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09120064 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10256 N STELLING RD CONTRACTOR:TBD-TO BE DETERMINED PERMIT NO:09120064 OWNER'S NAME: WOLFGRAM/WENDT DATE ISSUED: 12/10/2009 c ER'S PHONE: 4082521133 PHONE NO: LICENSED CONTRACTOR'S DECLARATION — D�Q� BUILDING PERMIT INFO: BLDG ELECT PLUMB �License ClasLic.# &5 1 MECH RESIDENTIAL COMMERCIAL Contractor d p�� C�EIIVS l• Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:CHANGE OLD METER MAIN PANEL TO 200AMP METER (commencing with Section 7000)of Division 3 of the Business&Professions MAIN COMBO***SEE NOTES*** 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 Sq.Ft Floor Area: Valuation:$2000 permit is issued. APPLICANT CERTIFICATION APN Number:32630013.00 Occupancy Type: I certify that 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Mu icipal Code,Section 9.18. '' 4 �2- lcsr� nl�+�n Issued by: Date: Signatur kJ ate li 10 G OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to constrict the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,Pnd 25534. Compensation laws of California. If,after making this certificate of exemption,I 6n07 become subject to the Worker's Compensation provisions of the Labor Code,I must er or au or' ed a e ) ve 7i d forthwith comply with such provisions or this permit shall be deemed revoked. 11 dIA0061Aate: 7 CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save )nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address L ,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional J sCITY OF C'UPERTINO CUPEkTINO GENERAL BUILDING PERMIT APPLICATION FORM APN# v Date: Building Address: A/. Mailing Address (if different from building address): 22-6e2 22 Are Hazardous Materials being used as part of this project? Yes LJ No HOA: Exterior work on Yes ❑ No If ves, provide letter from HOA Owner's Name: Phone#:toy Contractor: Phone: 6-5-0Z faA � c d .� Fax: Contractor License#: 6,,510 Cupertino Business License#: Contact: Phone° O 2.�� UX Fax: Residential Commercial 2 �1N 1'�tilV Job Description: ,CYA f✓2Sri Building Permit Info: Bld Elect �/ Plumb ❑ Mech ❑ Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ IUIII/V-A ❑ IUIII B, IV-HT, V-B Valuation: C> Square Footage: Project Size: Ex ress ❑ Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicable, include in plan set& the sheet index. Points Achieved: For help, contact Build it Green at www.builditgreen.or Revised 07/14/09 5E ` CITY OF CUPERTINO CITY OF GENERAL BUILDING APPLICATION CUPEI�TINO FEE SCHEDULE Quantity/Sf Fee ID Fee Description Fee Permit Type Group 1GENRES or 1GENCOM 1STUCOAP Stucco Applications (up to 400 sf) B additional stucco application 1 WINREP Replacement windows/sliding glass B door (ea 8 windows) 1 WINMEWSTR New Window-structural shear B wall/ma:onry (includes plan ck fee) IEPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechani aal Permit Fee M 1 PPERMITFEE Plumbin,;Permit Fee P IELCPLNCK Stand Alone Electric Pln Ck(hourly) E 1MECPLNCK Stand Alone Mechanical Pln Ck (hrly) M 1PLMBLNCK Stand Alone Plumbing Pln Ck(hrly) P 1 STPLNCK-(3 Hr Min Standard Plan Check(when no E/M/P) B when not over counter) hourly-sl and alone 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICR Seismic:,esidential B 1BSEISMICO Seismic ,'ommercial B / 1 TRAVDOC Travel & Documentation B 1BUSLIC Business License B 5 of 5 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 __. ., _ Fax(408)777-3333 CITY OF XPEkTINO Buildin De artment JOB ADDRESS: PERMIT # �U �6 ti•S relli� , �/ OWNER'S NAME: Lv0 L�6 �E 1/T PHONE # `l`�� Z —�/ 33 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: l Zzoz-r— Slirg nature Date Please check appEcable subcontractors and comp.ete the followin information: :2ESUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile er/Contractor Signature Date 6q CITY OF CUPERTINO ADDITION/REMODEL SIV "d CUPEkTINO PERMIT APPLICATION FORM APN # �� , � , � � Date: Is a 7,dunit being added? Yes ❑ No If yes, please fill out the permit application for 2" unit. Building Address: Mailing Address (if different from building address) Owner's Name: Phone# : -/_V ,J 0 Contractor: -57 y) c rn'i Fe C.. , �:_ / 1-1l Phone#: c� - ct ,ti - � ; c Fax #: 7 Contractor License#: Cupertino Business License#: c=- Contact: -- Phone#: c - i ' C t+ J__ a t" 1 , Fax#: Building Permit Info: Bldg. ❑ Elect. ❑ Plumb. [] Mech. ❑ Hillside ❑ Job Description: A Addition-What is being added?(Be Specific): ` {,�� v What is being remodeled (not including addition)? Remodel Includes Re-Roof. Yes ❑ No [] If yes list number of squares Remodel Includes Structural: Yes ❑ No [] Do you have the pre-application planning approval? Yes ❑ No ❑ If yes, please provide a copy of your plannin approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen Bath I0�:, � Other Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B ❑ IUIII/V-A ❑ II/III B, IV-HT,V-B Valuation: _4�;, Please check this box if the project is a second-story addition ❑ Project Size: Ex ress ❑ Standard ❑ Large ❑ Ma'or❑ 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 0 Revised 07/06/09 CITY OF C'UPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft DECKS 1R3SFDADD OR IR3SFDREM 1 DECKWOOD Deck (Wood)4 ach B (Each) 1DECKRAIL Deck Railing-Each B (Each) GARAGES 1R3SFDADD OR DETACHED IR3SFDREM 1GARDTW<=1K Wood Frame up to B 1,000 SF (eaclii 1GARDTM<=1K Masonry up to 1,000 SF B (each) 1 BCONSTAXR Construction T ix Res (new detached garage) PATIO'S OPEN 1R3SFDADD OR IR3SFDREM 1PATIOWOOD Wood Frame up to 300 B SF 1PATIOMETAL Metal Frame u3 to 300 B SF 1PATIOOTHER Other Frame u3 to 300 SF B PATIO'S CLOSED IR3SFDADD OR & SUN ROOMS IR3SFDREM 1PATIOENCLW Enclosed Wood up to 300 B SF 1PATIOENCLM Enclosed Metz1 up to 300 B SF 1PATIOENCLO Other Enclose Patio up B to 300 SF 1 COVPORCH Porch Covered-Each B (Each) REMODELS IR3SFDREM 1 REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan 300 SF check 1 REMRESBAT Bath Remode up to 300 B " SF 1REMREOTH Other Remod,;l up to 300 B " SF CITY OF CUPERTINO ADDITON/REMODEL FEE SC-.HEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft 1MECPLNCK Stand Alone mechanical M Pln Ck hourly 1 PLMPLNCK Stand Alone F lumbing P Pln Ck(hourly) 1BCBSC Cal Bldg Stanlards B ALL PERMIT TYPES Commission I'ee 1BSEISMICRE Seismic Residential B 1 TRAVDOC Travel &Doc imentation B 1BUSLIC Business Liceise B