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14040046I CITY OF CUPERTINO BUILDING PERMIT I 1 BUILDING ADDRESS: 10146 ALPINE DR I GALE CONTRACTOR: AVRAM MEYERS AND I PERMIT NO: 14040046 MEYERS I OWNER'S NAME: AVRAM MEYERS AND GALE MEYERS OWNER'S PHONE: 4155156644 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic.# Contractor 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. 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 permit is issued. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9 18. Signature Date Ly OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non- poi,Ut source regulaVgns per the Cupertino Municipal Code, Section 918. -9-1%/ 10146 ALPINE DR UNIT 1 ! DATE ISSUED: 04/08/2014 CUPERTINO, CA 95014 1 PHONE NO: JOB DESCRIPTION: RESIDENTIAL [] COMMERCIAL 0 REMODEL KITCHEN 250 SQ FT, (2) BATHROOMS, 190 SQ FT, REMOVE AND REPLACE 9 WINDOWS TO MEET EGRESS IN BEDROOMS, 2 SLIDING DOORS Sq. Ft Floor Area: I Valuation: $2000 APN Number: 32615105 00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN DAYS OF PERMIT ISSUANCE OR 180 DAY LAST CALLED INSPE T N. Issued by: Date: / RE- ROOFS: 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. Signature of Applicant: Date- ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Mr Quality Management District I will maintain compliance with the upertiuyf Municipal Code, Chapter 9.12 and the Health & Safety Code, Sect' ns 5505, 5533, and 25534. Owner or authorized agent: v "" Dater CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Profess CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • buildingg-)-cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION 1�Ue v� \O r ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS 1,-1-211f,6 /J � G.- e APN# 05 OWNER NAME j// /" �i`id ,/"• 0' PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP ,- av� i 01 NVIAE-MAIL CONTACT NAME A/� [ PHONE STREET ADDRESS CITY, STATE, ZIP FAX OWNER 11 OWNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER 777SFTYPE BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE J DESCRIPTION OF WORK rh /P6C 1z -/ v C-4-rf ,q� rat �3s4i �f_ SEC oc;9TE sh`E1� Tol - -7- W E -7W ?- ,C ExignNG USE v PROPOS D USE CONSTR. _` S TYPE � D # STORIE S 2 USE TYPE OTC. SQ.FT. VALUATION (S) EXISTG _ AREA / f&,p NEW FLOG AREA Y &P DEMO /'y AREA /4?Z>0 C ( TOTAL NET AREA BATHROOM( REMODEL AREA KITCHEN REMODEL AREA ��© OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: H I ACH I # DWELLING UNITS: IS A SECOND UNIT ❑ YES BEING ADDED? f?Kr SECOND STORY ❑YES ADDITION? e3Q6^ PRE- APPLICATION El YES IF YES, PROVIDE COPY OF PLANNING APPL # 3�K6 PLANNING APPROVAL LETTER IS THE BLDG AN [] YES EICHLERHOME? ®ddtf akRECEIUE I +;`' ' � ��' - TO By my signature below, I certify to each of the following: I am the property owner or authorized a to act on the property owner's behalf. I have read this application and the information I have provided 1 ITect. I have d the Descrip n of Work and ify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building ction.�I a o e repre;n tives of Cupertin o enter the above- identified Tperty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED .. g ,_RGUTIncsLlr_ New SFD or Multifamily dwellings: Apply for demolition permit for z- OVER THE -CO TIER k �I' DII�(i P,L'AN REVIEW existing building(s). Demolition permit is required prior to issuance of building,, permit for new building. g. EaPRESS a +� � GPL�REVIEW� _Commercial Bldgs: Provide a completed Hazardous Materials DisclosuresTAIDnRD form if any Hazardous Materials are being used as part of this project. �� us IC Wb7t�TCS�. _Copy of Planning Approval Letter or Meeting with Planning prior to �11lAJb �� � ANLT y,$EWERDISTRICI' submittal of Building Permit application., }���'•�9a_ }� V' �, . ,.;,a. n -'. -„ � ❑;EENVIRONMENTAIY liEALTH�� ,�-' -t. -:' B1dgApp_2011.doc revised 06121111 WE CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION 1f�c11. P/� rz t.:G�a Phwib. Plan feed, 1" he,!. CYZcCIC I:�ia, r' ruK Fee: F'(rtm . F' m1:1 T cc. Chher Plumb Insp. C ?tlrL -f tier. l sp. tlz°cr rs,s7�. Fe:e: P /urvrb. lisp. 1"Ve: I >lec. Insp. NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Tlicirinf of, 1 Th— fnno nrn hnaod nn A. nrolimi »nnt infnrmntinn munilnhlo and nro nnk nn nctimnto_ Cn"mrt tho Dont fnr nddn'l info_ FEE ITEMS (Fee Resolution 11 -053 E f 711113) 10146 alpine dr DATE: 04/08/2014 REVIEWED BY: Mendez IlaADDRESS: APN: BP #: "VALUATION: 1$2,000 YPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex Suppl. PC Fee: Reg. ®OT PENTAMATION PERMIT TYPE: 1 R3SFDRE WORK remodel kitchen 250 sq ft 2 bathrooms 190 sq ft remove and replace 9 windows to meet egress in SCOPE bedrooms, 2 sliding doors 1f�c11. P/� rz t.:G�a Phwib. Plan feed, 1" he,!. CYZcCIC I:�ia, r' ruK Fee: F'(rtm . F' m1:1 T cc. Chher Plumb Insp. C ?tlrL -f tier. l sp. tlz°cr rs,s7�. Fe:e: P /urvrb. lisp. 1"Ve: I >lec. Insp. NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Tlicirinf of, 1 Th— fnno nrn hnaod nn A. nrolimi »nnt infnrmntinn munilnhlo and nro nnk nn nctimnto_ Cn"mrt tho Dont fnr nddn'l info_ FEE ITEMS (Fee Resolution 11 -053 E f 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 EKI s. f. $488.00 Remodel, Other IREMRESOTH Suppl. PC Fee: Reg. ®OT 0.0 hrs $0.00 PME Plan Check: $0.00 = # $557.00 Window / Sliding Glass Door IWINREP Replacement Permit Fee: $0.00 Suppl. Insp. Fee-.