13060003CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20064 JOHN DR CONTRACTOR-` 1!rBE PERMIT NO: 13060003
OWNER'S NAME: MICHAEL TIMPANARO PERROTTA �(� 6}.j r DATE ISSUED: 06/03/2013
OWNER'S PHONE: 4088214086 I , 1 PHONE NO: I
❑ LICENSED CONTRACTOR'S DECLARATION
License Class)) S Lic. # C,G3l
Contractor L)IL ,4A� 0 f — 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.
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
permit is issued.
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 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
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.
Signature Date
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
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
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
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
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
forthwith comply with such provisions or this permit shall be deemed revoked.
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 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
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.
Signature Date
JOB DESCRIPTION: RESIDENTIAL
COMMERCIAL
REMOVE AND REPLACE 2 WINDOWS IN FAMILY AND
LAUNDRY
ROOM TO INCLUDE DRY ROT REPAIR, DRYWALL
REPLACEMENT, UPGRADE LIGHTS 8 LIGHTS IN
FAMILY
Sq. Ft Floor Area: I Valuation: $6000
APN Number: 36934027.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAY R LAST CALLED INSPECTION.
Issued by: Date: 4pt�
RE -ROOFS:
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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air 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 Health & Safety Code, Sectio 25505, 25533, and 25534.
Owner or authorized agent: Date: 3
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CONSTRUCTION PERMIT APPLICATION
Is COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildin-ga-cupertino.org
❑ NEW CONSTRUCTION ❑ .ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS `T
APN #
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT D
ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
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LICEISTIE�
LICENS YPE
BUS. LIC #
CO NAME
E-MAIL
FAX
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PHONE
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC # '
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
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EXISTING USE
PROPOSED USE CONSTR.
TYPE
i # STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
IJATTACH
# DWELLING UNITS:
IS A SECOND UNrr ❑ YES
SECOND STORY ❑ YES
_
BEING ADDED? ❑NO
ADIIITION? ❑NO
PRE -APPLICATION ❑YES. IF YES, PROVIDE COPY OF
IS -TRE BLDG AN ❑YES
- ...
_
_..._,
TOTAL VALIJA�T ON:
PLANNING APPL # ❑ NO - PLANNINGAPPROVAL LETTER
EICHLER HOM,B? ❑ NO
j` o C//4u-
By my signature below, I certify to each of the following: I am the property owner or authorized agent to
t on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify
is accurate. I agree to comply with all applicable local
ordinances and state laws relating to b Wing co frac ion. I authorize representatives of Cupertino to enter the abov -id ntified property for inspection purposes.
Signature of Applicant/Agent: A Date:
(e
SUPPLEMENTAL INFORMATION REQUIRED
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
BIdgApp_2011.doc revised 06/21/11
-� CITY OF CUPERTINO
IMPIP 1VQ9r1r1%4 A WnD — RTTTT .D1NC DIVTClON
Weeh. Plan Check Plumb.:Plan Check Elec. Plan Check 0.0 1 hrs $0.00
Jklech. Perwit I ee ' Plumb. Permit ree: Elec. Permit Fee: IEPERMIT
Other tech. Insp. Other Plumh Imp. Other Elea Insp. 0.0 hrs $45.00
1..11ech. Insp. Fee: Plumb. Insp. Fee: Elec. Insp, Fee:
NOTE. This estimate does not include fees due to other Departments (i.e. rtanntng, runac rrorKs, rtre, aanuary newer �t�zrou, .c owi
District, etc.). These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info,
ADDRESS: 20064 john st
DATE: 06/03/2013
REVIEWED BY: mendez
MISC ITEMS
APN:
BP#:
"VALUATION:
1$6,000
*PERMIT TYPE: Building Permit-
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Du lex
USE: p
PME Plan Check:
PENTAMATION 1GENRES
PERMIT TYPE: A
WORK
remove and replace 2 windows in family and laundry room to include dry rot repair, drywall
SCOPE
replacement, upgrade lights 8 lights in family room
Weeh. Plan Check Plumb.:Plan Check Elec. Plan Check 0.0 1 hrs $0.00
Jklech. Perwit I ee ' Plumb. Permit ree: Elec. Permit Fee: IEPERMIT
Other tech. Insp. Other Plumh Imp. Other Elea Insp. 0.0 hrs $45.00
1..11ech. Insp. Fee: Plumb. Insp. Fee: Elec. Insp, Fee:
NOTE. This estimate does not include fees due to other Departments (i.e. rtanntng, runac rrorKs, rtre, aanuary newer �t�zrou, .c owi
District, etc.). These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 11-1153 E . 7/1/12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.002=
# Window / Sliding Glass Door
$400.00 IWINREP 7 Replacement
Suppl. PC Fee: Q Reg. 0 OT
0.0 I
hrs
$0.00
PME Plan Check:
$0.008
Electrical
$67.00 1BREMFIXT Fixtures, Lighting
Permit Fee: Hourly Only? Yes No
$0.00
Suppl. Insp. Fee: Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$45.00
C onstrztclion .Tax.
Administrative Fee: IADMIN
$42.00
E)
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Feer
$0.00
Select a Non -Residential G
Building or Structure
Travel Documentation Fee: I'TRA VDOC
$4.5.00
Strom Motion Fee: IBSEISMICR
$0.60
1.0
hrs Inspections
IBCBSC $1.00 $133.00 ISTINSP Inspection, Hourly
$133.60 $600.00e: $733.60
Revised: 04/29/2013
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CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS:(J �✓
PERMIT # /30tn0�3
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR: S e0 G GL
BUSINESS LICENSE #
ADDRESS:
CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:�
Signature Date
Please check applicable subcontractors and complete the following information:
/ Contractor Signature
4.[al is
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
(?j
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
/ Contractor Signature
4.[al is
Date