13010130CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20156 MERRITT DR
CONTRACTOR: SOUTH VALLEY
PERMIT NO: 13010130
CONSTRUCTION
OWNER'S NAME: WRIGHT MARLENE M
1604 MCKEE RD
DATE ISSUED: 01/24/2013
OWNER'S PHONE: 4083165830
SAN JOSE, CA 95116
PHONE NO: (408) 206-9088
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL II
License Class_ Lic. # p O 0
REMOVE EXISTING SIDING AND REPLACE WITH
STUCCO ON
Contractor So�T� �il�.lx`1 SON Date 1-��-
FRONT (3) WALLS (400 SQ IT).
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:
N a I cation: $5000
performance of the work for which this permit is issued.
1 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
CPN Number. 31633101.00
Occupancy "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 OF PERMIT 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 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accn aid City in consequence of the
7 , .
rG Date:
granting of this permit. Ad ' ' a ly, thea scant understands and will comply
Issued b y: 4
with all non -point so regulations a Cupertino Municipal Code, Section
9.18.
,1
(� Z
RE -ROOFS:
Signa Date \' ��
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
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,
Business & Professions Code)
1, 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(x) 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 device hich emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air anagement District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertin nic Code, Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections , 2553 d 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized age 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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, l
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 property 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
1 understand my plans shall be used as public records.
granting 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
CONSTRUCTION PERMIT APPLICATION D j
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION �) `
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 13
(408) 777-3228 • FAX (408) 777-3333 • buildinclacupertino.orq
n ��rcon rine i rn oPVICInKI nPPPRQPn (11?11-IMAI PPPKATT Jl
u
PROJECT ADD S ( S
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133
APN #-7,�
OWNER NAME
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STREET AD?RE � n ' /� fJ
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FAX
CONTACT NAMEIazryL
P OTE �If -`"
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STREETDRES `' Yl
CITY, TATE, ZIP t t oto
FAX 2Z
❑ OWNER ❑ OWNER -BUILDER e0wNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
S
LICE%6 R -
i
TLICEVYPE
BUS. LIC #
COMPANY NAM
3
E-MAIL
S n. C
FAX
STREET ADDRESS
CI ST TE, IP q
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUSS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCR TION OF WORK
015
EXISTING USE
PROPOSED USE CONSTR.
TYPE
# STORIES
(n,
(`^
1
1
1
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
�7
,
fl
OC70
V 15
L/
BATHROOM
REMODEL AREA &
KITCHEN
REMODEL AREA VA I
OTHER
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA:ETACH
ATTACH
I
# DWELLING UNITS
ISA SECOND UNIT ❑ YES
BEING ADDED? O
SECOND STORY S
ADDITION? NO
1
PRE -APPLICATION OYES IF YES, PROVIDE COPY OF
ISTHEBLDGAN ❑YES
RECEIVED
TOT; VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? �O//�
DD O
By my signature below, I certify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information 1 have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to 1 in c n. I or ra*��of Cupertino to enter the above-' entifi d property for inspection purposes.
Signature of Applicant/Agent: Date: 21 3 24 13
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
BUILDING PLAN REVIEW
_ New SFD or Multifamily dwellings: Apply for demolition permit forOVER-THE-COUNTER.
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
11 EXPRESS
/
PLANNING PLAN REVIEW `d`l
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ 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
5
���CITY OF CUPERTINO
Fo—w—W TPI Ti. FCTIMATOR—R1TILDING DIVISION
ialADDRESS:
20156 Merritt Drive
DATE: 01/24/2013
REVIEWED BY: Sean
APN:
BP#:
*VALUATION: $5,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
p
"lurnb. lisp. Fee::
PENTAMATION 1GENRES
PERMIT TYPE: A
USE:
$0.00
PME Plan Check:
WORK
Remove existing siding and replace with stucco on front 3 walls 500 sq ft).
SCOPE
Permit Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public works, tire, Nanuary Sewer utsrrccy acnoot
.,__.___. TL ! ._ L . a n.. ago .,rat:..,:., .r„ infnrmniinn avnilahle and are anlV an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Ef: 7%1.'12)
FEE
''lumb. Plan Check
Elec. Plan Check
Plumb. Permit Fee
Elec. Permit Fee
Other Mech. la.j,
(Vier Plumb Insp.
Other Else. Insp.
/, c h. Insp. Fee:
"lurnb. lisp. Fee::
Elec. Ins,,,
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public works, tire, Nanuary Sewer utsrrccy acnoot
.,__.___. TL ! ._ L . a n.. ago .,rat:..,:., .r„ infnrmniinn avnilahle and are anlV an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Ef: 7%1.'12)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
400 s. f.
$400.00
Siding
ISIDEOTHER All Other
Suppl. PC Fee: Q Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. Q OT
0,0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
_F_T_
Construction Tax:
Administrative Fee:
1
E)
Work Without Permit? O Yes (F) No
$0.00
Advanced Planning Fee.
$0.00
Select a Non -Residential
Building or Structure
E)
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$1.50
$400.00
TOTAL FEE:
$401.50
Revised: 10/01/2012
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: O
ve ` y � V -C'
PERMIT #
OWNER'S NAME: 1AQa W k
G
PHONE #
GENERAL CONTRACTOR: S3% -KN
41,L4Cone EAQ,
BUSINESS LICENSE #
ADDRESS: l tN c,\z,d9 i' 1D
5-3 c s, ` 15j
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 INSP ON(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCO TO HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
Owner / Contractor Signature
Date
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
Owner / Contractor Signature
Date
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