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10030051 l CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22577 SAN JUAN RD CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO: 10030051 OWNER'S NAME: MICHAEL J DHUEY DATE ISSUED:03/09/2010 'PER'S PHONE: 4085053226 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT F_ PLUMB License Class j✓" Lic.# c� MECH RESIDENTIAL COMMERCIAL� Contractor � ,j_�/lDate �'' / /CJ DES I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMODEL 2 BATHROOROOF( 30SQ (commencing with Section 7000)of Division 3 of the Business&Professions MECH,PLUMB,ELECT;NONSTRUCTURAL;NO-REROOF(130SQ) **SEE NOTES** 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. 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:$20000 permit is issued. APPLICANT CERTIFICATION APN Number:34217084.00 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, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant toderstands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulatio er the Cup o Municipal Code,Section 9.18. � -3 Issued by: Date: Signatur ' 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 1,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, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors 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 Ow} r or Otho a ent: forthwith comply with such provisions or this permit shall be deemed revoked. If 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 upon the above mentioned property for inspection purposes.(We)agree to save '-rnnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the king of this permit.Additionally,the applicant priderstands and will comply ARCHITECT'S DECLARATION with all non-point source regulations er the C ino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date �'' '-'fid Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 34217084 . 00 DATE ISSUED. . . . . . . : 03/09/2010 RECEIPT #. . . . . . . . . BS000009900 REFERENCE ID # . . . : 10030051 SITE ADDRESS 22577 SAN JUAN RD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER MICHAEL J DHUEY ADDRESS 22577 CITY/STATE/ZIP CUPERTINO CA, CA 95014-3932 RECEIVED FROM JAN B EISHNBACH 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 20, 000 . 00 1. 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 20, 000 .00 2 . 00 0 . 00 2 . 00 0 . 00 1REMRESBAT SQ FEET 130 . 00 570. 00 0 . 00 570 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 573 . 00 0 .00 573 . 00 0 . 00 RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number: 'P Name of owner. M Ii L<�r Project address. S `2- 3 57 Contact person. V�AJ -�7 sEdv'�� Phone. '5/6 Z - Fax. �. r rte. Net square footage of lot. ,.. 4- Existing Proposed Square footage: First floor: Second floor: Garage: TOTAL: i Are there at least two 10 foot by 20 foot clear spaces inside the garage? r—<� Is privacy protection planting required for the project? Build it Green Total Points On what floor(s) is work being done? Brief description of work. Code editions: 2007 CBC 2007 CFC -N)2007 CMC ON) 2007 CPC ( )2007 NEC N) Effective 1/1/08 APPHl wFD IN A(;(-.ORUAN( t 'iITH THE CITY OF CUPf HTINO C,0[)t ` AN )ORDINANCES This set of plans an(1 spec.rficafions MUST be kept on the Ir,t)at all times and it is unlawful to make,iry har eyes or alterations on same without .v,!ttrr,perrnrssion from "--•",,,,,,��``` the Building Dilj>,W' �r.f,t Carty of Cupertino. The stamping of thr pl,if and specifications SHALI NOT tu- owty)it(-)r to be an aiziProtial of th( ir y I�rovi,,ions Ut iry (;iii . r in t aw Plan Review Process Work Book Page-8-Revised 8/05/08 f 1 , , i l ii , vy Ll RRcv, l I {!i f F(F( l CITY OF CUPERTINO ADDITION/REMODEL CUPEkTINO PERMIT APPLICATION FORM APN # Date: Is a 2" unit being added? Yes ❑ No © If yes, please fill out the permit application for 2" unit. Building Address: 25� � \,�4 Mailing Address (if different from building`address): Owner's Name: Phone# : yu�G S'v 3,,Z 6 Contract Phone#: C A< Fax#: Contractor License#: G?� Cupertino Business License#: Contact: Phone#: 2 l� -3 �Y 7}� t-/-,54 Fax#: Building Permit Info: Bldg. ; Elect. [ Plumb. ❑' Mech. E, Hillside ❑ Job Description: Addition-What is being added?(Be Specific): What is being remodeled (not including addition)? 1 (?_.vim sem► '1 `A e - dA- Remodel Includes Re-Roof: Yes ❑ No ® If yes list number of squares Remodel Includes Structural: Yes ❑ No 0 Do you have the pre-application planning approval? Yes ❑ No RT If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen Bath__Zj C;, Other Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B 0 II/III/V-A ❑ II/III B, IV-HT,V-B Valuation: �� .� Please check this box if the project is a second-story addition ❑ Project Size: Express n__51t�andard ❑ Large ❑ Major❑ 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. ***For Office Use Only*** ❑ Revised 07/06/09 Over-the-Counter CITY OF CUPERTINO ADDITION/REMODEL CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft ADDITIONS 1R3SFDADD 1PLLONGRNGR Long Range PL Planning/Residential 1 R31NSP Dwellings Inspections B 1 R3PLNCK Dwellings plan check B 1R3REPINSP Dwellings Repeat B Inspection 1 R3REPPLNC Dwellings Repeat Plan B Check 1R3HINSP Dwellings Hillside B inspection 1R3HPLNCK Dwellings Hillside plan B check 1R3HREINSP Dwellings Hillside B Repeat Inspection 1R3HREPLNC Dwellings Hillside B Repeat Plan Check 1R3ALTINSP Dwellings Alternate B Materials Inspection 1R3ALTPLNC Dwellings Alternate B Materials Plan Check 1PCESS Cesspool P 1PPRSEWG Ea. Private Sewage P Disposal System 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 1RER00FRES Residential Re-roof Each B 100 SF CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft DECKS 1R3SFDADD OR 1R3SFDREM 1 DECKWOOD Deck (Wood)-Each B (Each) 1 DECKRAIL Deck Railing-Each B (Each) GARAGES 1R3SFDADD OR DETACHED 1R3SFDREM 1GARDTW<=1K Wood Frame up to B 1,000 SF (each) 1 GARDTM<=1 K Masonry up to 1,000 SF B (each) 1 BCONSTAXR Construction Tax Res (new detachedgarage) PATIO'S OPEN 1R3SFDADD OR 1R3SFDREM 1 PATIOWOOD Wood Frame up to 300 B SF 1 PATIOMETAL Metal Frame up to 300 B SF 1PATIOOTHER 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 1PATIOENCLO 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 " SF 1 REMREOTH Other Remodel up to 300 B " SF