14100039CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10238 E ESTATES DR CONTRACTOR: FOUNDATION PERMIT NO: 14100039
SOLUTIONS INC
I OWNER'S NAME: ANDREW & MOONY CHUM 13710 MARICOPA RD I DATE ISSUED: 10/07/2014 1
OWNER'S PHONE: 4082521122
❑ LICENSED CONTRACTOR'S DECLARATION
License Class A Lic. #
Contractor � Date__0L r , ? 2-7114
1 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
verfuxwance of the work for which this permit is issued.
I e and will maintain Worker's Compensation Insurance, as provided for by
ecti 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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
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 may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non lations per the Cupertino Municipal Code, Section
9.18. f
Signature
Date GG2 -:-Lr
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
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 subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
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
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City ofCupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date
ATASCADERO, CA 93422 1 PHONE NO: (805) 462 -0100
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
FOUNDATION REPAIR
Sq. Ft Floor Area: I Valuation: $19000
APN Number: 36907027.00 1 Occupancy Type:
PERMIT EXPI IF WORK IS NOT STARTED
WITHIN 0 DAYS O PERMIT ISSUANCE OR
180 DAYS ROM LAST CALLED INSPECTION.
Issued by: Date: 101-711q
RE- ROOFS:
All roofs shall be inspected prior to any rooting material being installed. If a roof is
installed without fast obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(x) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, ions 5, 25533, and 25534.
Owner or authorized agen%� T �T Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • building(dcupertino.org
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❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS
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❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CO�N�r?°TRACTOR NA.M
LICENSE NUMMBER
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DESCRIPTION OF WORK
WN W ti+ VrJ pA'r(.3 N k) C A51Nt S"/ &c(. f' /b1lj
EXISTING USE
PROPOSED USE CONSTR.
TYPE.
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK /PORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
# DWELLING UNITS:
ISASECOND UNIT ❑YES
SECONDSTORY OYES
BEINC ADDED? ONO
ADDITION?
PRE- APPLICATION ❑ YES IF YES, PROVIDE COPY OF
k[]NO
IS THE BLDG AN
TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME?
y
By my signature below, I certify to each of the following: I am the property owner or authorized agent to on t orel erty owner's behalf. 1 have read this
application and the information I have provided is correct. 1 have read the Description of Work and ypily ipolaccurate. 1 agree to comply with all applicable local
ordinances and state laws relating to mg co ction. I authorize representatives of Cuperti Iter the above - identified property for inspection purposes.
Signature of Applicant/Agent: Date: 0 C 1-
SUPPLEMENTAL INFORMAf46N REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
❑ OVER - THE COUNTER
❑ BUILDING PLAN REVIEW
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
1-1 SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
imADDRESS: 10238 E ESTATES DR
FEE
DATE: 10/07/2014
REVIEWED BY:
MENDEZ
Plan Check Fee:
APN:
BP #: VI0003 9
'VALUATION:
1$19,000
nPERMIT TYPE: Building Permit
Suppl. PC Fee: Reg. Q OT
PLAN CHECK TYPE: Tenant Improvement
hrs
PRIMARY
USE:
PME Plan Check:
PENTAMATION
PERMIT TYPE:
•
WORK
�vu►�ci� �t
Permit Fee:
SCOPE
Suppl. Insp. Fee:Q Reg.
0 OT
T 0,0
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addh 7 info.
FEE ITEMS (Fee Resolution 11 -053 EfJ' 7%1'13)
FEE
QTY /FEE
MISC ITEMS
Plan Check Fee:
$0.00
0 #
$859.00
Foundation Repair
1FOUNDREPA
Suppl. PC Fee: Reg. Q OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg.
0 OT
T 0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
G)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
E)
0
Strom Motion Fee:
IBSEISMICO
$5.32
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$6.32
$859.00
TOTAL FEE:
$865.32
Revised: 08/20/2014