14060025 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10487 S DE ANZA BLVD CONTRACTOR:ELEVEN WESTERN PERMIT NO: 14060025
BUILDERS,INC
OWNER'S NAME: BDC HAYWARD LP 2862 EXECUTIVE PL DATE ISSUED:06/05/2014
OWNER'S PHONE: 9255882219 ESCONDIDO,CA 92029 PHONE NO:(760)796-6346
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL F]
LL,,7Q REPAIR(E)TRELLIS OVER GAS METER ENCLOSURE,
License Class Lic.# T 7—I q�.� LIKE
` �r , /6FOR LIKE LUMBER
Contractor�iL9Y /�Cmay �" Date , "17
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
formance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1000
�. ve 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:35917019 10487 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 PE 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 D RO LLED 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 S
granting of this permit. Additionally,the applicant understands and will comply sued by: te:
with all non-point source regulations per the Cupertino Municipal Code,Section
918.
RE-ROOFS:
Signature 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.
❑ OWNER-BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
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. I 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(a)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,Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent- Date:Ga—s_
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
N PERMIT APPLICATION
CONSTRUCTION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE-CUPERTINO, CA 95014-3255 c v
Its (408)777-3228• FAX(408)777-3333-building(Wcupertino.org
CUPERTINO
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS
t� D( C 6-7 �- ' L 2_,o4 Z?CVb APN# J ? e) /
OWNERNAME PHONE E-MAIL
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STREET ADDRESS1 SS CO 'p�-�•%�i� CIW A%,N U s P CR•L^Ig K FAX
PHONE E-MAIL
A2.UZ4Q4 Q
CONTACT NAME 1 Ot./W1iNJ lo h.GkyfC +iv/
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NA V l4� S LICENSE NUMBER D LICENSE TYPE BUS.LIC#
�F_SAN
l�Ev !`� 13
COMPANY NAME E-MAIL
C R Can/� FAX
(? -7&0-74?(e UP
STREET ADDRESS CITY,STATE,ZIP PHONE
0190-Z V_)<EcuctJF 1"eX E56141"U4140 G4 90021 Zoo_796-63Y&
ARCHITECT/ENGINEER NAME N4 LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
t
REPA�QZ Cxt nJ &AS I'IVCL 5,1140 7-aE1LL- LunaB^ /K o /KE
EXISTING USE PROPOSED USE CONSTR.;TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO ALAREA AREA AREA AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
[]ATTACH
#DWELLBVG UNITS: IS A SECOND UNIT []YES SECOND STORY ❑YES
BEING ADDED? []NO ADDITION? ❑NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES I '" TOTAL VALUATION:
PLANNINGAPPL# []NO PLANNING APPROVALLETTER EICHLERHOME? NOd�-
�y'r
By my signature below,I certify to each of the following: I am the property owner or authorized to c o
an the pro y 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. is te. I agree to comply with all applicable local
ordinances and state laws relating to bui tion. I authorize +l 'yes of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLE TAL INDORMATIO QUIRED p �cgECx TrPE J3 .,.1 , ROUTING"SL
.. 3
��{
_New SFD or Mul i y dwellings: Apply for demolition permit for gyp,tjii Ta>rcouxT�x ❑zBUILDINGrLaNxEvi w '
existing building(s). Demolition permit is required prior to issuance of building ' `
permit for new building. a Exrss ❑ �PLANNINGPLAN REVIEVi
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure I #is�.Iv aRb7 rtJBLlcwotucs
�t
form if any Hazardous Materials are being used as part of this project.
n�� afL�RGE �. ,❑ :•FIRE DEPx �
_Copy of Planning Approval Letter or Meetingwith prior to o `y
h Planning �� ��` � C3 �SANITARYSEWERDISTRICT
submittal of Building Permit application. ��
q,�+,'� s��"' r i .��., ,�:t, .,❑.:`;ElVVIItONTNIENTAL:HEALTH'.;5 x�.•*-,:
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10487 S DE ANZA BLVD DATE: 06/05/2014 REVIEWED BY: MELISSA
APN: 35917019.10487 BP#: *VALUATION: j$1,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration /Addition / Repair
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1 GENCO
WORK REPAIR E TRELLIS OVER GAS METER ENCLOSURE
SCOPE
Tech, PlanC'he,rk Platt;(", 1'lrrn Chcci' !"/Cc. I'I' Ch:ek
L1ech. 1'et;rtit Fee l'lumh. 1'errmir Fee. tih°e )'croa"fee.
OTher,llech Fnspv Other I'lum&lny,v. Othr.r"Jcc_Insp,
a°!>ci'a. Ttzilz t:<-: 1'laerth. htsp. lee: kk"r_ Insp, 1"-:
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc . These ees are based on the prelimina information available and are only an estimate Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? ®Yes Q No $0.00 0 hours Plan Check,Hourly
Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 $139.00 ISTPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes (E) No $0.00
Suppl. Insp. Feer Reg. ® OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Fc 1Yti71tri'c:t;il'c'!'c'r.'. 0
Work Without Permit? 0 Yes No $0.00 G
Advanced Planning Fee: $0.00 Select a Non-Residential
f' f,<.t }r,r•t t:r 2jczri itr
Fees:
Building or Structure 0
Strong Motion Fee: IBSEISMICO $0.50 1.0 hrs Inspections
Bldg Stds Commission Fee: IBCBSC $1.00 $139.00 ISTINSP Inspection,Hourly
a 1 $1.50 $278.00 TOTAL FEE: $279.50
Revised: 04/01/2014
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CO►NPLIA�ICE
REVtE�NED FOR CODE
Gvvp4,A4eviewed By:
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Gas Meter Enclosure Plan 10445 S. De Anza Blvd Cupertino, CA 6-4-2014
1 Bx14x12 PT WOOD/PRIMED/ 6x14x2o PT WOOD/PRIMED/
PAINTED TO MATCH EXISTING PAINTED TO MATCH EXISTING
20% 0"
A
2 4x4x10 PT WOOD/PRIMEDI
PAINTED TO MATCH EXISTING
(E)CHAIN LINK TOP TO
BE RE-USED
(E)CMU BLOCK
WALL
(E)RAZOR WIRE
TO BE RE-USED
(TYPA)
CuPER
TOP VIEW -r���
Building Depatnent
;I JUN 0 5 2014
REVIEWED FOR CODE COMPLIANCE.
Reviewed By: '�- G
Gas Meter Enclosure Plan 10445 S. De Anza Blvd Cupertino, CA 6-4-2014
(E)LEDGER ANCHORS TO BE SIMPSON HUC814 FACE
RE-USED.(TYP.6) MOUNT HANGER.
z r /(M-5)
L Ll K 11 11
Ledger Detail
(N)6X14X20 (N)8X14X12 PT PROVIDE/INSTALL
LEDGER LUMBER TO UNI STRUT FOR(NEW/ (E)CMU CLIPS/
MATCH(E) EXISTING)GAS LINES. THRU BOLT TO
BE RE-USED
(TYP.5)
(E)CMU BLOCK
WALL
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REVIEWED JUN ® Partrper7t
5 2014
DETAIL SHEET FpR DDDe CO
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