10100189I CITY OF CUPERTINO BUILDING PERMIT I
BUILDING ADDRESS: 10775 WUNDERLICH DR C014TRACTOR: FARBEX CONSTRUCTION PERMIT NO: 10100189
SERVICES
OWNER'S NAME: IAN GERBODE & SARA -JANE SKIWSKI 1 109., KELLY DR
t, . , NER'S PHONE: 4085905410
LICENSED CONTRACTOR'S DECLARATION
License Class Li, # YeL�
Contractor t'�% PZ3>F Date
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:
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 r by )
Section 3700 of the Labor Code, for the performance of the work for w tl}is/
permit is issued.
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
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.
Sionatu�r� Date t�
❑ 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:
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
permit is issued.
I 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, I
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 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
v- the above mentioned property for inspection purposes. (We) agree to save
nify and keep harmless the City of Cupertino against liabilities, judgments,
cohts, 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.
SAr JOSE, CA 95129
DATE ISSUED: 10/26/2010
PHONE NO: (408) 590-5410
BU. LDING PERMIT INFO: BLDG F ELECT r PLUMB r—
MECH F RESIDENTIAL r COMMERCIAL r-
JOI I DESCRIPTION: KITCHEN REMODEL, 180 SF, NON-STRUCURAL, NO
REROOF-12 WINDOWS & STUCCO REPAIR (SQ)
Sq. pit Floor Area:
APr Number: 37529006.00
Valuation: $8750
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
t80 DAYS FROM LAST CALLED INSPECTION.
Issued b Date:
RE -ROOFS:
All r )ofs 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
insp(ction.
Sign iture of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I hay �e read the hazardous materials requirements under Chapter 6.95 of the
Cali ornia Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safe y Code, Section 25532(a) should I store or handle hazardous material.
Add: tionally, should I use equipment or devices which emit hazardous air
cont iminants as defined by the Bay Area Air Quality Management District I will
mair tain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner oral o gent•
Date:--����-'
CONSTRUCTION LENDING AGENCY
I her, :by affirm that there is a construction lending agency for the performance of work's
for w hich this permit is issued (Sec. 3097, Civ C.)
Len( er's Name
Len( er's Address
ARCHITECT'S DECLARATION
I and erstand my plans shall be used as public records.
I- Date �? I Licensed Professional
CITY OF CUPERTINO
rMI-7 FEE ESTIMATOR —B17ILDING DIVISION
NOTE: These fees are based on the Preliminary information available and are onlv an estimate. Contact the Dent for addn'1 info
FEE ITEMS (Fee Resohltion 09-051 a. T'1,10)
ADDRESS:
DATE:
REVIEWED BY:
F177,
APN:
BP#:
*VALUATION: 1$8,750
*PERMIT TYPE: Building Permit
PLAN C HECK TYPE. Alteration / Repair
PRIMARY SFD or Duplex
USE:
: Its, ,t
��� I,,,�,�_
PENTAMATION 1R3SFDREM
PERMIT TYPE:
WORK
$0.00
$0.00
SCOPE
Window / Sliding Glass Door
I WINREP Replacement
NOTE: These fees are based on the Preliminary information available and are onlv an estimate. Contact the Dent for addn'1 info
FEE ITEMS (Fee Resohltion 09-051 a. T'1,10)
tc, b t','.xt'r i ,
QTY/FEE
fec'. Plan,.'i,'c7.
F177,
Plan Check Fee:
$0.00
$0.00
L_ILOJ s.f.
$570.00
Remodel, Kitchen (<=300 sf)
IREMRESKIT]
tt7f'3' I z. a .(/}ly,Li
Suppl. PC Fee: E) Reg. 0 OT
0.01hrs
ti
NOTE: These fees are based on the Preliminary information available and are onlv an estimate. Contact the Dent for addn'1 info
FEE ITEMS (Fee Resohltion 09-051 a. T'1,10)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
$0.00
L_ILOJ s.f.
$570.00
Remodel, Kitchen (<=300 sf)
IREMRESKIT]
A
Suppl. PC Fee: E) Reg. 0 OT
0.01hrs
PME Plan Check:
$0.00
$0.00
= #
$506.00
Window / Sliding Glass Door
I WINREP Replacement
Permit Fee:
Suppl. Insp. Fee -.0 Reg. 0OT
0.0
hrs
$0.00
$0.00
=1s.£ Restucco
$443.00 ISTUCOAPP
PME Unit Fee:
PME Permit Fee:
$0.00
Coll"4rl!clion 1' ix
Acoustical Fee: 0 Yes (F) No
$0.00
$1,519.00
0
0
Work Without Permit? Yes () No
Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
I
Trtn el Z)outtill crrfcrtiorI 7�ces:
Strong Motion Fee: IBSEISMICR
$0.88
Select an Administrative Item
Bldp; Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$1,520.88
$1,519.00
TOTAL FEE:
$3,039.88
Revised: 10/17/2010
2 ITEMS OF 2
CITY OF CUF ERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Iot:
APN ........: 37529C06.00
DATE ISSUED.......: 10/26/2010
RECEIPT #.........: BS000(11850
REFERENCE ID # ... 10100189
SITE ADDRESS .....: 10775 WUNDERLICH DR
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OPERATOR: patg
COPY # : 1
OWNER IAN GERBODE & SARA -JANE SKIWSK
ADDRESS ..........: 10775 WUNDERLICH DR
CITY/STATE/ZIP ...: CUPER"INO, CA 95014
RECEIVED FROM ....: GREG WNOROWSKI
CONTRACTOR .......: GREGOI'.Y WNOROWSRI LIC # 29686
COMPANY ..........: FARBE). CONSTRUCTION SERVICES
ADDRESS ..........: 1093 KELLY DR
CITY/STATE/ZIP ...: SAN JOSE, CA 95129
TELEPHONE ........: (408) 590-5410
FEE ID UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
----------
-----------------------
1BCBSC VALUATION
----------
8,750.00
-----------
1.00
----------
1.00
----------
0.00
0.00
1BSEISMICR VALUATION
8,750.00
0.88
0.88
0.00
0.00
1REMRESKIT SQ FEET
2.00
1:.40.00
1140.00
0.00
0.00
1STUCOAPP SQ FEET
85.00
886.00
0.00
886.00
0.00
1WINREP EACH 8
12.00
1012.00
0.00
1012.00
0.00
----------
TOTAL PERMIT
-----------
3039.88
----------
1141.88
----------
1898.00
0.00
METHOD OF PAYMENT
AMOUNT
REFERENCE
NUMBER
----------------- ---------------
CREDIT CARD
1,898.00
--------------------
MC
---------------
TOTAL RECEIPT
1,898.00
RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number:- 3-7
Name of owner. A 1-�
,-J
Project address. 0-7 76 LJ L) t Y) 4,;>
Contact person.
