10040155 CITY OF CUPERTINO BUILDING PERMIT
BLJILDING ADDRESS: 11607 CEDAR SPRING CT CONTRACTOR:TBD-TO BE PERMIT NO: 10040155
DETERMINED
WNER'S NAME: ALEX LYZSHEVSKY DATE ISSUED:04/26/2010
OWNER'S PHONE: 4089300243 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lic.#��<�L� REMODEL 121 SQ FT TO KITCHEN,80 SQ FT TO(2)
[ BATHROOMS 96 SQ FT TO OTHER
Contractor ��C �� ��(6r�� 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:
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:$45000
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 APN Number:36654067.00 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
corcect.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 FROIVN AST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, � � r
costs,and expenses which may accrue against said City in consequence of the Issued by• Date: ���� 1 �
granting of this permit Additionally,the applicant understands and will comply
with all non-point sou regulations per the Cupertino Municipal Code,Section
9.18.
/ RE-ROOFS:
;nature Date — 2 b � � 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.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby aftirm 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[o 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 maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. 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 permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections O5,25533,and 25534.
Section 3700 of the Labor Code,for the erformance of the work for which this ~� ��
p Owner or authorized agent: Date:
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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Warker's Compensation provisions of the Labor Code,I must I hereby affirm that[here is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permi[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
building construction,and hereby authorize representatives of this city to enter
n the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
,:��emnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point souroe regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
���'` ADDITION/REMODEL
CUPEi�TINO PERMIT APPLICATION FORM
�
�b� "�
APN # �} Date:� 2� �, �JD
���.5- DCo7«J � �
Is a 2" unit being added? Yes ❑ No If yes, please fill out the permit application for 2" unit.
Building Address: ���"0�' e��Q ��I�GI� �' � �����/2�s�il2.Or � �✓�l� -
/
Mailing Address (if different from building address):
Owner's Name: C�`I � /��y'j�- Phone# : !_("Q�—�� —C:�� ��
� � � �D ' 8'6�— ��qc
Phone#: g�� 7�� '�
Contractor: n �� ``� n�, �
rt � � ' C � c,� , Fax #: 4
Contractor License#: �'�1'��
Cupertino Business License#:
Contac • , Phone#:
�oa,� �4� �i��� F� #:
Building Permit Info: Mech. Hillside ❑
Bldg. ❑ Elect.� Plumb.
Job Description:
Addition-What is being added?(Be Specific):
. S �1,�,,�' �
What is being remodeled(not includmg 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 es, lease rovide a co of our lannin a roval letter. Planners name:
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
�i �1 ,� ��
Remodel: Kitchen �'�-� Bath ��- G Other
Type of Construction (Usage Class): Occupancy Type:
1-A 1-B IUIII/V-A ❑ II/III B, IV-HT,V-B � �-3
' � Please check this box if the project is a
Valuatio� �� � �,��
second-story addition ❑
Project Size: Express ❑ Standard ❑ Large ❑ Ma�or❑
Please complete relevant portion of the Green Building
' Checklist & attach it to the application or if applicable, Green Building Points Achieved:
include in lan set& the sheet index.
***For Office Use Only*** Revised 07/06/09
Over-the-Counter �
,t.-� CITY OF CUPERTINO
'`���`�' ADDITION/REMODEL
CUPEi�TiNo ' FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
S Ft
ADDITIONS 1R3SFDADD
1PLLONGRNGR L,ong Range PL
Plannin esidential
1R3INSP Dwellings Inspections B
1R3PLNCK Dwellings plan check B
1R3REPINSP Dwellings Repeat B �
� Ins ection
1 R3REPPLNC Dwellings Repeat Plan B
Check
1 R3HINSP Dwellings Hillside B
ins ection
1 R3HPLNCK Dwellings Hillside plan B
check
1 R3HREINSP Dwellings Hillside B
Re eat Ins ection
- 1R3HREPLNC Dwellings Hillside B
Re eat Plan Check
1R3ALTINSP Dwellings Alternate B
Materials Ins ection
1R3ALTPLNC Dwellings Alternate B
Materials Plan Check
1PCESS Cesspool P
1 PPRSEWG Ea. Private Sewage P
,
Dis osal S stem
1 PRSEWER Sewers P
1BPSPRINK Lawn Sprinkler/Backflow P
1BPWSVCS Main Water Service P
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
� Commission Fee
1BSEISMICRE SeismicResidential B
( __.
