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14020089 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19872 PORTAL PL CONTRACTORS :P9 PERMIT NO: 14020089 DLXFIY n OWNER'S NAME: VERKHOVSKI MICHAEL AND VERKHOVSKAYA o DATE ISSUED:02/13/2014 OWNER'S PHONE: 4085405429 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL REMOVE AND REPLACE DRYROT ON TRELLIS License Class Lic.# Contractar fimf 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:$2000 I ha and will maintain Worker's Compensation Insurance,as provided for by 3700 of the Labor Code,for the performance of the work for which this APN Number:36946015 00 Occupancy Type: per t 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 FR ST 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 2 granting of this permit. Additionally,the applicant understands and will comply Issued by: 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 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 the Health&Safety Code,Section 25505,255 ,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this 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 �(J` COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 GUPEtt't`I[CO (408)7 77-322 8• FAX(408)777-3333•building(a)cugertino.org \� ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS I q&/2, -Pbrfrtt rj> I'APN# r^ O/C� OWNERNAME rlo ( K ovr S �/Cf' E-MAIL, STREET ADDRESS CITY,STATE,ZIP FAX CONTACT NAME PHONE E-MAIL () (// STREET ADDRESS 7 , -COn" CITY,ST � J�� ^ff/ ��c�v J FAX ❑ OWNER ElowNER-Bu DaL . [3 OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT LICENSE NUMBER q•�1(;r7A LICENSE TYP BUS.LIC# COMPANY NAMEn EMAIL �C. r FAX STREET ADDRE / CITY,STATE,(J✓GtLC[i 6x `/ ! q1 6 )4 6,6? ARCHITECT/ENGU MER NAME" LI F NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS 1. r CITY,STATE,ZIP / PHONE ' DESCRIPTION OF WORKIj1_p /p 'O l C 1 ✓VI EXISTING USE PROPOSED USE CONSTIL 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 -DECK AREA - TOTAL DECK/PORCH AREA I GARAGE AREA: EIDETACH []ATTACH #D WELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? []NO PRE-APPLICATION [:]YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YESNREIVEII-Ig"3 r TOT V UATION:PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NOBy my signature below,I certify to each of the following: I am the property owner or authored agente pr erty owner's behalf I have read this application and the information I have rovided is correct. I have read the Description of Work and verify it i e. I agree to comply with all applicable local ordinances and state laws relating ilding c ction. I Drize representatives of Cupertino.to.enter the above-id tified pr perty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED --- _New SFD or Multifamily dwellings: Apply for demolition permit for oTlix x LN14 . 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 with Planning prior to submittal of Building Permit application. o - ISxRL BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION 1121 ADDRESS: 19872 PORTAL PL DATE: 02/13/2014 REVIEWED BY: Mendez APN: BP#: *VALUATION: $2,000 YPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: p PERMIT TYPE: WORK remove and replace dryrot on trellis SCOPE Lt,,<:h 17an f "Ic(l; 11boO,Plan('heek f'le<:,Plan CA P rwit Fee: phwlhPermit Ft�,C: F;,tr. Pcrttr C?riowlet kiec_Imp, 11l1mh. Insp. Fee: Icer_InsrJ #ae: 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 Ef.7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? ®Yes (E) No $0.00 11 hours Plan Check,Hourly Suppl.PC Fee: (F) Reg. ® OT 0.0 1 hrs $0.00 $139.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: Hourly Only? ®Yes Q No $0.00 Suppl. Insp. Fee-.(F) Reg. () OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 FT�" r rr.5it trt ri rrr pr.<:�: 0 Work Without Permit? ® Yes Q) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Building or Structure 0 ra�>rr Do lrtn` ,Itltlt7or7 Fees: � Strom Motion Fee: IBSEISMICR $0.50 1.0 hrs Inspections Bldp Stds Commission Fee: IBCBSC $1.00 $139.00 ISTINSP Inspection,Hourly Vigo $1.50 $278.00 TOTAL FEE. $279.50 Revised: 01/15/2014 6L'ilding Department PPI FEU k 2014 REVIEWED FOR Mike Bloeman <mike@raycomail.com> ReviewedBy: Y#d, ,12, 2014 at 9:03 AM To: "miketb022@gmail.com" <miketb022@gmail.com> 5 N :.T v� O"Y Cley Go f- CIATCC I l6 ctl►c( I-,ewUe 4 /e4c-e mo o6". t !f^pf.at the V ;v ally PLOT PLANS _ CHECKED By a; ' rcial. DATE L i_NOT s li1C�vi..iZdT4 i_�?W. I ANNIN EPT. I)aT I)FPT w7AA .. \| CUPERTINO S%/hgDepartment -�� FE ) / k RE+E\ED FOR CODE COMPLIANCE Review B/ �� i k: CUPERTINO �:� i n.�ilding r)PPartrnent 4 2014 `'C)DE COMPLIANCE Reviewed By; ;; ah ` 011 : .. s � 0 4 . It �E ZA�F y� :p Mike Bloemen Project Manager M: (925) 330-4321 E: mike@raycomail.com www.raycopainting.com In an effort to service our clients in the fastest manner possible, this message was sent from my mobile phone. Please excuse typing errors and brevity. I JIVa rbinent MPLIANce