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13100014CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10297 S DE ANZA BLVD CONTRACTOR: AD ART INC. PERMIT NO: 13100014 OWNER'S NAME: ROBERT ALLARIO 5 THOMAS MELLON CIR. #260 DATE ISSUED: 10/01/2013 OWNER'S PHONE: 4088673060 SAN FRANCISCO, CA 94134 PHONE NO: (415)869-6462 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ' G U S l INSTALL 2 (N) ILLUMINATED WALL MOUNTED SIGNS & License Class Lic. # * AL Date /0 1( _` REPLACE FACING ON (E) MONUMENT SIGN Contractor �'T'i�� 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 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 APN Number: 35917001.10297 Occupancy Type: Section 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 PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WI TIiIN 180 D RMIT 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 D OM LAS ALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of theDate l�% 3 Issued y: granting of this permit. Additionally, the applicant understands and will cc; with all non -point sour lations per the Cupertino Municipal Code, Section 9.18. ' Signature ii/ DateW r/ �` % RE -ROOFS: 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 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(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 I use equipment or devices 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 Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 2 ,c25and 25534. 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 r Owner or authorized agent: 'J �/ �� 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, I 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 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(ftuoertino.ora ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS n _ , 2 ^ 0 APN # 5 - I. / �y - 0 Q 1 . a Z_ OWNER NAME r' I PHO ' y / y 2 �� EMAIL / L STREET ADD4S / U l� CITY, STATE, ZIP FAX CONTACT NAME � PI -1 ��. `! E-MAIL; ST ET `,Nr–'S,, M r 0AJ G/X V CITY, T�Er{Z�Ig , n ^' 1� 661 �Y/3 FAX 13 OWNER 13A OWNER -BUILDER 13 OWNERAGENT 2f�_VNTRACTOR ❑ CONTRACTOR AGENT 13 ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRAC R e_/__LI 51GtvGd SE 5 LICENS TYPE S BUS. LIC # COMP N E E-MAIL FAX STREET ADDRE S U F �U X/ G CITY, STATE, ZIP A -*C -S C o PHONE S "% 4O ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 7— .' 772'C-- -K EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. I SQ.FT. AALUATION(S) EXISTG AREA NEW FLOOR AREA DEMO TAREA TOTAL NET AREA P 6UU �1 BATHROOM REMODELAREA KITCHEN REMODEL AREA OTHER REMODEL AREA 1 g �,f I •o0o PORCH AREA DECK AREA TOTAL DECK -PORCH AREA GARAGE AREA:DETACH ATTACH I # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO f O O By my signature below, I certify to each of the following: I am the property ow authorized agen act on r0perty owner's behalf.( -have read this application and the information I have provided is correct. I have read the Description of Work and s accurate. I agree to comply with all applicable local ordinances and state laws relating to buildin representatives of Cupertino to enter the above -identified property for inspection purposes. �tilrize Signature of Applicant/Agent: Date: SUPPLEMENT FORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP _ New SFD or Multifamily dwellings: Apply for demolition permit forVER-THE-COUNTER �_Q ElBUILDING PLAN REVIEW 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 1011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION SIGN TYPE FEE ID Plumb. Plan Check QTY Plan Check F'ee: 10297 S DE ANZA BLVD DATE: 10/01/2013 REVIEWED BY: MELISSA liaADDRESS: APN: 359 17 001 BP#: QQ/ VALUATION: $10,000 %PERMIT TYPE: Building Permit PLAN CHECK YPF.,: PRIMARY 1SIGNOTHER PENTAMATION 1 CEAP5 Sign S S D'strict School PERMIT TYPE: USE: PME Unit Fee: $47.00 WORK INSTALL 2 N ILLUMINATED WALL MOUNTED SIGNS & REPLACE FACING ONE MONUMENT SCOPE SIGN SIGN TYPE FEE ID Plumb. Plan Check QTY Plan Check F'ee: SIGN FEE IESIGN Elec. Permit Fee: IEPERMIT Wall Sign, Electric 1SIGNWELEC hrs 2 Other Plumb Insp. $556 Other Sign 1SIGNOTHER Suppl. Insp. Fee -0 Reg. Q OT 1 S S D'strict School $349 PME Unit Fee: $47.00 PME Permit Fee: $47.00 Construction Tdv: I Clministrathv Fee: Work Without Permit? Yes No $0.00 TOTALS: $0.00 i Travel Documentation Fee: ITRAVDOC $905.00 Strong Motion Fee: IBSEISMICO NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, anttary ewer t , n d aro nnty an O.Ctimate. Contact the Dent for addn7 info. District, etc . /nese fees are aaseu on me preterrunal FEE ITEMS (Fee Resolution 11-053 Eff.' 7i7%132 F' tm c_'hacA Plumb. Plan Check # Branch Circuits 1 $47.00 Plan Check F'ee: Plumb. P<;:,,, i��e�: IESIGN Elec. Permit Fee: IEPERMIT Mech. P�:r;:r? <, 0.0 hrs Other alcc•h. Insp, Other Plumb Insp. Other Elea Insp. 0.0 $47.00 Permit Fee: $905.00 Suppl. Insp. Fee -0 Reg. Q OT 0,0 S S D'strict School NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, anttary ewer t , n d aro nnty an O.Ctimate. Contact the Dent for addn7 info. District, etc . /nese fees are aaseu on me preterrunal FEE ITEMS (Fee Resolution 11-053 Eff.' 7i7%132 •• FEE » _ -• - QTY/FEE ...__ ___ ---- _____ MISC ITEMS Plan Check F'ee: Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 Plumh.AVfeeh.1Elee Permit Fee: $905.00 Suppl. Insp. Fee -0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $47.00 PME Permit Fee: $47.00 Construction Tdv: I Clministrathv Fee: Work Without Permit? Yes No $0.00 Sign Master Plan: Q Yes 0 No $0.00 i Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: IBSEISMICO $2.10 Select an Administrative Item Blda Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1,049.10 $0.00 TOTAL FEE: $1,049.10 Revised: 08/01/2013