15060059 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10138 RIDGEWAY DR CONTRACTOR:STERLING GENERAL PERMIT NO: 15060059
CONSTRUCTION
OWNER'S NAME: SUSAN HARRIS 1506 DELL AVE STE D DATE ISSUED:06/26/2015
OWNER'S PHONE: 4085684973 CAMPBELL,CA 95008 PHONE NO:(408)871-1372
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
FIRE DAMAGE REPAIR- 1ST STORY(771 S.F.),2ND
License Class Lic.# 7 a(p`dV STORY(1128 S.F.)REPAIR EXTERIOR SIDING AND
�— ��_la �, ._>�_f c> INSTALL NEW RETROFIT WINDOWS TO MATCH
Contractor /�/ f /U Date 4` EXISTING.
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. Sq.Ft Floor Area: Valuation:$50000
.khave 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:34241013.00 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 DS 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 // I 1s
granting of this permit. Additionally,the applicant understands and will comply Issued by: V Date: l
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date 604J 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.
ElOWNER-BUILDERDECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(x)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,VSec,1ion255 , Z133, 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen4 Date:
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 CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I 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 Licensed Professional
9.18.
Signature Date
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
,UPERTINO (408) 777-3228 •FAX (408) 777-3333•buildinga-cupertino.org J
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS to/3? APN#34a 10
O 13
OWNER,31 n GLI Y I J PHcjIN� J �—/ J Zq�'3 E-MAIL
S T e CITY, TE,ZIP j FAX
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CONT. NAM Ti�, 1 `SOCA' TSS. HO _ G 6 3l✓ 1 �I�il.i��'
STREET ADD S .izloo 1 S O C[TY, Pp I C C►1 ` [ v
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT AENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMELICENSE NUMBER LICENSE TYPE BUS LIC#
COMPANY NAME I EMAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHI T ff/1
ER E LICENSE NUMBER C +/ BUS.LIC#
I
Cofdm c//t ��tt� E 0 ul 2� nGQctS S t� FAX
STREET�p1 O S (S C� Y STATZ,1^P U (V O ((0 30
L,_ ,RIPTION OF WORK
tA
Il �� 1
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
[]ATTACH
H DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY YES
BEING ADDED? ONO ADDITION? []NO
PREAPPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES EC VED Y' TQtAL VALUATION:
PLANNTNG APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? []NO
I�)
By my signature below,I certify to each of the following: I am the property owner or author ed agent to act on the property owner's behalf I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating tp building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED Pt,AN CHECK TVPE ROUTING
_New SFD or Multifamily dwellings: Apply for demolition permit for {] oVER-THE-COUNTER ❑ BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. [] EXPRESS ❑ PLANNMG PLAN REVIEW
ommercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD ❑ PUBLIC WORKS
ft,..,,if any Hazardous Materials are being used as part of this project. M, LARGE ❑ FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR; ❑ SANITARY 90VER DISTRICT
submittal of Building Permit application.
EI'NIRONMENTAL HEALTH
BldgApp_201 1.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 10138 RIDGE WAY DATE: 06/08/2015 REVIEWED BY: PAUL
APN: 342 41 013 BP#: r "VALUATION: 1$50,000
R*PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Du lex _F_ PENTAMATION 1 GENRES
USE: p PERMIT TYPE:
WORK Fire Damage Repair- 1 st story 771 S.f. 2nd Story 1128 S.f. Repair exterior siding and install new
SCOPE retrofit windows to match existing
Meech. Plan ChecA P!"w tii,c icy•.Phar Check
t1ec:h_ Pc>rnlitFce :C
l::IC( f'' nrii i UC
f)dw Wech. Inv. )' ., t'.`,.r ,•
IPU')'. i"'c
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Thesefees are based on the prelimina information available and are only an estimates Contact the Dept for addn'l into.
FEE ITEMS (Fee Resolution 11-053 Eff. 7.%1113) FEE QTYIFEE MISC ITEMS
Plan Check Fee: Hourly Only? Yes Q No $0.00 2 hours Plan Check,Hourly
Suppl.PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $286.00 ISTPLNCK ---
PME Plan Check: $0.00999 s.f. Remodel, Other
Permit Fee: Hourly Only? ()Yes Q No $0.00 $647.00 1 1REMRESOTH
Suppl. Insp. Feee. Reg. Q OT 0.0 hrs $0.00
__TPME Unit Fee: $0.00
PME Permit Fee: $0.00
Coin !ruction
Z�1FdlI1L4U"L7lIL'c' 1'c'Er': O
Work Without Permit? 0 Yes No $0.00 (D
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Building or Structure 0
TrOvel Doc ulnentalion Fees: L
Strong Motion Fee: 1BSEISMICR A$6.50 =hrs Ins tions
Bldg Stds Commission Fee: IBCBSC - 2.00 $572.001 ISTINSP Inspection,Hourly
SUBTOTALS: $8.50 $1,505.001 TOTAL FEE: $1513.50
Revised: 05/07/2015