11060095I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20777 GREENLEAF DR
1"1,1NER'S NAME: PETER WILSON
..NER'S PHONE: 4088326351
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. # [ .� V
Contractor �� a<. �ti .� t'✓1 5'/ Date Z , "
I hereby affirm that 1 am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
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 wl ' tyifiis
permit is issued./�% J
APPLICANT CERTIFICATION / v
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,
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 sourc ulas per the Cupertino Munici/aZecon
9.18.
Signature /� Date
U OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
I have acid 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.
I 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 become subject to the Worker's
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, 1 must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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
4emnify and keep harmless the City of Cupertino against liabilities, judgments,
,ts, and expenses which may accrue against said City in consequence of the
,ranting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature
Date
CONTRACTOR: FISCHER PLUMBING & PERMIT NO: 11060095
CONSTRUCTION
2766 SCOTT BLVD DATE ISSUED: 07/25/201 1
SANTA CLARA, CA 95050 PHONE NO: (408)727-2426
JOB DESCRIPTION. RESIDENTIAL COMMERCIALS
ADD 280SQFT FLAT -ROOF COVERED PORCH @REAR OF
EXISTING RESIDENCE, REMOVE & REPLACE WINDOWS
DOORS @, DINING,MASTER BATH & DINING ROOMS,
Sq. Ft Floor Area: I Valuation: $20000
APN Number: 32609002.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: 'i Date: - 7, 2-f- Ll
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an*inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should 1 use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District 1
will maintain compliance with the Cuperpo Municipal Code, Chapter 9.12 and
the Health & Safety Code, Secti l.5,50 , 25533, and 25534.
n
Owner or authorized agent. Date: f
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Profes
COVERSHEET
11060095-D
20777 GREENLEAF DR
E'vik* P R E S S
PERMIT A DAM
PROM,�C-�0,FJZM) 2-0
76
ADDRESS Z d7
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APPLICANT r—jSc446'A W-St&?4 OWNER
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APN# 3-2-� -'a I - 00 Z. RES. (LVNO)
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CONTACT r—)Sy 46-A- 06--�lir4 PnoNE# 22-? - -zq 2-A FAXT2-7--7?ii�
VALUATION (Cost of
11 AkVAMAL REQD. PAID
NOns: 4 %, 66� qLA J I V'll tjj� CONSTRUCTION TAX M (M
SCHOOL FEES MO)
HOUSING NMG m (m
HEART O1FTHE CITY M "
ISSUED BY Tv rA Lmm 2:30 0 q
DATE
I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 20777 GREENLEAF DR CONTRACTOR: FISCHER PLUMBING & PERMIT NO: 11060095
CONSTRUCTION
OWNER'S NAME: PETER WILSON 2766 SCOTT BLVD DATE ISSUED: 07/25/2011
OWNER'S PHONE: 4088326351 SANTA CLARA, CA 95050 PHONE NO: (408)727-2426
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL
License Class Lic. N
Contractor �i Sc L� P z/ ��s�, Date `Z 5�
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
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 w ' s
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is
correct. 1 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 accrue against said City in consequence of the
granting of this permit. Additions y, the applicant understands and will comply
with all non -point sourc ula ' ns per the Cupertino Municipal Co e, Se 'on
9.18. I
Signature ' Date
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
1 have and wil I 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.
1 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
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.
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is
correct. 1 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 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
9.18.
ADD 280SQFT FLAT -ROOF COVERED PORCH @REAR OF
EXISTING RESIDENCE, REMOVE & REPLACE WINDOWS
&i
DOORS @ DINING,MASTER BATH & DINING ROOMS,
Sq. Ft Floor Area: I Valuation: $20000
APN Number: 32609002.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: , Date: -%" 2-r- 0
RE -ROOFS:
Al I roofs shal I be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cuper p1po Municipal Code, Chapter 9.12 and
the Health & Safety Code, Secti 5 , 25533, and 25534.
