09070208CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10128 LEBANON DR
CONTRACTOR: TBD -TO BE DETERMINED
PERMIT NO: 09070208
OWNER'S NAME:
DATE ISSUED: 03/23/2010
OWNER'S PHONE:
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
I " F r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.f{
MECH r RESIDENTIAL COMMERCIAL
Contractor Date
1 hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: SFD ADDITON/REMODEL - MASTER SUITE, MEDIA
(commencing with Section 7000) of Division 3 of the Business & Professions
ROOM,
LAUNDRY, CHANGE FLAT ROOF TO A PITCH ROOF
Code and that my license is in full force and effect.
1 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: $280000
permit is issued.
APPLICANT CERTIFICATION
APN Number: 34214023.00
Occupancy Type:
I certify that I have read this application and state that the above information is
correct. 1 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,
PERMIT EXPIRES IF WORK IS NOT STARTED
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non -point source regulations per the Cupertino Municipal Code, Section
180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Date
Issued by;/-- Date:
❑ OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of
RE -ROOFS:
the following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
1, as owner of the property, or my employees with wages as their sole compensation,
installed without first obtaining an inspection, I agree to remove all new materials for
will do the work, and the structure is not intended or offered for sale (Sec.7044,
inspection.
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
Signature of Applicant: Date:
construct the project (Sec.7044, Business & Professions Code).
1 hereby affirm under penalty of perjury one of the following three
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
declarations:
1 have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance, as provided for by
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain
Section 3700 of the Labor Code, for the performance of the work for which this
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
permit is issued.
Additionally, should I use equipment or devices which emit hazardous air
1 certify that in the performance of the work for which this permit is issued, I shall
contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Compensation laws of California. If, after making this certificate of exemption, I
Health & Safety Code, Sections 25505, 25533, and 25534.
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.
�°,�
:�C/
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
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
I hereby affirm that there is a construction lending agency for the performance of work's
to building construction, and hereby authorize representatives of this city to enter
for which this permit is issued (Sec. 3097, Civ C.)
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Lender's Address
granting of this permit. Additionally, the applicant understands and will comply
with all non -
1 understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10128 LEBANON DR
OWNER'S
OWNER'S PHONE:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. #
Contractor
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 for by
Section 3700 of the Labor Code, for the performance of the work for which this
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.
Signature.
CONTRACTOR: TBD - TO BE DETERMINED I PERMIT NO: 09070208 .
DATE ISSUED:03/23/2010
PHONE NO:
BUILDING PERMIT INFO: BLDG F ELECT r— PLUMB F
MECH r� RESIDENTIAL r COMMERCIAL F
JOB DESCRIPTION: 5/18/10- REVSN# I -PORCH AREA,MEDIA RM ADD
WINDOW, CLOSE DOOR OPENING AT GARAGE.
SFD ADDITON/REMODEL - MASTER SUITE, MEDIA ROOM, LAUNDRY, CHANGE
FLAT ROOF TO A PITCH ROOF
Sq. Ft Floor Area:
APN Number: 34214023.00
Valuation: $280000
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Date I Issued by Date: (- -3-- l G
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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 (See.7044,
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code). 600-IX
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.
1 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, 1 must
forthwith comply with such provisions or this permit shall be deemed revokadd.
APPLICANT CERTIFICATION LL
1 certify that 1 have read this application and state that the above information is
correct. 1 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
d-
RE-ROOFS:
All roofs 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
inspection.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
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
Health & Safety Code, Sections 25505, 25533, and 25534.
