13080030 CITY OF CUP ER'I INO BUILDING PERMIT
T
BUILDING ADDRESS: 10297 S DE ANZA BLVD CONTRACTOR:NOVO CONSTRUCTION PERMIT NO: 13080030
OWNER'S NAME: ROBERT ALLARIO 1460 O'BRIEN DR DATE ISSUED:09/03/2013
OWNER'S PHONE: 6503200280 MENLO PARK,CA 94025 PHONE NO:(650)701-1500
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class -6: Lic. ACCESSIBILITY UPGRADES TO INCLUDE NEW ADA
/ COMPLIANT WALKWAY TO PUBLIC RIGHT AWAY,
Contractor �o,jy C-a�^s��.,c � Date cls (as(�1'� INCREASE
I hereby affirm that I am licensed under the provisions of Chapter 9 LANDSCAPE AREAS,MINOR STORM[DRAIN
(commencing with Section 7000)of Division 3 of the Business&Professions IMPROVEMENTS
Code and that my license is in Cull 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:$30000
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 APN Number:35917001.10297 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES ILF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating ��,� � ��®� ISSUANCE IT ®�
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 OMI �CALLi INSPECTION.
PIECTION.
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 5e -
installed
ate:
with all non- int source re ulations er the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date c� O (T All roofs shall be inspected prior to any roofing material being installed.If a roof is
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 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 Worker's Compensation Insurance,as provided for by I the Health&Safety Code,Se ons 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: Dater 0,
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
CITY OF cCI. P ERTffNO
FEE ]ES'I MATOR—BUILDING DIVISION
ADDRESS: 10297 5 De Anza Blvd /DATE: 08/06/2013 REVIEWED BY: Mendez
AP1N: ]BP#: /30 00 0 `VALUATION: 1$30,000
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION
SFD or Duplex 1GENRES
USE: PERMIT TYPE: - A
WORD ACCESSIBILITY UPGRADES TO INCLUDE NEW ADA COMPLIANT WALKWAY TO PUBLIC RIGHT
SCOPE AWAY, INCREASE LANDSCAPE AREAS, MINOR STORM DRAIN IMPROVEMENTS AND
L1ech.Plan Check Plumb.Plan Check Elec.Plan Check
Lteclr.Permil Fee Plumb. Permit Fee: Elec.Permit Fee:
Other R1ech. Insp. C Other Plumb Insp. EJ Other Elec.Insp.
Mcch.fnsp.Fie: Plumb. Insp. Fee: 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,etG . TheseLees are based on the relimina in ormation available and are on l an estimate Contact the De t or addh7 in o.
]FEE ITEMS (Fee Resolution II-053 Eff. 711/12) FEE (QTY/FEE MISC ITEMS
Plan Check Fee: Dourly Only? 0 Yes E) No $0.00 hours Plan Check,Hourly
Suppl. PC Fee: (D Reg. Q OT 0.0 hrs $0.00 $278.00 1STPLNCK
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Feer Reg. 0 OT 0 0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Conswuction Tax:
Adininistrati ve.Fee: Q
Work Without Permit? 0 Yes 0 No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Fees: Building or Structure
i
Strong Motion Fee: 1BSEISMICR $3.00 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $2.00
SUBTOTALS: $5.00 $278.00 TOTAL FEE: $283.00
Revised: 07/01/2013