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13060167 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20777 GREENLEAF DR CONTRACTOR:BELLA CONSTRUCTION PERMIT NO:13060167 &STRUCTURAL CO OWNER'S NAME: PETER WILSON 1845 ROCHELLE DR DATE ISSUED:06/20/2013 OWNER'S PHONE: 4088236351 SAN JOSE,CA 95124 PHONE NO:(408)205-3721 II ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL a COMMERCIAL RLicense Class g _ Lic.# APPLY STUCCO OVER(E)WOOD SIDING TO MATCH(E) 9 j 5 3 TEXTURE Contractor 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. Sq.Ft Floor Area: Valuation:$8000 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:32609002.00 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 PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter T CALLED INSPECTION. upon the above mentioned property for inspection purposes. (We)agree to save 180 D indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I Date: granting of this permit. Additionally,the applicant understands and will comply with all non-point sour is the Cupertino Municipal Code,Section 9.18. RE-ROOFS. Signature Date RZ018 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. ❑ OWNER-BUILDER DECLARATION Date: Signature of Applicant: 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 isnot intended or offered for sale(Sec.7044, Business&Professions Code) HAZARDOUS MATERIALS DISCLOSURE 1,as owner of the property,am exclusively contracting with licensed contractors to 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. 1 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 will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,as provided for by 25534. the Health&Safety Code,Sections 5 Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age Date: 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,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 1_icensed Professional 9.18. Signature Date J \b s, CONSTRUCTION PERMIT APPLICATION O G COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION b 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 "J CUPERTINO (408)777-3228• FAX (408)777-3333•buildingna cupertino.org ❑NEW CONSTRUCTION ElADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIIGINAL PERMIT 9 PROJECT ADDRESSAPN# —O 6 - rJ lee, e 36� , r7 - 0 / Z OWNER NAME Petfr ` !I '>COQ PHONE C n 2-3— /(�351 E-MAIL STREET ADDRESS 20q11 6'.-ee e 11 /Ve CITY, STATE,ZIP Cd fe.,tl h o FAX CONTACT NAME C PHONE EMAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAMEW-4 LICENSE NUMBER ^ ., LICENSE TYPE BUS.LIC 11 t y COMPANY NAME I� n j I� L E-MAIL FAX r�C Il Gn r(4 Tip ►titdtt✓ STREET ADDRESS ZZ Q/J s S C�V Q CPTY,STATE,ZIP /"I,A I J J tJ �S PHO 0 \59 j ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK r 1 EXISTING USE PROPOSED USE CONSTR TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECKAREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BE EVG ADDED? E]NO ADDITION? NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑TES RECEI VED BY: TOT UATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HONE? ❑NO GG O By my signature below,I certify to each of the following: I am the property owner or auth `z nt act on property owner's behalf. I have read this application and the information I have provided is coqI have read the Description of and ri accurate. I agree to comply with all applicable local ordinances and state laws relating to build' v, uu, 1. uQor, esematives of Cupertino nter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INF RMATION REQUIRED PLAN CHECK TYPE ROi.'TING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BLH DiNc PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REN 1Ew _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ElPUBLIC-1voRKS, form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. NAaoR El SANITARY sER ER DISTRrCT ❑ E\1TRONNIENT.ALHEALTH Bldg,4pp_2011.doc revised 06/21111 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20777 GREENLEAF DR DATE: 06/20/2013 REVIEWED BY: MELISSA APN: 326 09 002 BP#: `VALUATION: $8,000 rPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY PENTAMATION 1GENRES USE: SFD or Duplex PERMIT TYPE: WORK APPLY STUCCO OVER E WOOD SIDING TO MATCH E TEXTURE SCOPE Ltech. Plan t' Pl unb.Plan Check r>C.Plan Check Plumb. Permit Fee: Elec. Permit Pee: Other i1fech.Insp Other Plumb Insp, Lj )cher Elee.Insp. Ll Plumb. Insp Fce: r lncp_ FCC, � ' r11cc•h.Insp. Fee: t NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7%1121 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F,,200 s.f. Restucco Suppl. PC Fee: (F) Reg. ® OT 0.0 hrs $0.00 $535.00 1STUCOAP7P PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tay: .Administrative Fee: Work Without Permit? © Yes (F) No $0.00 Advanced Planning,Fee: $0.00 Select a Non-Residential 0 Building or Structure 71'uvel Docuinentaliorr (•e cs_ I A Strong Motion Fee: IBSEISMICR $0.80 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.80 $535.001 TOTAL FEE: $536.80 Revised: 04/29/2013