(E) Reg. ® OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Flee: $0.00 0 G Work Without Permit? ® Yes (j) No $0.00 Advanced Plannin& Fee: $0.00 Select a Non - Residential Building or Structure � .fI "(dl e 1 !)E)C.! € }Pr'E'Yllftf7(i77 l'k'E'S': Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldp- Stds Commission Fee: 1BCBSC $1.00 - A $1.50,$1,045.00 , :. TOTAL FEE: $1,046.50 Revised: 04/01/2014 <r M t s OWNER- BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255 (408) 777 -3228 - FAX (408) 777 -3333. - buildinala cuoertino.ora Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property i ements specified at: SITE ADDRESS C j ®14ems/ FPN B? / OVdhER NAM, v ^7 e! I'� ` /� /,/ [� OWNER ADDRESS DESCRIPTION OF WORK: e/) J� t / 6,, ' C) �, L We are providing you with an Owner - Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner - Builder. We will not issue a building permit until you have read, initiated your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGIIIENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verity this information.) 0e, I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner - Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner - Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. ot -I understand building permits are not required to be signed by property.owners unless they are responsible for he construction and are not hiring a licensed Contractor to assume this responsibility. ��- I understand as an "Owner - Builder" I am the responsible parry of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. J4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 0�1V" 1 I. understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction' is at least five hundred dollars ($500), including labor and materials, I may be � considered an "employer" under state and federal law. ckyt6 I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. U"7. I understand under California Contractors' State License Law, an Owner- Builder who builds single - family residential structures cannot legally build them with the intent to offer them for sale, unless all work is perormed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is eriormed under contract with a licensed general building Contractor. I understand as an Owner - Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. Oia;rzezBzrildezFonn 2010.doc revised 01114110 E understand I may obtain .more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800 - 321 -CSLB (2752) or vvww.cslb.ca.gov for more information about licensed contractors. 10. 1 am aware of and consent to an Owner - Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner- Builders as well as employers. QA)2. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner - Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verrfcation acceptable to the may be required to be presented when the permit is issued to verify the property owner's si nature. Property Owner's Signature: Date: "� l - - ------------------------------------------------------------------------------------------------------------------------------------------- (NOTE: The foliowing Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner - Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Properly Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner - Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: Oi 'nerBuilde?Fonn 2010.doc revised 04114110 %lVRf1i`iE;�E� �y7.v�rL1��� ?'' �n sT�i =NY „� fir, , n• Ja,0 GfNIT 2 Gu(4'E2TI,d . C/7 ly /3,9 SrM E,v T - IclauE C,)4RklalG15-79 RAGE 8 6u &4, ,olp,�J6 uAIDI T Ilec OF co-A u 010A) o.0 - DATE PLOT PLANb CHECKED BY G DEPT. 131,i.)(_ EYEP T CUPERTINO Building DePatent REVIEWED FOR CODE COMPLIANCE Reviewed BY ;2yXlB•� %1"r ?-?, M i /O pc9D k 72 Xy2 //a I�Z/o/.v_k P/P , 64&17,_Z CA _5c? Or W k : k�7cF /FAl- RELoc47E fR pJBL o✓E,V, ,pA. ^ ,ct,) CA 6 /NL /J/+ 3/I - RELoc,Ar6 Ta GuEs> dA -RE( oc q o/L 67' HALL cLOSFT 2 ­)-to VE i3E,,)R,,J6� CO�A/V16IQTTD Ll1i AREA REpLAcI =" 9 w „�n��s a pA�-io vaa�2s -� SH/yE s /zFS, A")p LiV /N6: r2oo� w�N�oW SILL 7-Z) �ER.�ls�v /9” NEA1) 6k 7-0,4 &-'A 1-1) �s /s Repl,4 c fko,1jT- rho"- C61I Lv/PEO h'sPL /4cc- cj IaITEklo /POOAs ( u P" w71 RN,sc L1V /A,6A66Al F 110U F_ 141aA/ - l3 /4 A NO `')r,✓9-T R47-1 ©A t xv. -414 CUPERT INU uilding Department i APR 0 7 2014 REVIEWED FOR CODE COMPLIANCE Reviewed By: