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09040035- PUB Edi O N N C �0 \ y O 'I U O q LOW O Q OD p Q ^I W H H o a E; H x LO F W P. FL F Q HHy f 5 W F4 x U a F p P7 W u p U p O w O W N P] x \ w0 c W U 00 > M U C9 in W w SL LoU p o a cz O Fu M W H H O O F W 0 O p Z a .Ue�+ PU7 \ U C7 F P p C6 f_S Ctrl [q to pq L, Cj _ Z v w a� p m O -j EW H CD C, _ } E = U ai �i i11 `n r U Lo Lo x Q W c O N lei rw � ".; CD n a xLLIo O s : w o 0 0 w �- v v u idi idi lei OL �-13 a a a z CD U 0 O O O = itCD COui CD C2 lei w 10 ui CD i _ CO C- - CL. < W pp W W C IML «I LL m ,� F- w Z _ M or) W !m N c �4 C CJ M CD � W w WW W J O -a 1 W J m � � Q .7 Z R -Sal CD w o o f1 � � � � � � � O' c o o w o o u7 Q Q U- Q, w QC i Q N � . v l x 3 W C ®� in % 61 q� -0 CL EO y v �D d f� _ _ xVi �h (] S i t1 y � 3 L xa f0 L.L U ~ xE cl hl C xQ LL- � ~ v � U 7 w a� o `o s cn o c x NN N N Q 3 `y U Ql E U U E c 0 Ll CL A wJ a� o a v v. , v E CL 0 O Q u, U O 0- O w W U) c W Q W CL v U U U 6 y F CL LL CITY OF CUPERTINO BUILDING DIVISION PERMIT IMO.. BUILDING ADDRESS: PERMIT NO. 10839 SYCAMORE TBD - T BE DETERMINED nqn4nn�r, OWNER'S NAME. PERMIT ISSUE DATE 2889 S A CONTROL NO. ARCHTTECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u cc LICENSED CONTRACTOR'S DECLARATION Job Description N P I hereby affirmat I am licensed under provisions of Chapter 9(commencing Z U with Section 7000)of Division 3 of the Business and Professions Code,and my license is y in full force and a c4 (� /y{ g t f >, ADD DETCHD GAZEBO, DETCHD PATIO (19 8 SQ). j 4 Licenx lass _ _a L1e.0 F-p Date L4• '��d+=f Contractor ARCHITECTS DECLARATION UI understand m av)� be ygcd as p�records W In Licensed Professional fJ'�� t C OWNER-BUILDER DECLARATION ny—t I hereby affirm that 1 am exempt from the Contractors License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county K m Pi which requires a permit to construct,alter,improve,demolish,or repair any structure 't Z In prior to its issuance,also requires the applicant for such permit to file a signed statement < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation YF=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y .. that he is exempt therefrom and the basis for the alleged exemption Any violation of $6000 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(a500). 34257029 . 00 ci I.as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure isnot intended oroffered for sale(Sec.7044.Business Required Inspections and Professions Cade:The ContraLicenses License Law does not apply to an owner of fl P property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,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 sale.). 1,as owner of the propertyy,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li. ecru Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law. I am exempt under Sec ,B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: d1 have and will maintain a Certificate of Consent to self-insure for Workers Compen- sa'on,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 3100 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number are: Carrier. Policy No.: CERTIFICATE OF EX MMFT70N FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foram hundred dollars(5100) or less) 1 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 subjec_t{o the Workers'Compensation Laws of Califppm��ea.n r- D z-vf- lY % _'o Q— Applicant'1G1,� •0 A; r T . NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workces Compensation provisions of the tabor Code,you must .J O forthwith comply with such provisions or this permit shall be deemed revoked. z""' CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of fYr the work for which this permit is issued(Sec.3097,Civ.C.) Q Lencices Name , Z Lenders Address U 0 1 certify that 1 have read this application and stale that the above information is G1,'—' carrecL 1 agree to comply with all city and county ordinances and state laws relating to 0 V building construction.and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes a (We)agree to save,indemnify and keep harmless the City of Cupertino against ►F-i rA liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. APPLICANT UNDERSTANDS A D WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE R�RGULAT10 �t/l-L-A A-A �. Jln -jl a '(Dq Re-roofs Signature of Applicant/Contractor Dale HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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 Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes ]�No Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? 0Yes No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must be me prior to issuance of certificate orOccupancy. Signature of Applicant Date Owner orauthori.dagent' Date A]l roof coverings to be Class '. or better CITY OF CUPERTINO ADDITION/REMODEL CUPEI�JINO FEE SCHEDULE APN # :qA ®-q Date: Building Address: o k3z 1 Y Mailing Address (if different from bui ding address): Owner's Name: / G,Jv a .C,�� Phone# : G ��_ ���_ ✓�s-G HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA Contractor: Phone#: \-),a _ 2 3 -� Lo,v.p4 tCoy 1 K c---)f (QS.S- Fax #: `1 Contractor License#: 69 4 q Cupertino Business License#: Contact: d Phone#: — 2-- 60( O VLL/1 Gp - �.e-c �(-.� �/ Fax #: Building Permit Info: Bldg. ❑� Elect. ❑ Plumb. ❑ Mech. ❑ Hillside ❑ Job Description: Addition-What is being added?(Be Specific): What is being remodeled (not including addition)? z4dc6'r2 c. Remodel Includes Re-Roof: Yes ❑ No P3,\ If yes list number of squares Remodel Includes Structural: Yes E No ❑ Do you have the pre-application planning approval? Yes ®- No ❑ 6���y� If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch:_tJWSo.Deck: Garage: Detached Attached Remodel: Kitchen /Bath Other Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B - fz -3 Valuation: Please check this box if the project is a 6,170��'' — second-story addition ❑ Project Size: Express dard ❑ Large ❑ Major ❑ Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, Green Building Points Achieved: G� include in plan set & the sheet index. ***For Office Use Only*** Over-the-Counter 0 Revised 02/05/09 CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Sq Ft Group ADDITIONS 1R3SFDADD PLLONGRNGR Long Range PL Planning/Residential 1 R31NSP Dwellings Inspections B 1R3PLNCK Dwellings plan check B 1R3REPINSP Dwellings Repeat B Inspection 1R3REPPLNC Dwellings Repeat Plan B Check 1R3HINSP Dwellings Hillside B inspection 1R3HPLNCK Dwellings Hillside plan B check 1R3HREINSP Dwellings Hillside B Repeat Inspection 1R3HREPLNC Dwellings Hillside B Repeat Plan Check 1R3ALTINSP Dwellings Alternate B Materials Inspection 1R3ALTPLNC Dwellings Alternate B Materials Plan Check 1 PCESS Cesspool P 1 PPRSEWG Ea. Private Sewage P Disposal System 1PRSEWER Sewers P 1BPSPRINK Lawn P " Sprinkler/Backflow 1BPWSVCS Main Water Service P 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE SeismicResidential B 1REROOFRES Residential Re-roof Each B 100 SF yam;: Community Development f 10300 Torre Avenue aa4 ,. Cupertino CA 95014 7vi y Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT # Oct0 0C)q G ©-''4 S cc1ni��E' �er"- r OWNER'S NAME: o u v o . ., PHONE # , GENERAL CO NT /TOR: e_ 2 g g S` FAX# / I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Z !�Z �z -2 - Owner/Contraktor 2 -Owner/Contractor Signature Date