B-2016-1339 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-1339
10440 LINDSAY AVE CUPERTINO,CA 95014-4518(369 12 018) POWFUL
CONSTRUCTION
SAN JOSE,CA 95116
OWNER'S NAME: FILANOWSKI PAUL AND DONNA TRUSTEE DATE ISSUED:04/29/2016
OWNER'S PHONE:408-981-2640 PHONE NO:(408)687-7607
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B Lic.#853051
Contractor POWFUL CONSTRUCTION Date 01/31/2017 X BLDG _ELECT _PLUMB
MECH X RESIDENTIAL_COMMERCIAL
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. JOB DESCRIPTION:
CHANGE OF ROOF STRUCTURE AT THE FRONT OF THE FAMILY
I hereby affirm under penalty of perjury one of the following two declarations: ROOM FROM SHED TO GABLE ROOF(113 SF)
t. 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.
2s 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. Sq.Ft Floor Area: Valuation:$20000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above APN
information is correct.I agree to comply with all city and county ordinances Number: Occupancy Type:
369
and state laws relating to building construction,and hereby authorize 369 12 018
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 PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulati er the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
l ature D 4/29/2016 Issued by:Abby,eende
Date:04/29/2016
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
r. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:4/29/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(x)should I store or handle hazardous
material. Additionally,should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety ode,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. 04
caner or authorized en
APPLICANT CERTIFICATION Date:4/29/2016
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 4/29/2016 Professional
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 —
CUPERTINO (408)777-3228• FAX(408)777-3333. buildinga-),cupertino.org
xM
®NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS 10440 LINDSAY AVE APN# 369-12-018
OWNER NAME PAUL FILANOWSKI PHONE 408-981-2640 E-MAIL pfilanowski@gmaR.com
STREET ADDRESS 10440 LINDSAY AVE CITY, STATE,ZIP CUPERTINO, CA 95014 FAX
CONTACT NAME KYLE CHAN, ARCHITECT PHONE 510-396-9731 E-MAIL kyle@kylechan.com
STREETADDESS5205 PROSPECT ROAD #135-120 CITY.STATE, ZIP SAN JOSE, CA 95129 FAX
❑ OWNER ❑ OWNER—BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT IN ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME' Te�'''1',r� LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME E—MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
r
ARCHITECT/ENGINEER NAMEKYLE CHAN, AIA LICENSE NUMBER C-31616 BUS.LIC# C
5,
COMPANY NAME KYLE CHAN ARCHITECT E-MAIL kyle@kylechan.co1-qi� FAX
STREET ADDRESS 5205 PROSPECT ROAD #135-120 CITY,STATE,ZIP SAN JOSE, CA 95129 PHONE
DESCRIPTION OF WORK CHANGE OF ROOF STRUCTU E AT THE FRONT OF THE FAMILY ROOM FROM SHED
TO GABLE ROOF.
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
RESIDENTIAL RESIDENTIAL V-B 1 USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA 2,754 AREA Q SF AREA NETAREA2,754 SF ROOF CHAN E NA $20,000
BATHROOM KITCHEN OTHER
EMODELAREA REMODFLAREA694 SF
REMODELAREA 163 SF 230 SF
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
NA NA NA 364 ATTACH
#DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY []YES
1 BEING ADDED? NO ADDITION? NO
PRE—APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN YES RECEI TOTAL VALUATION:
PLANNINGAPPL# ONO PLANNING APPROVAL LETTER EICHLERHOME? �NO $20,000
By my signature below,I certify to each of the following: I am the property owner or authorized age t a t o t roperty owner's behalf. I have read this
application and the information I have providV is correct. I have read the Description of Work and verify itis urate. I agree to comply with all applicable local
ordinances and state laws relating to building c ction. I authorize representatives of Cupertino to enter the above-identifi property or inection purposes.
Signature of Applicant/Agent: Date:
SUPP T FORMATION REQUIRED PLAN CHECK-TYPE ROUTING SLIP
New SFD or Multifa dwellings: Apply for demolition permit for ❑ "oVER-TH[&COUNTER BUILDING PLANREVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ .EXPRESS ❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD" ❑i,PUBLIC WORKS." "
form if any Hazardous Materials are being used as part of this project.
❑ "LARGE" ' ❑ FIRE DEPT.*
_Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR ❑'SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21/11