15100153CITY OF CUPERTINO BUILDING PERMIT I
13UILDING ADDRESS: 837 LONNA LNI CCEONTRACTOR: AMERICAN HOME I PERMIT NO: 15100153
OWNER'S NAME: ROCK STEPHEN M AND LYNNE M 1310 SHAW RD STE A I DATE ISSUED: 10/20/2015 1
OWNER'S PHONE: 4082533832 1 S SAN FRANCISCO, CA 94080 1 PHONE NO: (650)553-9054 1
SCJ LICENSED CONTRACTOR'S DECLARATION
License Class F> C t l Lic. # ? qd S q 7
r
Contractor / �,i f—�" E Date 1 _2-0 I
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:
1. 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
ormance of the work for which this permit is issued.
have and will maintain Worker's Compensation Insurance, as provided for by
ection 3700 of the Labor Code, for the performance of the work for which this
rmit is issued.
APPLICANT CERTIFICATION
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,
costs, and expenses which may accrue against said City in cone of the
granting of this permit. Additionally, the applicant under s and will comply with
all non -point source regulations per the Cupertin
o_.Mtffiicipal Code, Section 9.18.
Date 1 O -2� If
0
I hereby affirm that I 11—m exempt from the Contractor's License Law for one of
the following two reasons:
1. 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)
2. I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
1 hereby affirm under penalty of perjury one of the following three declarations:
t. 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
performance of the work for which this permit is issued.
2. 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.
3. 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
become subject to the Worker's Compensation provisions of the Labor Code, I
must forthwith comply with such provisions or this permit shall be deemed
revoked.
APPLICANT CERTIFICATION
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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature Date
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REMOVE (E) SIDING ON FRONT SIDE OF (E) SFD &
REPLACE WITH (N) HARDIE SIDING (700 S.F.)
Sq. Ft Floor Area: I Valuation: $17000
APN Number: 35919025.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
:180;DAYS F T CALLED INSPECTION.
Date:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, C r 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25$ .
Owner or
,2-<:, If i7
I hereby affix,wgi&lhere is a construction lending agency for the performance of work's
for which difIrpermit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
CONSTRUCTION PERMIT APPLICATION
12 COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
GUPERTINO (408) 777-3228 - FAX (408) 777-3333 - building0cupertino.orcl
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION /TI ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 073 7 { - OAWA / A JJ C
APN # :3 7 9 19
W'NLRNAME "j'v t gCiZl�
PHONE7-5�5
E-MAIL
STREET ADDRESS 1-o,
7 � AJ�J A &A J c
STATE, ZIP
cCITY�P�-rZ�,,Jo c A 9 Soi� f
FAX
CONTACT NAME EILEEN BAUGHMAN
PHONE 707-527-7727
F'_'" I eileen@permitservices.com
STREET ADDRESS
CITY, STATE, ZIP
❑ OWNER ❑ OwNER-BUH,DER ❑ OWNER AGENT ❑ CONTRACTOR 14 CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC #
Natal Gutierrez
740587
B C17
COMPANY NAME
E-MAIL
FAX
AMERICAN HOME RENEWAL
650-553-9053
STREET ADDRESS
CITY, STATE, ZIP
PHONE
310 SHAW ROAD STE
SOUTH SAN FRANCISCO CA 94080
650-553-9054
ARCHITECTIENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
tiTREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
7
12
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
�c
USE TYPE
O('('. SQ.FT.
4'ALUATION (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 DECKIPORCH AREA
GARAGE AREA: DETACH
H ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY [:]YES
BEING ADDED? []NO
ADDITION? []NO
AL VALUATION:
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG ANT
PLANNING APPL # []NO PLANNING APPROVAL LETTER
EICHLER HOME? �O
O -C9
By my signature below, I certify to each of the following: I am the property owner or auth age a pe wner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and venfy it is accurst agree to comply with all applicable local
ordinances and state laws relating to building constructio representatives of Cupertino to enter the ah dentified property for inspection purposes.
Signature of Applicant/Agent: "Z8
SUPPLE11rENTAL INFORMATION IRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
_ New SFD,or Multifamily dwellings: A or demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_ 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
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
@�_VWO
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 preliminar information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-033 Ef. 7/1/13)
ADDRESS: 837 LONNA LN
DATE: 10/20/2015
REVIEWED BY: MELISSA
:leech. Permit hec.
APN: 35919 025
BP#:
*VALUATION: 1$17,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
1'himb. Insp_ heC
PENTAMATION 1GENRE
PE MIT TYPE:
WORK
REMOVE E SIDING ON FRONT SIDE OF SFD 700 S.F.TT N
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 preliminar information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-033 Ef. 7/1/13)
:leech. Plan Check
Plumb. I'lan (:Yurek
hlec. Plan Check
:leech. Permit hec.
I'/,�P„?
?_7<;z. 1'crmit i
�tlier.11ech..Irtsp.
titherPlumb Insp.
t)ther I:lec. hap.
'rch_ Insp. Fee:
1'himb. Insp_ heC
l:Yec. Insp. tree
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 preliminar information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-033 Ef. 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
=s.f.
$646.00
Siding
ISIDEOTHER All Other
Suppl. PC Fee: (F) Reg. ® OT
1 0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:O Reg. ® OT
Fo.ol
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
'onstruction Tax:
11ministrative Fee:
Q
E)
Work Without Permit? ® Yes (F) No
$0.00
Advanced Planning Fee.
$0.00
Select a Non -Residential
Building or Structure
E)
O
�
7r��r L?ucrrretct�t�tiU�r 1•t �:5:
Strong Motion Fee: 1BSEISMICR
$2.21
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$3.21
$646.00
TOTAL FEE:
1 $649.21
Revised: 10/01/2015
4FF1 P, E- COP
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION - CUPERTINO
APPROVED
This set of plans and specifications MUST be kept at the
job site during construction. It is unlawful to make any
changes or alterations on same, or to deviate
therofrom, without approval from the Building Official.
The stamping of this plan an Ions SHALL NOT
be held to pf-rrni e n the violation
of any ions of ance or State Law.
0%�Zc)/L
PERMIT NO.
CUPERTINO
3uilding Deeartment
OCT 2 0 2015
REVIEWED FOR CODE COMPLIANCE
Reviewed By
91
837 Lonna Lane
Cupertino, CA 95014
PO# ROC150914
(All lap sided
areas on front of
House in scope)
Brick Cladding to
be removed and
covered with
siding
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-7J0 C --.o �vu t,✓5 J
J 11 1--"'s t
End Point of
Siding
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CZ
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Z
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20
O L ,_
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION - CUPERTINO
APPROVED
This set of plans and specifications MUST be kept at the
job site during construction. It is unlawful to make any
changes or alterations on same, or to deviate
therofrom, without approval from the Building Official.
The stamping of this plan an Ions SHALL NOT
be held to pf-rrni e n the violation
of any ions of ance or State Law.
0%�Zc)/L
PERMIT NO.
CUPERTINO
3uilding Deeartment
OCT 2 0 2015
REVIEWED FOR CODE COMPLIANCE
Reviewed By
91
837 Lonna Lane
Cupertino, CA 95014
PO# ROC150914
(All lap sided
areas on front of
House in scope)
Brick Cladding to
be removed and
covered with
siding
'- t �F-
-7J0 C --.o �vu t,✓5 J
J 11 1--"'s t
End Point of
Siding