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07120267 - PUB T � 0 D H o v E y v v v CL ti 1 ut o I m u 4a- 4- Q :zU u [n z Lej BI U3 �V-1 t 1 `" ' i t - I a 3 1 4T� I w r� 10 �LO { a < F H f N 7r A H' 'IF Id ,l j F F I a H w A o iWJ %U I1 ti U ;�J jmi ICC mo,' H 4< U UI �i T1 w o i U I J{p N li I(Z I 00 N CL _,� Fcc AV 1 LO L -4 PO A [ W v 1 C) v OC © m Erj �� w u T f4J m `(( Q� O;ff ((fit a qAqto H F a C, O �..., k xy v fZ ro w � (u y 20 v u, It u I 43 f C � .o � ��j•� f��� � 'O II EI r I $ 12 y j _ m f ,,,,C,,, ° } t ° a z ar `v v U IC7;I va (L) { 0 0 0 y J'I w ., I`LLJ ;� �O a r. Ir (I fI fff, flfICD Q i3l I� o T( Q 1 QilktA '( �•� r r a N LU t f , W �� LL2, 1 f' t ppF cc) m ij pl(QI C � ;O� vl Q I�4` ,, >' w w (° v l 1 ` c kui > oC CL I0Nfjo N � � Chi( ] —p f � I�©IIS jT � .N T , p �.Tljt �� � � � T� � ��,.. l p C 11 21 v © ro v v v v m ip v y o y xv o n x m W v 4) CD C 1 _0 � (U LL y Ci l 0.j � Z x� a� cva 0 � � E � _a M � v U CD OL 0 15 LO � c .� tA ami 6' v ° '� a v a� a ar Q in U O Z v o cr, ti a C u u u it,a � v I _�. .e.�. ...._..ryt"r a- w CITY OF CUPERTINO 7� - -----BUILDING DIVISION_ _PER#II� BUIL 1 RFSS: PERMrr N0. PATRIC CT CRITCHFIELD CONSTRUCTION 07120267 OWNER'S NAME: PERMIT ISSUE DATE MATS & MARIA OBERGE 845 S MCGLINCY LN 02/08/2008 PHONE: SANITARY NO. CONTROL NO. ARCWTECT/ENGlNE1R BUILDING wGP ADD 1158 ' FMLY RM, DINING BLDG ELECT �Pe PLUMB MECH O p LICENSED CONTRACiURS DECLARATION r r r O o o O UF ere I hereby affirm that I am licensed under provisions of Chapter 9(commencing ^T^ --- — - ^- ^-T8b Description t i� with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect D n? License Class Lie.N 7 F,w Date Contra= ARCHITECTS DECLARATION ? U I understand my plans shall be used as public records A. H Licensed Professional y; OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the D O following reason.(Section 7031.5,Business and Professions Code:Any city or county m 11 which requires a permit to concoct,alter.improve,demolish,or repair any structure y prior to its issuance,also requires the applicant for such permit to file a signed statement p=o that he is licensed pursuant to tine provisions of the Contractors Licensc'Law(Chapter 9 Sq.Ft.Floor Area Valuation i(t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 70315 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars($500), P Y x]P ❑L as owner of the property,or my employees with wages as their sale compensation, will do the work.and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Conracwr's License Law does not apply to an owner of Required Inspections property who builds or improves thereon,and who does such work himself or through his awn employees,provided that such improvements are not intended or offered for salt If, however,the building or improvement is sold within a¢year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑I.as owner of the property,am exclusively contracting with licensed contractors to concoct the project(Sec 7044,Business and Professions Code:)The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such pmjects with a contractor(s)licensed pursuant to the Contractors License Law. ❑I am exempt under Sec ,B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declaratiortu ❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compen. sation,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 Workers Compensation Insurance,as required by Section 4100 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number am: Carrier-�-''iA C t l VN Policy No.:634 0o l yZ 1-05 OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Ibis section need not be completed if the permit Is forone hundred dollars(SI00) or less.) 1 certify that in the performance of the work for which this permit is issued,)shall not employ any person in any manner so as to become subject to the Worker{Compensation Laws of California.Date Applicant . NOTICE TO APPLICANT.If