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09020006- PUB Ill 14110 1 `- "it 1r l I 1� I IllI,�°I IINJ 1�11,12- 1 Idl Id x a z v to L z o Q Qy H H R a W Q O H H It O U O `moi `moi H �y \ iOi H H W \ U --I O a q 0 w o LU [ u N v H H \ o A a a o0 U U -0 cr O b w H H a W H Cl) O ] W O O O N ~ u LO cr o m w O O '- Q rc � "> Q5 U CL O � M a w v, p CV LO - 2 U �3 � iJ5 N U OL = xo a xy Q1 N N y (J J O Q1 U1 a •� y _0 Ids as LL- a m m O a a J xLLJ 0 0 i+ U O T M C LU z 16 16 0 uIdl � Idl Id a OL T a a CL C a� O O O y J IcSI� co 3 3 0 CDr no � J � ui Z M o , w y a o a c oa J 'z LLIx LL g w w w Q _ O _ 0 0 o m OC LL Lo O a� cr � c o a� o 0 o p c D w w w rt O a 1 1 1 w O LL.Cn J m m O •> c � wIL M C=O No yr r O N m _ = v IL C a y o w o 0 o w cn = = v Q Q r w Q p ,' o (D a`� x (U ti -0 a y x � �D CL T o a� Q1 p 2 O xo . 7 7 a a O E x Z IL OL.� T W xO CL N O C Q o y a� a� a� O U M fu o s cn +o OL O c w, o i w `m +o m o a a 'a 'a (tf UCL IL O Q m U O CL O IL ILin CL Q CL U U U I a lL CL LL CITY OF CUPERTINO BUILDING DIVISION PERMIT ® TCTQR INORMTIOIY BUILDING ADDRESS: PERMrr NO. 22113 STOCKLMEIR CT VANNI OWNER'S NAME: PERMIT ISSUE DATE PHO 5 A CONTROL NO. 408) 253-7028 ARCHrrECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH a 0 0 0 o p LICENSED CONTRACTOR'S DECLARATION W 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description Z UJ with Section 70(10)of Division 3 of the Business and Professions Code,and my license is �y in full force and effect - BEAM REPAIR & ADDIT'L BEAM BEING INSTLI); NO RE-RF ? License Class7 a �e Dated C otactor AA'11 OPM-, COMS�& & YES TO STRUCTURAL ARCHITECT'S DECLARATION cd< I understand my plans shall he used as public records yU O y Licensed Professional } OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county $li which requires a permit to consimc4 alter,improve,demolish,or repair any structure !Z y prior to its issuance,also requires the applicant for such permit to file a signed statement =C that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). El 1,as owner of the property,or my employees with wages as their sale compensation, 35709045 . 0 0 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 Q p property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements arc 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 Contractor's L3- _ cense Caw dors not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a conlractor(s)licensed pursuant to the Contractor's 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 declarations: (31 have and will maintain a Certificate of Consent to se)f-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. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 or 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. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Mit section need not he completed if the permit is for onehundred dollars(SI00) or less.) 1 terrify thct in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to bccomczsttbject to the Workcrs'Compensation Laws of California.Date Applicant - NOTICE TO APPLICANT:If,atter making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must 2 forthwith comply with such provisions or this permit shall be deemed revoked. N O CONSTRUCTION LENDING AGENCY '-+ I hereby affirm that there is a construction lending agency for the performance of �i ' the work for which this permit is issued(See.3097,Civ.C.) Cl Q Lender's Name z Lenders Address Q 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 Vbuilding construction,and hereby authorize representatives of this city to enter upon the N W above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against ~.4 Vp"] liabilities,ud mcnts,costs and expenseswhichma in any way accrue against saidCitY Z in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 2 SOUR ULATI NS G'G� Re-roofs Signatum of Applicant/Coniractor 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)? All-roofs shall be inspected prior to any roofing material being installed. ❑Yes �lo 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 emir hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? � ❑Yes Erg.- 1 have mad 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 docs not currently have a tenant that it is my responsibility to notify the occupant of the requircmcV5 which must be met r to issuance of a Certificate or c upancy. Signature of Applicant Date 2- -a owntaagenl! �� Da _ All roof coverings to be Class''''or better �� b� C) 00� CITY OF CUPERTINO ADDITION/REMODEL CUPER:11NO PERMIT APPLICATION FORM APN # Date: Building Address: 2 2— C 4/�erF;,;r v Com! Mailing Address (if different from building address): Owner's Name: Phone# c��°�� t I Contractor: \ J Phone#: Fax #: 40S 2573-70z Contractor License#: Cupertino Business License#: Contact: Phone#: e7,o O —0©s 5-� 4/&./ <�,✓ Fax#: Building Permit Info: Bldg. LJ Elect. ❑ Plumb. ❑ Mech. ❑ Hillside ❑ Job Description: Addition-What is being added?(Be Specific): What is being remodeled (not including addition)? �� Remodel Includes Re-Roof. Yes ❑ No [f If yes list number of squares Remodel Includes Structural: Yes Er No ❑ Do you have the pre-application planning approval? Yes ❑ No 2-- If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen Bath Other P-le 611— 2Fx f s Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT,V-B Valuation: 4t'? check this box if the project is a second-story addition Project Size: Express Standard ❑ Large ❑ Major❑ Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, Green Building Points Achieved: include in plan set & the sheet index. ***For Office Use Only*** Over-the-Counter ❑ Revised 01/07/09 CITY OF CUPERTINO ,1 ADDITION/REMODEL 1, , CUPEkTiNO FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft ADDITIONS 1R3SFDADD PLLONGRNGR Long Range PL Planning/Residential 1 R31NSP Dwellings Inspections B 1 R3PLNCK Dwellings plan check B 1R3REPINSP Dwellings Repeat B Inspection 1 R3REPPLNC Dwellings Repeat Plan B Check 1 R3HINSP Dwellings Hillside B inspection 1R3HPLNCK Dwellings Hillside plan B check 1 R3HREINSP 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 1PRSEWER Sewers P 1BPSPRINK` Lawn Sprinkler/Backflow P 1BPWSVCS Main Water Service P 1 BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE SeismicResidential B 1REROOFRES Residential Re-roof Each B 100 SF