The URL can be used to link to this page

11080184 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10600 STOKES AVE CONTRACTOR:MP3 MASONRY PERMIT NO: 11080184 OWNER'S NAME: WALLACE LORETTA R AND WARREN R 4530 FAIRVIEW RD DATE ISSUED:08/24/2011 ^WNER'S PHONE: 4083097775 HOLLISTER,CA 95023 PHONE NO:(831)637-6663 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB F License Class Lic.# /� MECH RESIDENTIAL COMMERCIAL Contractor /" to a I hereby affirm that I am licensed under t e provisions of Chapter 9 JOB DESCRIPTION: SFD CHIMNEY REPAIR FROM SHOULDERS (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. Sq.Ft Floor Area: Valuation:$2740 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:32649002.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued byt-� Date:,,C', 9.18. Signature Date RE-ROOFS: OWNER-BUILDER DECLARATION 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 I hereby affirm that I am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the P Health&Safety Code,Sections 25 05,25533,and 25534. 1 certify that in the performance of the work for which this permit is issued,I shall l not employ any person in any manner so as to become subject to the Worker's Ow or a d en Compensation laws of California. If,after making this certificate of exemption,I Date: 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. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name 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 Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION ,rs,and expenses which may accrue against said City in consequence of the ting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records. Ln all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: TraciC COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32649002 . 00 DATE ISSUED. . . . . . . : 08/24/2011 RECEIPT #. . . . . . . . . BS000014560 REFERENCE ID # . . . : 11080184 SITE ADDRESS . . . . . : 10600 STOKES AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER WALLACE LORETTA R AND WARREN R ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1237 RECEIVED FROM . . . . : MP3 ENTERPRISES CONTRACTOR . . . . . . . : PATRICIA GERE LIC # 27197 COMPANY . . . . . . . . . . : MP3 MASONRY ADDRESS 4530 FAIRVIEW RD CITY/STATE/ZIP . . . : HOLLISTER, CA 95023 TELEPHONE . . . . . . . . : (831) 637-6663 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 2, 740 . 00 1 . 00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 2, 740 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1BUSLIC FLAT RATE 1. 00 115 . 00 0 . 00 115 . 00 0 .00 1CHIMNEYRE EACH 1 . 00 523 . 00 0 . 00 523 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 639 .50 0 . 00 639 .50 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 639 .50 5011 --------------- TOTAL RECEIPT 639 .50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 101 FOUNDATION 312 CHIMNEY REBAR & STRAPS 517 FINAL CHIMNEY CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10600 stokes ave. DATE: 08/24/2011 REVIEWED BY: bob s. APN: BP#: "VALUATION: $2,740 "PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Chimney/Chimney Repair PRIMARY PENTAMATION 1CHIMNEYR USE. SFD or Duplex PERMIT TYPE: WORK sfd chimney repair. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY BP FEES Chimney Repair 1CHIMNEYR 1 $523 TOTALS: 77 7-7 Ll Li NOTE. These fees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addh 7 info, FEE ITEMS 01� e Resolution 11-055 F:ff' 1.-/IJ FEE QTY/FEE MISC ITEMS Permit Fee: $523.00 Work Without Permit? 0 Yes E) No $0.00 i Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $524.50 $0.00 TOTAL FEE: $524.50 Revised: 07/04/2011 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 L9 777-3228 • FAX 408 777-3333 • building(c7cupertino.org (408) ( ) CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROTECT ADDRESS FNI701 / r�U OWNER NAME 1 n/'� �' !J� u PHO 7 ^ �7 E-MAIL y� STRE1=T ADDRES((sv//IVVJ `5 CITY, STATE,ZIP FAx PHO ?+ E-MAIL CONTACT NAME NE��,�^ 3�—LrJ(c%CIJ.� STREET ADDRESS / V1 C;ZJ CITY,STA Z�' ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENTCONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMB LIC EN E TYPE BUS.LIC# - MPANY NAME ' E-MAII CO / FAX 2G'� "&51 1v37—Cv�o STREET ADDRESS/ S3 o (lZ GC(J �� ST TE ZIP L-3 P ONE W:3/- 6 ARC=CT/ENGINEER NAME LICENSE NUMBER BUS.LIC# (, COMPANY NAME E-MAIL FAX STREET ADD CITY,STATE,ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE #STO USE TYPE OCC. SQ.FT. VALUATION(5) flJ5 r NEW FLOOR DEMO TOTAL AREA AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DAETAACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? []NO ADDITION? []NO PRE-APPLICATION [E]YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED B : TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO 2 i By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the prnperty owner's behalf. I have read this application and the information I hav vided is correct. I have read the Description of Worik and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating buil ' construction. I a ze representatives of Cupertino to enter the above;identified property for inspection purposes. Signature of Applicant/Agent: Date: e?ld [l,�10 1-1 SUPPLEMENTAL lNT RMAT106 RE =D PLAN CHECK TYPE TIN �- ROUG SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for K]-�_-THE-COUNTER u BEING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building [1EXPRESS ❑ PLANNING PLAN REVIEW permit for new building. _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DE" _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH Bldg 4pp_2011.doc revised 06/71/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: �pC� PERMIT# OWNER'S NAME: jJ} r�CC PHONE # Q —6:3-7 GENERAL CONTRACTOR: BUSINESS LICENSE# CITY/ZIPCODE: ADDRESS: *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 SIJBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. -- R ��//I I am not using any subcontractors: Date Si atur 11 Please check applicable subcontractors and complete the following information: 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