09010072 CITY OF CUPERTINO �, +
BUILDING DIVISION PERMIT
PERMIT NO.
BUILDING ADDRESS:
21881 L BAY AREA
PERMIT ISSUE DATE
OWNER'S NAME:
S A CONTROL NO.
(408) 238-5043
BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH
v p p LICENSED CONTRACTOR'S DECLARATION Job Description
UI hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business and Professions Code,and my license is
=y in full force and effect r7 * �� t FNDTN REPAIR WEST SIDE OF SFD
DtR4 License Class
t-a DatcContractor_ M/
A�CTS DECLARAT1piV
1 understand my plans shall be used as public records
DW�96U
o y Licensed Professional
OWNER-BUILDER DECLARATION
.< I hereby affirm that I am exempt from the Contractor's License Law for the
OO following reason.(Section 703 1.5,Business and Professions Cade:Any city or county
k$g which requires a permit to construct.alter,improve,demolish,or repair any structure
y yy prior to its issuance,also requires the applicant for such permit to tilt a signed statement $q.Ft.Floor Area Valuation
=>. that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9
Y.
t-a (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $4500
that he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars(M). 35614031 . 00
❑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 Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If.
however,the building or improvement is sold within one 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
construct the project(Sec.7044.Business and Professions Code:)The Conuactoes Li-
cense law docs not apply to an owner of property who builds or improves thereon.and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec. B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a Certificate of Consent to self-insum 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.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation 1 ranee 'u and Polity number aQm:�(
Grtier fi-k 'Policy No.:
CERTIFICA E OF EX PTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
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 Workers'Compensation
Laws of California Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z 2 CONSTRUCTION LENDING AGENCY
Fr r�-i I hereby affirm that them is a construction lending agency for the performance of
p; the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
Z Lender's Address
I certify that I have mad this application and state that the above information is
U torted I agree to comply with all city and county oNinances and state laws relating to
0 V building construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
LZw
(We)agree to save,indemnify and keep harmless the City of Cupertino against
„p"4 liabilities,judgments,costs and expenses which may in y accrue against said City
U z in consequence of the granting of this permiL Date
►�
APPLICANT
UNDE ANDS AND WILL CO LY WITH ALL NON-POINT Issued by:
SOURCE
REG NS.
Re-roofs `v —
Signature o Applicant/Con tor Date T Of Roof
HAZARD S MATERIALS ISCLOSURE Type
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(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes ❑No
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or tum building occupant use equipment or devices which
hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
.,trice?
❑Yes ❑
1 haw road dee by s materials require n u r Chapter 6.95 of the Califor-
nia Health&SafctyC 'ons 25505.25533 5 .I undckstand that if the building
does not currently ha a ant.that it is my res ity to n'tify the occupant of the
requirements whit met prior to issu lea of occupancy. Signature of Applicant Date
All roof coverings to be Class I or better
Owner orauth rizcd agent Da
1
PERMIT #
PROJECT
ADDRESS
APPLICANT
/6O ` 2 Z
DATE r/S�
PUBLIC
WORKS
APN# Orb —/ RES. (LVNG) (GARAGE)
COMM. SQ. FT. (NEW) T.I. SQ.FT. RES. REMODEL
CONTACT S �i_- �� i f �- PHONE# Zg Y" ,S� Y 3 FAX
VALUATION (Cost of Project) i zo
REQD. PAID
NOTES: CONSTRUCTION TAX (Y) (N)
SCHOOL FEES (Y) (N)
HOUSING MTTIG (Y) (N)
HEART OF THE CITY (Y) (N)
ISSUED BYE - DATE �`�� TOTAL FEES
BUILDING DIVISION PERMIT
OWNER'S NAME:
ARCHITECI•/ENGfNEER
a O Zp LICENSED CONTRACTOR'S DECLARATION
In] I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Divldon 3 of the Business and Profeuiont Code, and my license 0
in full force and effect c +
License Class Lk. N p a
t Date Contractor
3 4F4 CHITECI-S DEC
,� oZ I understand my plans shall be used as public records
D d
a Licensed Professional
S OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
G O following mason. (Section 703 ", Business and Professions Code: Any city or county
which requires a permit to construct alter• improve, demolish, or repair any structure
y prior to its issuance, also requires the applicant for such permit to file a signed statement
LW he is licensed pursuant to the provisionsofthe Contractor's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
y R E that he is exempt therefrom and the buts for the alleged exemption Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (550
❑ L as owner of the property, or my employees with wages as their sole compensation,
will do sire work and the structure is not intended or offered for talc (Sec. 7044, Business
and Professions Code: The Contractors License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
awn employees, provided that such improvements arc not intended or offered for sale, lf,
however, the building or improvement Is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
salt.).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec 70". Business and Professions Code:) The Contractors Li-
cense Law does not apply to an owner of property who builds or improves thereon, and
who conuacts for such projects with a contractor(s) licensed pursuant to the Contractors
License Law.
