11060063 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10079 RIDGEWAY DR CONTRACTOR:SILICON VALLEY PERMIT NO: 11060063
BUILDERS GROUP
OWNER'S NAME: CAROL WATSON 1961 OLD MIDDLEFIELD WAY DATE ISSUED:06/09/2011
'S PHONE: 4082524420 MOUNTAIN VIEW,CA 94043 PHONE NO:(408)627-4177
LICENSED CONTRACTOR'S DECLARATION
n / BUILDING PERMIT INFO: BLDG" ELECT PLUMB
License ClassLic.# �}'!l/�( F ""
/ / > MECH RESIDENTIAL COMMERCIAL
Contractor S�`�4 Date J
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SIDING REPAIRS TO REPLACE SIDING DAMAGED BY
(commencing with Section 7000)of Division 3 of the Business&Professions DRY
Code and that my license is in full force and effect. ROT PRIOR TO PRINTING COMPLEX(224SQFT)
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. Sq.Ft Floor Area: Valuation:$700
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:34241020.00 Occupancy Type:
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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations pe the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. /
Sign Date U f Issued by: Date:
Li OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code) _
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
1 have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
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 read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
1 certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the CiVertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sectio 5505,25533,and 25534.
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. Own ri ent: Date:6 � �/ ' /
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of Hork's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
nify and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
WAPN:
DDRESS: 10079 ridgeway dr. bldg#2 DATE: 06/08/2011 REVIEWED BY: bobs.
BP#: '"VALUATION: $700
Y,PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
PRIMARY SFD or Du lex __T PENTAMATION 1GENRES
USE: p PERMIT TYPE:
WORK replace siding due to dryrot damage.
SCOPE
T7 I T 1 7
NOTE. Theseees are based on the preliminarV information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (I ee Resolution 09-051 hff. 71"b"10) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.f. Siding
Suppl.PC Fee: G Reg. Q OT 0.0_1 hrs $0.00 $380.00 1SIDEOTHER All Other
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Feer'' Reg. 0 OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
eer
Acoustical Fee: 0 Yes (E) No $0.00 0
Work Without Permit? 0 Yes E) No $0.00 E)
Planninee: $0.00 Select a Non-Residential E)
Building or Structure
i
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $1.50 $380.00 TOTAL FEE: $381.50
Revised: 04/29/2011
CONSTRUCTION PERMIT APPLICATION-
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333•building0cuaerlino.ora
CUPERTINO
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS APN# 3 yZ • / I/ Q
OWNERNAME ��it
U L- (J� T S O/V �W d ZS Z' ��I E-MAIL
STREET ADDRESS/ CITY, STATE,23 FAX
GG7 IZ�DG EG✓!r�' �. Cc..PE�[G✓b 4Ag-TOl� A-)
CONTACT NAME / 'L`� t&L P ONE 1 1A."tiAe
STREETADDRESS I 1 CTfY,STA ZII' A7�
4172 As,�wE ca Q�iz.d 7- 27-63
❑OwNER ❑ OwNE;LBUIIDER ❑ OWNER AGENT ❑ CONTRACTOR ❑commACTORAGENT ❑ ARc=cT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMECy`D �� C JBEBUS.LIC# 3,o Ps[
COMPANYNAME 4��, � S 6i.r�CrS rov •Gc F f,,,, $Sl7 2 Zk?
141.1-91' /3c.OxI.
STREET ADDRESS CITY,STATE,ZIP PHONE
1,4c.7-L Au
ARCHITECTIENG]NEER NAME f �/ LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MATT, FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ESCRIPTION OF WORK �G PA<R L L d! < <N TP /46 eb 13 �J
EXISTING USE PROPOSED USE CONSTIL TYPE #STORIES -:
EXISTG NEW FLOOR DEMO TOTAL
. .
AREA AREA AREA NET AREA
BATHROOM KITC1Ia1 OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECWPORCH AREA GARAGE AREA:❑ DETACH
t
ATTACH ... k«
1 a
M DWELLING UNITS: IS A SECOND DNI! r]YES SECOND STORY ❑YES
SEINGADDED? ❑NO ADDITION? ❑NO
PRE APPLICATION
YES ff YES.PROVIDE COP PLANNER' NAME:
PLANNING APDL 6 ❑ NO PLANNING=01
... t. "
By my signature below,I certify to each a following: the p p owner or authorized agent to act on the property owner's behalf. I have read this
application and the infomlation I have vided is correct. ave I Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relatin to ding constructio I autho ' CA sentatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INIPkMATION REQEA
4 F
t - f�:jaf
_New SFD or Multifamily dwellings: Apply for
de permit for ,� � 'per.' 4
R.
existing building(s). Demolition permit is required prior to issuance of building >>Y= y x3 i
permit for new building. ! 1!
T
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure3
form if any Hazardous Materials are being used as part of this project w
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
B1dgApp_2011.doc revised 03116/11