (USDA ENCYCLOPEDIA OF WOOD)
OF POST FAILURE LOAD OF POST:
7 1/4" (EXISTING METHOD) POST 19.484 x 5220 = 101,706 POUNDS
161, POST BRACKET
3 16D NAILS
THROUGH BRACKET
INTO POST
(EXISTING METHOD) 1 EXISTING METAL
BRACKET EMBEDDED IN SLAB
POST 3/4" 2" ' WITH 16D NAIL INTO POST
FSLAB
OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
its 10300 TORRE AVENUE-CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228-FAX(408)777-3333- :)ui1ding(a7cuPe_ino.org
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
SITE ADDRESS�O„/ �� .-�S O/� APN BP#
OWNER NAMES -� i4s OWN Q)QRS/ -Sr-�-�
/ (J C:
DESCRIPTION OF WORK: G/�C G �oTj/� G 010, �y 0-��—
We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We
will not issue a building permit until you have read, initialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you,the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.)
I understand a frequent practice of unlicensec persons is to have the property owner obtain an"Owner-
Builder' building permit that erroneously implies that the property owner is providing his or her own labor and material
personally. I, as an Owner-Builder, may be held IiablE!and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully actir g as an Owner-Builder and am aware of the limits of my
insurance coverage for injuries to workers on my property.
1412. 1 understand building permits are not requirec to be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contrai:tor to assume this responsibility.
/.,-(/- 3. 1 understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that I may
protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
name instead of my own.
/ 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
/%5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
total value of my construction is at least five hundred dollars($500), including labor and materials, I may be
considered an"employer"under state and federal lay.
/0�'f6. I understand if I am considered an"employer" under state and federal law, I must register with the state and
federal government,withhold payroll taxes, provide workers'compensation disability insurance, and contribute to
unemployment compensation for each"employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
��. I understand under California Contractors'Slate License Law, an Owner-Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is performed under contract with a licensed general )uilding Contractor.
,/6/8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any s ibsequent owner(s)that result from any latent construction
defects in the workmanship or materials.
OwnerBuilderForm 2010.doc revised 04/14/10
,09. 1 understand I may obtain more information ref larding my obligations'
as an"employer"from the Internal
evenue Service,the United States Small Business Administration,the California Department of Benefit Payments,
and the California Division of Industrial Accidents. I al.,-,o understand I may contact the California Contractors' State
License Board (CSLB)at 1-800-321-CSLB (2752)or\wvw.cslb.ca.gov for more information about licensed
Wts.am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that 1
amt arty legally and financially responsible for proposed construction activity at the site address listed above.
11. I agree that, as the party legally and financia ly responsible for this proposed construction activity, I will abide
by all ap licable laws and requirements that govern Owner-Builders as well as employers.
/�/121 agree to notify the issuer of this form immediately of any additions deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated1by laws designed to protect the public. If
you contract with someone who does not have a license, the Contractors' St to License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint.i Your only remedy against unlicensed
Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while wo*ing on your property,you may be held liable for damages. If
you obtain a permit as Owner-Builder and wish to hir:Contractors, you will be responsible for verifying whether or not
those Contractors are properly licensed and the statL s of their workers'compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECTIONS:Please complete the following construction lending agency information.)
I hereby affirm that there is a construction lending agern;y for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name: Lender Address:
Before a building permit can be issued,this form must be completed and signed by the property owner and
returned to the agency responsible for issuing the pi:rmit. Note:A copy of the property owner's driver's license,
form notarization, or other verification a ptable to he ,-ity may be requiro to be presented when the permit is issued
to verify the property owner's si nat
Property Owner's Signature: Date: 6 °fid
---------------- ----------------------------------------------------------------------------------------------------------------------------
(NOTE. The following Authorization Form is required to be completed by the property owner only when designating an
agent of the property owner to apply for a construction l:ermit for the Owner-Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner,the execution cif which I understand is my personal responsibility, I hereby
authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an
Owner-Builder Permit for my project.
Scope of Construction Project(or Description of Work):
Project Location or Address:
Name of Authorized Agent: Tel No
Address of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy. Note:A cop.t of the property owner's driver's license, form notarization, or other
verification acceptable to the city may be required to bE-presented when the permit is issued to verify the property owner's
signature.
