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14100050CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19608 PRUNERIDGE AVE CONN RACTOR: 7 PERMIT NO: 14100050 OWNER'S NAME: SFERS REAL EST CORP UU e ()/'Lf'k,��V JA �T DATE ISSUED: 07/15/2015 O R'S PHONE: 4088739090 Fittft (A—q1f5L%PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ 811® ARIOSO- CONSTRUCT NEW PATIO AREA, FENCING �✓ License Class Lic. # Ll LIGHTING 4, J40. Date J1#aZ01S_ AND FIRE PIT (1800 SQ) Contractor $7. 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 hereb affirm under penalty of perjury one of the following two declarations: av d will maintain a certificate of consent to self-insure for Worker's pensation, as provided for by Section 3700 of the Labor Code, for the erformance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $153000 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. APN Number: 31647018.00 Occupancy Type: 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 agreecomply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter WITHIN 180 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 D,6.WROM 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 . Additi ly, the Issued by: pe applicant understands and will comply Date: with all non-po. so rce re a" s per the Cupertino Municipal Code, Section 9.18. �r `� S— RE-ROOFS: Signator Date J 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 ❑ OWNER-BUILDER DECLARATION inspection. 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 Ar /Air Quality Management District I performance of the work for which this is issued. permit will maintain compliance with � Ctr Ir b unicipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Se Ion 55 33, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this / tJ age 7 1 permit is issued. Owner or authorized Date: 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION 90300 TORRE AVENUE 9 CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 m building cupertino.orq ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS ®� D 4 `'e APN # r W `Y V PHONE ({11�)JEMAIL OWNER NAME CORP Ag 4rtaso STREET ADDRESS CITY, STATE,ZI l ®:�/ '73`�' 73-7 CONTACT NAME �JA PHOEt� ® t5® l "d*e _ iGAJI goal STREET ADDRESS /9y�� (� CrrY STAT�Ey�ZI„eP� a4 113 p q ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENTNTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRA OR NAMEONAI I LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL STREET ADDRES w}� ) q / ry �j 61 6� / 6 %f®lV� 9 els CITY, ATE ZIP ry rqv �] Q� /- �i�8"IV�1 i7A. fWla HO p �7�y�t ��V "•vG/ ARCHITE /EjV�i1N� ER NA�E� 0 -E-MAIL LICENSE NUMBER �� BUS. LLC # COMPANY AME /-41VO BAUA 5-k&Zo ol, .,qjw NU 10/3-7. ET ADDRESS 1 R�v�1-� s�' #eco CITY, STATE, ZIP RLQ Uo 90 Cif C�1. ON ,� 6 ® 76e/S- DESCRIPTION OF WORK FW P io qgeA r-5Ai6r 'Ra EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES I USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA 8 jO PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREAS : DETACH ATTACH DWELLING UNITS: IS A SECOND UNITL��g- BEING ADDED? SECOND STORY Y ADDITION? 1�"0 PRE -APPLICATION OYES IF YES, PROVIDE COPY OF PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER IS THE BLDG AN EICHLERHOME? 13O YO I RECEIVED OTA`L�VALUA�TI%ON 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 ed is c9ffAct. 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 u' mg co 'on. I authorize representatives of Cupertino to enter the above- en •fled property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER ❑ BUnDING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑, EXPRESS 0 .PLANNINGPLANREVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIREDEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER7lI5TRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 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 Dreliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E f' 7'1/13) 19608 PRUNERIDGE AVE DATE: 10/08/2014 REVIEWED BY: MENDEZ IlaADDRESS: APN: BP#: 'VALUATION: 1$153,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi -Family Dwelling USE: Building is >3 Stories C) Yes Q No PENTAMATION 1GENRES PERMIT TYPE: WORK ARIOSO- CONSTRUCT NEW PATIO AREA FENCING LIGHTING AND FIRE PIT 1800 SQ SCOPE 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 Dreliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E f' 7'1/13) ?.idC!`,. /rI,Y t.•%!dC.. Ph-wih. 111u;' chee', �;i',.. P'i7rl 14e':/r. 1'e,;ni: Fc... 1 himb Penni! "F e. lil ac F'ea„rit ;'inp.ET_L_ 01hr .. 1 'hill Inst. . Other f-'lec.. Suppl. PC Fee: 0 Reg. Q OT 1'<<.. 1 kzr. In. vii). 1'"k.. 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 Dreliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E f' 7'1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes) No $0.00 hours $286.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: 0 Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? Q Yes Q No $0.00 Suppl. Insp. Fee:(•) Reg. Q OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 1icn: r r.• . .. O E) Work Without Permit? 0 Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential E) Building or Structure 0 A TT -a -v l 1:}r;c!rrr;fr!ttrt r'rr E res: Strong Motion Fee: IBSEISMICR $19.89 3.0 hrs $429.00 Inspections 1STINSP Inspection, Hourly Bldg Stds Commission Fee: 1BCBSC $7.00 SUBTOTALS; $26.89 $715.00 TOTAL FEE, $741.89 Revised: 07/10/2014