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15080176CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10355 N DE ANZA BLVD CONTRACTOR: BARRON BUILDERS INC PERMIT NO: 15080176 OWNER'S NAME: VIDOVICH-CUPERTINO LIMITED PARTNERS 415 CLYDE AVE STE 105 DATE ISSUED: 08/25/2015 OWNER'S PHONE: 4088622341 MOUNTAIN VIEW, CA 94043 PHONE NO: (650) 269-7061 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL APPLE - REMOVE/REPLACE (E) ROOF SCREEN Is License Class ' J LiJJc. # / S�' y AW&d`d l ✓� d (�� Contractor Date 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: $75000 erformance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 32633113.00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this 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 WITI N 180 DAYS 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 DA VI L ALLED 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 Date / Issued b L granting of this permit. Additionally, the applicant understands and will comply with all non -point so regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date/ f 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 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. I have and will maintain Worker's Compensation Insurance, as provided for by will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and 5, 25533, and 25534. the Health & Safety Code, S?UCTION Section 3700 of the Labor Code, for the performance of the work for which this P 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 CONST LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I 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 CUPERTIINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 Ile (408) 777-3228 • FAX (408) 777-3333 • building(31cupertino.org ffO ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS /® F— p(49G V6 APN # • f5s d, OWNERNAME PHO APPLE fi4 E-MAIL s v STREET ADDREScTTV �� cT,g�ry�", rn s, �f �s� "7!/�� FAX _ Ld�`+`f CONTACT NAME PHO E-MAIL p STREET ADDRESS CTTYeATE, ZIP FAX ❑ OWNER ❑ OwNER-BuiLDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER TENANT CONTRACTOR NAMELICENSE ,XRNF NUMB W4 36 LICENSE TYPE BUS. LIC # COMPANYNIE C.M xgo"� ��aa �� (� j' E-MAIL Q ff beed Av'P e-eLlft-t Lit Irt"O • FAX 4-0 56C' 7.3,� STREETADD S� rJ 'C CITY, STATE, ZI'P� ,/ a A PHONE ARCHITECT/ENGINEERNAMEp LICENSENUMBER _ /. g� BUS. LIC # a a0 COMPAI]YNAME E-MAIr $ O �tC-( a r • I� eV FAX STREET ADDRESS C�TY� STATE, ZIP PHONE DESCRIPTION OF WORK � / PP 6 AJ& kool- Sc.9-vC4 Ala & 6 aC-a- ka#f- $ A 6A-47z-1-Jc EXISTING USE PROPOSED USE CONST& TYPE # STORIES USE TYPE OCC. SQ.FT. 1 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 TOTAL DECK/PORCH AREA GARAGE AREA: LJ DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑ NO ADDITION? ❑ NO PRE -APPLICATION El YES IF YES, PROVIDE COPY OF IS THE BLDGAN REtrE1yFBh:. TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? NO »-;•'. F �,ry . .., By my signature below, I certify to each of the following: I am the property owner or autgent t6'a6t on th property o behalf. t have read this application and the information I have pr is correct. I have read the Descripti ork and verify-it-is-accur ee to comply wI a plicable local ordinances and state laws relating to ildin struction. I authorize representatives of Cupertino to e abov-identif d property for inspection�wrposes. 1 5- Signature of Applicant/Agent: Date: SUPPLEMENTAL,iNFORMATION REQUIRED'� PLANCHECKTYPE Yy ' S: ROUTINGSLIP © ❑ y(/ New SFD or Multifamily, d ellings: Apply for demolition permit for _ existing building(s). Demolition permit is required prior to issuance of building OVER THE COUNTER r BTJILDINGPLAN REVIEW permit for new building. ❑; EXPRESS , I t ❑ iP�LANNINGPLAN REw ' µ ?+ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure r+ { ❑ sTnNDnRD ❑ PUBLIO WORKS t r _ form if any Hazardous Materials are being used as part of this project ❑ a ,r t, F 4 �'Y Copy of Planning Approval Letter or Meeting with Planning prior to T,ARGT':' � �� EiREDEPT _ ❑'� MAJOR- � � r � ❑' SAI�'ITATtY SEwERI)ISTRICT submittal of Building Permit application, , ❑ti:�NYII20IQMENTAI'.IiEAI:TFIt:-.. BldgApp_201 1. doc revised 06/21/11 IM -7 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the prelimina information available and are onip an estimate. Contact the Dept for addn'1 into. FEE ITEMS (Fee Resolution 11-053 E . 711113) ADDRESS: 10355 N DE ANZA BLVD DATE: 08/25/2015 ' REVIEWED BY: MELISSA rtlec:h. Pet7uit Fee: APN: 326 33 113 BP#:�l *VALUATION: $75,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition/ Repair PRIMARY USE: Commercial Building Civil / Religious activities in BQ zone? 0 Yes G No PENTAMATION 1 GENCOM PERMIT TYPE: i WORK APPLE - REMOVE/REPLACE E ROOF SCREEN SCOPE NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the prelimina information available and are onip an estimate. Contact the Dept for addn'1 into. FEE ITEMS (Fee Resolution 11-053 E . 711113) Atech. Plan Check Phinth. Plan ('heck Elec. Plan Check rtlec:h. Pet7uit Fee: Plumb. Permit Fere: Elec. Permit Fee: Other A/ech. Insp. Other Plumb Insp. Other 1>lec. If h,. sirlech. Insp. Fee: Nwnb. hrsh, Tire: Elec. Ihsp. Fin;: NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the prelimina information available and are onip an estimate. Contact the Dept for addn'1 into. FEE ITEMS (Fee Resolution 11-053 E . 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 0 hours $143.00 Plan Check, Hourly ISTPLNCK Suppl. PC Fee: (2) Reg. 0 OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee:0 Reg. ,Q OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $0.00 Administrative Fee: 0 G Work Without Permit? Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential 0 Building or Structure 0 i Trm,el Documentation Fees: Strong Motion Fee: IBSEISMICO $21.00 2.0 hrs $286.00 Inspections ISTINSP Inspection, Hourly Bldg Stds Commission Fee: IBCBSC $3.001 - <SUBTOTAL=S;;,. $24.00 $429.00 TOTAL FEEw` $453.00 Revised: 07/02/2015