15100102 I
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10395 N STELLING RD CONTRACTORI VU - ,JeQ PERMIT NO: 15100102
OWNER'S NAME: ALVES RONALD J TRUSTEE on ce, DATE ISSUED: W3/2015
OWNER'S PHONE: 4088191966 '� c�
4rM PHONE NO:
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL El
yl�
TO CLEAR CODE)ENFORCEMENT CASE:CONVERT ILLEGALLY
License Class 13 Lie.# CONVERTED GARAGE TO BEDROOM BACK TO BEING A LEGAL
�qq GARAGE(NO OT�IER ADDITIONAL WORK)
Contractor 1/Id s S Date C3 j12-P 1
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
I hereby affirm under penalty of perjury one of the following two declarations:
i. I have and will maintain a certificate of consent to self-insure for Worker's Sq.Ft Floor Are Valuation:$2000
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. APN Number:316 28 094 Occupancy Type:
Nave 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.
FERMI EXPIRES IF WORK IS NOT STARTED
APPLICANT CERTIFICATION 180 DAYS OF PERMIT ISSUANCE OR
I certify that I have read this application and state that the above information is WITHIN
correct.I agree to comply with all city and county ordinances and state laws relating 180 DAI S FROM LAST CALLED INSP C ION.
to building construction,and hereby authorize representatives of this city to enter a
upon the above mentioned property for inspection purposes. (We)agree to save G
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Issued by: Date:
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 s rce regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS:
Signature t.(� I a----�6• Date i01AZ,1ZV1 All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without f rst obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION Signature of Appl'cant: 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
t. 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 HAZARDOUS MATERIALS DISCLOSURE
sale(Sec.7044,Business&Professions Code) -
2. I;as owner of the property,am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the
construct the project(Sec.7044,Business&Professions'Code). California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
compliance with die Cupertino Municipal Code,Chapter 9.12 and the Health&
I hereby affirm under penalty of perjury one of the following three declarations: Safety Code,Section 25532(a)should I store or handle hazardous material.
1. I have and will maintain a Certificate of Consent to self-insure for Worker's Additionally,should I use equipment or devices which emit hazardous air
Compensation,,as provided for by Section 3700 of the Labor Code,for the contaminants as efined by the Bay Area Air Quality Management District I will
performance nthe work for which this permit is issued. maintain compli nee with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety Code,Sections 25505,25533,and 25534.
2. I have and will maintain Worker's Compensation Insurance,as provided for by ^o
Section 3700 of the Labor Code,for the performance of the work for which this ter or auth a zed agent:
permit is issued. Date:
s. I certify that in the performance of the work for which this permit is issued,I shall
0
not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I I hereby affirm that there is a construction lending agency for the performance of work's
become subject to the Worker's Compensation provisions of the Labor Code,I for which this per it is issued(Sec.3097,Civ C.)
must forthwith comply with such provisions or this permit shall be deemed Lender's Name
revoked. 1
Lender's Addre4
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION
correct.I agree to comply with all city and county ordinances and state laws relating I understand my p ans shall be used as public records.
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save
Licensed Professional
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. i
Signature Date
i
i
I
CONSTRUCTION PERMIT APPLIOATION I
COMMUNITY DEVELOPMENT DEPARTMENT•BUIL ING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-32 55
2 U51-01h
(408)777-3228• FAX(408)777-3333•buildinga()cut) ino.orq
CUPERTINO
❑1`TEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVIS�ON/DEFERRED ORIGINAL PERMIT
P oMarADDRESS APN
OWNS AIDE f
PHOg�
AR t"°m. :"1" L✓1�'�� I
S ETe S� n I CITY, STAT IP I FAX S v---
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CONTA 'AIIE PHONE E-MAIL
STREET ADDRE CITY,STATE, Z P 1 FAX
❑OWNER ❑. OWNER-BUILDER ❑ OWN-ERAGENT �CtiN RACTOR ❑CONTRACTOR AG ❑ ARCHITECT ❑ENGINEM ❑ DEVELOPER ❑TENANT
CONTRA�ORNAME LICENSENUA�BER { I LICENSE BUS.LIC R
60hIPANY NAhMJAIAA'JC f-(� �� E-IJAIT S ` I FAX
STREET ADDRESS CITY,STATE.ZIP PHONE
ARCHITECT/BNGINEERNAJ4B I LICENSE NUMBER. BUS.LIC n
COMPANY NAhM E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP I PHONE
DESCRIPTION OF WORK
lAA Pb f
i
EXISTING USE I PROPOSED USE I CONSTR TYPE STORIES ISE 1 TYPE I OCC. SQ.FT. VALUATION(S)
I` I I 1111
EXISTG 14EW FLOORDEMO TOTAL
AREA AREA I AREA NTEPAREA -
BATHROOM KITCHEN OTHER
REMODEL.AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: LJDETACH -
❑ATTACH
D�JELLINGUNITS ISASECONDUNrr E3 YES SECOND STORY []YES
BEING ADDED? ❑NO ADDITION? []NO I -
I 1
PRE-.APPLICATION ❑TES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES -- CDWE :� �. TOTAL,VALUATION:
PLAA'NING APPL R ❑NO PLANNING APPROVAL LEITER EICHLER HOME? ❑NO IBM
By my signature below,I certify to eaA of the following: I am the property owner or authori ed agent to act on the property owner's behalf. I have read this
ff
application and the information I hav provided is c ect, I have read the Description of Work an verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating ,r° uiiding construe'on. I authorize representatives-of Cupertin to enter the above-identified propei.y for inspection purposes.
