15110006CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10166 MCLAREN PL
OWNER'S NAME: HATAMI (h ov'(0Ed N 4 tuT) 1
CONTRACTOR • T g -J M `i-- I PERMIT NO: 15110006
L -X earn ► n-drs
DATE ISSUED: 11/02/2015
OWNER'S PHONE: 4084460802 1 , 1 PHONE NO:
129 LICENSED CONTRACTOR'S DECLARATION
571- e—rn.9 c Y11 -sr 2 �4 7
License Cl � ! CJ�✓1'/ OL Lia"
Contracto%&/07
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
performance of the work for which this permit is issued.
'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.
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 compl
with all non -poi ource regulations per the Cupertino Municipal Code,
9.18. /
Signature �✓ �a zIaa'fe� Z
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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
performance of the work for which this permit is issued.
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.
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 ❑
REPAIR SIDING TO FRONT, LEFT PORTION OF SFD, LIKE FOR LIKE (180
S.F.). REPAIR TRIM FOR ALL 3 IST FLR FRONT WINDOWS
Sq. Ft Floor Area: I Valuation: $3500
APN Number: 31621046.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS EF1R M LAST CALLED INSPECTION.
G%
All roofs shall be insp r any roofing material being installed. If a roof is
installed without first aming 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, Chapter 9.12 and
the Health & Safety Code, Secti s 5505, 255 and 25534.
Owner or authorized agert }° ' Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
ak
CUPERTINO
❑ NEW CONSTRUCTION
CONSTRUCTION PERMIT APPLICATION
COMIMUNI TY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(-cuDeftino.org
❑ ADDITION ALTERATION / TI ❑ REVISION / DEFERRED 0RICTINAL PERMTT 4"
PROJtCf PDDRESS / 0/ J/j/j C / q f -f^/ _ Z I APN 31 ` t ®(/
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CONTACT NAME
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113 ORTNER ❑ OR'NER-BMDFR ' ❑ OWNERAGEN'T%�CONMRACTOR ❑ CONTRACTOR AGENT ❑ ARChTlr-CT ❑ ENGINEER ❑ DE%IELOPER ❑ TENANT I
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FAX
STREET ADDRESS
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ARC-IITECT/ENGINEFR NAMES
LICENSE NUMBER
BUS. LIC R
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE; ZIP
I PHONE
DESCRIPTION OF WORK 12_cleL.,�
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EXISTING USE
PROPOSED USE CONSTRTYPE ?STORIES
ordinances and state lays relatingnQ const n. I authorize representatives -of
Cupertino to enter the above-identifiedproperty for inspection purposes.
Signature of Applicant/Agent:
I
I I
I
-
F CHECKIPE---,
USE TYPE. I OCC. SQ.FT. I
VALUATION (S)
=TG
AREA
BUILD
NEW FLOOR
AREA
DEMO
AREA
k�� IGPLSNRE� it
TOTAL
NET AREA
EXPRI 5$ -
L� FLA A'�jiZiGPL4?� RE�ZEFi —
'
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
_
'tom
'� STANDARD L�
F
> unO
$�a�oRxs
_
i form if any Hazardous Materials are being used as part of this project.-
'
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_ Copy of Planning Approval Letter or Meeting with Planning prior to
T I
submittal of Building Permit application.oR
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA
GARAGE AREA:
DETACH
❑ATTACH
DWELLING UNITS:
IS A S£OOND UNIT ❑ YES
SECOND STORY
❑YES
BEING ADDED? No
ADDITION?
❑NO
PRE--.UPLICATION [:]YES IF YES, PROVIDE COPY OF I
PLA KING 4PPL R ❑ NO PLANNING APPROVAL LETTER
IS THE BLDG AN
EICHLER HOh1£?
❑ 1 rS
- CSI\�D TOT V UATION:
CDO, rJ J
By my signature below, I certify to each of the following: I am the property owner ohorizP rite -amt I �y ow•ier's behalf. I have read t�il�—
Vand
vided is correct. I have read the Description of Vkl Vu4f; -' Is accurate. I agree to comply vrith all applicable local
application and the information I h�buii
ordinances and state lays relatingnQ const n. I authorize representatives -of
Cupertino to enter the above-identifiedproperty for inspection purposes.
Signature of Applicant/Agent:
Date: Z��
SUPPLEMENTAL INFORMATION REQUIRED
Q
-
F CHECKIPE---,
– _
I=•OI2Z�GSLIE.�__-
New SFD or Multifamily cl-,vellings: Apply for demolition permit for
T MSE
«R SHI COL'ITER
BUILD
existing building(s). Demolition permit is required prior to issuance of building
–
k�� IGPLSNRE� it
permit for new building.
EXPRI 5$ -
L� FLA A'�jiZiGPL4?� RE�ZEFi —
'
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
_
'tom
'� STANDARD L�
F
> unO
$�a�oRxs
_
i form if any Hazardous Materials are being used as part of this project.-
'
f
_ Copy of Planning Approval Letter or Meeting with Planning prior to
T I
submittal of Building Permit application.oR
_ a� _�'�`TT'YS)iERDIS�RICT
BIdg.4pp_2011.doc revised 06/21/11
CITY OF CUPERTINO
rr—
.- FF,F, ESTIMATOR - BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Tlictrirt otr 1 Thoco foot aro haaod not tho nroliminary infarmatinn ovoilohlo and aro only on ectimoto_ Contact the Dent for oddn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13)
ADDRESS: 10166 MCLAREN PL
DATE: 11/02/2015
REVIEWED BY: MELISSA
Plan Check Fee:
APN: 316 21 046
BP#:
*VALUATION: 1$3,500
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex
PME Plan Check:
PENTAMATION
PERMIT TYPE: 1GENRE
WORK
REPAIR SIDING TO FRONT LEFT PORTION OF SFD LIKE FOR LIKE 180 S.F.. REPAIR TRIM
SCOPE
FOR ALL 3 1ST FLR FRONT WINDOWS
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Tlictrirt otr 1 Thoco foot aro haaod not tho nroliminary infarmatinn ovoilohlo and aro only on ectimoto_ Contact the Dent for oddn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
DKI s.f. Siding
$431.00 ISIDEOTHER I All Other
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:(D Reg. Q OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Adrninistrative F'ee:
0
E)
Work Without Permit? 0 Yes Q) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential G
Building or Structure 0
i
1'r rn el t3�acu7nentatzcrn Fees:
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTAis. '
$1.50
$431.00 TOTAL FEE: '
$432.50
Revised: 10/01/2015