13080235CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10760 MORENGO DR
CONTRACTOR: VANNI BROTHERS
PERMIT NO: 13080235
CONSTRUCTION
OWNER'S NAME: LESLIE SKOWBOR
18964 SARA PARK CIR
DATE ISSUED: 08/30/2013
OWNER'S PHONE: 4088131375
SARATOGA, CA 95070
PHONE NO: (408)253-7028
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
d2/LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # S 37Z 9
RECONFIGURE (E) KITCHEN, ADD (N) LIGHT FIXTURES,
I% X03 6119'' Date 8 �25'—�3
Contractor Qn n ,
(N) OUTLET RECEPTACLES & UPGRADE (E) ELECTRICAL
SERVICE TO 200 AMPS
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
Sq. Ft Floor Area:
Valuation: $3100
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
APN Number: 37535057.00
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 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
�i 3v 3
granting of this permit. Additionally, the applicant understands and will comply
y: Date:
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18.
RE-ROOFS:
Signature Date r��2%� ��
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
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)
1, 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. 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(x) 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 25505, 25533, ap d 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
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
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
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 �
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION \
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building a cupertino.org
CUPER'T'INO I \
[:]NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADD j jj J % r p r• APN 903
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OWNER NAME �-1 [� % PI -IN o �y �% 13 ,-+ f 3 �� E-MAILAV119 (j
STREET ADDRESS /o
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CONTACT NAME 6 V C` /PHONE y� M�b l o d -e / f Q�' G
STREET ADDRESS
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IS A SECOND UNIT LJ YES
BEING ADDED? ONO
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❑OWNER ❑OWNER-BUII.DER ❑OWNER AGENT ❑ CONTRACTOR ❑ CONiRACTORAGENT
❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAMEj1%/ ,
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LICENSE NUMBER
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CITY, STATE, ZIP
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BUS. LIC #
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LICENSE NUMBER
USE TYPE
BUS. LIC #
COMPANY NAME
IS A SECOND UNIT LJ YES
BEING ADDED? ONO
SLUUrvu b i unx U i no
ADDITION? ❑NO
E-MAIL
FAX
STREET ADDRESS
PRE -APPLICATION OYES IF YES, PROVIDE COPY OF IS TAE BLDG AN ❑ YES s -TOTAL VALUATION:
EICALER ROME? ❑ NO
3 ��o
PLANNING ADPL # ❑ NO PLANNING APPROVAL LETTER
CITY, STATE, ZIP
application and the information I have provided is correct. I have read the Description of Work and verify accurate.
I thorize representatives of Cupertino to enter the above-iidentified propertyfor inspection purposes.
PHONE
DESCRIPTION OF WORK
/ TGA L'
of
SUPPLEMENTAL INFORMATION REQUIRED
EXISTING USE
PROPOSED USE
CONSTR. TYPE
#STORIES
USE TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
RD
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F -
REMODEITCHEN OTHER
REMODEL AREA REMODEL AREA
T -A, r rvmnvrN.ARTA I GARAGE AREA: I_I DETACH
_ Copy of Planning Approval Letter or Meeting with Planning prior to
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REMODEBATHRL
A
REMODEL AREA
______ .__. .•..,.., ....-.
# DWELLING UNITS:
IS A SECOND UNIT LJ YES
BEING ADDED? ONO
SLUUrvu b i unx U i no
ADDITION? ❑NO
PRE -APPLICATION OYES IF YES, PROVIDE COPY OF IS TAE BLDG AN ❑ YES s -TOTAL VALUATION:
EICALER ROME? ❑ NO
3 ��o
PLANNING ADPL # ❑ NO PLANNING APPROVAL LETTER
By my signature below, I certify to each of the following: I am the property owner or authorized agent R on then perry owner's behalf. I have read this .
it is I agree to comply With all applicable local
application and the information I have provided is correct. I have read the Description of Work and verify accurate.
