09070172 CITY OF CUPERTIN D BUILDING PERMIT
BUILDING ADDRESS: 20659 SHELLY DR CONTRACTOR:ANTHONY HODDER PERMIT NO:09070172
CONSTRUCTION
n"'NER'S NAME: SQUARCIA LARRY G AND YOLANDA "504 BOLLINGER RD DATE ISSUED:07/27/2009
th. VER'S PHONE: 4083147575 CUPERTINO,CA 95014 PHONE NO:(408)257-4317
❑ LICENSED CONTRACTOR'S DECLARATION
WILDING ILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
�/�j),�0MECH r— RESIDENTIALF COMMERCIAL�
Contractor f /�/ 1 1 0 Date 'Z/ O
1 hereby affirm that am ice�ed under the provisions of Chapter 9
JOB DESCRIPTION:RE MODEL MASTER BATHROOM,120SQ
(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 Sq,Ft Floor Area: Valuation:$30000
performance of the work for which this permit is issued.
1 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 APN Number:3591 1024.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
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 ssued by: Date:
with all non point source regulations er the Cupertino Municipal Code,Section
9.18. , �1 ?•Z? ' 01
S;` -tur D .y
ate9•Z-?
RE-ROOFS:
UI roofs shall be inspected prior to any roofing material being installed. If a roof is
❑ OWNER-BUILDER DECLARATION installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: Signature of Applicant: Date:
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) ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). HAZARDOUS MATERIALS DISCLOSURE
1 hereby affirm under penalty of perjury one of the following three have read the hazardous materials requirements under Chapter 6.95 of the
declarations: -'alifornia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain a Certificate of Consent to self-insure for Worker's i ompliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Compensation,as provided for by Section 3700 of the Labor Code,for the !iafety Code,Section 25532(a)should I store or handle hazardous material.
performance of the work for which this permit is issued. Additionally,should I use equipment or devices which emit hazardous air
ontaminants as defined by the Bay Area.Air Quality Management District I will
I have and will maintain Worker's Compensation Insurance,as provided for by inaintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Section 3700 of the Labor Code,for the performance of the work for which this lealth&Safety Code,Sections 25505,25533,and 25534.
permit is issued.
I certify that in the performance of the work for which this permit is issued,I shall ;(,WH r or,r h*1agM �not employ any person in any manner so as to become subject to the Worker's ( � %� Date:
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 CONSTRUCTION LENDING AGENCY
forthwith comply with such provisions or this permit shall be deemed revoked. hereby affirm that there is a construction lending agency for the performance of work's
or which this permit is issued(Sec.3097,Civ C.)
APPLICANT CERTIFICATION .ender's Name
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 -ender's Address
to building construction,and hereby authorize representatives of this city to enter
u 'le above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
ii, iify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Accused Professional
9.18.
Signature Date
CITY OF CUPERTINO
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk : Lot :
APN . . . . . . . . : 35911024 . 00
DATE ISSUED. . . . . . . : 07/27/2009
RECEIPT #. . . . . . . . . : BS000008275
REFERENCE ID # • • . : 09070172
SITE ADDRESS . . . . . : 20659 SHELLY DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER SQI;ARCIA LARRY G AND YOLANDA
ADDRESS 20659 SHELLY DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2923
RECEIVED FROM . . . . : LARRY SQUARCIA
CONTRACTOR . . . . . . . : ANTHONY HODDER LIC # 28979
COMPANY . . . . . . . . . . : ANTHONY HODDER CONSTRUCTION
ADDRESS 75C4 BOLLINGER RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (4C8) 257-4317
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 30, 000 .00 2 . 00 0 . 00 2 . 00 0 . 00
1BSEISMICR VALUATION 30, 000 . 00 3 . 00 0 . 00 3 . 00 0 . 00
1REMRESBAT SQ FEET 120 . 00 570 . 00 0 .00 570 . 00 0 .00
1WINREP EACH 8 1 . 00 380 . 00 0 .00 380 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 955 . 00 0 . 00 955 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 955 . 00 AMEX
---------------
TOTAL RECEIPT 955 . 00
0010-70
CITY OF CUPERTINO
otgl
ADDITION/REMODEL
CUPEkTINO PERMIT APPLICATION FORM
APN #2571 0,2 '( 00 Date: 77 , 2-? , 0 c)
Is a 2" unit being added? 'Yes ❑ No ❑ If yes, please fill out the permit application for 2"d unit.
Building Address: Z O 4 S5`? �-�G�� J,1z) VL:.