Signature of Applicant/Agent: LIZ, Date: a t P 4P
SUPPLEMENTAL IIQPORMATION REQUIRED
New SFD or Multifamily d«-ellings: Apply for demolition permit for - _ r
OZR TH2<COUhTER BUILDLhGPL iii REVIl 4Y
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. E71L__-JEX-PRESS
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
_Copy of Planning Approval Letter or Meeting with Planning prior to Ys �zsaxr
submittal of Building Permit application. :
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
° ADDRESS: 10395 N.Stelling Rd DATE: 101 312015 REVIEWED BY: PAUL
APN: 326 28 094 BP#: *VALUATION: $2,000
"PERMIT TYPE: Building Permit PLAN CHECK TY E: Addition
PRIMARY SFD or Duplex _AJPENTAMATION 3
USE: PERMIT TYPE:
WORK To Clear Code Enforcement Case: Convert illegally converted Garage to bedroom back to being a
SCOPE Legal Garage
I
Vech..Pfan C tiec;k 111,71mh. Plan(71zecA. Dec. Plata Clt,.ck
1-leclt. Permit/ee: PhirftL.PerwIT Fee: Alec.Perinit
€Jltff tl cc h rrttil C1t1=t:rPltf=ttx .Lrt.k1. C1t128i'1'ec. Ir'SP.
171
V c a. fav). Fee: Ptumb. lrus,p. 1ee: L >c°..(t41�. Fee:
NOTE. This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Theseees are based on the preliminar information available and are only an estimate. Contact the De t or addn't MO.
FEE ITEMS(Fee Resolution 11-053 E . ZI 13, FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 j Select a Mise Bldg/Structure
Suppl. PC Fee: 0 Reg. 0 OT 0.0 has $0.00 or Element of a Building
PME Plan Check: $0.00
I
Permit Fee: Hourly Only? 0 Yes 19 No $0.00
Supp/. Insp.Feer Reg. 0 OT 0,0 has $0.00
_I
PME Unit Fee: $0.00
PME Permit Fee: $0.00 j
('011struc:t on Tax: LJ
�rhni�r;' rtfive �`E>�>:
Work Wit t Yes 0 No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
I revelc�c°lanc>nzutlotr 1=r�,. Building or Structure
s: A
Strong Motion Fee: IBSEISMICR $0.50 hrs Inspections
Bldg Stds Commission Fee: IBCBSC $1.00 $572.Q0 ISTINSP Inspection,Hourly
SVBTOIAL`S $1.50 $572,00 _ = TtTALF .' $573.50
Revised: 10/01/2015
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APN: 326-28-094
Scope of Work:
We will be converting an illegally converted garage
back to a garage. We will reinstall garage door and
install fire door from house to garage. No
additional alterations will be made.
4o3oDH a 0 q PDH 3o3oDH
3o3oDH
Sidewalk
Existing
R
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I
4o3oDH aM ro3o1)H 3o3oDH 3o3oDH
e4bu
New Garage door
Proposed
948 -
Existing Front Elevation
t
6036TS
Proposed Front Elevation
OFFICE COPY
CUPERTINO
Building Department
OCT 13 2015
REVIEWED FOR CODE COMPLIANCE
Reviewed By:p�(Wvw
COAA�A,1NnY DEVELOPMENT DEPARTMENT
BUILDING WISi0N - Gi PERTiNO
APPROVED
This set of plans and specifications MUST be kept at the
job sito during construction. It Is unlawful to make any
Changes or alterations on same, or to deviate
therefrom, without approval from the Building Official.
The stamping of this plan and specifications SHALL NOT
be held to permit or to be an approval of the violation
of a revisions of any City Ordinance or State Law.
BY
DATE ra
PERMIT NO.
OFFICE COP
RECEIVED
OCT 13 2015
BY___ ---
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DATE:
10/13/15
SCALE:
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10/13/15
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