14020072 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19778 LA MAR DR CONTRACTOR:SIGURA PERMIT NO: 14020072
CONSTRUCTION INC
OWNER'S NAME: FU HORNG-SEN AND ROSA C 614 NATIONAL AVE DATE ISSUED:02/12/2014
OWNER'S PHONE: 6509691302 MOUNTAIN VIEW,CA 94043 PHONE NO:(408)736-7952
❑ LICENSED CON'TRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑
REMOVE PONY WALL LOCATED AT(E) FRONT PORCH
License Class Lic.# Z AND
S� vr0. Co�skr��� A INSTALL NEW SUPPORT POST AND FOOTING
Contractor °d Date 2 1 Z'I 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.
1 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:$3700
1 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:36912030.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 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 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 DAYS FROM LAST CALLED 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
Dategranting of thi ermit. Add itionall the applicant understands and will comply Issued by:
with all non of t source regulations p r the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signatu�e - Date Z'I ti' 1`-{ 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
I,as owner of the property,or my employees with wages as their sole compensation,
wil I 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. 1 will
1 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
1 have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 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 thepertino Mu ipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections�5505,2553 d 25534.
Section 3700 of the Labor Code,for the performance of the work for which this i
permit is issued. Owner or authorized agent: Z Date:
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,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
{
CONSTRUCTION PERMIT APPLICATION
2
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION dO
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUpERTINO (408) 777-3228• FAX(408)777-3333• build ing(akupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS APN# /� 12/).W
t G 1 � L N�y r r. ( L/
OWNER NAME PHONE E-MAIL
650 3o2
J
STREET ADDRESS CITY, STATE,ZIP FAX
CONTACT NAME PHONE / (,ck E-MAIL
0C( �:50 gG ��t' l7 rlrl OC31 6yz"-&7S'fl✓Cf'o r(
Lrvr
STREET ADDRESS CITY,STATE, ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHI'T'ECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME T LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME E-MAIL FAX
`-,,,, L, U l � on<.�4rUc 'k- .'vC� `G ��tQ vTC�G�`:�>'F;��[_'F..�:7c. �OQj —� 1(o Z ��7
� �u
STREET ADDRESS CITY,STATE,ZIP PHONE
(; ly uLJ, _kICI e\ i4cl-IZ L—,LD 6ci n`L
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
y'3,LAO
DESCRIPTION OF WORK
(ewav or.
EXLSTINGUSE 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: DETACH
❑ATTACH
#DWELLING 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 RECEIVED BY; '�iwq :' � y�. TOTAL VAL TION:
PLANNING APPL# [:]NO PLANNING APPROVAL LEITER EICHLER HOME? ❑NO � 4+, '�''*'' T4s '
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act o(the pr3Nrfy 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 ac gree to comply with all applicable local
ordinances and state laws relating to building construcfli)r I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Age6t /'��'� Date: Frhr� kh 1
SUPPLEMENTAL INFO TION REQUIRED �'`�' �' `4 ' ^"'�� ' *� ��� t"'.
a •�'�.s P CHECI��T�YPE� ��y' .,�*% l;rO�INGSLI�'I ����.,� 6^
_New SFD or Multifamily dwellings: Apply for demolition permit for +
.DVER-`fHFrCO[)N�'ER� d`.,,iJILDI1xGPl; Rfi�SEW a
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. axrixFSS � w
Commercial Bldgs: Provide a completed Hazardous Materials Disclosurer1vn.xD 'r.,
form if any Hazardous Materials are being used as part of this project.
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. r Yr
BldgApp_201 1.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 19778 La Mar Dr DATE: 02/12/2014 REVIEWED BY: Mendez
APN: BP#: `VALUATION: 1$3,700
'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: PERMIT TYPE:
WORK remove pony wall located in front of sfdwl
SCOPE
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Puhlic 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 addn'l info.
FEE ITEMS (Fee Resolu(ion 11-05.3 Eff 71,13 FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? Yes Q No $0.00 1 hours Plan Check,Hourly
Suppl. PC Fee: (j) Reg. 0 OTT 0.0 1 firs $0.00 $139.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? ()Yes D No $0.00
Suppl. Insp. Fee:() Reg. 0 OT 0.0 firs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
0
Work Without Permit? 0 Yes No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential )
Building or Structure 0
Strong, Motion Fee: IBSEISMICR $0.50 2.0 firs Inspections
Bldg Stds Commission Fee: IBCBSC $1.00 $278.00 ISTINSP 7 Inspection,Hourly
SUBTOTALS: $1.50 $417.00 TOTAL FEE: 1 $418.50
Revised: 01/15/2014