❑ 1 am exempt under See B & P C for this reason
Owner Due
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑ i hire and will maintain a Certificate of Consent to self -Insure for Workers Compcn-
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
37M of the Labor Codc, for the performance of the work for which this permit is issued
My Workers Compensation 1 ranee 'er and Policy number air.
Cartier. Cr 4 lsolicy No
CERTIFICATE OF EX IT1C N FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S 100)
or less)
1 certify that In the perrurmance 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 Worl=' Compctuation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, alter making this Cenificatc of Exemption, you should
become subject to the Workers Compensation provisions of the Labor Code, you must
,J z forthwith comply with such provisions or this permit shall be deemed revoked
'74 CONSTRUCTION LENDING AGENCY
[� ►rA-r 1 hereby affirm that there is a construction lending agency for the performance of
pi > the work for which this permit is issued (Sce. 3097, Civ. C.)
W ❑ Leaders Namt
z Lenders Address
iJ 0 l certify that 1 have read this application and state that the above information is
V. ►-r correct. I agree to comply with all city and county ordinances and stake laws relating to
0 t building construction, and hereby authorize mpmsc)madvts of this city to enter upon the
W above-mendoned property for inspection purposes
(We) agree to save, indemnify and keep harmless the City ro Cupertino against,.., rrA liabilities, judgments. costs and expenses which may In y acarut against said City
V In consequence of the granting of this permit
APPLICANT UND ANDS AND WILL CO L WITH ALL NON -POINT
SOURCE REG NS, r D
Signature o pplicant/Con r Dato
HAZARDMS MATERIALS ISCLOSURE
Will the applicant or future building occupant store or handle bsartdom material
as defined by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety
Code, Section 25532(a)7
❑ Yes ON
o
Will the applicant or rare building occupant use equipment or devices which
emit ha/aMous air contarrlrtans as dcflwd by the Bay Area Air Quality Management
Disuict7
❑ Yesyh-m—atcrials
I have read requimm 0-d
ter'&95 ofthe Cilifor-
niaHcalth&Sale1y3M.25533an 5 .IthatUthcbuilding
does not Cure ntly t it is my ity ry the occupant of the
requirements whitr to f Occupancy.
408)238-50
PERMiT NO.
PERMIT ISSUE DATE
S CONTROL NO.
BURRING PERMIT INFO
BLDG ELECT PLUMB MECH
Job Description
FNDTN REPAIR WEST SIDE OF SFD
Floor Area
umber
35614031.00
Issued by:
Re -roofs
Type of Roof
Required Inspections
Valuation
Occupancy
Date
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
Owner or
All roof coverings to be Class a% " or better
711tvzr
CITY Of
CUPEkTINO
CITY OF CUPERTINO
GENERAL BUILDING
PERMIT APPLICATION FORM
d? 0 /oo79
APN #
356— f — 03/ ou
Date: s
0-7 '
Building Address:
a 169 ( Co f rAU t4-ve
Mailing Address (if different from building a
(dress):
Owner's Name:
Phone #: �D(� 2 3 Q r K
-dam [ r'-e �ZA" r-1 ,
Contractor:
Phone: 5-6 y3
Ir fr,,SQ
Fax: Vd e'l /7 3 3S
Contractor License #: //7 817
Cupertino Business License #:
Contact:
Phone: V0 r 23 0 a
Fax: <<�� 7 3 6 3 S-p ,
Residential Commercial
Job Description: �
ouKd�*{i d rn
,
tt/W of -
Building Permit Info:
Bldg P�' Elect ❑
Plumb ❑ Mech ❑
Type of Construction (Usage Class):
Occupancy Type:
1-A 1-B II/III/V-A El II/111 B, IV -HT,
V-B
Sin / V
Valuation: S&-b �--
Square Footage:
Project Size: Express Z/ Standard ❑
Large ❑ Major ❑
Green Building: Please complete relevant portion of the Green Building/LEED Checklist & attach it
to the application or if applicable, include in plan set & he sheet index.
