08100020 CITY OF CUPERTINO
BUILDISC DIVISION PERAUT CONTRACTORANF01 O
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BUILDING ADDRESS: PERMIT NO.
10862 LEAVESLEY PL TBD - TO BE DETERMINED 08100020
OWNER'S NAME: PERIM LS(IE DATE
JOSEPH T AND KATHY Y LEON 10/03/2008
N£TIRRR RRfI SANITARY NO. CONTROL NO.
ARCHfiECrfENGINEER: BUILDING PERMIT INFO
REMODEL: 275 SQ IN BATHROOM BLDGEO "`O O
X00 LICENSED CONTRACTOR'S DECLARATION Job Description
1 hm Nal ereby affirm 1 am licensed under providons of Chapter 9(commencing p
wit Section 70(10)cGivision 3 ofthe Business and Pr lmanw Code.and my licensee
in full font and effert .T sZG
j
M4 License Class
nFp Da¢_]r-n_v -.0 G, Contracwr _-- -_
7W ARCHITECTS DECLARATION
1 u alorsund my,law ahall he feed u publicmcnAs
int
g G L'ccrtsed Professionil
a 3 OWNER-BUILDER DECLARATION
0 0 I hereby ream (sect Nat I am tempt from to Contractor's Co :Any cense Law for to
a O which r j rtamn(Saito 70313,witness and are,de ons Cade:Any city or enmuy
z$on which requires a,mots re cones to
alter.Improve,demolish,m repair any muewm
—iy pd.miuiensedf W.requiresW ft Neapptiuvf forsucthe Cohpermitmcense file a Law(ned utemenl
ss tatthe is mencing wit fondant tate of Division
is)oa of to ComrxerYLi Pro
(Chapter Sq.F[. Floor Area Valuation
Y s-S (commencing 1.ere wit section 70OO)dd the
Dnarb f r the
to Business ectom d PrafessvI Code)or
.
that he u wempt tert(rae sod Ne bssu for Ince illegcd exmption.Any violation of
Sued.7031.5 by any appiicmt for a permit subject Ne applicant nc a civil Faulty of .APN Number OCCU ane T e
rot more Wer five hundred dollms(3500). P Y YP
0 1,as owner of the property.or my employees with wages As their sole component
willdolbewea andtesuuchumis not WteMed oraRend foram(Sec.RW.Bu bass
and Professions Code:The Consciences License Law don not apply m An owner of Required Inspections
property who buildsmimprows teteon,and whodunsuchwork himselforth ough his
ownemploy MoA&dtatsehimpmv muartnotinl,n moRaW for sale IL
however,One Wilding or improvement is to n6min one year of cmnpmtion,Ne ower-
builder will have Ne burden of poring that W did rot Wild or improve for purpose of
saie.).
1,n ower or to property,.Business vdus and confessions Cod Darted css nc s
0 1.nrsi Ik or of t(Sec.70d/, s and Rofrsdew Code)Tse CommencesmponntLt.
W pd/�gr0{k�,
cense face does not apply b ts owner of propertyCds who duals rs)suprofen Corton.and /`I \"\ r e
who contracts for such project wiNaeonfeacmr(q licensed punwmmCo Convador's //J//yam--a=v^',tY\U\ 11�\� f
License Law.
Olameaere tunderses. ,B&PCfm Nis¢uw 11 V yd
Owner Dat
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury use of the following decimations
I have and will..loud•Certifmae orconsent m self-i.fm worker's Compe t.
tion,As provided for by Section 3]110 of the labor Code,for the performance of Ce
work for which this permit is issued.
0 1 have and will maintain Workers Compensation Insurance,An ngMred by Section
3700.f to labor Code,for to performance of Ne work for which this permit is Issued.
My Workers Compeaation laurm card.and Policy numbs(art:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE .
(TMs seems need not he completed time permit is foronc hundred dollen($100)
or leve)
1 artily,Nat I.to podme.of to work for which this permit is Lensed.I shod)nut
employmypermninmymonmr umbecome mblatm Ne Worker'Compensation
laws of California.Due /o—
Applicmt
NOTICE TO APPUCANP.If,afar making Nu Cemificae of Exemption,you shouts
became subject W to Worker's Compcasatian provisions of use Labor Cade,no must
,J O foMwith comply wit such Provision or Nu permit shall be domed rooked.
ZCONSTRUCf10N LENDING AGENCY
V
[—� Ihereby Affirm tu open,uaconstruction d(Seclending agency for Ne performm of
a to woes for which Nu permit is issued(Sec.J0097.Civ.C.I
GQ L. s Name
.7. z l<nW&dees Address
V Q 1 citify that 1 have read Otis application and sum to the ahow information is
U, comm 1 allm to comply with all city and county on inane and a=laws relating in
O V Wilding conmuction,and hereby•utorirs representatives of Nu city in wmr upon Ne
W above-mentioned property for inspection purposes.
G (We)agree to ave,indemnify and kap harmless Co City of Cupm)no again,
N tiabilitca.judgments.costs tad expenses which may in any way amus against said City
(J ,Z in consequence of to gmm ing of this permit.
^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 01-
SOURCE REGULATIONS.
