11100022 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11009 SYCAMORE DR CONTRACTOR:S.EA.CONSTRUCTION PERMIT NO: 11100022
OWNER'S NAME: CHRISTOPHER MiGDAL 1941 OTARRELL ST DATE ISSUED:03/23/2012
OWNER'S PHONE: 6504280826 SAN MATED,CA 94403 PHONE NO:(650)287-4202
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL IJ COMMERCIAL
License Class Lic.# 5 G BASEMENT ADDITION(1,339SQFT)WITH LIGHT WELL,
AND
Contractor�Sk'k C C,V, Wate 1-15 NEW BUILT IN BARBEQUE AT GRADE&REMODEL
1 hereby affirm that I am licensed under the provisions of Chapter 9 CLOSET
(commencing with Section 7000)of Division 3 of the Business&Professions INTO STAIR(25 FT)
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations: 11/$112-REVIS 012-LIGHTWELL STAIR,TREADS
I have and will maintain a certificate of consent to self-insure for Worker's -ISSD 4/10/2013
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:$320000..
I.have and will maintain Worker's Compensation Insurance,as pro y
Section 3700 of the Labor Code,for the performance of the work for which this APN Number 34256025.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and stale 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 WIT $O 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 DA F OM 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 /b
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point era7re regulations o Municipal Code,Section
9.18.
r y _ RE-ROOFS:
Signature Date "i All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection,l 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,
33usioess&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
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 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 the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worki is Compensation Insurance,as provided for by the Health&Safety Code,Sections 545533,and 25534.
Section 3700 of the LaborCode,for the performance of the work for which this Owner or authorized agent: Date: `l U
`
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
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
eorrect..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
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 11009 Sycamore Dr. DATE: 11/08/2012 REVIEWED BY: Sean
APN: BP#: 11100022 `VALUATION: Iso
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or DuplexJ PENTAMATION 1GENRES
USE: PERMIT TYPE:
WORK Revise to li htwell stair, treads cantilever
SCOPE
Xf4?ch, Plan Check Plumb. Plan Check Elec. Plan Check
r II—T Perwil Fuca: Plumb, Permit Fee: l7ec. perrnir Fec:
Other Atech.Insp. (,)(her Plumb Insp, Ll 01her Elee.Insp. E]__L_
Alcech. lnsl.. Fee: 11111mb. hrsp. Fec: Elec. Insp. Fee.:
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School
District,eta). 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 EL' 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: - Hourly Only? O Yes Q No $0.00 2 hours Plan Check, Hourly
Suppl. PC Fee: (!) Reg. 0 OT0.0 hrs $0.00 $266.00 ISTPGNCK
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
ConstrNction.Tax:
Adininish•ative Fee.-
Work
ee.Work Without Permit? Yes (F) No $0.00 Q
Advanced Plannin Fee: $0.00 Select a Non-Residential
Travel Documentation Fees: Building or Structure Q
A
Strong Motion_Fee: $0.00 Select an Administrative Item
Bldg Stds Commission Fee: $0.00
SUBTOTALS: $0.00 $266.00 TOTAL FEE: $266.00
Revised: 1010112012
CITY OF CUPERTINO BUILDING PERMIPEMSION# '
BUILDING ADDRESS: 11009 SYCAMORE DR CONTRACTOR:S.EA.CONSTRAW§ LUL=2
OWNER'S NAME: CHRISTOPHERMIGDAL 1941 OTARRELL ST DATE ISSUED:03/23/2012
OWNER'S PHONE: 6504280826 SAN MATEO,CA 94403 PHONE NO:(650)287-4202
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lie.t! 5 La BASEMENT ADDITION(1,339SQFT)W1TH LIGHT WELL,
Ln
AND
Contractor /—
� Atr ,_ Li'Ut✓tcwbate �" �—' ?✓ NEW BUILT IN BARBEQUE AT GRADE&REMODEL
1 hereby affirm that 1 am licensed under the provisions of Chapter 9 CLOSET
(commencing with Section 7000)of Divisiou 3 of the Business&Professions INTO STAIR(25SQFT)
Code and that my license is in full force and effect.
