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10010047 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7543 NORMANDY WAY CONTRACTOR:SIERS CONSTRUCTION PERMIT NO: 10010047 OWNER'S NAME: SOHN JEFFREY B AND AVRIL 748 COLEMAN AVE STE D DATE ISSUED:01/11/2010 ,WNER'S PHONE: 4082559582 SAN JOSE,CA 95110 PHONE NO:(408)781-0124 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lic.# —jy �r 1 �' REMODEL 70 SQ FT TO BATHROOM,SKYLIGHT 2X2 NON-OPP Contractor- ''_#�Z'u f 0"` Date /3eee0 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:$10000 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 APN Number:36611152.00 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 Issued by: Date: granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. ,,> v RE-ROOFS:Date All roofs shall be inspected prior to any roofing Signature f`'� material being installed.If a roof is z. installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ 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 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 5505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this �v Owner or authorized agent: Date: Z 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 Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there 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 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 to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION demnify and keep harmless the City of Cupertino against liabilities,judgments, .,)sts,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 source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date l �U CITY OF CUPERTINO 1"W ADDITION/REMODEL UPEY TING PERMIT APPLICATION FORM nO I to APN # Date: f Is a 2"d unit being added? Yes es, please fill out the permit application for 211 unit. ❑ No If Y Building Address: J. Mailing Address (if different_from building address): Owner' Name• Phone# : Contractor: Phone#: Fax #: Contractor License#: f Cupertino Business License#: Contact: Phone#: Fax #. Building Permit Info: Bldg. r Elect. Plumb.` Mech. ❑ Hillside Job Description: Addition-What is being added?(Be Specific): A 0k What is being remodeled (not including addition)? f/ Remodel Includes Re-Roof: Yes ❑ No If yes list number of squares Remodel Includes Structural: Yes ❑ No p Do you pp re- have the a lication planning approval? Yes ❑ No [` If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen Bath C/ —�� ~Other Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B Valuation: Please check this box if the project is a C�C 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 plan set& the sheet index. ***For Office Use Only*** Over-the-Counter ❑ Revised 07/06/09 CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE ---------------- Fee Description Fee Group Permit Type Quantity Fee ID p S Ft IR3SFDADD OR DECKS 1R3SFDREM I DECKWOOD Deck (Wood)-Each B (Each) B I DECKRAIL Deck Railing-Each (Each IR3SFDADD OR GARAGES IR3SFDREM DETACHED 1 GARDTW<=1 K Wood Frame up to B 1,000 SF (each) 1 GARDTM<=1 K Masonry up to I,000 SF B (each) 1 BCONSTAXR Construction Tax Res (new detached garage) DADD OR OPEN PATIO'S IR3SFIR3SFDREM IPATIOWOOD Wood Frame up to 300 B SF 1PATIOMETAL Metal Frame up to 300 B SF 1PATIOOTHER Other Frame up to 300 SF B PATIO'S CLOSED 1R3SFDADD OR IR3SFDREM & SUN ROOMS 1PATIOENCLW Enclosed Wood up to 300 B SF IPATIOENCLM Enclosed Metal up to 300 B SF IPATIOENCLO Other Enclosed Patio up B to 300 SF 1 COVPORCH Porch Covered-Each B (Each) IR3SFDREM REMODELS RESKIT Kitchen Remodel up to B educt "$"for ea plan 1 REM 300 SF check 1REMRESBAT Bath Remodel up to 300 B « SF 00 B « 1 REMREOTH Other Remodel up to 3 SF CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee GroupPermit Type S Ft yp 1 MECPLNCK 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 i 1 BSEISMICRE Seismic Residential B 1 TRAVDOC Travel & Documentation B 1 BUSLIC Business License B `• . 1 A � C � fi5.rol Community Development 10300 Torre Avenue Cupertino CA 95014 wgw, Telephone(408)777-3228 _. .... Fax(408)777-3333 CITY 0 ,.,U PEkTIN0 Building Department JOB ADDRESS: /1/ 0'y �-�'' `� PERMIT # OWNER'S NAME: �.• �-�' !✓, S / PHONE # ��' _ `� S••, GENERAL CONTRACTOR:%t''•S C FAX # C: I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: F-a 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 Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date