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11110016 i CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20488 STEVENS CREEK BLVD UNIT 2115 CONTRACTOR:DRAEGER PERMIT NO: 11110016 CONSTRUCTION INC 4 s OWNER'S NAME: TSAO SUSAN M ET AL 605 COMMERCIAL ST DATE ISSUED: 11/03/2011 OWNER'S PHONE: SAN JOSE,CA 95112 PHONE NO:(408)536-0420 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Clas ic.# MECH RESIDENTIAL COMMERCIAL Contractor t4- Date I hereby affirm tha am licensed under the provisions of Chapter 9 JOB DESCRIPTION:DECK REAPIR AT CONDO PODIUM,REPLACE CURB& (commencing with Section 7000)of Division 3 of the Business&Professions EDGE& Code and that my license is in full force and effect. STUD CORNER 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. 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 Sq.Ft Floor Area: Valuation:$2500 permit is issued. APPLICANT CERTIFICATION APN Number:36953012.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point Cupertino Municipal Code,Section 9.18. Signature Date Issued by: - Dater, /"—,- ❑ WN BUI DECLARATION RE-ROOFS: I hereby affirm thrill am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: I 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety de,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Ownor_ TAPPLICANT CERTIFICATION STRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of Nwrk's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the 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. I understand my plans shall be used as public records. Signature Date Licensed Professional i CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228 • FAX(408)777,7-3333• building(�cupertino.or4 CUPERTINO I rZ ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# j PROSECT AD RESSAPN# OWNER q FAX CONTACT NAME PHONE N E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER FCENSE TYPE BUS.LIC# e9 S— FAX A�IN e � COMPeNxr ;pae:rlc)_4d E s� �21 c+� STREET ADDRESS /,? CIIY ATE zI� PHONE ARCHIrECTIENGINEER NANIE LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK CC EXISTING USE PROPOSED USE CONSTF-TYPE I #STORIES USE TYPE OCC, SQ.FT. VALUATION(S) EXISTG NEWFLOOR DEMO TOTAL AREA AREA AREA NEC AREA = BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA I GARAGE AREA: Ll DETACH ❑ATTACH #DWELLING UNITS: ISASECONDUNIT ❑YES SECONDSTORY C]YES BEING ADDED? ❑NO ADDMON? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY: 6TOTAL VALUATION: PLANNINGAPPL# []NO PLANNING APPROVAL LETTER EICHLERHOME? []NO L _ a/svQ lts By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the pipperty 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 relatingto b ildin on ction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. i Signature of Applicant/Agent; Date: SUPPLEMENTAL E40RN#TIVREQUIRED PLAN CMCX TYPE izt G Si" _New SFD or Multifamily dwellings: Apply for demolition permit for -TlzE-cornvTix BUILDING PLAN REVIEW 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 ElSTANDARD Elmucwopm form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ Fns DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH. i B1dQSPP2011.doc revised 06/21/11 _ I Building Department artment i City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N Fax: 408-777-3333 ' CONTRACTOR/ UBCONTRACTOR LIST JOB ADDRESS: t 9 i' .� � �. �&V:!/ PERMIT# OWNER'S NAME: ® PHONE# �& GENERAL CONTRACTOR: � , ,� �,,�, BUSINESS LICENSE# ADDRESS: ks®e CITY/ZIPCODE: . .- j'-; / -57�` *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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: n to •e Date Please check applicable subcontractors and comt te a following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/Glazing Heating i Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Co tract Si rture Date CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 20488 stvns crk blvd#2115 DATE: 11/03/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$2,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: PERMIT TYPE: WORK deck re air at condo podium, replace curb and edge and stud corner. SCOPE ti,t� , �),itr rz'z ia. IJ3_StJ. )Utes,'llhwt i>I}� MO 17F int£?t'.h7:S;t>, r'f'C?: NOTE.This estimate does not include fees due to other Departments(i.e.Planing,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 Resohition 11-053 E . 711/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes 0 No $0.00 hours Plan Check,Hourly Suppl.PC Fee: 0 Reg. 0 OT0.0 hrs $0.00 $260.00 ISTPLNCK PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp.Fee:Q Reg. 0 OT O.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 f`«lv"Owcfioll Tax 0 Work Without Permit? 0 Yes (D No $0.00 1 0 Advanced Planning Fee: $0.00 Select a Non-Residential Trtwr(Lr3rr�lrr�r;: rcrz�3;z 1��<r:�': Building or Structure 0 A Std Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item i Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.501 $260.00 TOTAL FEE: $261.50 j Revised: 10/01/2011 i I