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14060134 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10118 MELLO PL CONTRACTOR.-TBH—+9-UE PERMIT NO: 14060134 OWNER'S NAME: EDITA TEJNIL rL � DATE ISSUED:06/19/2014 OWNER'S PHONE: 6508686485L/ ifI— PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ REMOVE AND REPLACE BAY WINDOW License Class Lic.# 312- 3O Contractor on �c wit" to a6 I hereby affirm that Yam 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:$2800 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:36905033 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXP WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 0 DAYS 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 ROM L 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 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 j t�`9 « N 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 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(Sec.7044, Business&Professions Code) I,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,Sections 25555,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: d Date: 06 1 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 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 U�3 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION O� 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408) 777-3228• FAX(408)777-3333• building Qocupertino.orq CUPERTINO PROJECTNEW ADDRESSCONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGIN(/ALL PEEER3MI,T.# APN# 0-,5- 40449, im Le L- Cu �10 C R 5 0 r y OWNER NAME F Ja t a "rte t t Q PHONE6.r,0 �L Q_//� E-MAIL STREET ADDRESS ! O ` CITY, STATE,ZIP I FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑ OR'NER ❑ OWNER-BUILDER ❑ OWMTTERAGENT ❑ CONTRACTOR ❑CONTRACTORAGENTT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME je f` DOS 6\14 LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME 1 E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NA%4E LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY/,STATE,ZIP' PHONE DESCRIPTION OF WORK i h dl Re�Q�t t�h� 5tx3 V J. EXISTING USE PROPOSED USE CONSTR TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(£) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODELAREA PORCH AREA DECK AREA TOTAL DECKNORCH AREA GARAGE AREA: Ll❑DETACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY []YES BEING ADDED? []NO ADDITION? E]NO PRE-APPLICATION YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED$Y It $s� TOTAL VALUATION: PLAIQNTING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO �" °Z .0' aw r ` " - 0©,00 By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the 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 it is accurate. I agree to comply with all applicable local ordinances and state laws relating t;�uilding nst� I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date 06 I —1 x A1 CHECK TYPE : .*SUPPLEMENTAL INFORMATION REQUIRED Pi ROUTING SLIP t New SFD or Multifamily dwellings: Apply for demolition permit for M�`OVER THE COUnTER iBunnmGPLA1REVIEW existing building(s). Demolition permit is required prior to issuance of bulldina ry a permit for new building. ❑ EaPRESSa n TT AIQhP\G PL�ri'REVIEW "i ' PUBLIC WORKS Y _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �,p sTD�cRn�� �� � ��" s form if any Hazardous Materials are being used as part of this project. 'G i , ❑ prat.nEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ANITA;-�RYss ERY �submittal of BuildingPermit application. .RDISTRaI CT r M :R°; I .FENS'IROI�T4ENTAL`FIEA'IvTH `:' ?�,;' BldgApp_2011.doc revised 06/21/11 Building Department City Of Cupertino Lo 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: 10j m Q,� P 2. er ;.o (' Q50�t1 PERMIT# OWNER'S NAME: f2 ;{a, -Tp_j-v-,1e PHONE# GENERAL CONTRACTOR: �BUSINESS LICENSE# ADDRESS: 234 �QQ 5o,, ` o e CA ejS7 CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS 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: j/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE# Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date T)w-NV-1) i-rA Itj N i�_ SCoP !:efj_NC.� EXtS-tNG `x3° wiNpvvi wc�rtl BAY Wi'N ZW � � E A r� f boo L�vjh � Q1�� I t � 0 RoomI ,. YLU Y PLAN' CHECKED BY )ATE ANNING CPT. +SATE _. 7 T1 1, ���„ f y�` comtAL;tlrn Ui-i—ON- ;U3V n BUILE)ING ecifications MUST 10 OPROVED be pt at the of plans and sp make any This set construction. It is unlawful t �t„+� q �_ 0 1 job site during or to d 4ricial. ��''� CA changes or alterations on ,n the lid” 19 therefrom,witliout app+e`""' �' a �NOT Ian and specl5catio"s ,•iolation CUPERTINO ,e Stamp�n9 his P ro�:al ofBuilding Department be he', to Frrrriit or to be an aFP. 4 r 4'Vov'aca or State Law• r ,visions of a,�Y City _ ,�U9 201 e ar: p tC m._ uODE COMPLIANCE. 15,6- ,, �T NO. �gg ,;,eviewed By: ,� "