atter making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you mus .J O forthwith comply with such provisions or this permit shall be deemed revoked. ,Z.r VI CONSTRUCTION LENDING AGENCY [-��--� 1 hereby affirm that there is a construction lending agency for the performance or lyi 5 the work for which this permit Is issued(Sec.3097,Civ.C.) �W Q Lender's Name Z Lenderess Lender's Addr U Q I certify that I have read this application and sate that the above informafiun is (y �" correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorize representatives of this city to enter upon the >'aabove-mentioned property for inspection purposes (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and exprrtses which may in any way scenic against said City U J Z in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATION s.­, U�� Re-roofs Signature of Apple ontraclb­r Datd HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? ❑Yes ON. All roofs shall be inspected prior to any roofing material being installed. a Will the applicant or future building occupant use equipment a roof is installed without first obtaining an ins Pection,I gree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? Dyes ®No 1 have read the hv2rdoos materials requirements under Chapter6.95 of the Califor- nia Health&Safely Codc,Sections 25505,25533 and 25534.1 undcrs=d that ifthe building docs not currently have a tenant.that it is my responsibility to notify the occupant of the requirements which must be met prior to issuance of a Certifre•t•of Occupancy. Signature of Applicant Date _ 'D2 figAll roof coverin s to be Class"B"or better toner or au gem ��-- Date" � g a 1 /C_� 0?�� CITY OF CUPERTINO ADDITION/REMODEL CUPERTINO PERMIT APPLICATION FORM APN# �w el r C) o Date: Building Address: Mailing Address (if different from building address): Owner's Name: � � Phone# Contractor: L�f'�t 2( r� , � 6" y7, Phone#: !{Ofj-'j71 • l a'77 Fax#: Contractor License#: —7 7 0>3 GG, Cupertino Business License#: 9.06 Contact: r1W NS Phone#:c Fax #: Building Permit Info: C—T$ Bldg. Elect. EA Plumb. Mech. X Hillside ❑ Job Description: g Addition(adding sq footage): n 1 )Q I C ?&**,m �u! What is being remodeled? #G1-76 401, V1/11I/� Remodel Includes Re-Roof. Yes T No ❑ If yes list number of squares Remodel Includes Structural: Yes ❑ No ❑ Square Footage: Addition: Porch: q3 Deck: Garage: Detached Attached Remodel: Kitchen jjR Bath Other Type of Construction (Usage Class): Occupancy Type: 1 FR, 11FR ❑ 11, 111, V-1HR ❑ 11, 111, 1V V-N Valuation: Please check this box if the project is a 6 �i second-story addition ❑ Green Build' g Check list must be completed and Green Building Points Achieved: attached to the plans. ***For Office Use Only*** Over-the-Counter ❑ CITY OF CUPERTINO ADDITION/REMODEL CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft ADDITIONS 1R3SFDADD PLLONGRNGR Long Range PL Planning/Residential 1R3INSP Dwellings Inspections B 1R3PLNCK Dwellings plan check B 1R3REPINSP Dwellings Repeat. B Inspection 1R3REPPLNC Dwellings Repeat Plan B Check 1R3HINSP Dwellings Hillside B inspection 1R3HPLNCK Dwellings Hillside B plan check 1R3HREINSP Dwellings Hillside B Repeat Inspection 1R3HREPLNC Dwellings Hillside B Repeat Plan Check 1R3ALTINSP Dwellings Alternate B Materials Inspection 1R3ALTPLNC Dwellings Alternate B Materials Plan Check 1PCESS Cesspool P 1PPRSEWG Ea. Private Sewage P Disposal System 1 PRSEWER Sewers P 1BPSPRINK Lawn P Sprinkler/Backflow 1BPWSVCS Main Water Service P 1BSEISMICRE SeismicResidential B DECKS 1R3SFDADD OR 1R3SFDREM 1DECKWOOD Deck(Wood)-Each B (Each) 1DECKRAIL Deck Railing-Each B (Each) y Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408) 777-3333 CUPEkTINO Building Department JOB ADDRESS: �),b-a- 1 ice- C. PERMIT # C OWNER'S NAME: O-A _ rr PHONE # 0�5 37'x`7 GENERAL CONTRACTOR: t ' ,�_ �S l i�r� FAX # Ll I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date