The URL can be used to link to this page

11120046-DCOVERSHEET 11120046-D 10200 MILLER AVE ffffA m WWII EWMN CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10200 MILLER AVE CONTRACTOR: LEON PERMIT NO: It 120046 CONSTRUCTION OWNER'S NAME: FONTAINBLEU ASSOCIATES 10285 STERN AVE DATE ISSUED: 12/07/2011 OWNER'S PHONE: CUPERTINO, CA 95014 PHONE NO: (408) 209-1272 ❑ LICENSED CONTRACTOR'S DECLARATION F— F— F- --7 License Class C) # / BUILDING PERMIT INFO: BLDG ELECT PLUMB ��L`ic. CC�r�%14Yu I MECH RESIDENTIAL COMMERCIAL Contractor LeC it el�A1 Date hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: CABANA- RE -ROOF 900 SQ FT, MODIFY ROOF (commencing with Section 7000) of Division 3 of the Business & Professions INCREASING PITCH 2% TO 4% 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 Sq. Ft Floor Area: Valuation: $0 performance of the work for which this permit is issued. 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: 37503005.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 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 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 - granting of this permit. Additionally, the applicant understands and will comply Issued b Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. 40 J� ROOFS: Signature L'' gDate J��Lr ,J_� All roofs shall be inspected prior to anyny 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, 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. 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 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 25505, 25533, nd 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner Date: l a' permit is issued. or authorized agent: L 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, 1 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 950143255 (408) 777-3228 • FAX (408) 777-3333 • building(aDcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # In PROJECT AD S ` C �:CJ/ i ^� A APN # 3 / J 63 a o,sa o OWNER NAME � � PHONE � � ' a� / E-MAILro STREET ADDRESS CITY STATE. ZIP CONTACT AME vI �Jf re P O� , A E Il �eS.ie- . Q STREET ODRESSZO tJAZA Fe - O� ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTR&CTOR NAME ! 1 SO �(� LI $NUMB 7 I I TYPE BUS. LIC #� / CDMP NAME a n 14- E- of 4 hao FAX STREET TDRESS La3fL� Y STATE, ZIP 4 q5D1 PHONE o q (2 2 ARCI=CT/ENGIT NAME LI SE NL1�ER BUS. LIC # �-, a c COMPANY e_ E-MAM F l -o/- 33 l i rT`cy- t -Sif;�SS STREET ADDRESSSTATE �{ ZIP ao PHONE r'33 /-d 3 DESCRIPTION OF WORK EXISTINGUSE PROPOSED U CONSTR. TY E # STORIES Boa r IJat I 1 ��'''��tiit ��' USE TYPE OCC. SQ.FT. VALUATION (5) EXLSTG AREA e,4) v J NEW FLOOR AREA ,s DEMO TOTAL NET .4RE Lq0O V= �I /� - BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKNORCH AREA GARAGE AREA LJ 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 PLANNING APPL # ❑NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICIMER HOME? ❑ NO R„ECEWED BY. TOTAL VALUATIQN: �//'j By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the pTperty 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 accurate. I agree to comply with all applicable local ordinances and state laws relating to g constru&tion. I auth pres fives of Cupertino to enter the above-iidre�nti ed pryperty for inspection purposes. Signature of Applicant/Agent: Date: " SUPPLEMENTAL INFORMATION REQ D PLAN CHECK TYPE ROUTING SLIP ❑ ovER-rlurcouNTER L�f BUILDING PLAN RLviEw New SFD or Multifamily dwellings: Apply for demolition permit for 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 L7 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 El El submittal of Building Permit application. MAJOR SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH . BldgApp_201 1. doc revised 06/21/11 4 �04