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CTrY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PELMIT NO.
20900 HOMESTEAD RD BLDG 4 A-L
TBD - TO BE DETERMINED
07120154
OWNER'S NAME:
PERMIT ISSUE DATE
VS II A CALIFORNIA LIMITED
07 08 2008
PHOpgn p MAT
SANITARY NO. CONTROL NO.
ARCFITIECIYENGfNEER:
BUFLDING PERMIT NM
REMODEL DECK,STAIR RAILS &
UECT MECH
0 OPLUMB
O
LICENSED CONTRACTORS DECLARATION
licensed under Chaper 9
F21k±NcP A5B HOT WATER
..^ — ^ ^^ Job Description
I hereby dnmt that I am provisions of (commencing
with Section 7009) ofDividon 3 of the Business and Professions Code, and my License is
in full form and effect.
[kene Lys LJeConraetor
.
Dam _
ARCHITE('I'S DECLARATION
I understand my plan shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am ammpt from the Contractors License law for the
following reason. (Section 7M 1.5, Business and Professions Code: Any city or county
which requires a permit to construct. dhr, improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed =lement
that he is licensed parswnt to the provisions of the Contractors License Law (Chapter9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
.
that he is exempt thmefrom and the basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031-5 by any applicant for a permit subjects the applicant to a civil penalty of
not mace than flw hundred dollars (sSaW
❑ L as owner of the prop", or Toy employees with wages as their sole eanpensadon,
Required Inspections
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions code The Contractors I Icense Law does roapply to an owner or
et q P
property who builds or improves thmmork and who does such work himself or through his
urn employees, provided that web improvements are not inended or offered for sales 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
ale.).
❑ L as owner of the property. am exclusively contracting with licensed contractors to
estrous the InVect (See. 7044, Bualnea and Profession Coda) The Contractors Ll-
cene Law domf4w apply to an ovmer of property who builds or improves thereon. and.
cts whir ■ ccoractor(s) licensed pursuant to the Contractors
who conV71RC,
l.keae
01 smB&PCfathismason
OwnsDam
RI' 'S COMPENSATION DECLARATION
I hereby penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of Consort to self -insure for Workers Compen-
sation, as provided for by Section 3700 of the Labor Code. for the performance of the
w ork.for which this permit is )sued.
.❑ I have and will maintain Wort es Compensation Insurance, as required by Sation
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Workers Co eosadon Irunu cc artier and Policy rq=ber am:
` / 4�;LJDOO
Carver 5 Policy No.: I'tJ5
CERTIFICATE OP LEMPrION FROM WORKERS
COMPENSATION INSURANCE
(This season need oat be canpimcd If the permit Is for one hundred dollars (S 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 so as to became subject to the Werk rs' Compensation
Laws of California. Dam
Applicant
NOTICE TO APPLICANT. If. after mating this Certificate of Exemption. you should
became Subject to the Workers Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be darned revoked
CONSTRUCTION LENDING AGENCY
1 hemhy &Mnu that there is a construction lending agency for the performance of
the wort for which this permit Is lamed (Sec. 3097, Cfv. C)
Lender's Name
Lender's Address
1 cmdty that 1 have read this application and state that the above Information Is
'
ennecL I agree to comply with all city and county ordinances and stem laws minting to
building construction. and hereby amhorlse rep, esm Wives of this city to enter upon the
above -mentioned property for inspection purposes.
agree to and keep harmiea the Cry of Cupertino against
IiabBitia, gments, cats and wMenms which may in any way acme against said City
:STANDS
of
of the t.
AP C NDI STANDS AND WIIL.L, COMPLY WITH ALL NON -POINT
Issued by: Date
SO nONS.
7 S
__L10_6kr
Re -roofs
Srgnatum D.m
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupant stem or handle hazardous material
as deeded by the Cupertino Munislpal Code. Chapter 9.12. and the Health and Safety
Code, ration 25532(a)7
All roofs shall be inspected to any roofing material being installed.
❑ YesrVy/N,
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or fuumm building occupant use equipment or devices which
emit hazardous air conuminanls defined by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑ Ya No
Ih readthehawdous-aerialsrequbemcmandsChapmr6.95oftheCalifor-
nnia Health myCode. Sedan 25505.25533 and 25534.1 mnderrand the if the building
does t have s tmnam, ebat h is my tespm bilily to notify the occupant of the
requ mat be net prior to i.� of ■ certificate of Occupancy.
-7-6
Signature of Applicant Date
g 1D
All roof coverings to be Class"�}'' or better
Owner Dam '
u ed agar
CITY OF CUPERTINO
FM-1 FEE ESTIMATOR - BUILDING DIVISION
ADDRESS:
DATE:
REVIEWED BY:
APN:
BP#:
`VALUATION:
$90,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Du lex
USE: p
OVER THE
COUNTER? 0 Yes - No
APPLICATION
TYPE:
1 R3SFDADD/REM
MECHANICAL Q Yes Q No
PLUMBING 0 Yes Q No
ELECTRICAL
Q Yes 0 No
�w
p� a
OD
3�
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s .ft.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-2 (Apartment)
II-B,III-B,IV,V-B
0
$0.00
$0.00
TOTALS:
0
$0.00
$0.00
. , � :h�, „
T77771
Plrrn•f,. f'1[f7! L�ItE'�:/�
FT7
/ , r.
NOTE. These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 09-051 Eft' 71'1 /09)
FEE
QTYIFEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: E) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee:) Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
(. oa"fr u(ion ]Tax
Acoustical Fee: 0 Yes Q No
$0.00
0
Work Without Permit? 0 Yes (D No
$0.00
Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
0
7 iral'crl 1)Ut rtntcr+�tcrfion I�'t'cr.t:
Strom; Motion Fee: 1BSEISMICR
$9.00
1� #
$633.00
Revision
IREVRESADD Addition
Bldy Stds Commission Fee: IBCBSC
$4.00
SUBTOTALS:
$13.00
$633.00
TOTAL FEE:
$646.00
Revised: 6/30/2010