07120025COVER SHEET
07120025-D
10773 STEVENS CANYON RD
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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
C�1TRL�CTOR Ltd a �r��Or '
BUILDING ADDRESS:
PERMIT NO.
10773 STEVENS CANYON RD
MARINKO BALDE
07120025
OWNER'S NAME:
PERMIT ISSUE DATE
MARINKO BALDE
10773 STEVENS CANYON RD'
01/28/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Cade, and my license is
REVISION -EXTEND (E) BEDROOM, FIRST FLR .ORI G
in full force and effect-
ffectLicense Class Lie. #
License
#05010117 NO NEW PERMIT.
Date Contractor
ARCHrMCrS DECLARATION
1 understand my plans shall be used as public records
'
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 703 1.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the previsions of the Contractor's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$ 0 ,
.that he is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
64 Number
Occupancy Type
not more than five hundred dollars (S500).
34217101 (i' l7
❑ I, as owner of the property, or my employers with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law dors not apply to an owner of
Required Inspections
property who builds or improves thereon, and who does such work himself or through his
own employers, provided that such improvements are not intended or offered for sale" If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
as owner of the property, am exclusively contracting with licensed contractors to
Zns
ruct the project (Sec. 7044. Business and Professions Code:) The Contractor's U.
cease Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
❑ 1 am exempt under Sec. B & P C for this reason
Owner/A - i. i Date R ' 0 �
��f��bb'"' 1 DECLARATION
COMP eN
I hereby affirm under penally of perjury one of the following declarations:
❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
sation, 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 required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
'
My Worker's Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE 6 -FE EMPTTON FROM WORKERS'
COMPENSATION INSURANCE
,
(This section need not be completed if the permit is foronc hundred dollars ($100)
or less)
1 certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner soaz�O be�me subject to the Workers' Comprasadon
Laws of Califomia Datc / A 4 , '5 ��
Applicant A t
NOTICE TO APPLSIM-If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be decmed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
'
Lender's Address
1 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, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit,
APPLICANT UNDE STANDS AND WILL COMPLY WITH ALL NON -POINT
SONS"
Issued by: Date _ - c�
UR REGULrA O.
- o y
//,
Re -roofs
•��
Type of Roof
Signature ofApplicanVContractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hayardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
❑Yex No
All roofs shall be inspected prior to any roofing material being installed.
ns a
If a roofis installed without first obtaining an iPection, I gree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Yes
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Hcalth & SafetyCodc, Sections 25505, 75533 and 25534.1 understand thalif the building
does not currently have a ane, Lha it is my responsibility to notify the occupant of the
requireme hich met ' to is an of a Ccrtifrcate of Occupancy.^
Signature of Applicant Date
All roof coverings to be Class "B" or better
Ow Date
or authorixcd agent
aO CITY OF CUPERTINO
0-7
CUPE1Q:1N0 REVISION/DEFERRED
PERMIT APPLICATION FORM
APN #
Date: D`7
Original Permit #:
D�6 CD Il
Building Address:
Mailing Address (if different from building address):
fa -�tr
Owner's Name:
Phone #:
q /
Contractor:
Phone:
Fax:
Contractor License #:
Cupertino Business License #:
Contact:
Phone(P&7�) 5'� 11 _ 72 r2-
ZFax:
Fax:so-)
Building Permit Info:
Bldg lam' ElegZ P11196 Dech
Residential Commercial ❑
Job Description:
t�
N2� PC 2) I �i✓�" } iUar
Type of Construction (Usage Class):
Occupancy Type:
1 FR, 11FR ❑ 11, 111, V -IHR ❑ 11, 111, 1V V -N [�]�
Valuation (cost of project):
Project Size: Standard Z Large ❑ Major ❑ Valuation:
January 23, 2008
Sue Winslow
City of Cupertino — Building Division
Community Development Dept.
10300 Torre Avenue
Cupertino, CA 95014
Re: 10773 Stevens Canyon Road / 07120025
Hi Sue,
Per your request we are sending back the above plans and documents.
Sincerely,
Nicole Newton
Plan Check Coordinator
6150 Stoneridge Mall Road
Suite 370 Main: (925) 468.7400
Pleasanton, CA 94588-3241 Fax: (925) 468.7413
www.us.bureauveritas.com