09090153 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 16150 MELLO PL CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO:09090153
OWNER'S NAME: TIM WIDMAN DATE ISSUED:09/22/2009
FR'S PHONE: 4082521960 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F ELECT F PLUMB F
License Class_ t- Lic.# �� —t (P f—
MECH RESIDENTIAL COMMERCIAL
ContractorccvDate Z Z 6
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:INSTALL FRAMING ANGLES PER DRAWINGS AT
(commencing with Section 7000)of Division 3 of the Business&Professions CRAWL SPACE
Code and that my license is in full force and effect. AROUND PERIMETER OF FOUNDATION;CONTRACTOR(BAY
AREA RETROFIT)PD FOR BUS LIC 9/22/9
1 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:$2400
permit is issued.
APPLICANT CERTIFICATION APN Number:36905026.00 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 understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Signature Date z Issued by- 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
I,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:
I,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:
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 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&
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
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,1
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner
forthwith comply with such provisions or this permit shall be deemed revoked. % r Date: ( 1
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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
',�mnify 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
,..oting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36905026 . 00
DATE ISSUED. . . . . . . : 09/22/2009
RECEIPT #. . . . . . . . . : BS000008734
REFERENCE ID # • • . : 09090153
SITE ADDRESS 10150 MELLO PL
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER TIM WIDMAN
ADDRESS 10150 MELLO PL
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3336
RECEIVED FROM . . . . : JEFF BAILEY
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 2, 400 . 00 1 . 00 0 . 00 1. 00 0 . 00
1BSEISMICR VALUATION 2, 400 . 00 0 .50 0 .00 0.50 0 . 00
1BUSLIC FLAT RATE 1. 00 114 .00 0 . 00 114 . 00 0 . 00
1INSPCRT HOURS 1 . 00 253 . 00 0 . 00 253 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 368 .50 0. 00 368.50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 368 . 50 VISA
---------------
TOTAL RECEIPT 368 .50
RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number: 3 6
Name of owner. ` f "Lt t�✓ G�L'^ ✓1
Project address. 10 l S O 14-4- D (�
Contact person. FG c.c Phone. 5!'o . `f 1 • U YS
Fax.
Net square footage of lot.
Existin Proposed
Square footage: First floor:
Second floor: _
Garage:
TOTAL:
-e there at least two 10 foot by 20 foot clear spaces inside the garage?
Is privacy protection planting required for the project?
On what floor(s) is work being done? UrJA4(oa✓�LrGw�SPSC�
Brief description of work. I V\ PC, ( d S t S P r t vxQ�
Code editions:2008 CBC N)2008 CFC (Y-N)2008 CMC (Y-N)
2008 CPC (Y -N)2008 NEC (Y -N)
Effective 1/1/08
Plan Review Process Work Book Page-8-Revised 1/1/08
T YPICAL FLOOTOMUD SILL co
NECTIONSN
FIRST FLOOR
WALL FRAMIN%j
FLOORING
RIM JOIST FLOORING
--4- or SLOGGING
FLOOR JOIST RIM JOIST
FLOOR JOIST
LII OR LW FRAMING SLE
MUD .. .a x.-10 OR LW FRAMING AWGLE
MUD vILL
SILL
•d
t CIONGRIE
CONCRETE FOUNDATION
d FOUNDATION •` a v•
F
(Mud sill boitldnchor not shown)
(Mud sill bolt/anchor not shown
FLOOR JOIST MW-'"1DVM1 IAR TO FOUNDATION MOOR "IST IDA# ALLEL TO FOUNDATION
44' 9'
21'
)VID
tIN ACCORGAM 4 M l H T H CITY OF
_ _UPf RTINU(:o[tl `;ANO OINANCES
DATE
-__-- E ' 2 200
SIGNE Noun
This set of plans and sPec:ifications MUST
be kept on the lob at all tines and it is f3iY --
unlawful to make any changes or alterations
same without written Pt rmission from
55` t4 Building DB rjn►Pnt, (,qty of Cupertino. 14'
Th stamping of this plan and specifications
LL NOT be held to permit or to be an
ap oval of the violation of any provisions
any City Ordinance or State Law.
Shear Transfer Ties, Simpson
H-10's, 1-90's, A23's, or KC Metal
equivalent as access allows.
ACCESS Design and actual placement of
bolts, plywood panels and other
hardware may vary depending on
existing site conditions. All work
takes place in crawlspace area
below main floor.
Legend --
25°
I shear transfer tie
Tim Widman
Ij 10150 Mello Place
Cupertino, CA 95014
408-252-1960
-40-2y Area Retrofit
Howard Cook, Contractor
24' -- s' ----e3' ---_________� <510) 548-1111
CITY OF ��
CITY OF CUPERTINO
GENERAL BUILDING
CUPERTINO PERMIT APPLICATION FORM
APN# 2
0 Date:
! J C�;ZC/, � v
Building Address:
to l 5o Auljorjege
Mailing Address(if different from building address):
Are Hazardous Materials being used as part of this project? Yes El No
HOA: Exterior work only) Yes ❑ No If yes,provide letter from HOA
Owner's Name: Phone#:
Contractor: Phone: S (40. s Y B, r t(/
�, _ Fax: 5�o. 7r,`/• Y��g
Contractor License#: f3 SS g-Y& 2-
Cupertino
Cu ertino Business License#:
Contact:• Phone:
igc,.je Fax: S(d • 704- qVd
Residential 19 Commercial
Job Description: �-f-c t I ...,, .,5 c,.�j��f ,� r��G �� c� c,,�-c ,•-a c v�t�
Building Permit Info:
Bld Elect ❑ Plumb ❑ Mech ❑
Type of Construction(Usage Class): Occupancy Type:
I-A, I-B ❑ II/IIIN-A ❑ II/VI B, IV-HT,V-B V-
Valuation: Square Footage:
b
Project Size: Express[l'-"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.buildit reen.or
Revised 07/14/09
SM
CITY OF CUPERTINO
OF GENERAL BUILDING APPLICATION
CUPEI�T1N0
FEE SCHEDULE
Quantity/Sf Fee ID Fee Description Fee Permit Type
Group 1GENRES or
1GENCOM
1STUCOAP Stucco Applications (up to 400 sf) B
additional stucco application
1 WINREP Replacement windows/sliding glass B
door (ea 8 windows)
1 WINMEWSTR New Window-structural shear B
wall/masonry (includes plan ck fee)
1 EPERMITFEE Electrical Permit Fee E
1 MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit Fee P
IELCPLNCK Stand Alone Electric Pln Ck(hourly) E
1 MECPLNCK Stand Alone Mechanical Pln Ck(hrly) M
1PLMBLNCK Stand Alone Plumbing Pln Ck (hrly) P
1 STPLNCK-(3 Hr Min Standard Plan Check(when no E/M/P) B
when not over counter) hourly-stand alone
1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT
TYPES
1 BSEISMICR Seismic Residential B
1BSEISMICO Seismic Commercial B
1 TRAVDOC Travel &Documentation B
1BUSLIC Business License B
.T�1s'Q�r�` 5of 5