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12100164-EXPIREDCITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10881 NORTHFORDE DR CONTRACTOR: QUALITY BUILT PERMIT NO: 12100164 CONSTRUCTION OWNER'S NAME: LUNG ROCCA T AND KATHEREEN C 1160 DANBURY DR DATE ISSUED: 10/23/2012 OWNER'S PHONE: 4085719695 SAN JOSE, CA 95129 PHONE NO: (408) 666-6096 ❑ LICENSED CONTRACTOR'S DECLLARRATION License Class �.p Lic. #-72) 2 l L30 ContractoiN A(— t t 1 � q l �.( Date'L-- 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 performance of the work for which this permit is issued. 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. APPLICANT CERTIFICATION 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 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 comply with all non -point source regulations pir the Cupertino Municipal Code, Section 9.18. Signature_ka J, Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 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 comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date BUILDING PERMIT INFO: BLDG r ELECT r- PLUMB' MECH r RESIDENTIAL r— COMMERCIAL JOB DESCRIPTION: REMOVE AND REPAIR DECK AND RAILING AND SECOND STORY BALCONY/DECK (52 SQFT) Sq. Ft Floor Area: I Valuation: $2200 APN Number: 31637048.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAY�Sj FRnO_M/ LAST CALLED INSPECTION. Issued by: /€H/I' %G Date: /D RE -ROOFS: 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: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will Lal c mpliance with the Cupertino Municipal Code, Chapter 9.12 and the fe CodEQNSTRUCTION 533, and 25534. a or' LENDINGAGENCY I hereby affirm that there is a construction lending agency for the performance of cork's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINQ CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(E)cupertino.org � 2- 16(-)( cog ElW CONSTRUCTION ❑ ADDITION TERATION / Ti El REVISION / DEFERRED ORIGINAL PERMIT # PR N=)2T 4 r0 C �� 5� 04 OWNER NAMEn 0 ' \ P d �� E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME � LICENSE NUMBER L LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE A LICENSE NUMBER BUS. LIC # COMPANY NAME IW1'A E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK c2^ %^ , J ` PROPOSE USE CONSTR. TYPE _ STORES T L USE TYPE OCC. SQ.FT. VALUATION (S) y 1' FEXISTG NEW FLOOR DEMO AREA TOTALAREA NET AREA KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECKtYLA4-6 TOTAL DECKIPORCH AREA I GARAGE AREA: El DETACH []ATTACH `_JG/,:(G,�/✓��7" # DW FEEING UNITS: IS A SECOND UNIT 0 yES SECOND STORY [:]YES BEING ADDED? NO ADDITION? O PRE -APPLICATION❑ }�.5 IF YES, PROVIDE COPY OF PLANNING ADPL # O PLANNING .APPROVAL LETTER IS THE BLDG AN [],YES EICHLER HOl•IE? per' NO RECEIVED BY: ' '." -.. TOTAL VALUATION - - By my signature below; I certify to each of th followine: I am tproperty owner or authorized anent to act on the property owner's behalf. I have read this application and the information I have provi is ect. I hav read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to uildi con ction. I a oriz epresentatives of Cupertino to enter the above -i dentiled pro rty for inspection purposes. Signature of Applicant/Agent: !< Date: Jf! W 2 SUPPLEMENTALORMATION Q PL ANCHEcxTYPE, .:; RoiTilvcsiiP . ~ ' otER raE couNTER BUILDING rLaN REvtEw . New SFD or Multifamily dwell ngs: Apply for molition permit for existin_o building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ 'EXPRESS❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STAND.kRD ❑; PUBLICWORxS ' form if anv Hazardous Materials are being used as part of this project. ❑: LARGE ❑, FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to❑ IAaou` ❑ 'sANITARY=sEtSERDisTRICT� submittal of Building Permit application. ❑ ENVIRONIIIENTAL HEALTH CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: �� �}(Z j '�- PERMIT # OWNER'S NAME: /JL PHONE # `t`V6,y�) 5-7 — GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL S MORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: ig re ate Please check applicable subcontracto s and co Tete the following information: Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date CITY OF CUPERTINO FM_7 FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1!12) 10881 Northforde Dr DATE: 10/23/2012 REVIEWED BY: Sean lialADDRESS: APN: BP#: "VALUATION: 1$2,200 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY Multi -Family Dwelling USE: Buildino is 3 Stories Yes Q No PENTAMATION 1GENRES PERMIT TYPE: WORK Remove and repair deck and railing and second story balcony/deck 52 sq ft). SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1!12) Meeh. Plan (,heck Plumb. Plan Check 0ec...Plan Check Plumb. Permit Fee: Flec. Permit Fee: Other blech. J,, ,i=, Other Plumb Insp. 0,41e1� L-1 7(,( . lnsp. Li �It:i'l'. 172•'17. Fc'(c' fi'i71_ 1`Ce, 1 n /`co ' NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1!12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # $467.00 Deck / Deck Railing 1DECKWOOD Deck (wood) Suppl. PC Fee: Q Reg. Q OT T0,01 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conso-uction :Tax: A(Jn?i171111'C=`�°i�' �'C>f>, 0 G Work Without Permit? Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) 0 i Travel Documentation Fees: Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: 1 $1.501 $467.00 TOTAL FEE: $468.50 Revised: 10/01/2012 L4 2r& es G@c c w:>:OD mid aGt'�NmRw » mrrx s � e� o 3'A'- < c< m rtm c « / »c ,rm I d twd ---�. _ t . ! «9 uA1--- r G / RAIR o RZ m 15 r'l Er \ d \u&\ j/ /!i%Rt9E2« y C4<0 .�, Q 1EYU�110(n PLOOR Trj! 1k4, o'c" fo LA lie t, I - R71'