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13050210 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20650 VALLEY GREEN DR CONTRACTOR:DEVCON PERMIT NO: 13050210 CONSTRUCTION INC OWNER'S NAME: SI 50 LLC 690 GIBRALTAR DR DATE ISSUED:05/30/2013 OWNER'S PHONE: 4089745662 MILPITAS,CA 95035 PHONE NO:(408)942-8200 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class_ Lic.# 7 ADDITION OF 43 FEET OF FENCE AND TRELLIS Contractor ]� � Date 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:$45000 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:32610053.00 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 DAYS F 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 the (`— granting of this permit. Additionally,the applicant understands and will comply Is Date: J with all non-point sourc egulation the Cupertino Municipal Code,Section 9.18. or RE-ROOFS: Signatur 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. ❑ WNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby a firm 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) 1,as owncy 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 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 Are it Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cuper Municipal Code,Chapter 9.12 and l have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec'0 5 25533, 534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent- Dat . 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,1 CONS TION 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 . V CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 �O CUP'ERYI +10 (40,8).777-3228• FAX(408)777-3333 • building(g-kupertino.org NEW CONSTRUCTION ❑ ADDITION TERATION/Ti ElREVISION/DEFERRED ORIGINAL PERMIT# PROIECf ADD ^ APN# 2 r 7/fp r/ //� C6 7[ l lJ J 7 OWNER NAME PHONE E MAIl ♦ "' STREET ADD SCITY, STATE,ZIP FAX ag CONTACT O STREET ADD SCrrY�li FAX ❑ OWNER .❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENG4NEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LI E LICENSE T E BUS.LIC# COMPANY FAX STREET ADDRESS h CITY,STATE, ^ OMB ARCHr=., /EN WEER NAME LICENSE NUMBER BUS.LIC# el— 5P COMPANY B-MAIL FAX STREET.AD S CITY,STATE, DESCRIPTION OF WORK ExisTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($). EXISTGNEW FL60R 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: LJ DETACH ❑ATTACH DWELLING UNrfS: IS A SECOND UNIT ❑YESSECOND STORY []YES _ BEING ADDED? ❑NO ADDITION? ❑NO .PRE.APPUCATION ❑YES IF YES,PROVIDE COPY OF. IS THE BLDG AN ❑YES TOTAL VALUATION• - PLAMNING APPL# ❑-NO PLANNING APPROVAL Li;i"rER EICHLER HOME? ❑NO - - By my signature below,I certify to each of the following: I am the property owner or authoriz nt to act on the property owner's behalf. 1#6ave read this application and the information I have provide 's correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to b nstruc'on. I authorize representatives of Cupertino to enter the above-identified pro rt y for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMEINF MAtON REQ7t5 ("i TV('N FI IT New$FD Or Multifamily J�,ellin gs: Apply for demolition permit for � existing building(s)...Demolition permit is required prior to issuance of building !'VF;hTF,I.c nI vrF.0 t u DING I I �a hIV!Lw> permit for new building. u' LXI La" I L VNNING.PLA;).R.VlHhr. _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 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. BIdgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20650 valley green dr DATE: 05/30/2013 REVIEWED BY: melissa APN: 326 10 053 BP#: /M aj /� 'VALUATION: $45,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement PRIMARY Commercial Building PENTAMATION 1GENCOM USE: PERMIT TYPE: WORK addition of 43 feet of fence and trellis SCOPE t:;l�c�ak Plumb,l'i'm Checf, Mech. P<r.=r i!Fee' i'.'trmn. Permit Fff E1_L_ £t'i'r t'lrrrr 1 1r,.p_ E tr E1_L_ '� c . NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These fiees are based on the preliminary information available and are only an estimate. Contact the De t for addn'l info. FEE ITEMS(Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? ()Yes (E) No $0.00 0 hours Plan Check, Hourly Suppl. PC Fee: (F) Reg. 0 OT 0.0 1 hrs $0.00 $133.00 1STPLNCK PME Plan Check: $0.00 43 1.£ Fence Permit Fee: $0.00 $400.00 [FENCE>6FT Fence, Non-Masonry>6' Suppl. Insp.Fee:Q Reg. OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Pen-nit Fee: $0.00 Construction Tax: 4,1ministrulive Fee: 0 Work Without Permit? 0 Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential 7)�r�e1L <�rrtrnt?r7t�r1irin.l�:��s. Building or Structure Strong Motion Fee: /BSEISd11CO $9.45 Select an Administrative Item Bldg Stds Commission Fee: [BCBSC $2.00 SUBTOTALS: $11.45 $533.00 TOTAL FEE: $544.45 �' Revised: 04/29/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RTI N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 0'x.66 PERMIT# OWNER'S NAME: PHONE GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: o 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 OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUB NTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractor / �0 Signature _ Date Please check applicable subcontract and complete the following information: . Z 6/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork i 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 Awv!gno�er�N,—T—ra—ctor�Sii!iiature Date