15070116 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 830 STENDHAL LN CONTRACTOR::DAN FULGA DBA PERMIT NO:15070116
AXISCON LLC
OWNER'S NAME: LIOU DEREK AND CATHERINE AMY P O BOX 471 DATE ISSUED:11/13/2015
OWNER'S PHONE: 4085977546 REDWOOD ESTATES,CA 95044 PHONE NO:(408)507-2733
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
CONSTRUCT ONE STORY ADDITION(314 SQ FT)
License Class� Lia# �3 BATHROOM
Contractor Date �z�-!�`°-tr ' ( Q FT
REMODEL(148 SQ FT); KITCHEN REMODEL 136 S °
��� )�
OTHER REMODEL(1770 SQ FT);REROOF(2312 SQ FT);
I hereby affirm that I am licensed under the provisions of Chapter 9 REV#1 STRUCTURAL CHANGES FOR DRYROT REPAIR AT GARAGE-
(commencing with Section 7000)of Division 3 of the Business&Professions ISSUED 12/16/15
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:$350000
I 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
permit is issued. APN Number:37541020,00 Occupancy Type:
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 18S'�OF P T 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 18 SPECTION.
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 c p y uY: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date Z-16- 15
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
❑ OWNER-BUILDER DECLARATION inspection.
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(See.7044,
Business&Professions Code)
1,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 ertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 25533,and 25534..
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:/Z-J-4-d
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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certif tate of exemption,I
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 CERTIFICATIONLender'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
CCMMIUN1 Y DEVELOP101ENI DErAR i AEN •BUiLWNG D1 I
10300 i ORRE AVENUE-CUPER i INO,CA 55014-3255
CUP=RTINO• (408) 777-3228" FAX(408)777-3333, buiidinOrcu.-prt•'uao.QrQ
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1 L'SE I TYPE I OCC. SQ.FT. VALUATION(S)
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nDliTLLTCUNI S: 1 IS A SECOND UNrr AYES I SECOND STORY MT:—:S
BUNG ADDED? ElNO ADDITIOI:? ONO
PP,r cnpr lCATiO'1 ❑YZS 7 YES.PRC%W-COPY OF I. IS 111E BLDG/-N ❑�a n z' - '�- �TOTAT�UA-1103\1:
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By my signature below,I ce if- to each of the follo,,inE: I em the property ovmtr or aw _ nt to act on the proper ow-ner's behalf I have recd this
application and the information I have p IreVct, Lh�ee read the i7esc;iptioa , ork end verny it is accurate. I agree to comply�Mth all applicable local
ordinances end State latis rely ing to ing n. I authorize repreSCn-2:1 'eS'Of Cupertino to enter the ab OVe-ie lti ed property for I�SpeCtlOn purposes.
'Zi
--iature ofApplicanW.Eent: Date: $ ~J
Sb-PPLE-M,— T :L TF SIO?T REQUIRED � � �� � � waw- y5 j
.a_ amu=, Lan!
New SFD or Multifamily dui elhnp .=_p l�y f0I demob Ion D '21st IOr -� � "-
❑ O�tRTCOL�TER BLTTSD�G�L3�ReS?i' i
ea.IStin-building(S). Demolition per--.,it is recull ed prior to.SniEnce Of building
permit for new buildin1GSL
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� �1'i..nS�� �- - �L:4��� 'tP��Fi ..
CO ,?'lerCial Bldgs:Provide Scompleted l,Tazaid011S �teri lS 1715closure. -l_.s �'�'�A - ' L�1G4rOELK�S
7,o—=. SI Lny Eaiardo»s b/Laterle.la are bein',u1se l as part Oi�il1S project. �
J IRS RG> fiu 1 DEPS
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Copy of P12,nmi ng Approval Letter or Mfeeting wish PI �� g prior to , :
submittal of Buildip_g Pei?Iit application.
Bid,'_aD_?011,doc revised 06121111
. CITY OF CUPERTINO
21 1
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 830 STENDHAL LN DATE: 12/16/2015 REVIEWED BY: MELISSA
APN: 375 41 020 BP#: 15070116 *VALUATION: $0
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION
USE: PERMIT TYPE: 1 GENRES
WORK REV# 1 - STRUCTURAL CHANGES FOR DRYROT REPAIR AT GARAGE - ISSUED 12/16/15
SCOPE
('h-;,:.. . £. .��33 ?{`:.::
tt„ s
r gs' -n a_
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the preliminar information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS(Fee Resolution 11-033 Elf. 711113,) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (E) No $0.00 1 hours Plan Check,Hourly
Suppl. PC Fee: •; Reg. 0 OT Q,0 hrs $0.00 $143.00 1STPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes !; No $0.00
Suppl. Insp.Fee-e) Reg. OT Whrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
ILI
4dirtinis-lm i%.(,f'ee'.
Work.Without Permit? 0 Yes , No $0.00
.Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure
Stron,Motion Fee: $0.00 1.0 hrs Inspections
Bldg Stds Commission Fee: $0.00 $143.00 ISTINSP Inspection,Hourly
SI7BT0IALS $0.00 $286,00 $286.00
Revised: 1 0101/201 5