—kiPhon,.. �5(-) 514 ) 0
Fax. -- —e � j92_ - S2LA CL_,
Net square footage of lot.
Existing
Square footage: First floor:
Second floor: 4L
Garage:
TOTAL:
Proposed
A9 e
V/'A
Are there at least two 10 foot by 20 foot clear spaces insido, the garage? Y N
Is privacy protection planting required for the project? Y N
Build it Green Total Points I
On what floor(s) is work being done? r, Q�, t -k hw
Brief description of work.
iz
k
A Y (' l--) -t> 47--t_
C�
I A) '4 d1J lit PL -A C'f VL
Code editions 007 C,
N)2007 CFC �-N)12007CMC O)N)
20
0 C -PC
N)2007 NEC N)
Effective 1/1/08
IN A(-( T (,ITY
WIN()
)1A AND ()MANANCE
UATE
4L
.�2
'
S'N
chis so-�t G 01�
PC my fions k4US-Y
kPpt an the I"t) at -ill t!'T)P� and it i,:
inlaNt,; to maki, _1,
,)n 1;arne WithOU
pern s -,,or,
the I'lalding DIT,,
The 'otampinq
NOT
Plan Review Process Work Book Page -8-Revised 8/05/08
All dimensions size designations
given are subject to verification on
job site and adjustment to fit job
conditions.
20 '}
TECHNC LOGIES
This is an original design and must
not be released or copied unless
applicable fee has been paid or job
order placed.
Designed: 8/31/2010
Printed: 10/26/2010
Wunderlich Remodel.kit All Drawing #: 1
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: 6 7 Tgr
<tj to t C1 -`i C 0 r:,t L
PERMIT #
OWNER'S NAME:
!= 14. r
PHONE #
GENERAL CONTRACTOR:
T Ct t; —t �,� -�'t,
BUSINESS LICENSE #
ADDRESS: �;
Tld, -rt-
CITY/ZIPCODE`SC
*Our municipal code requires all businesses working in the city to have a Uity of c upernno business ucense.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCON RAC'ORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using Y an subcontractors:
- Signature Date
Please check applicable subcontractors and complete the following information:
Owner / Contractor Signature Date
SUBCONTRACTOR
BUSINESS 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 �
ADDITION/]REMODEL
CUPERTINO FEE SCHEDULE
APN# y�J� ���
Date:
Is a 2,unit beingadded? Yes ❑ No If es, please fill out the permit application for 2° unit.
Building Address:
% %
Mailing Address (if different from building address):
Owner's Name: I.A^j 6Zrb=>cf t�
Phone #
Contractor:
Phone #: (14 C -0 44 c.' e
Fax #: 44 c-
Cupertino Business License: State Contractor License #:
Contact: Cn i� �- . l `l L,0 N R C c _ 9 a 1 . ;
Phone #: f
Fax #: .:.l Z-1 Vit; f u
Landscape Ordinance Compliance:
Landscape area in sq. ft. (includes all irrigated areas):
If 2,500 sq. ft. or less, compliance with the Landscape Water -Efficiency Checklist is required.
If more than 2,500 sq. ft., a complete Landscape Project Submittal is required.
Compliance Method: ❑ Plant Type ❑ Water Budget
Building Permit Info:
Bldg. Elect. 1K Plumb. Mech. ❑ Hillside ❑
Job Description:
Addition -What is being added?(Be Specific): C ( q4C u")
What is being remodeled (not including addition)? t ?,
c
L "
Remodel Includes Re -Roof. Yes ❑ No If yes list number of squares
Remodel Includes Structural: Yes ❑ No
Do you have the pre -application planning approval? Yes ❑ No ❑
If yes, please provide a copy of your planning ap, roval letter. Planners name:
Square Footage:
Addition: Porch: Deck: _ Garage: Detached Attached
Remodel: Kitchen C' - � Bath Oth :r
Type of Construction (Usage Class):
Occupancy Type: V,—
1-A, 1-B [I II/III/V-A ❑ II/III B, IV -HT, V -B [
Valuation: ' IS U t ``,
Please check this box if the project is a
Project Size: Express Standard ❑ Large ❑ Major ❑
second -story addition ❑
Please complete relevant portion of the Green Building
Checklist & attach it to the application or if applicable,
Green Building Points Achieved:
include in plan set & the sheet index.
Revised 05/13/10