141100863L
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19825 STEVENS CREEK BLVD
CONTRACTOR: A -TEAM
PERMIT NO: 14110086
CONSTRUCTION INC
OWNER'S NAME: BLAINE PROPERTIES
3044 SCOTT BLVD
DATE ISSUED: 11/14/2014
OWNER'S PHONE: 4082538049
SANTA CLARA, CA 95054
PHONE NO: (408) 482-2565
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL F] COMMERCIAL ❑
YOSHINOYA- REPAIR STUCCO ON SIDE COLUMN
/
� �'�� 6
License Classy Li.. #
Contractor I OON�G'{, L,;1 vv'l Date l l— l L�-4
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: $0
performance of the work for which this permit is issued.
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: 31621032.19825
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT K2TJR.ES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WI 180 DA 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 AYS FROM LAST 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.
Signature -2_ Datel I-- ( �^i y-
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.
ElOWNER-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 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 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: (— I
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
6/
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
CUPERTINO
F-1.
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingacupertino.orq
- M A"nrrTnT.T IRf AITrl?ATrnM/TT n RFVTRTC)N/T)RFF.RRF.D
r f
jtti�
RIGINAL PERMIT #
B1dgApp_2011.doc revised 06/21/11
PROJECT ADDRESS ly rj �r /.I C li
"l D `7
APN # J (� p 0
(J �l4_
OWNER NAME �oSl� �2� r u�
PPHONECCC]]] 8
E-MAIL ' , C v y 4k t " O yok � S
i Vl o A \
,� I
STREET ADDRESS lj Q �("� / �Ums cv� _ I- 'i11 J�
7 y �j15-• Dl
CITY, STATE, ZIP /'� yt 0 % Id,
lJ
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 't Yo O N TQ e_ L I m
LICENSE NUMBER /
LICENSE TYPE a
A N
BUS. LIC
COMPANY NAME lCl%tIM CO KctruaO h
E-MAIL , „N ®at�OW1 C O V1St . COY))
STREET ADDRESS O ii / G I J
`f
CITY, STATE, ZIP / „ota C(a vzy ' /+/1 a �l)�
!/r1'it Y ✓t l.fT
PHONE�6Q_ n2 Z 16
o b
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC ii
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK _20(VA0, _ I / LA L 0 \,-J + Q^ I
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
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
I
# DWELLING UNITS:
IS A SECOND UNIT []YES
SECOND STORY []YES
BEING ADDED? []NO
ADDITION? [:]NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPL # NO PLANNING APPROVAL LEITER
IS THE BLDG AN ❑ YES.
EICHLER HOME? ❑ NO
EIVE11BY�+�hult
c wa ° �'�&
TOTAL VALUATION:
❑
0v, x,€+ I is ad.
157
By my signature below, I certify to each of the following: I am the property owner or authorized agen the roperty o is 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. a o comply with all applicable local
ordinances and state laws relating So building ceinstructign. I au t 'ze representatives of Cupertino to enter the above -identified property for inspection purposes.
Date:
Signature of Applicant/Agent: v
SUPPLEMENTAL TION REQUIRED
esti " rCcYrE�,.'�',.
ROUTINGS IP,
L�oyEii�TIIE couivTER
❑uILDINc PLAN REVIEW
Nlit
ew SFD or Multifamily dwellings: Apply for demolition permit for
is to issuance of building
existing building(s). Demolition permit required prior
permit for new building.
#+EXi'REss
❑INNING PLAN REVIEW
sTnNDARD
1]UBLIcwoRlcs
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
_
form if any Hazardous Materials are being used as part of this project.
x
IQ T AIiG s
FIRE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to`1
0 MAJOR
❑ �ANITARYSEWERDISTRICT'
submittal of Building Permit application.
z
ENVIRONMENTALHEALTH ,;
B1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FM_7 FEE ESTIMATOR - BUILDING DIVISION
1AADDRESS: 19825 scb
DATE:
QTY/FEE
REVIEWED BY: Mendez
APN:
BP#:
$0.00
"VALUATION: 1$6,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE:
Tenant Improvement
PRIMARY Commercial Building
USE:
$0.00
PME Plan Check:
PENTAMATION
PERMIT TYPE:
ORK
oshino a- repair stucco on side column
OPE
F
Permit Fee: Hourly Only? ® Yes (E) No
$0.00
gr
` as u., .,. i.�.d.r P,..t s
�� gra _ i^it.�i'r� b, ..�...�•'. �,s kY� a' .3 �,... �'-
t 9c�cir,
Nun Check l'Irmrh. Pleat (11cck J."lec. l' an Check,
Pep,wid Fee: Plum!". Permit T Aee. Perri- Fcae
Clther ,March, Other Plwnlr frup.Li o het'Ins,.,,
lac a f,zsh. 1117w1b, hisp. Fee.: I.Jec", Itxi Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, -tire, sanitary sewer uistrtct, scnool
District_ etc ). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13,)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: Reg. OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? ® Yes (E) No
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
(1'011si:�tt tion
"jr'Jry(Ftt4rr"""c?I1L'e' l'c'£"
0
Work Without Permit? ® Yes (j) No
$0.00
Advanced Planning? Fee:
$0.00
hours
$286.00
Inspections
ISTINSP Inspection, Hourly
0
Tro cl Do, tit entol ont Fees:
Strong; Motion Fee: IBSEISMICO
$1.68
=hrs
$45.00
Admin./Clerical Fee
]ADMIN
BldaStds Commission Fee: IBCBSC
$1.00
$2.68
$331.00w
TOIL FEE:
$333.68
Revised: 10/01/2014
. . . . . . . . . . . .
Vg%
K
Ill
(D
ma
OP