11060062 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10078 RIDGEWAY DR CONTRACTOR:SILICON VALLEY PERMIT NO: 11060062
BUILDERS GROUP
OWNER'S NAME: ROBIN MELNICK 1961 OLD MIDDLEFIELD WAY DATE ISSUED:06/09/2011
ER'S PHONE: 4088731757 MOUNTAIN VIEW,CA 94043 PHONE NO:(408)627-4177
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class � Lic.# / / r
Sy� � MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE SIDING DUE TO DRYROT DAMAGE(213SQFT)
(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:
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 Sq.Ft Floor Area: Valuation:$700
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:34241019.00 Occupancy Type:
APPLICANT CERTIFICATION
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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue agai t said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Additionally,th plicant understands and will comply
with all non-point source regulations the Cupertino Municipal Code,Section
9.18. Issued by: Date:
Signatu Date
Li O ER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for
the following two reasons: inspection.
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, Signature of Applicant: Date:
Business&Professions Code)
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: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sectio 5505,25533,and 25534.
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 Owner nt: DatFJ
become subject to the Worker's Compensation provisions of the Labor Code,
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
nify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 24 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34241019. 00
DATE ISSUED. . . . . . . : 06/09/2011
RECEIPT #. . . . . . . . . : BS000013702
REFERENCE ID # . . . : 11060062
SITE ADDRESS . . . . . : 10078 RIDGEWAY DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : ROBIN MELNICK
ADDRESS . . . . . . . . . . : 10078 RIDGEWAY DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : MICHAEL INOUYE
CONTRACTOR . . . . . . . : FRANCISCO BERRUETA LIC # 30850
COMPANY . . . . . . . . . . : SILICON VALLEY BUILDERS GROUP
ADDRESS . . . . . . . . . . : 1961 OLD MIDDLEFIELD WAY
CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94043
TELEPHONE . . . . . . . . : (408) 627-4177
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 700 . 00 1. 00 0. 00 1. 00 0. 00
1BSEISMICR VALUATION 700 . 00 0.50 0. 00 0 .50 0. 00
1SIDEOTHER SQ FEET 213 . 00 380. 00 0. 00 380. 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 381.50 0. 00 381.50 0.00
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10078 ridgeway dr. bldg#3 DATE: 06/08/2011 REVIEWED BY: bob s.
APN: BP#: 'VALUATION: $700
}PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: p PERMIT TYPE:
WORK replace siding due to dryrot damage.
SCOPE
F7
77
Li
NOTE. These ees are based on the prelintinary information available and are only an estimate. Contact the De t or addh 7 info.
FEE ITEMS (I ire Resolution 09-051 /.rff' ';'1.-10) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.f. Siding
Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 $380.00 ISIDEOTHER All Other
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Feer Reg. 0 OT 10.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
F7
Acoustical Fee: 0 Yes 0 No $0.00 0
Work Without Permit? 0 Yes 0 No $0.00 0
Planning Fee: $0.00 Select a Non-Residential 1
Building or Structure 0
i
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bid,Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.50 $380.00 TOTAL FEE: $381.50
Revised: 04/29/2011
CONSTRUCTION PERMIT APPLICATION- -
Is i..
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•building( t uoertino.org
CUPERT"INN
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERREDORIGINALORIGINALPERMIT#
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OWNERNAME S/ iZoI77-7—/7S"7 E-MAIL � A
STREET ADDRESS CITY, STATE,ZIP FAX
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CONTACT NAME _14A&4_
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STREET ADDRESS CrrY,w 'as E �A R�I Z� 7- 22,63
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❑OWNER ❑ OWNERBUIIAER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCFIITECT ❑ENGIDam ❑ DEvELoPER ❑TENANT
CONTRACTOR NAME LICENSE NUMBER MOO/ LICENSE TYPE � BUS.LIC# �O ��
FAX
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STREET ADDRESS CITY,STATE,ZIP PHONE
ARCS TECTIENGINEER NAME ,V f J U
LICENSE NUMBER BUS.LIC#
COMPANY NAME / E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK / / `R !PA
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EXISTING USE PROPOSED USE CONSTR.TYPE k STORIES
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EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
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BATHROOM KITCHEN OTHER ,
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA:❑ DETACH
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M DWELLING UMTS: Di A SECOND IIfffr ❑YES SECOND STORY ❑YES a
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REWGADDED' NO ADDTriON! ❑NO
PRE APPLICATIONP
❑ YES ff M.PROVIDE COP YLANI�R' NAME: �s
PLANNWG APPL A ❑NO PLANMNG APPROv •- y,r� .." �;< k c s
By my signature below,I certify to each 9fAe following: 4prpcowner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have vided is correct. vDescription of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin to d ng constructio I autesentatives of Cupertino to enter the abov dentifi d property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL TION REQ r Sk a
_New SFD or Multifamily dwellings: Apply for demol permit for
existing building(s). Demolition permit is required prior to issuance of buildingrs
permit for new building. l k '
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project. 7
:� Z r`. u�
Copy of Planning Approval Letter or Meeting with Planning prior to 4A
submittal of Building Permit application.
B1dgApp_2011.doe revised 03/16/11