14010139 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19761 BIXBY DR CONTRACTOR:EVERSPRING PERMIT NO:14010139
CONSTRUCTION INC
OWNER'S NAME:
SAN JOSE,CA 95129 PHONE NO:(408)446-8398
II LICENSED CONTRACTOR'S:DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
REPLACE(E)WOOD SIDING WITH(N)STUCCO FOR 2
License Class Lic.# hod5. STORY SFD(3600S.F.)
Contractor��(E�'�1 � foCwtc(I° ate 2�{
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 lis issued. Sq.Ft Floor Area: Valuation:$30000
{ 1 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:36909050.00 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 RMIT 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 L LED 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
granting of this permit. Additionally,the applicant understands and will comply Is Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
918.
_........"... ROOFS:
Signator -`"`�' --� Date t Zr'f any r
All roofs shall be inspected prior to y roofing material being installed.If a roof is
installed without fust obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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(See.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 the Health&Safety Code,Section 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for,which this i ._ -
permit is issued. Owner or author'zo<I agettt. 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
918.
Signature Date
CONSTRUCTION PERMIT APPLICATION "
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O�
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINOILE] (408)777-3228•FAX(408)777-3333•buildingC_Dcupertino.org \
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/SDE/FEE�RRED ORIGINAL PERMIT#
PROJECT ADDRESS �Cr i ft, Y�7 APN# SL,% 47 - 030
OWNER NAME $ E MAII
STREET ADDRESS 1 (o ( (j ( yts" pa_ Gl�ll�£i�-ll I�JO I G �S/ I `t FAX
CONTACT NAME 11 �Uw a rS�� P r 1E-MAII
62
STREET ADDRESS CITY,STATE,ZIP FAX
I l3 S A,�2A 13�,.I� � �u7� , CA qS 12�
❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT 1q CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME i j A _ LICENSE NUMBER C LICENSE TYPE kj BUS.LIC#
COMPANY NAME y�V( �� CtTG(J NC.I I E-MAIL J `� FAX(L( gk 1Lf -Z
STREET ADDRESS 113( 7 �Lv>:� CrrY,STATE,ZIP�� -,05E C� �,S 12; PHONE 1
1
ARCHITECT/ENGINEER NAME - _ - LICENSE NUMBER - BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
VJ1 11-4.
DESCRIPTION OF WORK
� L'i U Lj'C
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR. DEMO TOTAL
AREA AREA AREA NETAREA
BATHROOM KITCHEN OTHER'
REMODEL AREA REMODEL AREA REMODEL AREA "
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑DETACH
. . " ATTACH
0 DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? [IN 0 ADDITION?
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN -49U `- -` OTAL.VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO 0
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on t operty owner's behalf. I have read this
application and the information I have provided' correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildin c s YejEig`dffativesof Cupertino to enter the above-identified pro erty for inspection purposes.
Signature of Applicant/Agent:
_ p Fr
_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 withPlanning prior to
submittal of Building Permit application.'
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 19761 BIXBY DR DATE: 01/24/2014 REVIEWED BY: MELISSA
APN: 369 09 050 BP#: "VALUATION: 1$30,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: PERMIT TYPE:
WORK REPLACE E WOOD SIDING WITH N STUCCO FOR 2 STORY SFD 3600S.F.
SCOPE
MENEM
Xle.ch..Plan Check Plymb.Pleat Check Elec.Plan Check
,Ltee%.Permit Fee: Plumb.Permit Fee: Elec. Permit Fee:
Other;41ech.Insp. Other Plumb Insp. Other Elee.Insp.
.11ech.Insp.Fee: Plumb. lush.Fee: Elec.Insp.Fee:
Ei
NOTE:This estimate does not include fees due to other Departments('tie.Planning,Public Works,Fire,Sanitary Sewer District,School
District etc). Thesefees7 are based on the prelimina information available and are only an estimate Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 3,600 s.£ Restucco
Suppl.PC Fee: C) Reg. ® OT 0.0 hrs $0.00 $768.00 ISTUCOAPP
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-0 Reg. ®OT0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tarr:
A din in 1 Stmt i ve.Fee:
Work Without Permit? Yes (E) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Travel Doeninentution Fees:, Building or Structure
i
Strong Motion Feer 1BSEISMICR . $3.00 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $2.00
r $5.00 $768.00 $773.00
Revised: 01/15/2014