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10030070 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10128 RIDGEWAY DR CONTRACTOR:TBD-TO BE PERMIT NO: 10030070 DETERMINED WNER'S NAME: WENDY CANNON DATE ISSUED:03/11/2010 OWNER'S PHONE: 4082550487 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lic.# `� REMODEL 100 SQ FT TO MASTER BATH NON- ? to STRUCTURAL Contractor / Date *SEE NOTES* 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. Sq.Ft Floor Area: Valuation:$30000 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 APN Number:34241014.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the �G�l granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: "'nature Date �) L� 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. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: � Dater/ 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 n the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION mnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date ?7 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 34241014 . 00 DATE ISSUED. . . . . . . : 03/11/2010 RECEIPT # . . . . . . . . . BS000009920 REFERENCE ID # . . . : 10030070 SITE ADDRESS 10128 RIDGEWAY DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER WENDY CANNON ADDRESS 10128 RIDGEWAY DR CITY/STATE/ZIP CUPERTINO, CA 95014-2659 RECEIVED FROM . . . . : WILLIAM CAPPER CONTRACTOR TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- - 1BCBSC VALUATION 30, 000 .00 2 . 00 0 . 00 2 . 00 0 . 00 1BSEISMICR VALUATION 30, 000 . 00 3 . 00 0 . 00 3 . 00 0. 00 1REMRESBAT SQ FEET 100 . 00 570 . 00 0 .00 570 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 575 . 00 0 . 00 575 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 575 . 00 VISA --------------- TOTAL RECEIPT 575 . 00 f_, C. RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number: 3 y;� -,-t/ -0� Name of owner. We� d-pq Project address. / a / -Z`Z� �� Gh�� l� r r ✓�' 411 Contact person. W1 "e4 'Ot-I Phone. UU Fax. Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: Garage: /' '--- TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y Is privacy protection planting required for the project? Build it Green Total Points On what floor(s) is work being done? Bri des ri tion of work. �� l��rr�4 � h-0� r C a l rY7 G Ci h q n� Code editions:2007 CBC -N)2007 CFC N)2007 CMCN) 2007 CPC -N)2007 NEC -N) Effective 1/1/08 INA( (,OI+nAN,_I vviIi+ IHE CITY OF CUPS fil INO(,O[)t S AN()ORDINANCES DATE 5—L O--L d SIGN Thisset of plans and specifications MUST be kept on the fob at all times and it is unlawful to make any changes or alterationsry on same without written permission from the Building Department, City of Cupertino. The stamping of this plan and specifications SHALL NOT be held to permit or to be an �` ' k%c FTV is" approval of the violation of any provisions ' of any City Ordinance or State Law. Plan Review Process Work Book Page-8-Revised 8/05/08 A 44 �J Y\ P747 l� P CITY OF CUPERTINO ADDITION/REMODEL CUPEkTINO PERMIT APPLICATION FORM APN # � � O ( � • � Date: --;r r/ , Is a 2° unit being added? s ❑ No M If yes, please fill out the permit application for 2° unit. Ye Building Address: 101-Z� � .�v✓a. Mailing Address (if different from building address): Owner's Name: Phone# W16�4 WM4_1 y z� Contractor:L Phone#: &_5t U. -, Fax #: Contractor License#: r?j Cupertino Business License#: Contact: / // Phone#: (p 4 5- U C%C. , .w Fax #: Building Permit Info: Bldg. Elect. ® Plumb. ®' Mech. ❑ Hillside ❑ Job Description: Addition-What is being added?(Be Specific): What is b G ing remodeled (not i�ncludiDngtion)? z ✓ Remodel Includes Re-Roof: Yes ❑ No If yes list number of squares Remodel Includes Structural: Yes ❑ No 5 Do you have the pre-application planning approval? Yes ❑ No ❑ 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 Type of Construction (Usage Class): Occupancy Type: 1-A, I-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B lv— Valuation: -7p� ( � Please check this box if the project is a second-story addition ❑ Project Size: Express F Standard ❑ Lar e ❑ 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*** ❑ Revised 07/06/09 Over-the-Counter CITY OF CUPERTINO ADDITION/REMODEL CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft ADDITIONS 1R3SFDADD 1PLLONGRNGR Long Range PL Planning/Residential 1R3INSP 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 1 R3HPLNCK Dwellings Hillside plan B check"t- 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 1 PCESS Cesspool P 1PPRSEWG Ea. Private Sewage P Disposal System 1 PRSEWER Sewers P 1BPSPRINK Lawn Sprinkler/Backflow P 1BPWSVCS Main Water Service P f 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES 1 Commission Fee 1BSEISMICRE SeismicResidential B 1RER00FRES Residential Re-roof Each B 100 SF CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft DECKS 1R3SFDADD OR 1R3SFDREM 1DECKWOOD Deck (Wood)-Each B (Each) 1 DECKRAIL Deck Railing-Each B (Each) GARAGES 1R3SFDADD OR DETACHED 1R3SFDREM 1 GARDTW<=1 K Wood Frame up to B 1,000 SF (each) 1GARDTM<=1K Masonry up to 1,000 SF B (each) 1BCONSTAXR Construction Tax Res (new detachedgarage) PATIO'S OPEN 1R3SFDADD OR 1R3SFDREM 1PATIOWOOD Wood Frame up to 300 B SF 1PATIOMETAL Metal Frame up to 300 B SF 1PATIOOTHER Other Frame up to 300 SF B PATIO'S CLOSED 1R3SFDADD OR & SUN ROOMS 1R3SFDREM 1PATIOENCLW Enclosed Wood up to 300 B SF 1PATIOENCLM Enclosed Metal up to 300 B SF 1PATIOENCLO Other Enclosed Patio up B to 300 SF 1 COVPORCH Porch Covered-Each B (Each) REMODELS 1R3SFDREM 1REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan 300 SF check 1 REMRESBAT Bath Remodel up to 300 B " SF 1REMREOTH Other Remodel up to 300 B " SF