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11060060 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10138 RIDGEWAY DR CONTRACTOR:SILICON VALLEY PERMIT NO: 11060060 BUILDERS GROUP OWNER'S NAME: SUSAN HARRIS 1961 OLD MIDDLEFIELD WAY DATE ISSUED:06/09/2011 —/ER'S PHONE: 4082550661 MOUNTAIN VIEW,CA 94043 PHONE NO:(408)627-4177 .8' LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG IELECT PLUMB License Class 4 Lic.# 57J c//h MECH RESIDENTIAL r- COMMERCIAL Contractor d V L� S Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE SIDING DUE TO DRYROT DAMAGE(794SQFT) (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. 1 have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$2481 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:34241013.00 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 against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations pe Cupertino Municipal Code,Section 9.18. Issued by: Date: -S+ga DateI/Xi CJ OWNER-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. I,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) 1,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 permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will 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&SafetyCode,Secti ns 25505,25533,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 agent: l become subject to the Worker's Compensation provisions of the Labor Code,I Dated//, / 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 Mrk'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 FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10138 ridgeway dr. bldg#5 DATE: 06/08/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$2,481 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Repair PRIMARY SFD or Duplex PENTAMATION 1GENRES USE: I I PERMIT TYPE: WORK replace siding due to dryrot damage. SCOPE Li NOTE: Thesefees are based on the prelindnary information available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (I ee Resolution 09-05./ F_ff' 7,-1/10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Siding Suppl.PC Fee: G Reg. 0 OT 0.0 hrs $0.00 $570.00 ISIDEOTHER All Other PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes G No $0.00 Q Work Without Permit? 0 Yes G No $0.00 Planning Fee: $0.00 Select a Non-Residential G Building or Structure Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $570.00 TOTAL FEE: $571.50 Revised: 04/29/2011 CONSTRUCTION PERMIT APPLICATION- COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•building0cuperlino.org CUPERTINO [:]NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS `/ �L / APN# - Y /U / - O a 4( U / 7 i ii OWNERNAME �.S AJ ` A Rfw J �[�lO S' O E-MAIL �(J STREET ADDRESS CITY, STATE,ZIP ��/L./� TO��/ FAX /) loi/3 &Z p 46w,ty R, f CONTACT NAME�G`�� 1. VU PHONE 9 - / �� /kc STREET ADDRESSS, CITY,STA ZiP�w 'J'as� G4 4�/Zt� 6.ta 7' ZZ6-7 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINm ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMEC4`O LICENSE NUMBER Qv I D I. I .L'cENsETYPE J BUS.LIC# O �� Q V FAX COMPANYNAI� E-MAIL C'esa 1772ZZ.7 STREET ADDRESS CITY,STATE,ZIP PHONE IV t Ze,.zLK.a�I ,4v �� ,Sd4J fvSC G,q 9,r/Z! ya S9d-z3/ ARCHITECT/ENGINEER NAME 1 J LICENSE NUMBER BUS.LIC# COMPANY NAME ,V/ E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK A-Ze ` t— L C G _<i216V Pd 1-166 e-P A 5' fl-`e /_Z v t a 'f o 7�,f�v►/7�/�� CG S L !y z' 4 EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES 4 EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA IT BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODELAREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA:❑ DETACH c ATTACH M DWE[.LING IJNiT3: IS A SECOND UNIT ❑YES SECOND STORY ❑YES y BEING ADDYD' ❑NO ADDTrION7 ❑NO PRE-APPLICATION ❑ YES IF YES.PROVIDE COP PLANNER' NAME: PLANNING ADPL M [3 NO PLANNING=0C,0 .._.: r ..... ..::. ..... . ... By my signature below,I certify to each a following: the p pe owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have vided is correct. ave read Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin 'to ding constructio I autho ' resentatives of Cupertino to enter the above-identified property for inspection purposes. Signature ofApplicanVAgent: Date: SUPPLEMENTAL RqkMATION REQ : New SFD or Multifamily dwellings: Apply for demol permit for 4 "* ' existing building(s). Demolition permit is required prior to issuance of building n , permit for new building. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure n form if any Hazardous Materials are being used as part of this project. _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application E BWApp_2011.doe revised 03/16/11