Mailing Address (if different from building address):
Owner's Name: Z41 SrpA,O?Ac)-,.9 Phone#
Contractor: -To•vy H 0 /.J G"l C-057- Phone#: 4 Cl 4:S C)9 Q
7.x"'0�1 BO LW r../�1 R AD Fax #:
Contractor License#:
Cupertino Business License#: n/T Q01
Contact:
/Zj2,/ Phone#:
Fax #: 7
Building Permit Info:
Bldg. ❑ Elect. ❑ Plumb. [ Mech. ❑ Hillside 13
Job Description:
Addition-What is being added?(Be Specific):
What is being remodeled (not including addition)? -r�/j,S7�"/2
Remodel Includes Re-Roof. Yes ❑ No If yes list number of squares
Remodel Includes Structural: Yes ❑ No 2
Do you have the pre-application planning approval? Yes ❑ No ❑
If yes, please provide a copy of your planning approval letter. Planners name:
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen Bath ) 2-0 Other
Type of Construction (Usage Class): Occupancy Type:
I-A, I-B ❑ II/III/V-A ❑ IFIII B, IV-HT,V-B JZ 3
Valuation: 3O� 000 - — Please check this box if the project is a
second-story addition ❑
Project Size: Express ❑ Standard ❑ Large ❑ Major❑
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.
***For Office Use Only***
Over-the-Counter ❑ Revised 07/06/09
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
DECKS 1R3SFDADD OR
1R3SFDREM
I DECKWOOD Deck (Wood)-:3ach B
(Each)
1 DECKRAIL Deck Railing-Fach B
(Each)
GARAGES 1R3SFDADD OR
DETACHED 1R3SFDREM
1GARDTW<=1K Wood Frame up to B
1,000 SF (each)
1GARDTM<=1K Masonry up to 1,000 SF B
(each)
1BCONSTAXR Construction Tax Res
(new detached garage)
PATIO'S OPEN 1R3SFDADD OR
1R3SFDREM
1PATIOWOOD Wood Frame up to 300 B
SF
1 PATIOMETAL Metal Frame u)to 300 B
SF
1PATIOOTHER Other Frame u])to 300 SF B
PATIO'S CLOSED 1R3SFDADD OR
& SUN ROOMS 1R3SFDREM
1PATIOENCLW Enclosed Woo.1 up to 300 B
SF
IPATIOENCLM Enclosed Metal up to 300 B
SF
1 PATIOENCLO Other Enclosed Patio up B
to 300 SF
1 COVPORCH Porch Covered-Each B
(Each)
REMODELS 1R3SFDREM
1 REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan
300 SF check
1REMRESBAT Bath Remodel up to 300 B 64
z-0 SF
1 REMREOTH Other Remode.up to 300 B 6f
SF
CITY OF C'UPERTINO
ADDITON(REMODEL
FEE SC:EIEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
1REMRES2 Remodel Reside:ltial B
Greater than 10()0 s ft
1 REMRES3 Remodel Residential B
Greater than 2500 sq ft.
1REROOFRES Residential Re-roof Each B
100 SF
REMODEL PLNCK
I STPLNCK(1-3 for Standard Plan Check B NOT FOR OVER THE
remodel) COUNTER PLAN CKS.
WINDOW/SLIDING 1R3SFDREM
GLASS DOOR
1 WINREP Replacement windows B
ea 8 windows
1 WINNEWNSTR 'New Window (non- B
structural
1 WINMEWSTR New Window(Structural B
Shear Wall/Masonry)
1 WINBAYSTR Bay Window (Structural) B
SKYLIGHTS 1R3SFDREM
1 SKYL<10 SF Skylight less than 10 sf B
1 SKYL>1 OSF Skylight greater than 10 B
sf or structural
1STAIRS Stairs-first flight/ca addt'l B
1 EPERMITFEE Electrical Permit Fee E
1MPERMITFEE Mechanical Permit Fee M
1PPERMITFEE Plumbing Permit lee P
1 ELCPLNCKStand Alone Elect is Pln E
Ck (hourly)
CITY OF C-.UPERTINO
ADDITOPUREMODEL
FEE SCHEDULE
Quantity Fee ID Fee Descripi:ion Fee Group Permit Type
Sq Ft
1MECPLNCK Stand Alone Mechanical M
Pln Ck(hourly
1PLMPLNCK Stand Alone Plumbing P
Pln Ck(hourl i
/ 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Foe
f 1BSEISMICRE Seismic Residential B
1 TRAVDOC Travel & Documentation B
1BUSLIC Business License B