Owner or authorized agent. Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Professional
Signature Date
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS T ree f le 0 r I
AFN # _ O 1 00 !ram
v
OWNER NAME 1V
�F.i7 �•C It) , C7 11
PHONE
/
E-MAIL
O o� —6357
STREET ADDRESS
C ez(-T$ZIP
FAX
CONTACT NAME i
PHONE
�I
� r
STREET ADDRESS J j� B /�
CITY, S TE, ZIP ^' (� F&W
I
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT` {� CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT/ ❑`JENGINEER ❑ DEVELOPER ❑(TENANT
CONrxf�/OR N
LICENSE Nub�j
LI E TYPE
-
BUS. LIC ft
SC �f S�rUG� Y�
c�6 7
COMPANY
sA
E-MAIL
FAX
STREEr T 6 cJC c3 V i �C��
CITJ T A �!� • / �D(�U
PH �� ~or
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC ft
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
�' a cJ ?.'-4 c " 6y, rear
1n4
l %� d c� r•'h-(kc- IPA C3 /ri l i t1; n ' �JC�Ia'� � Gr � � �' /
EXITING
PROPOSED USE
CONSTR. TYPE
dSTORIES
- - - SF.:
=TGqqn
NEW FLOOR
DEMO
TOTAL
AREA /�v
AREA
AREA
NET AREA
.
BATHROOM
KTPCHEN
OTHER
a:.
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECIVPPORCH AREA
GARAGE AREA ❑ DETACH
4%
U
❑ ATTACH =
DWELLING UNrr& /
IS A SECOND U ar ❑ YES
SECOND STOSY ❑ YES
DEDYG ADDED? NO
ADDMONT O
PAS -APPLICATION ❑ YES IF YES, FROVIDE COPY OF PLANNER'S NAME:
PLANNING APFL 1 ❑ NO FLAMJ M APPROVAL LK=
By my signature below, I certify to each of the followin : I am the property owner or authorized agent to act on the property owner's behalf I have read this
' application and the information I have provid co I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buil I authorize representatives of Cupertino to enter the aboove-i property for inspection purposes.
Signature of Applicant/Agent Date: 6 %
SUPPLEMENT ORMATION REQUIRED
PLAN Ci3KK -i-.YP `
OVER _TrUICOUti7y.9
_ — 13Cn iTLNU Pf-A.N REFU-W
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
EXPRESS
p aLy+I�Tg rI �'[itJ;4T£+V'
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
STANDARD
r? .PLJJ11 WouxS
form if any Hazardous Materials are being used as part of this project
El
�'D
LARGE
FARE DEPr
_ Copy of Planning Approval Letter or Meeting with Planning prior to
L�
§EW>7 nm
submittal of Building Permit application.
hlArnitAC,
rV
L-L - �egtihfFYT i1 ffE #LTS
B1dgApp 2011.doc revised 03/16/11
CITY OF CUPERTINO
I�1 FEE ESTIMATOR - BUILDING DIVISION
balADDRESS:
20777 GREENLEAF DR
DATE: 06/13/2011
REVIEWED BY: LARRY S
APN:
BP#:
"VALUATION: 1$20,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY SFD or DU lex
USE: P
2nd Unit? Yes • No
OTC? 0 Yes 0 No
PENTAMATION 1 R3SFDADD
PERMIT TYPE:
WORK I
ADD 208 SQ FT PORCH REPLACE //i/> {-
SCOPE
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s.f.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,III-B,IV,V-B
208
$965.00
IADDPLCK
$934.00
IADDINSP
TOTALS:
208
1 $965.00
1
$934.00
NOTE: These fees are hated on the Drelindnarv, information available and are onlv an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 09-051 F. '. 7/1/10)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$965.00
0 #
$380.00
Window / Sliding Glass Door
IWINREP Replacement
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$934.00
Suppl. Insp. Fee.e Reg.
0 OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
{, (lFj.CtYjF�'/IEiF7 %[7.1
Acoustical Fee:
0 Yes 0 No
$0.00
0
0
Work Without Permit? 0 Yes (E) No
$0.00
Planning Fee:
PLLONGRNGR
$27.04
Select a Non -Residential
Building or Structure
0
0
/r�r+F 1I.� �r„�r�r�c:rtrctdr�rt I t�;:
Stron Motion Fee:
IBSEISMCR
$2.00
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$1,929.04
$380.00
TOTAL FEE:
F $2,309.04
Revised: 04/29/2011