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15080176-DP10355 N DE ANZA BLVD 15080176 F/P VIDOVICH-CUPERTINO LIMITED PARTNERS pi •1•• CITY 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 Er LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL � / %6 APPLE - REMOVE/REPLACE (E) ROOF SCREEN License Class Lie.it t /✓Qrrdn I°�« fl d m 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 erfonnance 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 APN Number; 32633113.00 Occupancy e: p y Type: 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 WITHIN 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 D L ALLED INSPECTION. indemnify, and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against City in consequence of the 7 .granting of this permit Additionally, the applicant understands and will comply Issued b ' Date: with all non -point so regulations per the Cupertino Municipal Code, Section 9.18. /t RE -ROOFS; Signature Date 0 G.l 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 1, 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. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sect' 505' 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner orauthorized 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 Compensation laws of California. If, after making this certificate of exemption, I CONST UCTION LENDING AGENCY 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 properly 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. graining 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 •FAX (408) 777-3333 • buildinoa cuoertino.oro /S-0 9 N00, ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # -3 PROJECTADDRESS(p bF-ANZh. Pit V6 APNR ,may(•/•(J 7L / — 3 `J MS IV. s OWNERNAME ✓!Od PH E-MAIL! ego&coM STREET ADDRESc - 6 ITv cT r• Zos tJ C R 191,92 Z FAX a s CONTACT N E QEL ter" PHO o $Gt Liy I E-MAIL .ui, s.kt¢(n a 4 • coy, STREET ADDRESS ' 6e /-Y6 CITY, TATE, ZIP FAX o A S � • ,n El OWNER ❑ owNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCFBTECT ❑ ENGINEER ❑ DEVELOPER O TENANT CONTRACTOR NAME n�r �� a ��o� ¢` LICENSENUM LICENSETYPE d BUS. LICK COMPANY I'A OI�cO E-MAILbeCe a,ria��u�ro.�bNi f!'Jv� �LL STREET ADD CS$ D�. A✓f wi O1A•(`�'ATIa1n V�W CA iY�y3 "ONE Z&O Icy '1Y93 ARCHITECT/ENGINEER NAME 3yrjA VITA LICENSE NUMBER _ / BUS. LIC k COMWE E-MN IA tF-StG 1V 6A — 1 FAX 1 STREET AD DRESS D 3f AnT $ CTYSTATE,ZIP /�loug1xto Life'i �Q PHONE 6So_2SY / Y DESCRIPTION OF ;"Nev Eysr/A1G goof Sc-Agt,1 A4.o nap(acA- Qe01A Se04tet rl+ 4re-/i L EXISTING USE PROPOSED USE CONSTR. TYPE SSTORIES I USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECKAR-A TOTALDECKPORCHAREA GARAGE AREA: DETACH ATTACH X DWELLING UNITS: ISASECONDONIT El YES SECONDSTORY OYES BUNG ADDED? ONO ADDITION? ONO PRE -APPLICATION OYES IF YES, PROVIDE COPY OF IS THE BLDG AN REOEI D-BY" _ =. TOTAL VALUATION'. PLANNINGAPPLO ONO PLANNWGAPPROVALLETTER E[CHLER HOME? NO •0'90 By my signature below, I certify to each of the following: I am the property owner or auth�enfto act on the property Sw�i5r' bebalf. have read this Ccu is correct. I have read the Descripti oI and verify It Is r e to comply w`ith-al a plicable local application and the information Ili52d ordinances and state laws relating to Istruction. I authorize representatives of Qlperti� e aQbow-idendf d property for inspecuompurposes. Z S� t Signature of Applicant/Agent Date: O SUPPLEMENTAL FORMATION REQUIRED PaN CHectcTmE' 'iiodrNc sLTP "_ OVER TAECOUNTEA �.—BUILDING PLAN REVIDW --� _ New SFD ox Multifamily d ellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ �xPxsss r< + QLANNING PI.rAN REVIE1v ' Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTnrroAAn = aLLPUHLIewoTvcs _ -_ r_m if any Hazardous Materials Tire being used as part of this project_ fo - LARGE -' ❑-FIRE DEPT---.�r�� -Y _ Copy of Planning Approval Letter or Meeting with Planning prior to MA]OA - 0" SAI�TARYEWERDISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL. REA1Tli. B1dgApp2011. doe revised 06121111 ��CITY OF CUPERTINO Ir,-�/�I FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10355 N DE ANZA BLVD DATE: 08/2512015 REVIEWED BY: MELISSA APN: 326 33 113 BP#: tl 'VALUATION: $75,000 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: Commercial Building Civil / Religious activities inBQzone? 0 Yes •. No PENTAMATION PERMIT TYPE: 1GENCOM A WORK APPLE - REMOVE/REPLACE E ROOF SCREEN SCOPE :Meth. Plan Check 1111auh. Plan Check Llee. Nan ('heck dtecb, Pejrnii Fee: Plumh. Permit I've: Uec- Permit Pee: Other ddech. 1nq) Otleer Plumb 7nsp Other Elec. Imp. �i4ech. hLq). Tee: Phtmb, Imp. Tee: LICC. 1wP. hire: NOTE: This estimate does not include fees Clue to other Departments (i.e. Planning, Public Works, Fire, Sanitary Server District, Sc/tool District. etc. ). These fees are based on the oreliminary information available and are only an estimate. Contact the Dept for arddn'd info. FEE ITEMS (Fee Resolution 11-053 E(. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? C) Yes Q No $0.00 0 hours $143.00 Plan Check, Hourly 1STPLNCK i Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? ® Yes (j) No $0.00 Suppl. Insp. Fee-.0 Reg. ® OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: IBCONSTAXC $0.00 Administrative Fats E) Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential or Structure i 1'rayel lwcurnentalion Fees:Building S $21.00 2.0 lns $286.00 Inspections ISTINSP Inspection, Hourly Bldg Stds Commission Fee: IBCBSC $3.00 SUBTOTALS: $24.00 $429.0 01, TOTAL FEE': 1 $453.00 Revised: 07/02/2015