Points Achieved:
For help, contact Build it Green at www.builditireen.org
Revised 01 /07/09
� - 51�
CITY of
CUPEKFINO
CITY OF CUPERTINO
GENERAL BUILDING APPLICATION
FEE SCHEDULE
Quantity/Sf
Fee ID
Fee Description
Fee
Permit Type
Group
1GENRES or
1 GENCOM
11313OILERI
For the installation or relocation of ea
M
boiler/compressor to & including 3
horsepower, or ea absorption sys to &
incl 100,000 Btu/h (29.3kw)
1 BBOILER2
Installation /relocation of ea
M
boiler/compressor over 3 horsepower
to & incl 15 horsepower, or ea
absorption sys over 100,000 Btu/h
1 BBOILER3
Install ation/relocation of ea
M
boiler/compressor over 15 horsepower
to & incl 30 horsepower, or ea
absorption sys over 500,000 Btu/h to
& incl 1,000,000 Btu/h
11313OILER4
Installation/relocation of ea
M
boiler/compressor over 30 hosepower
to & incl 50 horsepower, or for ea
absorption sys over 1,000,000 Btu/h to
& incl 1,750,000 Btu/h
1 BBOILER5
Installation/relocation of ea boiler or
M
refrigeration compressor over 50
horsepower, or ea absorption sys over
1,750,000 Btu/h
113APPLOTH
For ea appliance or piece of equip
M
regulated by this Code but not classed
in other appliance categories, or for
which no other fee is listed in this
code.
1 ELECINSP
Other Electrical Inspections (per hour)
E
1MECHINSP
Other Mechanical Inspections (per
M
hour)
1 PLMBINSP
Other Plumbing &. Gas Inspections
P
hour)
(per hour)
1MEETINGIHR
Application Meeting
B
2 of 5
CITY OF
CUPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
PERMIT #
OWNER'S NAME: s S ;
PHONE #
GENERAL CONTRACTOR: ,,,o
FAX # c 21 3 4 3 S-
Al
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
e /Contractor Signature
1 Date
FINISH GRADE
�I /-3/4" DRAINROCK
a
3/4" DRAINROCK
`4" DIA PERFORATED
PLASTIC PIPE WITH
FABRIC SOCK OVER
FR7—NCH DRAIN
EXISTING LOWER FLOOR PLAN
EXISTING ANCHOR BOLTS
AND MUD5ILL TO REMAIN
I" 0IAX12" AT 45"O.C. WITH
F REBAR5 AT TOP AND BOTTOM
°E GRADE AAAY FROM FOOTING
2% SLOPE FOR 5-0 MIN
'OOTING TO MATCH
SIZE SHAPE AND REBAR
12" _
FOOT I NCB DETAIL
NEA FOOTING TO MATCH
BTIN0 SIZE SHAPE AND REBAR
NEW REBAR ---
LAP REBAR 24" MIN
AND TIE TOGETHER WITH TIE WIRE
EXISTING ANCHOR SOLT5
AND MUDSILL TO REMAIN
10" EPDXY GROUT R976AP, 5"
/ INTO EXISTING OOTINCG
SAACUT
GOLD JOINT DETAIL
PROPOSED FOUNDATION REPAIR PLAN
SITE LOCATION MAP
NORTH
PROJECT DATA
APN 35G - 14-03 1
CODES:
THIS PROJECT SHALL COMPLY WITH THE 2007 EDITION
OF THE CALIFORNIA BLDG. CODE
SHEET INDEX
I . PROJECT DATA
2. FOUNDATION PLAN,
EXISTING LOWER FLOOR PLAN
r-,-- I ..
IC;�� / In�
a„
lam-"
CONSTRUCTION DATA
BUILDING TYPE: VB C.B.C.: 2007
NUMBER OF STORIES: I
OCCUPANCY GROUP: R3,U 1
FIRE SPRINKLER: NONE
SCOPE OF WORK
REMOVE AN & SECTION OF THE EXISTING FOOTING AND
REPLACE TO MATCH EXISTING, ADD ANEW FRENCH DRAIN
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