14050113 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10530 SANTA LUCIA RD CONTRACTOR:CONSTANTIN FILIN PERMIT NO: 14050113
OWNER'S NAME: CONSTANTIN FILIN 10530 SANTA LUCIA RD DATE ISSUED:06/13/2014
OWNER'S PHONE: 4082022793 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
INTERIOR REMODEL(1313 SQ FT); REMOVE AND
License Class Lic.4 REPLACE
(14)WINDOWS AND(5) DOORS; REMOVE AND REPLACE
Contractor Date FURNACE; REROOF WITH COMPOSITION SHINGLES
I hereby affirm that I am licensed under the provisions of Chapter 9 (2339 SQ
(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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$80000
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:34216059.00 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 YSFROM CALLED INSP CTION.
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 Issued by �� a
with al I non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature 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
1,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)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
onstruct 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 Worker's material. Additionally,should 1 use equipment or de 'ces which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air ity Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertin ode,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2 and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: 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
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,l must 1 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 1 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, ARCHITECT'S DECLARATION
costs,and expenses which m ecrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit. it y,the applicant understands and will comply
with all is e lations per the Cupertino Municipal Code,Section Licensed Professional
9.18. p
Signature Date
CONSTRUCTION PERMIT APPLICATION 0 �\'�
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228 •FAX(408) 777-3333•building(cDcupertino.org
\
❑NEW CONSTRUCTION ❑ ADDITION JK ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL,PERMIT 4
PROTECT ADDRESS `f 5� 14 bJ(a� APN* 3.42_
OWNER NAtiIEI.�NV9 1 J M� �1 L f (NP --'202- X77 3 ��IJ3�"F�IfN / )-09,M
STREET ADDRESS 24-8 �rt L 1 u 1 oe CTT 1'AT�,;_�_` ((L t, ) /f �( q L`l,3 FAX
CONTACT NAME M I.' _/�v I v MMry pLC
P ��41�`7 J Zl7qo Am Q7� Cod l�r�dFIwN i (��
STREET ADDRESS/
f65_3 �►`� �ir2 . C i l� `�SC C4 '?s 11,2-q1,2-q , -!85-57✓7
11 OWNER ❑ O
W
NER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGE NT �� ❑ENGAIEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME�,`'�rrp�. t-y li j h LICENSE NUMBER 71.ICENSETYPE BUS.LIC#
COMPANY NAME V W N �Jv w E-MAIL FAX
STREET ADDRESS !!! ( CITY,STATE,ZIP PHONE
etaWQTITECT/EN NPuW)6l't4 .L..� /� LICENSE NUMBER BUS.LIC# p �
AWA Pb De 9 l�Nly J' ,mac'. EQLA
-tact,✓1.evA I Com 4&-yb'S
STREET ADDRESS 0g 3 0/154'A (2 p P RSTVE CF5dD SG CIA_ /l L `'9'? !1 - 26-,6-6,Z6 d
DESCRIPTION OF WORK` F R <,F; </2a� -7t• - f1 C 9 / UCO
Ek'STING USE PROPOSED USE CONSTR.TYPE #, DRIES
V-6 USE TYPE OCC. SQ.FT. VALUATION($)
EXIST y^� TH'J71 NEWFLOO r DEMO TOTAL
AREA /V AREA /Pr, AREA '� NET ARE A/9(,-7
BATHROOM p KITCHEN OTHER
REMODEL AREA y"Y. 9 REMODEL AREA 2 3Z REMODEL AREA 1 S 10
P/;H AREA DECK A/ REA TOTAL nF.S;KiPOR.
c/JC/��_ CH AREA 'GE AREA: DETACH
'(77
ATTACH
#DWELLING UNrrs: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
rBEING ADDED? 2'NO .ADDITION? KO
PRE-APPLICATION YES IF YES,PROAIDE COPY OF IS THE BLDG AN ❑YES TOTAL VALUATION:
PLANNING APPL# NO PLANNING APPROVAL LETTER EICHLER HOME? WO
By my signature below,I certify to each of the following: I the property er o authorize gen ct o e property o s behalf. I have read this
application and the information I have provided,is. Description of Wor verify Is accurate ee to comply with all applicable local
ordinances and state laws relating twbt ilding con 4ti I authorize representatives of Cupertino to en v� 6r ipspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL I RMATION REQUIRED PLAN CHECKTYPE ROUTING SLIP
" ew SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ElEXPRESS ElPLANNING PLAN REVIEW
00 Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PuBLIc WORKS
form if any Hazardous Materials are being used as part of this project. 11LARGE ElFIRE DEPT
P�``
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 0621/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10530 SANTA LUCIA RD DATE: 05/19/2014 REVIEWED BY: MELISSA
APN: 342 16 059 BP#: �s *VALUATION: 1$80,000
"'PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 R3SFDRE
WORK REMODEL E SFD TO ENLARGE LIVING RM & MASTERBDRM/BTH WITH STRUCTURAL
SCOPE DETAILS. REMODEL (E) KICHEN & BATH. ( S.F. TOTAL) REPLACE FURNACE, SAME
Mech.Plan Check 0.0 1 hrs $0.00
Mech.Permit Fee: 1MPERNIIT
Other Mech. Insp. 0.0 hrs $47.00
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eft* 7%1113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.f. Remodel,Bath (<=300 sf)
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $626.00 1REMRESBAT
PME Plan Check: $0.00 EiTl s.f. Remodel, Kitchen(<=300 sf)
Permit Fee: $0.00 $626.00 1REMRESKIT
Suppl. Insp. Fee:Q Reg. Q OT 1 0.0 1 hrs $0.00 F975 I s.f. Remodel,Other
PME Unit Fee: $0.00 $628.00 1REMRESOTH
PME Permit Fee: $47.00 0 # Mechanical
171 $139.00 1MFR=<100 Furnace, Forced-Air
Administrative Fee: ]ADMIN $44.00 2,300 1 s.f. Re-roof
Work Without Permit? 0 Yes (j) No $0.00 $368.00 1REROOFRES E)
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Travel Documentation Fee: ITRA VDOC $47.00 Building or Structure
Strony, Motion Fee: IBSE1SMICR $8.00 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $4.00
SUBTOTALS: $150.001$2,387.00 TOTALFEE.-T $2,537.00
Revised: 04/01/2014