13100066Ell.
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22740 SAN JUAN RD
CONTRACTOR: ROSSETTAS ROOFING
PERMIT NO: 13100066
OWNER'S NAME: KOTTKE NELSON AND AMANDA T
401 LINCOLN AVE
DATE ISSUED: 10/09/2013
OWNER'S PHONE: 4088025173
SAN JOSE, CA 95126
PHONE NO: (408)294 -4400
a NE LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
Lic. #
REPAIR (E) BALCONY OVER GARAGE, INCLUDING (N)
License Class
Contractor C fr. �(� tf E-KL Date t 01h 3
PLYWOOD, RAILING & WATER - PROOFING. 377 S.F.
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: $20000
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 34221012.00
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITBIIN 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 F ED 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
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granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
RE- ROOFS:
All be inspected to any roofing material being installed. If a roof is
9.18.
��
(1 Date It, t l -
Signature
roofs shall prior
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. 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 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
Section 3700 of the Labor Code, for the performance of the work for which this
the Health & Safety Code, Sections 2550,5,, 25533, and 25534.
Owner or authorized agent: /�" Date: to �3
permit is issued.
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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
Licensed Professional
9.18.
Signature Date
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • buildingRcupertino.org
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❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT O
PROJECT ADDRESS 27 1 6 J d,
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❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT 1' CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
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LICENSE NUMBE
LICIS E
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
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FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK //� U •<
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EXISTING USE
PROPOSED USE CONSTR
TYPE
# STORIES
I
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
REMODEL AREA
KITCHEN
REMODEL AREA
OTHER
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
[] ATTACH
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#DWELLING UNITS:
IS A SECOND UNrr [3 YES
SECONDSTORY ❑YES
BEING ADDED? []NO
ADDITION? []NO
PRE - APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES TOTAL VALUATION:
PLANNING APPL # ❑ NO' PLANNING APPROVAL LETTER EICHLER HOME? [] N k` `" '�; c + --
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By my signature below, I certify to each of the following: I am the property owner or authorized agent to ac 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 accurate. I agree to comply with all applicable local
ordinances and state laws relating to building c struction. I authorize representatives of Cupertino to enter the abov -identified property for inspection purposes.
Signature of Applicant/Agent: Date: n 3
SUPPLEMENTAL INFORMATION REQUIRED
E
_ 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.'
R OUt`1TER, ',
. EXPRESS
at `
❑'`$UILDDVriP.L1.NRE �. ".;_.
❑ RR GP �
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if Hazardous Materials being
any are used as part of this project.
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
�
fl„ � x ONI�IENTAY.F�TIIi�,.
B1dgApp_2011.doc revised 06121111
rr•ry nTi CITPRRTINO
Tech. Plan (heck Plumb, Plan C'hcc °k Elec. Plan (.;heck
ifec.h. 1'ernrit Fee: Plumb. Permit Pee: lilec•. Permit Pee:
Other rllech. Insp. Other Plumb Insp. Other P.lec. Insp.
Plumb. Iris Fee: Elee. Insp. Fee:
,laech. Insp. Fee: � 1
_ n_ _ n.___..:..,. D..A /:.. *7. Fir. v..itnru.Qvwer District. School
NOTE: This estimate aoes not inctuae jeer aae w o118e1 ... , »• - . »•••- _ ______ .. _ _ _
District, etc.). These fees are based on the relimina in ormation available and are onl an estimates Contact the Dept or addn'1
FEE ITEMS (Fee Resolution 11 -053 E . 7ff /1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.£ �Rem�odel, Other Suppl. P C Fee: � Reg. ® OT 0.0 hrs $0.00
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. ® OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0
7 tax:
Administrative Fee:
Work Without Permit? ® Yes No $0.00
Advanced Planning Fee $0.00 Select a Non - Residential (2)
Building or Structure
Trawl Documentation Fees: � 0
Strong Motion Fee: 1BSEISMICR $2.00 Select an Administrative Item
Bldg, Stds Commission Fee: IBCBSC $1.00
$3.00 $488.00 W $491.00
Revised: 10/01/2013
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 22740 SAN JUAN RD DATE: 10/09/2013
APN: 342 21 012 BP #:
REVIEWED BY: MELISSA
`VALUATION: $20,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY PENTAMATION 1 R3SFDREM
USE: SFD or Duplex PERMIT TYPE:
WORK REPAIR E BALCONY OVER GARAGE INCLUDING N PLYWOOD RAILING &
SCOPE
WATER- PROOFING. 377 S.F.
wt
a
Tech. Plan (heck Plumb, Plan C'hcc °k Elec. Plan (.;heck
ifec.h. 1'ernrit Fee: Plumb. Permit Pee: lilec•. Permit Pee:
Other rllech. Insp. Other Plumb Insp. Other P.lec. Insp.
Plumb. Iris Fee: Elee. Insp. Fee:
,laech. Insp. Fee: � 1
_ n_ _ n.___..:..,. D..A /:.. *7. Fir. v..itnru.Qvwer District. School
NOTE: This estimate aoes not inctuae jeer aae w o118e1 ... , »• - . »•••- _ ______ .. _ _ _
District, etc.). These fees are based on the relimina in ormation available and are onl an estimates Contact the Dept or addn'1
FEE ITEMS (Fee Resolution 11 -053 E . 7ff /1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.£ �Rem�odel, Other Suppl. P C Fee: � Reg. ® OT 0.0 hrs $0.00
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. ® OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0
7 tax:
Administrative Fee:
Work Without Permit? ® Yes No $0.00
Advanced Planning Fee $0.00 Select a Non - Residential (2)
Building or Structure
Trawl Documentation Fees: � 0
Strong Motion Fee: 1BSEISMICR $2.00 Select an Administrative Item
Bldg, Stds Commission Fee: IBCBSC $1.00
$3.00 $488.00 W $491.00
Revised: 10/01/2013
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PLOT PLANS
CHECKED BY
DATE
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'�DATE
WiMG. OFT.
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OFFICE COP`S,
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PLOT PLANS
CHECKED BY
DATE
PLAAA
'�DATE
WiMG. OFT.
�n NOV 13 2013
OFFICE COP`S,
1 151 o046