1 hereby affirm under penalty of perjury one of the following two declarations: 7/6/12-REVISION#I-CHANGE USE OF INSULATED CONCRETE
I have and will maintain a certificate of consent to self-insure for Worker's FORMS TO THE USE OF SHOTCRETE-ISSD 8/17/12
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:$320000
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:34256025.00 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 ISO 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 10 save 180 DV ROM LAST CALLED INSPE TI N.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses whi may accrue against said City in consequence of the
granting of this perm'. ddi . nally,the applicant understands and will comply Issued by: Date:
with all non-point cc latiens per the Cupertino Municipal Code,Section
RE-ROOFS:
Signature Date /Z All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,l agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant; Date:
1 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(Sce.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(x)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 the Cupe 'nn Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 5,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this , l
Owner or authorized agent:
permit is issued. te.
I certify that in the performance of the work for which this permit is issued,l shall
not employ any person inany 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,l 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 1 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 1 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
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
WDDRESS: 11009 Sycamore Drive DATE: 07106/2012 REVIEWED BY: Sean
PN: BP#: 'VALUATION: Iso
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: PERMIT TYPE:
WORK Revision #1: Change from use of insulated concrete forms to the use of shotcrete.
SCOPE
Ifyc h. Man Check Phan&I.11cm Check Elec. flan Check
Fh:ch. Peermil Fee: Phtrnh. Permit Pee: Elec. Permit Peer
CJrfter Alec h. Irtvp, E1__L_ 0(/10'PIn11213 Inch. E1__t__ Other(Yee-. Insp. Ll —I_
Hach. Insp. Fee: Plumb. hup.Fey:: L lee.Insp. Pee'
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . These ees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Cr. 711111) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes Q No $0.00 0 hours Plan Check, Hourly
Suppl. PC Fee: Q Reg. OT 0.0 hrs $0.00 $133.00 IsrPL
NCK
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl.Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Consit-action Tire:
A(iministrative Fee:
Work Without Permit? 0 Yes Q No $0.00 O
Advanced Plannin Fee: $0.00 Select a Non-Residential E)
Travel Docionentation Fecw: Building or Structure Q
Strong Motion Fee: $0.00 Select an Administrative Item
Bld,.Stds Commission Fee: $0.00
SUBTOTALS: $0.00 $133.00 TOTALFEE-7 $133.00
Revised: 0710112012
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11009 SYCAMORE DR CONTRACTOR:S.EA.CONSTRUCTION PERMIT NO: 11100022
OWNER'S NAME: CHRISTOPHER MIGDAL 1941 O'FARRELL ST DATE ISSUED:03/23/20t2
OWNER'S PHONE: 6504280826 SAN MATEO,CA 94403 PHONE NO:(650)287-4202
❑ LICENSED CONTRACTOR'S DECLARATIONr-
BUlLDlNG PERMIT INFO: BLDG ELECT PLUMB
License Class Lie.#
CD
�
� MECH RESIDENTIAL r COMMERCIAL r
Contractor . CDPV;i le-1_L114 Date -AD
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: BASEMENT ADD1T10N(1,339SQFT)WITH LIGHT WELL,
(commeneing with Section 7000)of Division 3 of the Business&Professions AND
Code and that my license is in full force and effect. NEW BUILT IN BARBEQUEAT GRADE&REMODEL CLOSETINTO STA I R(25SQFT)
I hereby affirm under penalty of perjury one of the following two declarations:
1 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.
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
permit is issued. Sq.Ft Floor Area: Valuation:$320000
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is APN Number:34256025.00 Occupancy Type:
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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.ot.���Datc2
the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point sourper the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. f .l
Signature `2Z3' /Z Issued by: ✓ /� y�ffTri� Date:
❑ OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for one,of. . RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations-
1 have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. 1 have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District l will
not employ any person in any manner so as to become subject to the Worker's maintain complianee with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,l Health&Safety C ,5e liens 2.5505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. Owner a o zed r 2�r Z�
Date•
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Leader's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional