13070144 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10324 MINER PL CONTRACTOR:LOS GATOS FENSE CO& PERMIT NO: 13070144
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OWNER'S NAME: YOST GAIL A Ah+B-WA1U<E!7P TRUSTQF— 349 LINCOLN AVE DATE ISSUED:07/23/2013
OWNER'S PHONE: 4089963661 SAN JOSE,CA 95126 PHONE NO:(408)680-6581
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALEI
License Class Lic.# INSTALL(N)570 S.F.ATTACHED REDWOOD DECK,14"
�� OFF GROUND,90%OVER CONCRETE SLAB
Contractor Zas Ga-tGS rem W Date 2'- 3 — 3
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:$17000
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:31646026.00 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 FRO LED INSPECTION
indemnify and keep harmless the City of Cupertino against liabilities,judgments, l2�
costs,and expenses which may accrue against said City in consequence of the I
granting of this permit. Additionally,the applicant understands and will comply I Y Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
/ RE-ROOFS:
Signature Date 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
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
1,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 hazaXdous
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 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this �.23 -/3
permit is issued. Owner or authorized agent: Date:
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 CONSTRUCTION LENDING AGENCY
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 Licensed Professional
9.18.
Signature Date
CONSTRUCTION PERMIT APPLICATION r(��'
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION d'1
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 M
CUPEE2`CLhEO (408)777-3228• FAX(408)777-3333•building(a cupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROTECT ADDRESS /O a / n R' APN# 31/0-
1/- U� / p
OWNER NAME �� G PHONE�j�� �G/_ 3
/, E-MAIL
STREET ADDRESS �0�� I � �L' CITYvSTATE,��ZS✓�U �(p FAX
CONTACT NAME ��/'` � �� PHONEV_ /��� `� E-MAIL,
STREET ADDRESS IV: /w _/ ) w— CITY,STATE, � _7��` c� gig& FFAX
OWNER ❑ OUTIER! -BUIIAERC► ❑WOIWNERAGEENTT ❑ CONTRACTOR ❑CONI'RACTORAGENT ❑ ARCHTTECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME CNSENUMCC>>S�ETCYPlEB LIN � SIC#ger1/r?5.01
COMPANY NAME FAX� 9 /O%3CO
ST CITY STATE,ZIP PHONE
LtyftQS(?- / �v
//y�
ARCHITECT/ENGINTEER NAME LICENSE NUMBER BUS.LIC# /vV
COMPANY NAME E FAX
s K� 0 4 ( -Iry(3
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
7-0
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
USE I 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 DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA DETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY ❑YES
BEINGADDED? []NO ADDITION? []NO
PRE-APPLICATION YES IF YES,PROVIDE COPY OF IS THE BLDG AN YES ''-'-� `' �-
❑ ❑ DB Y" r�s TOTAL VALUATION
PLANNING AT'PL# ❑NO PLAIQNING APPROVAL LEITER EICHLER HOA4E? ❑NO - - n .
By my signature below,I certify to each of the following: I am the property owner or autho ' as o act o PWproperty owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verif�accurate. I agree to comply with all applicable local
ordinances and state laws relating to building constructio I authorize representatives of Cupertino to enter the above-identifiedproperty for inspection purposes.,
Signature of Applicant/Agent: Date: •/ '�. J
SUPPLEMENTAL INFO R ION REQUIRED rro � otiMEW I,ci4�{
_
New SFD or Multifamily dwellings: Apply for demolition permit fore
OVE t T COOtvTE UILDIIDGYLANREVIER a
existing building(s). Demolition permit is required prior to issuance of building = Wi
`
� F
permit for new building.
_Commercial Bldgs: Provide a completed Hazardous Materials DisclosureTAnu 1=1 pv�Llcwotires
Form if any Hazardous Materials are being used as part of this project.
_Copy of Planning Approval Letter or Meeting with Planning pfior to
pl? oR L1ARY sx IS
�.
submittal ofBuilding Permit application. ���
- � .
- 1�EA'1'IROn'MENTAI,.HEAT.1'FI :
Bld.-App_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10324 MINER PL DATE: 07/23/2013 REVIEWED BY: MELISSA
APN: 316 46 026 BP#: *VALUATION: 1$17,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION
USE: p PERMIT TYPE: i
WORK INSTALL N 570 S.F. ATTACHED REDWOOD DECK 14" OFF GROUND 90% OVER CONCRETE
SCOPE SLAB
Mech. Plan Check Plumb.Plan Check Elec:. Plan{.;heck
/lech.Permit Fee. Plumb.Per mit Pee: Elec.Permit Fee:
Other•Afech.Insp. Other Plumb Insp, Other Elec.lnsp.
Meeh.In.sp. Fe. Plumb. htslr.Fee: Elec.Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.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'1 in o.
FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 Select a Misc Bldg/Structure
Suppl.PC Fee: (E) Reg. ® OT0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: Hourly Only? ®Yes (D No $0.00
Suppl.Insp.Fee-0 Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tar:
Adrninistrative.Fee:
Work Without Permit? ® Yes No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure
Travel Documentation Fees: 'AStrong Motion Fee: 1BSEISMICR $1.70 2.0 hrs Inspections
Bldg Stds Commission Fee: IBCBSC $1.00 $278.00 ISTINSP Inspection,Hourly
$2.70 $278.00
11':= . a
Revised: 07/01/2013
Building Department
City Of Cupertino
10300 Torre Avenue
.Cupertino,CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: I 3� A4 iNee- Pte PERMIT# 91-6 q
OWNER'S NAME: GaiL Yo T PHONE#
GENERAL CONTRACTOR:Los k f^ {r•✓c,_ —r BUSINESS-LICENSE#"
ADDRESS: 3yaj ��/C%� S ti 3o3sc 5/a CITY/ZIPCODE: :5
*Our municipal code requires all businesses working in the city to have a City of Cupeptinobusiness 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:
SUBCONTRACTOR BUSINESS NAME --BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting 0 L-7 101
Linoleum/Wood
14 j
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
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This of `-'sus and specifications MUST be kart at t.'le 1 IQ�S�
l =ron;,truction. it is unlawful to-M ' -'any
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approval from the Building Oris!?.!.
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