13010067CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10420 BUBB RD
CONTRArTOR: SO t LP co
PERMIT NO: 13010067
Uh —i
OWNER'S NAME: HOME OF CHRIST CH CUPERTINO LLC
DATE ISSUED: 01/10/2013
OWNER'S PHONE: 4089968268
PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL II
License Class cad Lie. # /� �%3
T.I PREP 20,000 SQFT `%J %�
Contractor Date Q / a
I hereby affirm that I am licensed under the provisions of Cha ter 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� l
1 b
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.
Sq. Ft Floor Area:
Valuation: $10000
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
APN Number: 35720038.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPI/111FFRK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enterupon
the above mentioned property for inspection purposes. (We) agree to save
180 DAYS FROLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Issued by: Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regu tions per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signature Date O f
All roofs shall bei ected prior to any roofing material being installed. If a roof is
installed without t obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OWNE -BUILDER DECLARATION
Signature o 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
1, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure isnot 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. 1 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(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Work s
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for a
air contaminants as defined by the Bay Are Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupe no Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as p ided for by
the Health & Safety Code, Sections 05, 3 qd 25534.
Section 3700 of the Labor Code, for the performance of the wo for which this
permit is issued.
Owner or authorized agent: Date: O l t7
I certify that in the performance of the work for which thi ermit is issued, I shall
not employ any person in any manner so as to become ject to the Worker's
Compensation laws of California. If, after making ' certificate of exemption, I
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation pr isions 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 p it shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT RTIFICATION
Lender's Address
I certify that I have read this applicatio and state that the above information is
correct. I agree to comply with all cio and county ordinances and state laws relating
to building construction, and hereb 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
I 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
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ��
(408) 777-3228 • FAX (408) 777-3333 • building(a)_cupertino.orq \
I—I .156 A 11n- 1 11 n nGv11111r i nFFFRRFn ORIGIN AT, PERMIT #
I__.J 1VGW l.V1VJ 11�VV11V � LJ �✓viiiv.. .�.. `...---...... __ -�
2
PROJECT ADDRESS (ri')/;>7� , , i_b F-6
(l.
APN 4 35-Tyy�� ^ 4�12�6
c>
'7
n�iU�v
a'
OWNERNAME (�. tGQi(� PHONE �01�� �Zv(J f-t4AIL�.. BGG kt[,V, j AJ C+ ' A
STREET ADDRESS[, 6tb +_ vZ CITY, STATE, ZIP - /,- � p �ff I ' F j�'_«RJ
I'� vtv `..1�
.kii�('�1 1Sb
CONTACT NAME �� V �� L.CY �'C^,L-f{ (I Yc/ 1
PHONE toj 31;
3
B-MAIIL V' aVL� .fZCZ JC, VW .
-^
STREET ADDRESS /,, / V Q Q /' %Le -j gc�
CITY, STATE, ZIP }'�1 �V,
FAXC:
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT CHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME' f A "/2 �^ I
JyV �,1) I"t
LICENSE NUMBER
0 c.)
LICENSE TYPE
�
BUS. LIC #
COMPANY NAME
LAS\ d L tT type �vt
E-MAIL ,',, Cl Z
FAX
STREET ADDRESS . /
(^
!f /��L0/
CITY, STATE, ZIP N _ /A� �'� `
(�
PHONE
S J b
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
-f�g wt K"r W wzw �u wlro Ll iv -r6
EXISTING USE
tQ
PROPOSED USE CONSTR.
Gi�ur�,Pic,
TYPE
Q
# STORIES
t
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG
AREA 2[Yyi S,
NEW FLOOR
AREA Zc e¢in CY
DEMO
AREA '2�.
TOTAL
NET AREA �,O
BATHROOM
REMODEL AREA
KITCHEN
REMODEL AREA
OTHER
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECWPORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
#DWELLINGUNTIS:
IS A SECOND UNIT []YES
SECONDSTORY ❑YES
O
BEING ADDED? O
ADDITION?
PRE -APPLICATION []YES IF YES, PROVIDE COPY OF
PLANNING APPROVAL LETTER
IS THE BLDG AN 9 YES
EICHLERHOME? No
RECEI_.---'VED $Y
TOT4L.VALUATION
D
PLANNING APPL# ❑NO
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I 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 t building construction. I authorize representatives Cupertino to enter the above -identified property for inspection purposes.
�o,.f,
rl t CDate:
Signature of Applicant/Agent:
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
'r*OVER-THE-COUNTER
BUILDING PLAN REVIEW
111
New SFD Or Multifamily dwellings: Apply for demolition permit for
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
❑ 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
V
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: a
PERMIT #
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR:
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:
Signature
Please check applicable subcontractors and complete the following information:
Date
6/
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
�l o
D e