1REROOFRES Residential Re-roof Each B
100 SF
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
S Ft
DECKS 1R3SFDADD OR
1R3SFDREM
1 DECKWOOD Deck (Wood)-Each B
(Each)
1 DECKRAIL Deck Railing-Each B
(Each)
GARAGES 1R3SFDADD OR
DETACHED 1R3SFDREM �
1 GARDTW<=1 K Wood Frame up to B
1,000 SF (each)
1GARDTM<=1K Masonryup to 1,000 SF B
(each)
1BCONSTAXR Construction Tax Res
(new detached garage)
PATIO'S OPEN 1R3SFDADD OR
1R3SFDREM
1 PATIOWOOD Wood Frame up to 300 B
SF
1 PATIOMETAL Metal Frame up to 300 B
SF
1 PATIOOTHER Other Frame up to 300 SF B
PATIO'S CLOSED � 1R3SFDADD OR
& SUN ROOMS 1R3SFDREM
1PATIOENCLW Enclosed Wood up to 300 B
SF
1PATIOENCLM Enclosed Metal up to 300 B
SF
1 PATIOENCLO Other Enclosed Patio up B
to 300 SF
1 COVPORCH Porch Covered-Each B
(Each)
REMODELS 1R3SFDREM
1 REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan
� 300 SF check
1 REMRESBAT Bath Remodel up to 300 B "
1 sF
1REMREOTH Other Remodel up to 300 B "
SF
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36654067 . 00
DATE ISSUED. . . . . . . : 04/26/2010
RECEIPT # . . • • • • • • • : BS000010263
REFERENCE ID # . . . : 10040155
SITE ADDRESS . . . . . : 11607 CEDAR SPRING CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ALEX LYZSHEVSKY
ADDRESS . . . . . . . . . . : 11607 CEDAR SPRING CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5139
RECEIVED FROM . . . . : ABSOLUTE BUILDERS
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- --------
1BCBSC VALUATION 45, 000 . 00 2 . 00 0 . 00 2 . 00 0 . 00
1BSEISMICR VALUATION 45, 000 . 00 4 . 50 0 . 00 4 . 50 0 . 00
1REMRESBAT SQ FEET 80 . 00 570 . 00 0 . 00 570 . 00 0 . 00
1REMRESKIT SQ FEET 121 . 00 570 . 00 0 . 00 570 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT : 1146 . 50 0 . 00 1146 .50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER �
----------------- --------------- --------------------
CHECK 1, 146 . 50 10153
---------------
TOTAL RECEIPT : 1, 146 .50
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
( Telephone: 408-777-3228
C U P E RT I N O \ Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT#
OWNER'S NAME: PHONE # 1� 1�.� M ..
GENERAL CONTRACTOR: . G- ` BUSINESS LICENSE#� �J �S�
ADDRESS: (�� � CITY/ZIPCODE: v.� �i
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDINC FINAL OR FINAL OCCUPANCY 1 SPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTR CTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: J � �� �� �
Signa ure Date
Please check applicable subcontractors and complete the following information:
�/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork • (`� �j�
Cement Finishing �
Electrical � �
Excavation
Fencing --�)
Flooring/ Carpeting �---�—�
Linoleum/Wood
Glass/ Glazing v„V�� � (��Q,E - �{1.
Heating
Insulation
Landscaping ,
Lathing
Masonry
Painting/Wallpaper
Paving --'��
Plastering —f�-7
Plumbing '�'� � '
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile �C
�z�.�� �,��
Ow ontractor Signature Date
RESIDEN'�IAL PROJECT �OV�R SHEET
Assessor's Parcel Number: � �
� � ��a.Y�G �
Name of owner. �G _
Project address. � ' � v\ � �
Contact person.
��^� �j� / Q"1/1 Phone. � C`�
Fax.
