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Permit Information
Location Information
Permit Number "
' 09020102
Address "
11230 BUBB RD - _ _
—
%,00 OK
Status "
--
C - Closed v j
City/State/Zip
__
CUPERTINO _ ® 95014
— gack
Master Number
� Mi Notes 0
APN
36206033.00 �- -�
—�
e-.1 Contractors
Project
F_
Unit
Apply Date "
02/25/2009 Operator patg
1_1van?r Entity Intnrrnation
(Fees
Permit Issue Date
02/25/2009 Operator patg-
Owner Name
ELINORAMANTOVANI
I Plan Reviews
Certificate Issued
05/22/2009 Operator PALM
-
Use Default
-_
El
OL Inspections
Certificate Type
Certificate Number
__ _ ---- - - -------- - -- -----
Address
i Home -11238 BUBB RD v
Print Per
City/State/Zip
CUPERTINO CA 95014-4979
Adjustments
Permit " roperty �( Zoning "Applicant Contractor' " II Defined Fields P
Holds
Permit Details
Purpose/Special Conditions - — - - --
Wopy Permit
Permit Type'
1 R3SFDADD
NON-STRCTRL KTCHN RE -MODEL (160SQ) ;NO RH-RF
Close Permit
SINGLE FAMILY DWELLING ADDITIO
Usage Class'
IVIII B, [C
FILHED- 2011
I
l Overrides
II/III B, IV-HTV•B NEW
l��' Supplemental Fields
Applied Value "
_--
60000
_�
L Notes
SQUARE FT.
12
Calculated Value
F— 0
i Attachments J
US C-404 Type
434
ALT: RESIDENTIAL
J
Permit Form `
'AUTOPERM - PERMIT
'✓ j
Ownership
1 -Private
Project Size
;COUNTER -OVER THE COUNTER
[QAdd Default T
v
<
-_ >
Permit issued 0212512009
Enter the purpose or any special conditions for this permit
CITY OF CUPERTINO
BUILDING DIViSIo`7 PERNIITW.
�xLyR
BUILDING ADDRESS:
PERMIT NO.
11238 B BB RT)
CUPERTINO KI
OWNER'S NAME:
PERMIT ISSUE DATE
PHO
i�AtAiy�t�CONTROLNO.
(408)257-4900
ARCHnEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and effect. 6�OY63
License Class l� Lie. •
NON-STRCTRL KTCHN RE-MODEL(160SQ) 1NO RE-RF
Date Z/2 Sal Contractor A,-,r ¢ / o` C.r
' ARCHn=S DECLARATION
1 understand my plats shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby alTirm that t tun exempt from the Contractors License Law for the
following reason- (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter. improve. demolish, or repair any structure
prior to is issuance, also requires the applicant for such permit to flit a signed statement
that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 700M of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the allcged exemption. Any violation of
$60000
APN Number
Occupancy Type
Section 7031.3 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
36206033 0 0
❑ I, as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do the work. and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code The Contractors License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employers, provided that such improvements are not intended or offered for sale. If,
howevv, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
&air..).
❑ I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contacrors Li-
cense taw does not apply to an owner of property who builds or improves thereon, and,
who contras for such projects with a contractor(s) licensed pursuant to the Contractors
License Law.
❑ 1 am exempt under Sec. , B & P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ante of the following declarations:
❑ I hive and will maintain a Certificate of Consent to self -insure for Workers Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ I have and will maintain Workers Compensation insurance, as required by Section
3700 of the tabor Code• for the performance of the work for which this permit is issued.
My Worker's Compensation insurance carrier and Policy number are:
-
Carrier. -4, L4NR- .-4 N5 , hua Policy No.: AI67— 4v00 `>'/ U
CEIMFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This secdon need not he completed If the permit is far one hundred dollars ($I00)
or less.)
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this pcanii shall be drrmcd revoked.
CONSTRUCTION LENDING AGENCY
I hemby affirm that there lair construction lending agency for the performance of
the work for which this permit's issued (See. 3097, Civ. C.)
L.endcrIs Name
Lenders Address
I certify that I have read this application and state that the above infom adim is
'
correct I agree to Comply with all city and county ordinances and state laws relating to
building concoction, and hereby authorize representatives of this city to enter upon the
shove-mcntion cd property for inspection purposes
(we) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments. costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WiTH ALL NON -POINT
Issued by: Date - 2-J-,6 >
SOU CE REGULATIONS.
Re-roofs _ -
Type of Roof
Signature of pplicantrCantractor DST ——
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safely
Code, Section 23332(a)?
All roofs shall be inspected prior to any roofing material being installed.
❑ Yes j�No
I
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or forum building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
Oistrict?
❑ Yes C•Nu
I have read the hazardous materials requirements undo Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505, 25533 and 25534. I understand that if the building
does not currently hale a tenant. that it is my responsibility to notify the occupant of the
requirements which mtut be mtl or to ass cc of a ate a�panry.
Signature of Applicant Date
All roof coverings to be Class "�rt}'' or better
g f'T'
tt
ODatc
wner or authoriztd a