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� _ __ _ _ ------ - _ . __ .. } W
CITY OF CUPER 'INN
`:me� ' �.y���
, T1�BUILDING DIVISION PERMIT
BUILDING ADDRESS: PERMIT NO.
;.0284 VISTA CT TBD - TO BE DETERMINED 08070140
OWNER'S NAME: PERMIT ISSUE DATE
SAGES IRENE C 07/25/2008
PHONE: SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING IT INFO
2 BTHRMS RMMDLE NO BLDG L ETPER PLUMB MECH
EfnEeT o o LICENSED CONTRACTOR'S DECLARATION O 0 0
UW Ul hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
Z iwith Section 7000)of Division 3 of the Business and Professions Code,and my license is
in full force and effect.
r"�? License Class Lie.#
F„a Date Contractor
ARCHITECT'S DECLARATION
g g< I understand my plans shall be used as public retards
JyU
w O r" Licensed Professional
m OWNER-BUILDER DECLARATION
2<V 1 hereby alTirm that I am exempt from the Contractor's License Law for the
p 0 fallowing reason.(Section 7031.5,Business and Professions Code:Any city or county
1$�i which requires a permit to construct,alter,improve,demolish,or repair any structure
u Z y prior In its issuance,also inquires the applicant for such permit to file a signed statement
E s< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
eh$ (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or
u W F that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.3 by any applicant far a permit subjects the applicant to a civil penalty of ��Number Occupancy not more than five hundred dollars(5500). P Y YPe
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is notimended or offered for sale(Sec.7044,Business
and Professions Code The Contractor's License Law does not apply ED an owner of Required Inspections
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.).
D-1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law does 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 reason
Owner A--i Gid.Cr y TP�sF'Date 7t'�-����
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑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
warlc for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3710 of the Labor Cade,for We performance of the work for which this permit is issued. -
My Worker's Compensation Insurance carrier and Policy number are:
Carrier. Policy No.: "
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is forone hundred dollars($100)
or less)
1 certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so to bcrnme subject to the Workcrs'Compensadon
Laws of California.Date
Appricanl a21 f2; 3s--� -r-wi,r
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Cade,you must
® forthwith comply with such provisions or this permit shall be deemed revoked.
Ln CONSTRUCTION LENDING AGENCY
t-+ h� I hereby affirm that there is a construction lending agency for the performance of
5 the work for which this permit is issued(Sec.3097,Civ.C.)
QLender's Name
z Lender's Address
J® f certify that 1 have read this application and state that the above information ds
correct.I agree to comply with all city and county ordinances and state laws relating to
vJ V building construction,and hereby auLhoriM representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
04 liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /'Z S
SOURCE REGULATIONS.
Re-roofs
Signature of Applicant/Cotitractor Date
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)7
C:]Yes All roofs shall be inspected prior to any roofing material being installed.
Nv
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
cook hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes Nro
I have read the hazardous materials requirements under Chapter 6.95 of the Califor.
nia Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the building
does not curtent aveatcnant that it is my responsibility to notify the occupant of the
requ mments w sh must c mel prior to' of a Ccrtif atc of Occupancy.
Signature of Applicant Date
Owner or authorized agent Date
All roof coverings to be Class" °'or better
" �I
aa
A CITY OF CUPERTINO
� ADDITION/REMODEL
CUPE OF PERMIT APPLICATION FORM
APN# Date:
Building Address:
-z't7Z4- ' sG V
Mailing Address (if different from building address :
C_t 2v s L rJ —c o C--P- c? S-,Z v
Owner's Name: Phone# :
,.� 17 R � ( �r v s 1= �' �' tet' 2 m
Contractor: 1411, Phone#:
Fax #:
Contractor License#: X14
Cupertino Business License#:
Contact:4�k - Sa� °-i, , s f-.` Phone#:
Qt
PC tUH !amu q. Fax #:
Building Permit Info:
Bldg. ❑ Elect. ❑ Plumb. ® Mech. ❑ Hillside ❑
Job Description:
Addition (adding sq footage):
What is being remodeled (not including addition)? S�-
(Z�
Remodel Includes Re-Roof: Yes ❑ No If yes list number of squares
Remodel Includes Structural: Yes ❑ No 0
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen BathHO Other
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/IIUV-A ❑ I1/1II B, IV-HT, V oC_3-,FL.,ce 3
Valuation: - s-0 C) Please check this box if the project is a
second-story addition ❑
Project Size: Express ❑ Standard 0 Large ❑ Major ❑
Please complete relevant portion of the Green Building
Checklist & attach it to the application or if applicable, Green Building Points Acbieved:
include in plan set & the sheet index.
***For Office Use Only***
Over-the-Counter ❑ Revised 7/01/08
CITY OF CLTPERTINO
ADDITION/REMODEL
CUP'EkTINO 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
j inspection
1R3HPLNCK Dwellings Hillside plan B
check
1R3HREINSP Dwellings Hillside B
Repeat Inspection
1R3HREPLNC Dwellings Hillside B
Repeat Plan Check
1 R3ALTINSP Dwellings Alternate B
Materials Inspection
1 R3ALTPLNC Dwellings Alternate B
Materials Plan Check
l 1PCESS Cesspool P
1 PPRSEWG Ea. Private Sewage P
Disposal System
1PRSEWER Sewers P
1BPSPRINK Lawn Sprinkler/Backflow P
1BPWSVCS Main Water Service P
1BSEISMICRE SeismicResidential B
DECKS 1R3SFDADD OR
1R3SFDREM
1DECKWOOD Deck (Wood)-Each B
(Each)
1DECKRAIL Deck Railing-Each B
(Each)