Net square footage of lot. �
Existin Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL: �
Are there at least two 10 foot by 20 foot clear spaces inside the garage? �Y�'�
Is privacy protection planting required for the project? 'Y ��
3uild it Green Total Points -
On what floor(s) is work being done? �
�'�eS _ t e � (S �l�
,�Co� e� � Q el��
Bn f descn tion of work. - �
� �t � l �5S � �Q��/� �/�� 1����
�t���S �l�+ -G.oYc�i'
Code editions: 2007 CBC I�2007 CFC -1�2007 CMC �r-N)
2007 CPC -N)2007 NEC -N)
_, _
�-�'.�.�'���...° �':�. - '��.�.�.�
;�t�•t�(�� ���f CI
E'ffeCtlVe l�l��c� IN +i. i (1R!%r�'+ f �`a!T�t 'F{E �:ITY Uf
CU4 f E3TfNf�t��tUt'_� 4F�U;>RUINANGES
DATE___CI'� 6'I D ��'_�...
, . ._.._. ...__._._m. .,..____.__,
SIGNED_ V�
Thfs sef of pfans ar��1 ;�� �t�ct�t�<ms MUST �� � � �
be kept on tne��_,�>.�; �li n-�,���and�t�s
unlawf�:l to make a;zy chan�;e�,�3r��teraUc�ns
on same withcuc r.rrtten pYrmis:�on fro��
the Huiiding De;artn�c��,�. City c,t C�p�rnn��.
The stampmg o�th��,;�i.,��<ind specificat�ons
SNA!L NOT be hc�i,t+���perr�irt ��r to b�an
� approval of tho v���3at+o��i�.;t,�;��� F�i,�visions
Ot any�Ity Cn�Y��.�r��c.e=�x '�L�tr Lew
Plan Review Process Work Book Page-8-Revised 8/OS/08
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'L- L-, ____ _--- _ __ _
.��<,., . Community Development
,. 1 :�-. 10300 Torre Avenue
.;� ; ;�.
,� ; �'•�,. Cupertino CA 95014
Telephone(408) 777-3228
��-��� Fax(408) 777-3333
�.U���,T�1��
Building Department
All Cupertino building permits must meet certain conditions related to maintaining
environmental quality and public peace and safety. The two most common
conditions are described below.
STORMWATER POLLUTION CONTROL
State law requires that Cupertino, 12 other Silicon Valley cities, Santa Clara County and
the Santa Clara Vailey Water District control stormwater pollution. Educating local
residents and businesses and enforcing stormwater pollution control laws are key parts
of the City's compliance efforts.
Stormwater pollution prevention: It's up to us
In northern Santa Clara Valley, storm drains flow directly to local creeks and San
Francisco Bay, with no treatment. Stormwater poliution is a serious problem for wildlife
dependent on our waterways, for people living near streams and baylands, and for the -
local water suppiy. Common sources of stormwater pollution inclu�e:
• Dripped oil, fuel, and antifreeze from vehicles and heavy equipment;
• Construction debris, including dirt, concrete and paint;
• Landscaping runoff containing pesticides or weed killers; and
• Any material dumped or spilled into streets or storm drains
The property owner and the contractor share ultimate responsibility for activities
occurring at a construction site and will be held responsible for any environmental
damage caused by subcontractors or employees.
For more information on construction-related stormwater requirements, see the
Stormwater Quality Regulations section of the City of Cupertino web site at:
http //www cupertino or4/citv Qovernment/deaartments and offices/
environmental services
COMMUNITY NOISE CONTROL
The basic noise control requirements for construction sites are as follows:
• Typicel construction work hours are:
- Weekdays - 7 a.m. to 8 p.m.
- Weekends - 9 a.m. to 6 p.m. ` ` `
• Construction other than street construction is prohibited on holidays.
• Residential daytime noise levels from complaint site - 60 dBA
• Nonresidential daytime noise levels from complaint site - 65 dBA
For more information on noise control, please see Chapter 10.48 of the Cupertino
Municipal Code, which can be accessed at htt�•//www amleQal com/cupertino ca/ .
- �-
�, . _ � ;:<
Greg Casteel
Building OfFicial
_. `."a' _ _ �