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10030178 - PUB t ,o �p 4jj 11 E . O 1 3 L] ((( {{ r 1 0 x W t j # n i .1 r F_1[ # (gi s E Q , a F LLI a � llllll pIi w a e H CT) 9CL U x W fir? W p p j a O F i 1 _ 7�� Q[ kr7 I' W j� O1 E o3 �� r o po W P4 m z IL ZD 1 i � I JII fi a Cpl► `N.i� � r �,�3 { U � 11 it , 5 ..: ia CL 4 a# 1JI ( I E I x a07cr � 1 r oU i LL, ( o o i� a co 0 aLU a a ; , y j O O O ; CD CD LLIi Iuj o r it Jd;M F_ ..._. mil a I I �� m� N� ~` LLJ� 7 i F6 t ? ? tJ vr_ IL ? i _i O i ! ' .._ f ?. i I F_ I w j i O t { fti 1) `O 1OA I d W� ( W 'D H " o JQ1'�If i 'ocWr1J m m I ` � fp� Z CD cr IILo A" I- C:) L_ 1L� _.D VI O v o i x 3 ay N v � c. � a v0 Z3 fu OL o v_ 2 OL ft OL! 0 LL ¢ ; YY:: E a� U w as o LL_ € o Z ". Z o o 0 o a v v Q v v ar E a U U E v, °D —' E ar as a cn v � o ? vA a w a�° �, o a ay .� .� .� d < cn U O d I a7 `._' - d u IL ¢ w U U v E d a LL CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10953 SWEET OAK ST CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO: 10030178 OWNER'S NAME: GIOVANNA PETRICCIANI DATE ISSUED:03/30/2010 .1ER'S PHONE: 6502699907 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATIONr BUILDING PERMIT INFO: BLDG ELECT , PLUMB License Class Lic.# MECH r— RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMODEL HALL BATH&MASTR (commencing with Section.7000)of Division 3 of the Business&Professions BATH(150SQ)NON-STRUCTURAL 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 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$20000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:32651014.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Date: 9.18. Issued Signature Date OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. I,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, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& 1 have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 Or}ner or authorjzedenf" ' become subject to the Worker's Compensation provisions of the Labor Code,I must �'{ � 'tom{� .t-��cWDate: IvWW-CJ4 30,ZDl v forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address mify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Signature 40—YUr)V1 Date MAeW�1W( Licensed Professional G(21) C) 1 CITY OF CUPERTINO �(s ADDITION/REMODEL CUPEVFINO PERMIT APPLICATION FORM APN# _ Date: 3 � � 5 � ' W14ZC44 2.5, Z01b Is a 2" unit being added? Yes ❑ No ® If yes, please fill out the permit application for 2" unit. Building Address: ` 5 Sw �K ST2tFEr CCJpF�TiNv, CA QSv 1 Mailing Address (if different from building address): Owner's Name: Phone# GtioVnKiN a pr-_1-Ajoc±ipttl tom_ zu -qCIO 7 Contractor: Phone#: �6-Ll—'.q- &4oLk BA,) A2C7q CVG 0M u1 L_0E:72 S Fax #: 4O'c> - L4 Lk—- iz41 Contractor License#: Cj Z(a(v 44 Cupertino Business License#: Contact: Phone#: 4056- -14 5ci-&LLOc-1` ('_HAf2LEs 12>^LXN .-P o=t Fax #: .40'6- 441-- 1 ZL4/ Building Permit Info: Bldg. � Elect. Plumb. Mech. .r7f Hillside ❑ Job Description: Addition-What is being added?(Be Specific): What is being remodeled (not including addition)? HA4_L_ e-40- -i --rte. S-t� c �1 Remodel Includes Re-Roof. Yes ❑ No ® If yes list number of squares Remodel Includes Structural: Yes ❑ No Do you have the pre-application planning approval? Yes ❑ No If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen Bath 1150 Other Type of Construction (Usage Class): Occupancy Type: Co►-�Ov 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B Valuation: ;,p bap.-cc> Please check this box if the project is a second-story addition ❑ Project Size: Express Ej'::Standard ❑ Large ❑ Major ❑ Please complete relevant portion of the Green Building Checklist & attach it to the application or if.applicable, Green Building Points Achieved: include in plan set & the sheet index. ***For Office Use Only*** Over-the-Counter ❑ Revised 07/06/09 I CITY OF CUPERTINO ADDITION/REMODEL CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft ADDITIONS 1R3SFDADD 1PLLONGRNGR Long Range PL Planning/Residential 1R3INSP 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 $ Materials Inspection 1R3ALTPLNC Dwellings Alternate B Materials Plan Check 1PCESS Cesspool P 1PPRSEWG Ea. Private Sewage P . Disposal System 1PRSEWER Sewers P 1BPSPRINK Lawn Sprinkler/Backflow P 1BPWSVCS Main Water Service P 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee / 1BSEISMICRE SeismicResidential B 1RER00FRES Residential Re-roof Each B 100 SF Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E R-rl NCO Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: �S3 C„��Q7[- C�C� �'� PERMIT# 0030/7 OWNER'S NAM ��juCr1�1 c` -27 t Zioc'�a'o R PHONE# TD—2,,e,1C/ QD7 GENERAL CONTRACTOR: onrj A,,Aof BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: AcLxe-nr?�7,4�-t" 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 Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile "CC Owner/Contractor Signature Date