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B-2016-1482CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1482 10251 TORRE AVE STE 108 CUPERTINO, CA (369 40 996) (MARVIN DAVIS CONSTRUCTION INC) SAN JOSE, CA 95112 OWNER'S NAME: LEE WARREN L TRUSTEE & ET AL DATE ISSUED: 03/08/2016 OWNER'S PHONE: 6503257230 PHONE 0: 4089750200 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B Lic. #413420 Contractor ( MARVIN DAVIS CONSTRUCTION INC ) Date 3/8/2016 X BLDG — ELECT _PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing MECH X RESIDENTIAL, _ COMMERCIAL with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: SUITE #108: DRYWALL REPAIR DUE TO WATER DAMAGE 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 performance of the work for which this permit is issued. t1 z. I have and will maintain Worker's Compensation htsurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $5000.00 APPLICANT CERTIFICATION certify that I have read this application and state that the above information is correct. I agree to comply with all city and county APN Number: Occupancy Type: ordinances and state laws relating to building construction, and hereby 369 40 996 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 PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will WITHIN 180 DAYS OF PERMIT ISSUANCE OR comply with all non -point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION. Code, Section 9.18. QAfj . Issued b y PAUL O'SULLIVAN �f W Signatur •`` Date / Date:3/8/2016 OWNER -BUILDER DECLARATION RE -ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1. 1, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for sale (Scc.7044, Business & Professions Code) Signature of Applicant: 2. I, as owner of the property, am exclusively contracting with licensed Date: 3/8/2016 contractors to construct the project(Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL'ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 1 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance, as provided for California Health & Safety Code, Sections 25505, 25533, and 25534. I will by Section 3700 of the Labor Code, for the performance of the work for which maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the this permit is issued. Health & Safety Code, Section 25532(a) should I store or handle hazardous s. I certify that in the performance of the work for which this permit is issued, I material. Additionally, should.1 use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants asi defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Worker's Compensation laws of California. If, after making this certificate of the Health & Safety Code, Sections 5505, 25533, and 25534. 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 Q. Owner or authorized agent: be deemed revoked. Dater 3/8/2016 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address , judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant ARCIIITECT'S DECLARATION understands and will comply with all non -point source regulations per the I understand my plans shall be used as public records. Cupertino Municipal Code, Section 9.18. Licensed Professional Signature Date 3/8/2016 CUPER'i'INO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingCEDcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS �^�, APN # I. e -` OWNER DAME � PH N� EMAIL � � ' � STREET ADDRESS CITY, STATE, ZIP//��, FAX i CONTACT NAM PHONE E YYa �. 9_'7!5- N G17 a STREET ADDREE�SS CITY, STATE, ZIP FAX �@ ❑ OWNER ❑ OWNER -BUILDER ❑ OFYNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑; ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSENUMBER LICEN TYPE BUS. LIC # 6� o y, Rios 4i StitrV '1, COMPANY NAME E-MAIL FAX m Min -C-1 ry STREET ADDRESS CITY, STATE, ZIP PH -O �s 11C ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE - CONSTR. TYPE -# STORIES USE TYPE OCC. SQ.FT. VALUATIONS) 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. E] ATTACH . DWELLING UNITS ISA SECOND UNIT ❑ YES SECOND STORY ❑ YES' BEING ADDED? ❑ NO ADDITION? ❑NO ` PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES D B}'' TOTALVALUATION: PLANNING APPL Y ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO 3 ' 5f©0®,DO �: By my signature below, I certify to each of the following: I am e property owner or authorize& agent to act on the property owner's behalf. I have read this application and the information I have providedii, ect. ave rea Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to build/� str t>e representatives of Cupertino to enter the above -identified property. for inspection purposes. Signature of Applicant/Agent: / r Date: SUPPLEMENTAL INFORMATION REQUIRED � � OVER THE COUNTER �BUILDI\G PL�u3 RE�IE�3' x ' r — New SFD or Multifamily dwellings: Apply for demolition permit for building Demolition is required to issuance of building existing s). permit prior for new building. EaPRI ss © PLA�NI1\YGPi REIEir°x permit aOkr Commercial Bldgs Provide a completed Hazardous -Materials Disclosure I] sTA\DARDS I] riJBLic�voR s ` fo_nn if any Hazardous Materials are being used as part of this project. ` k S 1ARGE PIREDEPT k Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. MAJOR z 1 Srti�ITARI SER ER DISTRICT d 41 IItO\MENTAL HEALTH Bldo4pp_2011.doc revised 06121111 i CITY OF CUPERTINO F— 7 FEE ESTIMATOR -'BUILDING DIVISInN ADDRESS: 10251 TORRE AVE DATE: 03/08/2016 REVIEWED BY: PAUL APN: 369 40 996 BP#: *VALUATION; $5,000 "PERMIT TYPE; Building Permit PLAN CHECK TYPE: Addition PRIMARYPENTAMATION SFD or Duplex USE: _ PERMIT TYPE: 1 GENRES' WORK SUITE #108: DRYWALL REPAIR DUE TO WATER DAMAGE $0.00 SCOPE $0.00 1eeh , lon(exi: �F c:r_ S ifYrt, Fee i zgdc' � �;. .. i`�i Lia%c;.7 hap, �'c r... z hn" x?. t ;., iadt.: e": {fit ,. � td,4 a.. Tu'ED }d ,..... �u F';%— (:4"V" i ;1'%r;,a-. 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 relimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (FeeResolution 11-053 Lf: ? FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 1 hours Plan Check, Hourly $143.00 ISIPLNCK Suppl. PC Fee: r Reg...OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes .D No $0.00 Suppl. Insp. Feer Reg. Q OT Q_0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 M", —T—Ti Fee: Work Without Permit? 0 Yes No $0.00 Advanced Plannin Fee:$O,QO i Select a Non -Residential S TF ,:Ii c., . ,a . °rF„c h<” ;r, Building or Structure 0 Strong Motion Fee: 1BSPISMICx $0.65 F-2.6-1 hrs Inspections Bldg Stds Commission Fee: IBCBSC $1.00 $286.00 FISTINSP Inspection, Hourr�e—