10010079 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 8191 HYANNISPORT DR CONTRACTOR:HAGOS TEKLE PERMIT NO: 10010079
CONSTRUCTION
DATE ISSUED:01/19/2010
"NER'S NAME: MCNULTY DANIEL A AND ARLENE D 8791 FALLBRIGHT WAY
OWNER'S PHONE: 4082552459
ELK GROVE,CA 95624 PHONE NO:(408)314-6475
LICENSED CONTRACTOR'S DECLARATION PERMIT INFO: BLDG ELECT PLUMB r
❑ BUILDING
License Class Lic.# L4-3 i' J ECH RESIDENTIAL COMMERCIAL
M
i �� e ��' ��"'i��
Contractor ®� DatJOB DESCRIPTION:BATHROOM REMODEL(71 SQFT)ELECT/PLUMB/MECH&
I hereby affirm that I am licensed under the provisions of Chapter 9 NON-STRUCTURAL;CONTR RENWD BSL
(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.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq,Ft Floor Area: Valuation:$15000
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. i I APN Number:35611024.00 Occupancy Type:
APPLICANT CERTIFICATION
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 relatingIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter PERM
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, � DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the 18
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section r�
Dat
Issued by:
e• �-
9.18. ._
c ature '
Date1=0��Lcl ...........
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
I,as owner of the property,or my employees with wages as their sole compensation, Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 o the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety inodMunicipal Code,Chapter 9.12 and the Health&e,Sections 25505,25533,and 25534. 1 will tain
P compliance with the Cupertino p
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534.
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 O r o thorized agent- Date:
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
the above mentioned property for inspection purposes.(We)agree to save Lender's Address
nify and keep harmless the City of Cupertino against liabilities,judgments,
cc.,cs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signatur Date
2iJ-
RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number:
I - 1;-7C��u
Name of owner.
Project address.
Pro'
�
Phone.
Contact person.
C
Fax.
Net square footage of lot.
Existin
Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL: -�
here at least two 10 foot by 20 foot clear spaces inside the garag ? Y
Are t .�. ...�
Is privacy pr planting lanting required for the project? Y N
Build it Green Total Points
On what floor(s) is work being done? f/-XVX
WA
W -lap
4
Brief description of work.
_ FC 2007 CMC C N)
-
Code editions: 2007 CBC N)2007 C
2007 CPC N)2007 NEC -N) ` �
A P F'i�t;V1 ()
IN A; HE (;ITY OF
Effective 1/1/08 CUPI f4 r 1NO(-,Of)
F 4401NANCEs
DATE
This set of
be kept on it),+,}t, it ,sig ,, },s: ,ind.t iS
unlaw#ul to mah,�& y �,_S),t1E,,,:r alterations e
on same without from 'n
the hudding DO ;rtry - t f )f Cupertino.
The stamping o�itw,�:i,f ,j»cifica!ions
SHALL. NOT be hf•Iti r,; �-r tc)bean
approvai of the vrci,,',!„ ,f,j y ivns
of,any City �g ' t,Of Law.
Plan Review Process Work Book Page-8-Revised 8/05/08
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CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35611024 . 00
DATE ISSUED. . . . . . . : 01/19/2010
RECEIPT #. . . . . . . . . : BS000009585
REFERENCE ID # . . . : 10010079
SITE ADDRESS . . . . . : 8191 HYANNISPORT DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MCNULTY DANIEL A AND ARLENE D
ADDRESS . . . . . . . . . . : 8191 HYANNISPORT DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4063
RECEIVED FROM . . . . : HAGOS G TEKLE
CONTRACTOR . . . . . . . : HAGOS TEKLE LIC # 30019
COMPANY . . . . . . . . . . : HAGOS TEKLE CONSTRUCTION
ADDRESS . . . . . . . . . . : 8791 FALLBRIGHT WAY
CITY/STATE/ZIP . . . : ELK GROVE, CA 95624
TELEPHONE . . . . . . . . : (408) 314-6475
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 15, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BSEISMICR VALUATION 15, 000 . 00 1 . 50 0 . 00 1.50 0 . 00
1BUSLIC FLAT RATE 1 . 00 114 . 00 0 . 00 114 . 00 0 . 00
1REMRESBAT SQ FEET 1 . 00 570 . 00 0 . 00 570. 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 686 .50 0 . 00 686 .50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 686 .50 #2537
---------------
TOTAL RECEIPT 686 .50
CITY OF CUPERTINO
q'Y=
ITION/REMODEL
.. �.
ADD
rt QTY°F FORM
Cu T
�E Iti�o PERMIT APPLICATION
FXP_N_141 � _
_ Date: Q
rn
Is a 2n unit being added? Yes No [� If yes, please fill out the permit application for 2 unit.
❑
Building Address: OK
Mailing Ad ress (if different from building address):
Phone# r
Owner's Name: /�\� /Yf�
< Phone#(. 14oZ2 ,��1—r` �`
7 5`
Contractor.. Fax #:
Contractor License#: -1+5
t
Cupertino Business License#:
Contact:
#:
-. Fax#:
Building Permit Info: Mech. Hillside ❑
g
Bld . ❑ Elect. R-1
Plumb.
Job Description:
Addition-What is being added?(Be Specific):
What is being remodeled (not including addition)?
Remodel Includes Re-Roof: Yes ❑ No ® If yes list number of squares
Remodel Includes Structural: Yes ❑ No J�j
Do you have t pre-
he a lication planning approval? Yes ❑ No EJ
pp
If es, lease provide a co of our lannin a roval letter. Planners name:
Square Footage: Attached
' ion: Porch: Deck: Garage: Detached
Addition:
Remodel: Kitchen Bath 70 f Other
Typ4f Construction(Usage Class): Occupancy Type:
11/111/V-AA F-1II/III B. IV-HT, V-B
I P
1-A L�'''�
' 1-B ❑ II/IIPlease check this box if the project is a
Valuation:
second-story addition
Pro'ect Size: Express E] Standard ® Large [I Ma'or❑
�
Please complete relevant portion of the Green Building p is Achieved:
Checklist& attach it to the application or if applicable, Green Building 9c
Ch .�'
include in lan set & the sheet index.
***For Office Use Only*** Revised 07/06/09
Over-the-Counter ❑
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 1 R3 SFDREM
1 GARDTW<=1 K 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 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
1 PATIOENCLW 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 66
SF
1 REMREOTH Other Remodel up to 300 B
SF
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
1MECPLNCK Stand Alone Mechanical M
Pln Ck(hourly
1 PLMPLNCK Stand Alone Plumbing P
Pln Ck (hourly)
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1 BSEISMICRE Seismic Residential B
1 TRAVDOC Travel &Documentation B
1BUSLIC Business License B
' Community Development
Y 10300 Torre Avenue
z w " Cupertino CA 95014
Telephone(408)777-3228
C1W OF Fax(408)777-3333
U PEkTINO
Building Department
JOB ADDRESS: PERMIT #
f 0f �
OWNER NAME
I� �L�� n���� � PHO ' #(Z062 �l
GENERAL CONTRACTOR: FAX #
�' l_
I am not using any subcontractors: � �', 2r- /
Signature Date
Please check applicable subcontractors and complete the following information:
Fa SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
f/ Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date