14100095CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20984 ALVES DR
CONTRACTOR: ALPS CONSTRUCTION &
PERMIT NO: 14100095
REMODELING
OWNER'S NAME:
SAN JOSE, CA 95129
PHONE NO: (408) 898-6474
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL F] COMMERCIAL F]
�2J
INSTALL TEMP POWER
License Class Lie. #?()q
Contractor � Date �U• l(9i�
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
Sq. Ft Floor Area:
Valuation: $500
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
APN Number: 32631004 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 1 DAY 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 F M LAS C LLED 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
16
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point u ce regulations per the Cupertino Municipal Code ectio
9 18. If
RE -ROOFS:
Signature Date --L-Le
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.
ElOW R -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)
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 u rtino Municipal Code, Chapter 9.12 an
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code,
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
CONSTRU T 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
CUPERTINO
r—I
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(akupertino.org
I - 1 71 ♦ T IIT111 I IT F-1 T)TZAR c TOM /IlFFFR RPT
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1�
nRIMNAL PERMIT #
II NEW CONSTKUCIIUN 1J A11LJ111U1V U tU intwiaviv T ' u
A----_______
PROJECT ADDRESSO Q f�
APN # 2 ? `�
OWNER NAME
FAX
CONTACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE,
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
DESCRIPTION OF WORK
!^'1.
EXISTING USE
PROPOSED USE CONSTR.
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 TOTALDECK/PORCH AREA
GARAGE AREA: DETACH
[]ATTACH
# DWELLING UNITS:
ISA SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ANO
ADDITION? []NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
EICHLER HOME? NO
RECEIVED BY rt
u
i'�.,,*�'€'
,:'
ATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
By my signature below, I certify to each of the following: I am the property owner or authorized agent to ac the operty owner's behalf. I have read this
application and the information I have provi d . correct. I have read the Description of Work and verify it is accura e. I agree o comply it h all applicable local
ordinances and state laws relating to struction. I authorize representatives of Cupertino to enter the above-ide tiff property r Inspection purposes.
Signature of Applicant/Agent: Date
UIRED
5...
ROi37INGSLIP
SUPPLEMEI,TrAL INOYuired
T� CHECK TYPE_,
OVERTH)<COiIN1T s
rLANxEv1Ew
rt
_ New SFD or Multifamily dwellings:demolition permit forDmG
existing building(s). Demolition permitrior to issuance of building
x
permit for new building.
❑ETEssf a ,
pNNmG PLAN xEv1Ew
Commercial etMaterials
esDisclosurengued
Pusiic woTucs k
x'
ssas of
bel
x
form anyHazardous are part project.��
V. IR.DEP3T
_Copy of Planning Approval Letter or Meetingwith Planning prior to
g P
MORRO-
D
SAAIZARY SEWERDISTRIC7 _
submittal of Building Permit application.
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HEAtiTA 1
BldgApp 2011.doc revised 06121111
CITY OF CUPERTINO
FM -7 FEE ESTIMATOR - BUILDING DIVISION
191 ADDRESS: 20984 ALVES DR
FEE
DATE: 10/16/2014
REVIEWED BY: MENDEZ
APN:
BP#:
"VALUATION: $500
PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE: p
PME Plan Check:
PENTAMATION
PERMIT TYPE: 1 REAP1
WORK
TEMP POWER
SCOPE
Mvcn, F larr Chet k f'frw;b. Plan £: hecti Elec. Plan Check 0.0 1 hrs $0.00
mecfr. Per,wil Fee,. I'fAmbn Peonii Tee: Elec, Permit Fee: IEPERMIT
3rl�c.� sc:r. is��-El--L- h;�e, dal ms lns Other Elec. Insp. 0.0 hrs $48.00
d
f1hiw?lz fnq). Fee:I Llec_ Inst, lee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
Tlictrirt atr ) Thoca foot nro hacod a" tho nroliminary infnrmntinn availahle and nro ank an estimate_ Cnntact the Dont for addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7f /1113)
FEE
QTY/FEE
MISC ITEMS
Phin C 'he?c: k Fee:
PME Plan Check:
$0.00
PME Unit Fee:
$48.00
PME Permit Fee:
$48.00
(.,�mslrtichon Tax:
F1
Administrative Fee: ]ADMIN
$45.00
Work Without Permit? 0 Yes 0 No
$0.00
Planning
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldp- Stds Commission Fee:. IBCBSC
$1.00
r • • O RAXI
: 91 x ,_.
$190.501$0.00
,J� r TOTAL FEE•
$1 90.50
Revised: 08/20/2014