10100110 CITY OF CUPERTIN O BUILDING PERMIT
BUILDING ADDRESS: NILE DR BLDG M CONTRACTOR:AXIS CONSTRUCTION,INC PERMIT NO: 10100110
OWNER'S NAME: CUPERTINO WATERFALL HOA 2566 BARRINGTON CT DATE ISSUED: 10/19/2010
NER'S PHONE: 4084483080 HAYWARD,CA 94545 PHONE NO:(510)732-6111
❑ LICENSED CONTRACTOR'S DECLARATIONF r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
MECH r RESIDENTIAL[_ COMMERCIAL�
Contractor � ( Date
_� �U f
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: CUPERTINO WATERFALL-NILE DR BLDG M REPLACE
(commencing with Section 7000)of Division 3 of the Business&Professions DECAYED
STAIR STRINGERS.
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
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$2633
permit is issued.
APPLICANT CERTIFICATION APN Number:36950000.M Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source re lations per the Cupertino Municipal Code,Section
9.18.
n Issued by: Date:
Signature Date
i
U OWNER- UILDE ECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
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
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
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
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code, ections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I must Owneko'aauthorize ent:
forthwith comply with such provisions or this permit shall be deemed revoked. Date. Q
APPLICANT CERTIFICATION CONST CTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that t ere is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CU PERTI NO Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS:OLC5 PERMIT# zoy62
OWNER'S NAME: Q PHONE# o 7f51—
GENERAL CONTRACTOR: "� BUSINESS LICENS #,57,6
ADDRESS: ; CITY/ZIPCODE: 14 q
*Our municipal code requires all businesses working in the city to have a City of Cupertino busines license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
&/ SUBCONTRACTOR BUSINE:iS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum/Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
3 ITEMS OF 24 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk.: Lot:
APN 36S50000 .M
DATE ISSUED. . . . . . . : 10/ 19/2010
RECEIPT #. . . . . . . . . BSC00011783
REFERENCE ID # . . . : 10100110
SITE ADDRESS . . . . . : NIDE DR BLDG M
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER CUPERTINO WATERFALL HOA
ADDRESS . . . . . . . . . . : C/() CORNERSTONE COMMUNITY MGMT
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125-5635
RECEIVED FROM . . . . : AX-'S CONSTRUCTION
CONTRACTOR CHRISTOPHER DURKIN LIC # 32093
COMPANY AX-'S CONSTRUCTION, INC
ADDRESS 2566 BARRINGTON CT
CITY/STATE/ZIP . . . : HA"WARD, CA 94545
TELEPHONE (5:-0) 732-6111
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
1BCBSC VALUATION 2, 633 . 00 1 . 00 0. 00 1. 00 0 . 00
1BSEISMICR VALUATION 2, 633 . 00 0 .50 0 .00 0 .50 0 .00
1SUPINSFEE HOURS 1. 00 126 . 00 0 . 00 126 . 00 0 . 00
- --------- ---------- ---------- ----------
TOTAL PERMIT 127 .50 0 .00 127.50 0 .00
CITY OF C'UPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: NILE DR-BLDG M DATE: 10/14/2010 REVIEWED BY:
APN: BP#: "VALUATION: $2,633
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex f t __ PENTAMATION 1 GENRES
USE:
F` ?d�'< e: � PERMIT TYPE:
WORK
SCOPE
r.
P
Ll
NOTE: Theseees are based on the preliminary in ormation a-ailable and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS(Fee Resolution 09-051 Eft 7/1/10) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0 00 0 # Stairs
Suppl. PC Fee: (E) Reg. 0 OT 0.0 I hrs $000 $0.00 (Specify#of Flights of Stairs)
PME Plan Check: $000
Permit Fee: ISUPINSFEE $0.00
Suppl. Insp. Fee-0 Reg. 0 OT 1.0 hrs $12600
PME Unit Fee: $000
PME Permit Fee: $000
Acoustical Fee: 0 Yes (E) No $000 0
Work Without Permit? 0 Yes 0 No $000 0
Planning Fee:
$000 Select a Non-Residential E)
Building or Structure 0
1i"ct 'e'1 l)rr�•rllYte''7`.tPt'(>"7 �°kY>_
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $127.50 $0.00 TOTAL FEE: $127.50
Revised: 9/29/2010
CITY OF CJPERTLNO
CITY OF
CuPEKINO GENERAL BUILDLNG
PERMIT APPLI��ATION FORM
APN# W' 50 000 14 Date:Building Address: �� 1
Mailing Address (if different from buil ' g address):
Are Hazardous Materials being used as part of this Froject? Yes No
HOA: (Exterior work only) Yes No ❑ If yes, provide letter from HOA
Owner's Name- ELL6 Phone `t#:40y- 4 Y-3oeo
ASE-r2.
Contractor: Phone: S'10--7-3 Z-1P r�
1,5 Fax: 5"1v f3,Z-67_ZL
Contractor License
Cupertino Business License#: � 3
Contact: Phone: 40d -&,
C564� 9.4gk'AE7� Fax: -70 .3z-&ZZ Z
..esidential K Commercial
Job Description: 'V-� j(Y67
Building Permit Info:
Bldg 1' Elect ❑ Pl-umb ❑ Mech ❑
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/IIUV-A ❑ II/III B, IV-HT, V-B
Valuation: Square Footage:
Project Size: Express ["Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant portion of he Green Building/LEED Checklist& attach it
to the application or if applicable, ticlude in plan set & the sheet index.
uts Achieved:
I or help, contact Build it Green at www.bu-Rditzreen.org �
Revised 07/14/09