I thorize representatives of Cupertino to enter the above-iidentified propertyfor inspection purposes.
ordinances and state laws relating to buildin c struction.
o — L% ` �J
Signature Applicant/Agent: Date:
of
SUPPLEMENTAL INFORMATION REQUIRED
New SFD or Multifamily dwellings: Apply for demolition permit for
per,
_
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
RD
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_
form if any Hazardous Materials are being used as part of this project.
F -
_ Copy of Planning Approval Letter or Meeting with Planning prior to
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submittal of Building Permit application.
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FFF. FRTIMATOR — BUILDING DIVISION
:tech. Flan Check
blec;lt. Permit Fee:
Other ,llech. Insp.
_11ech. Insp. Few:
Phunb. Plan Check
Plumb. Permit Fee:
Other Plumb Insp.
Plumb. Insp. Fee:
Elec. Plan Check 10.0 1 hrs $0.001
Elec. Permit Fee: IEPERMIT I
Other Elec. Insp. 1 0.0 1 hrs 1 $47.00
Elec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public works, tire, sanitary Fewer Distract, school
aliefrint atn 1 Th— faac -a knead nn tha nroliminnrV infnrmatian ovailohlo and orH aniv an ewimalo- Contact the Dent for addn 11 info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12)
ADDRESS: 10760 morengo dr
DATE: 08/30/2013
REVIEWED BY: MELISSA
APN: 375 35 057
BP#:
*VALUATION: 1$3,100
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
SFD or Duplex
Suppl. PC Fee: (j) Reg. ® OT
PENTAMATION
1 R3SFDRE
USE:
$0.00
PERMIT TYPE:
WORK
RECONFIGURE E KITCHEN ADD N LIGHT FIXTURES N OUTLET RECEPTACLES &
SCOPE
UPGRADE (E) ELECTRICAL SERVICE TO 200 AMPS
:tech. Flan Check
blec;lt. Permit Fee:
Other ,llech. Insp.
_11ech. Insp. Few:
Phunb. Plan Check
Plumb. Permit Fee:
Other Plumb Insp.
Plumb. Insp. Fee:
Elec. Plan Check 10.0 1 hrs $0.001
Elec. Permit Fee: IEPERMIT I
Other Elec. Insp. 1 0.0 1 hrs 1 $47.00
Elec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public works, tire, sanitary Fewer Distract, school
aliefrint atn 1 Th— faac -a knead nn tha nroliminnrV infnrmatian ovailohlo and orH aniv an ewimalo- Contact the Dent for addn 11 info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
1 155 1 s.f.
$626.00
Remodel, Kitchen (<=300 sf)
1REMRESKIT
Suppl. PC Fee: (j) Reg. ® OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
F-2--00-1 amps
$47.00
Electrical
IBELEC200 Services
Permit Fee:
$0.00
Suppl. Insp. Fee,0 Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$47.00
Cnnsir action 1 ax.
Administrative Fee: 1ADMIN
$44.00
0
Work Without Permit? ® Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
1
0
Travel Documentation Fee: ITRAVDOC
$47.00
Strong Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
H �.
Wei
ti ,.,
$139.50
$673.00.
k®x:m
$812.50
A� N e Revised: 07/01/2013
DATE- Y?7
JOB- LAJ DOW I O'
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Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
L U P E RT I N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST-
JOB
IST
*Our municipal code requires all businesses working in the city to have a City of C- i no:business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL..BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRAC RS 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 t> BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing TA
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
3,
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner /Contractor Signature Date.
�_y
JOB ADDRESS: /D 760 o'r,O <` . PERMIT # 0 S-55
OWNER'S NAME: )D,4v/ 0 S%Z w h o PHONE # . 0?3` g 3"' ! 3
GENERAL CONTRACTOR: L/ „/1V, j3 r00w374, BUSINESS LICENSE #' _v3 72 S g
ADDRESS: Ig -916V 5;q.,,4 ���� Cz✓ , CITY/ZIPCODE:Sar- :
*Our municipal code requires all businesses working in the city to have a City of C- i no:business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL..BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRAC RS 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 t> BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing TA
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
3,
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner /Contractor Signature Date.
�_y