13100080 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10700 FARALLONE DR CONTRACTOR:ANTHONY HODDER PERMIT NO:13100080
CONSTRUCTION
OWNER'S NAME: JANICE LANKFORD 7504 BOLLINGER RD DATE ISSUED: 12/06/2013
OWNER'S PHONE: 4087614128 CUPERTINO,CA 95014 PHONE NO:(408)2574317
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL
License Class 'It> Lii'c.#
Contractor 44c(�sy Date Z
I hereby affirm that I am licensed under the provisions Ch 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 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
rformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$40000
ave 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:36934013.00 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.1 agree to comply with all city and county ordinances and state laws relating WIT�IIN 180 DAYS DAYS OF�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 F S' ED 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
granting of this permit. Additionally,the applicant understands and will comply Iss y: Date:
with all non int source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signatur e Z 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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)
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(a)should 1 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
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 5505, 5533,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.
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 CONSTRUCTION LENDING AGENCY
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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
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
�6 0
CONSTRUCTION PERMIT APPLICATION O
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION O
10300•TORRE AVENUE•CUPERTINO, CA 95014-3255 �O
(408)7 77-3228• FAX(408)777-3333• buildin9aacupertino.orq
CUPERTINO
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROSECT ADDRESS� A / �� !� � � � APN#
OWNER N—0 C „t Tot N r C p / �` l kC PHO ,Q ^�, - 14g EMAIL
STREET DDRESS �- (_44, CITY, ST E,ZIP +r� FAX
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STREFT A E S �l ITY,STATE, ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
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COLICENSE NAME LICE ER LICENSE BUS.LIC#
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COMPANY NAME E-MAIL FAX
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EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION($)
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: U DETACH
❑ATTACH
_ADWELLING UNITS: IS A SECOND UNIT E]YES SECOND STORY ❑YES
BEING ADDED? ❑NO ADDITION? []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RE TOTAL VALUATION'
PLANMNGAPPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? []NO
Ya DO�
By my signature below,I certify to each the Mowing: I am the propeVtatit'070:fCu
uthorized to ac on the property owner's behalf. I have read this
application and the information I have rovide 's correct. e read thef W an verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to uilding nstru a�orize reprti to enter the above-ide ified propeyyfor inspection purposes.
Signature of Applicant/Agent: �`2� ate:_(
SUPPLEMENTAL REQUIREO pLANCHECKr��E ,�ROUTINcsLIP-
_New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER THE CouivTER ❑ suILDrnG ri nN"VIEW
existing building(s). Demolition permit is required prior to issuance of building =,
permit for new building. ❑EXPRESS" " ❑ rnivNiNcrrArtltEvlEw ,
I
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD r ❑ Pu�Llcwoxxs
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_201 1.doe revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10700 FARALLONE DR DATE: 10/11/2013 REVIEWED BY: MELISSA
APN: 369 34 013 BP#: 'VALUATION: 1$40,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM
USE: PERMIT TYPE:
WORK 660 S.F. REMODEL OF KITCHEN & LIVING RM AREAS. REMOVE E FIREPLACE. INSTALL 4
SCOPE WINDOWS & 1 SLIDING DOOR, &ADD 1 SKYLIGHT. UPGRADE EL. PANEL TO 200 AMP
q_.,„ ilstl�'E�,, , Elec.Plan Check 0.0 hrs $0.00
Permit Fee: IEPERMIT
�. LjOther Elec.Insp. ETrs 1 $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.). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn7 info.
FEE ITEMS (Fee Resolution 11-053 Eff.' 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 6_6 07 s.f. Remodel,Other
Suppl. PC Fee: (F) Reg. () OT F6,61 hrs $0.00 $558.00 IREMRESOTH
PME Plan Check: $0.00 F-67 # Window/ Sliding Glass Door
Permit Fee: $0.00 $418.00 1WINREP Replacement
Suppl. Insp. Fee.0 Reg. 0 OT 0.0 hrs $0.00 200 amps Electrical
PME Unit Fee: $0.00 $47.00 IBELEC200 Services
PME Permit Fee: $47.00
Administrative Fee: (ADMIN $44.00 Q
Work Without Permit? Yes 0 No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Fee: ITPU VDOC $47.00 Building or Structure
i
Strong Motion Fee: IBSEISMICR $4.00 Select an Administrative Item
Bldy,Stds Commission Fee: IBCBSC $2.00
SUBTOTALS: $144.001$1,023.00 TOTAL FEE: 1 $1,167.00
Revised: 10/01/2013
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: b M PERMIT 13L600YO
OWNER'S NAME: e #
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 OC UPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND AL S BCONT ACTORS /HAVIO:BUINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: �y
Signatu a Date
Please check applicable subcontractors and complete the following information:
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