Property Owner's Signature: Date:
OwneiBuilderForm_2010.doc revised 04/14/10
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: I DATE: REVIEWED BY:
APN: BP#: *VALUATION: $70 -�
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARYSFD or Duplex �«� �� PENTAMATION 1GENRES
USE: C(1t�lr ',E t PERMIT TYPE:
WORK
SCOPE
7F-L-
111.°h, PCC t"r,nrh iosp, hllo, /,cc
NOTE. Theseees are based on therelimina in ormation available and are only an estimate. Contact the Dept for addh 7 info.
FEE ITEMS ("Fee Resolution 09-051 Elf. 7%1:701 FEE QTY/FEE MISC ITEMS
Plan Check Fee: : 0.00 L_P_j # Covered Porch
Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs :10.00 $0.00
PME Plan Check: 90.00
Permit Fee: 1SUPINSFEE $0.00
Suppl. Insp.Fee-.0 Reg. 0 OT 1 1.0 hrs $1:!6.00
PME Unit Fee: : 0.00
PME Permit Fee: : 0.00
(�.t)17so.1f",ti0i7 1,/A
Acoustical Fee: 0 Yes No 50.00
Work Without Permit? 0 Yes E) No 50.00
Planning Fee: S0.00 Select a Non-Residential
Building or Structure 0
Trzrrc+l/?cx rrt�7trrttcztrr>ra T,t.c�,s_
Strong Motion Fee: IBSEISMICR $0.50 0.5 hrs Admin./Clerical Fee
Bldj4 Stds Commission Fee: 1BCBSC $1.00 $39.00 ]ADMIN
SUBTOTALS: $127.50 $39.00 TOTAL FEE: $166.50
Revised: 9/14/2010
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk.: Lot:
APN 36513046 .00
DATE ISSUED. . . . . . . : 09/ 16/2010
RECEIPT #. . . . . . . . . BS(i00011485
REFERENCE ID # 10090161
SITE ADDRESS . . . . . : 10621 E ESTATES DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SMITHSON ROBERT C AND SUSAN D
ADDRESS : 10121 EAST ESTATES DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4505
RECEIVED FROM . . . . : RO3ERT C SMITHSON
CONTRACTOR LIC # *OWNER*
COMPANY . . . . . . . . . . : SMITHSON ROBERT C AND SUSAN D
ADDRESS : 10421 EAST ESTATES DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4505
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -------------
---------- ----------
---------- ---
1ADMIN HOURS 0. 50 39.00 0 .00 39. 00 0 . 0
1BCBSC VALUATION 70 . 00 1. 00 0 .00 1. 00 0 .00
1BSEISMICR VALUATION 70. 00 0 .50 0 .00 0 .50 0 . 00
1SUPINSFEE HOURS 1. 00 126 . 00 0 .00 126 . 00 -
0 .00
- --------- ---------- ---------- --
TOTAL PERMIT 166 .50 0.00 166 .50 0 . 00
METHOD OF PAYMENT AMOUNT --REFERENCE NUMBER
----------------- ---------------
CREDIT CARD 166 .50 VISA
---------------
TOTAL RECEIPT 166 .50
CITY OF C'UPERTINO
ITY Of
CUPEkTINO GENERAL BUILDING
PERMIT APPL[CATION FORM
APN# ,� � � � Date:
Building Address: S 7-q.-rE 57
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of thh project? Yes 0No
HOA: Exterior work only) Yes ❑ No �f es, rovide letter from HOA
Owner's Name: Phone#:
r c S�/7w,5*on/ lyo� 5-? -
Contractor: j Phone:
o l 1� Fax:
Contractor License#:
Fax:
Cupertino Business License#:
Contact: Phone:
�i--•--
Residential Commercial ❑
Job Description: �C U 7" �l T�/ �CJAI
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Building Permit Info:
BldgC � Elect ❑ Plumb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Tyke:
1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V B �-
Valuation: Square Footage:
a
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.
Points Achieved:
For help, contact Build it Green at www.buildity reen.or
Revised 07/14/09