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14110098CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20650 PARK CIR CONTRACTOR: JON BARTZ PERMIT NO: 14110098 CONSTRUCTION OWNER'S NAME: FELTON, CA 95018 PHONE NO: (831) 706-0228 JOB DESCRIPTION: RESIDENTIAL Ej COMMERCIAL 0 LICENSED CONTRACTOR'S DECLARATION UNIT 3 - REMOVE & REPLACE DECK RAILING/SIDING IN License Class # DD KIND, NO ALTERATIONS DUE TO WATER DAMAGE 1Lic. � Date l 'i Contractor , k ✓1 �A r2 I hereby affirm that I am licensed under the provision of hapter 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 Valuation: $2500 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area: Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 32632016.00 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 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter the above mentioned property for inspection purposes. (We) agree to save 180 DAYS LED INSPECTION. upon indemnify and keep harmless the City of Cupertino against liabilities, judgments, / costs, and expenses which may accrue against said City in consequence of the Issu granting of this permit. A ally, theapplicant understands and will comply with all non -point so a regu tions per the Cu rtino Municipal Code, Section 9 18. -ROOFS: Signature Date 1� All roofs shall be inspecte or 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. 13 OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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) HAZARDOUS MATERIALS DISCLOSURE I, as owner of the property, am exclusively contracting with licensed contractors to 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 Code, Section 25532(a) should I store or handle hazardous declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Health & Safety 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 with the Cupertino Municipal Code, Chapter 9.12 and performance of the work for which this permit is issued. will maintain compliance the Health & Safety Code, Sections 25505, 25533, and 25534. 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 Owner or authorized agent: Date: 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I 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 become subject 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 t (408) 777-3228 • FAX (408) 777-3333 • buildina(a)cupertino.orq n7,TT;117rr)ITCTT?TT(TTnU n Ar)nTTTnW n AT.TPRATTON/TT M REVISION /DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS_ 1 �1 �i APN # _ Q ` OWNERNAMEC,.] FF CONTACT NAM .a PHOO§3/_ -/ // E-MAIL D S CTT FAX gEE01 /tint `tel �'�/A ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTR,JOORLNAME [ LtCF�jS$DIUIyIB ? �� I&SETYPE P�US.LIC # COMPJNY NAMES E-MAIL FAX - (2 L4C7(/� STREET AD RESS CIA -, S E, ZIP r-� N oe --e— f� lZ q ARCHITECT/ENGINEER NAME LICENSE NUMBER ,$US. LIC # i COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK J , ' t 6 a Ql 4 o/La"Y/V EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL C��1 AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA - REMODEL AREA PORCH AREA DECK AREA I TOTALDECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY []YES BEING ADDED? ONO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ' TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO ...O 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 h pr vided is correct. I have read the .escription of Work and verify it is accurate. agre to comply with all applicable local ordinances and state laws relatin o bui inco I au representatives of Cupertino to enter the above-' entifi d property for inspection purposes. j� l L/ Signature of Applicant/Agent: Date: SUPPLEMENT INFORMATION REQUIRED PraIV CHECK ITE ;; �� _-� $, ROUrinc sLTP, ` ' New SFD or Multifamill dwellings: Apply for demolition permit for "M L7 BUILDINGPLAIVIZEVIEW 4B existing building(s). Demolition permit is required prior to issuance of building for new building. xP'REs 'LANnmGLAiV S. IiEVIEw permit ?fly `< y h + p t © _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �, sT�IVD : v ' 4- T 1'UBLICVVORIZS form if any Hazardous Materials are being used as part of this project. '�Jeta TGA ��IRE RGE+ F DEPT c Copy of Planning Approval Letter or Meeting with Planning prior to � -y- r �QxSA1�ITARXSE\i'ERDISTRIC'E _ submittal of Building Permit application.�� •©�tvIAJOR<� ,�''� s l r BldgApp_201 1. doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 20650 PARK CIR # 3 DATE: 11/18/2014 REVIEWED BY: MELISSA APN: 326 32 016 *VALUATION: $2,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair �ENTAMAT ION 1GENRESPRIMARY SFD or Duplex PERMIT TYPE: USE: TER WORK REMOVE & REPLACE DECK RAILING/SIDING IN KIND, NO ALTERATIONS DUE TO WA SCOPE DAMAGE � 1LI I �Igg "M i N ''M 1"Un - j I'Jec' PiOn' :rat: ' 1""nW1 Fee: Pcrmit 1'ec. E) ,< IA"'ch, jr"Y''�� Other Plunlb Inv) ED h,'v_ hzs)')_ 1111w16, hasp. Fee: Oe('. Ins 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 ff.. 711113) FEE QTY/FEE MISC ITEMS _(e Plan Check Fee: Hourly Only? ®Yes No E) $0.00 1 I hours Plan Check, Hourly Suppl. PC Fee: (j) Reg. 0 OT I 0.0=hrs $0.00 $143.00 ISTPLNCx PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes (E) No $0.00 Suppl. Insp. Fee -.(E) Reg. 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 i., nswl'iction Tax: r'd'Ifnlmli. E) Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential G Building or Structure 0 y'r,1ve! ],octunenlaiiori Fees: Strome Motion Fee: IBSEISMICR $0.50 1.0 hrs; Inspections $143.001 1 S TINSP inspection, Hourly ] BldStds Commission Fee: IBCBSC $1.00 $1.50 $286.00 T&AL FEE: $287.50 Revised: 10/01/2014 of ii . �� i' � � . A : ,� , ., fir, 911:. ' � � � , ft c e �.:7� kl s 1Y A• ko 1 3 g`_'r '• is � it. �j c s