Ow�
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Ad
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
REVISION #
CITY OF CUPERTINO BUILDING PERMIT =ATE - a c1 - --
BUILDING ADDRESS: 10128 LEBANON DR
CONTRACTOR: C & D FREITAS
PERMIT NO: 09070208
CONSTRUCTION
OWNER'S NAME:
23620 MORREL CUT-OFF RD
DATE ISSUED: 03/23/2010
OWNER'S PHONE:
LOS GATOS, CA 95033
PHONE NO: (408) 356-5780
LICENSED CONTRACTOR'S DECLARATION
r r 1
icense Class Lic. # w,
BUILDING PERMIT INFO: BLDG ELECT PLUMB
r I—
/J ,\ �Ly�,,p 7-/� ^
ontractor l.. O, / - Cr f / 45 Date ^2 7, v
MECH RESIDENTIAL COMMERCIAL
1
I hereby affirm that l am licensed under the provisions of Chapter 9
JOB DESCRIPTION: SFD ADDITON/REMODEL - MASTER SUITE, MEDIA
(commencing with Section 7000) of Division 3 of the Business & Professions
ROOM,
LAUNDRY,CHANGE FLAT ROOF A PITCH ROOF
Code and that my license is in full force and effect.
,
I hereby of the following two declarations:
yY
/O it M�0 � �, IL�'GYY� V 1l � tlY1
r �o 2 -Y
affirm under penalty of perjury one
I have and will maintain a certificate of consent to self -insure for Worker's
l
-�y ,-yy" '..k✓v-e
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: $280000
permit is issued.
APPLICANT CERTIFICATION
APN Number: 34214023.00
Occupancy Type:
1 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,
PERMIT EXPIRES IF WORK IS NOT STAR ED
costs, and expenses which may accrue against said City in consequence of the
granting of this pen -nit. Additionally, the applicant understands and will comply
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non -
L
Issued by.—�""� Date:�, 2 G
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
RE -ROOFS:
the following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
1, as owner of the property, or my employees with wages as their sole compensation,
installed without first obtaining an inspection, I agree to remove all new materiats for
will do the work, and the structure is not intended or offered for sale (Sec.7044,
inspection.
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
Signature of Applicant: Date:
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self -insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance, as provided for by
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
Section 3700 of the Labor Code, for the performance of the work for which this
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
permit is issued.
Additionally, should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued, I shall
contaminants as defined by the Bay Area Air Quality Management District [will
not employ any person in any manner so as to become subject to the Worker's
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Compensation laws of California. If, after making this certificate of exemption, I
Health & Safety Code, Sections 25505, 25533, and 25534.
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.
Owner or authorized agent:
Date:
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
1 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
I hereby affirm that there is a construction lending agency for the performance of work's
to building construction, and hereby authorize representatives of this city to enter
for which this permit is issued (Sec. 3097, Civ C.)
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Lender's Address
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
ARCHITECT'S DECLARATION
9,18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
ICI FEE ESTIMATOR - BUILDING DIVISION
ia
ADDRESS:
DATE:
REVIEWED BY:
APN:
BP#:
*VALUATION:
$100
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Addition /
Repair
PRIMARY SFD or Duplex
USE:
OVER THE
COUNTER. 0 Yes 0 No
APPLICATION
TYPE:
'I R3SFDW
MECHANICAL 0 Yes Q No
PLUMBING 0 Yes 0 No
ELECTRICAL
0 Yes 0 No
xW
ag a.
3(j
OCCUPANCY TYPE:
TYPE OF
CONSTR.
FLR AREA
s .ft.
PC FEES
PC FEE ID
BP FEES
BP FEE ID
R-3 (Custom)
II-B,III-B,IV,V-B
0
$0.00
$0.00
TOTALS:
0
$0.00
$0.00
Uthur Mec:h, In.,,
(hh, r Phoi 1, I».,;..
I OIltrr F/c'. Gt
NOTE: These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 09-051 Eff 7i1,%09)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Misc Bldg/Structure I
or Element of a Building
Suppl. PC Fee: G Reg. 0 OT
0.0
hrs
$0.00
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
Construction Tuv
Acoustical Fee:
0 Yes 0 No
$0.00
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Plannin 7� Fee:
$0.00
Select a Non -Residential
Building or Structure
O
0
l't-ur'(4 Uocume station Fck,S:
Strom Motion Fee:
IBSEISMICR
$0.50
1= #
$633.00
Revision
IREVRESADD Addition
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$1.50
$633.00
TOTAL FEET
$634.50
Revised: 7/22/2010