—moo— Re-roofs
Signakemol'ApplicasiVConmocusur Data,
HAZAItDOUS
MATERIALS DISCLOSURE Type of Roof
Will Nieapplinmmforum Wilding Cheri tomZ Add
Hesit Anmancriil
C defined io Ce 32(a)?sro Municipal Code.Chagcr 9.12 and to HoodN and Safety
Code.Schon l55J2(e)?
Yes •k.l GGG No All roofs shall be inspected prior to any roofing material being installed.
WRI the applicant or future Wilding occupant use equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove
I ha❑radnw air cwuminums As defined by to Bay Ama Air Quality Mawgcmem all new materials for inspection.
District?
0Yes lr
I have mad the hvadtuvueriad ru uirement under Ch.,mr6.95afCe Cilifor-
daHcxiN&Saf%yCode Stttiorn 2550.5,25533 and 25534.1moderated thatifte building
don not currently haw a scrams Nat It is my responsibility An notify the acupant of Inc
requirements which meet he sun prior nc issuance of a Conificae of Occupancy.
D Z' trt or better
� 3 � Signature of Applicant Date
`` All roof coverin s o be Class
Owneroramhodmdagent Dat g p
CITY OF CUPERTINO
• 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: , Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35615033 . 00
DATE ISSUED. . . . . . . : 10/03/2008
RECEIPT # . . . . . . . . . : BS000006275
REFERENCE ID # . . . : 08100020
SITE ADDRESS . . . . . : 10862 LEAVESLEY PL
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JOSEPH T AND KATHY Y LEON GUER
ADDRESS . . . . . . . . . . : 10862 LEAVESLEY PL
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014
RECEIVED FROM . . . . : DAI-ICHI ENTER.
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
•. FEE ID UNIT QUANTITY AMOUNT .PD-TO-DT THIS REC NEW BAL
------- ------------- ---------- ---------- ------ -------- ----------
1BSEISMICR VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1BUSLIC FLAT RATE 1 . 00 110 . 00 0 . 00 110 . 00 0 . 00
IREMRESBAT SQ FEET 275 . 00 551 . 00 0 . 00 551 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 662 . 00 0 . 00 662 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ------- -------
CHECK 662 . 00 4955
---------------
TOTAL RECEIPT 662 . 00
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Community Development
' 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OUPEkTINO
Building Department
JOB ADDRESS: PERMIT#
110 ,96z- L�-,4 VC5 4-,e-�7' 77�L- -Z�
OWNER'S NAME: -:j—osc-p,y Z. -�„l CE-121.,e,zv PHONE # 36L _ z31a
GENERAL CONTRACTOR:-TV/T FAX#
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring. Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
ADDITION/REMODEL
• CUPEkTINO PERMIT. APPLICATION FORM -
APN # Date:
Building Address:
/0 86
Mailing Address (if different from building address):
Owner's Name: Phone#
-mss Lo,✓G'l.�zAe co 36t Z3/o
Contractor: Phone#: flog'- Z9z ysj
Fax
Contractor License#:
Cupertino Business License#:
Contact: / Phone#: Sl664- Sc,F i - 9-;r�3
,F�i Fax #: Z&a —moi o
Building Permit into:
Bldg. J4 Elect. Plumb. Mech. Hillside ❑
Job Description:
Addition (adding sq footage):
What is being remodeled (not including addition)? i��� gy�
Remodel Includes Re-Roof: Yes ❑ NoIf yes list number of squares
Remodel Includes Structural: Yes F] No
5�
Do you have the pre-application planning approval? Yes ❑ Nof
If yes, please provide a copy of your planning approval letter. Planners name: .�—
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen Batb—. Other
Type of Construction (Usage Class): Occupancy Type:
I-A, I-B ❑ II/III/V-A ❑ H/III B, IV-HT, V-B
Valuation: q/o,00, Please check this box if the project is a
second-story addition ❑
Project Size: ExpressZ ExpressStandard ❑ Large ❑ Major ❑
Please complete relevant portion of the Green Building
Ahr'hecktist& attach it to the application or if applicable, Green Building Points Achieved:
11"include in plan set & the sheet index. S
***For Office Use Only***
Over-the-Counter 0 Revised 7/15/08
CITYNS
OF CUPERTINO ,
�`��� ADDITION/REMODEL
OF
CUPERTINO FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group _ Permit Type
Sq Ft
ADDITIONS 1 R3SFDADD
PLLONGRNGR Long Range PL
Planning/Residential
1R3INSP Dwellings Inspections B
1R3PLNCK Dwellings plan check B
1R3REPINSP Dwellings Repeat B
Inspection
1R3REPPLNC Dwellings Repeat Plan B
Check
1R3HINSP Dwellings Hillside B
inspection
1R3HPLNCK Dwellings Hillside plan B
check
1R3HREINSP Dwellings Hillside • B
Repeat Ins ection •
1R3HREPLNC Dwellings Hillside B'
Repeat Plan Check
1R3ALTINSP Dwellings Alternate B
Materials Inspection
1R3ALTPLNC Dwellings Alternate B
Materials Plan Check
IPCESS Cesspool P
1PPRSEWG Ea. Private Sewage P
Disposal System
1PRSEWER Sewers P
1BPSPRINK Lawn Sprinkler/Backflow P
1BPWSVCS Main Water Service P
1BSEISMICRE SeismicResidential B
DECKS IR3SFDADD OR
1R3SFDREM
1DECKWOOD Deck (Wood)-Each B
Each
1DECKRAIL Deck Railing-Each B
(Each)