13060097 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10141 DENISON AVE CONTRACTOR:FRAN YETSO PERMIT NO:13060097
CONSTRUCTION
OWNER'S NAME: JOHN TOLAN 675 GEORGIA AVE DATE ISSUED:06/12/2013
OWNER'S PHONE: 4087020058 SUNNYVALE,CA 94085 PHONE NO:(408)245-5314
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALS
License Class Lic.# -S REPLACE(E)WOODSIDING WITH(N)STUCCO SIDING
Contractor V y4 Date 3
1 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:$5500
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:31628026.00 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 D RMIT 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 D + OM L -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 Date _4e;
�2
granting of this permit. Additionally,the applicant understands and will compl ssu
with all non-point rce ulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature DateAll 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 er'no Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec' 5 5 25533, d 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:
permit is issued.
4��/
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 CONSTRUCTION LENDING AGENCY
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 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
upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify 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
9
CONSTRUCTION PERMIT APPLICATION D O
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION v
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•building0cugertino.ora t�7
[:]NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED `ORIGINAL PERMIT#
PROJECT ADDRESSL / D { /lI APN# / Z's /1 �f
'Oggi
OWNER NAME ,(fes. 1 J`� PHONE/ E-MAIL (fib
STREET ADDRESS �r Alm
�/ CITY, STATE,ZIP / FAX
CONTACT NAME 15
f�Y7�/t�l�f� PHONE C/ E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME 'jJ5 - LICENSE NUMBER r � LICENSE TYPE BUS.LIC#
COMPANY NAME �! /�__q s EMAIL �/ �f FAX
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STREET ADDRESS �� / �I _/� CTfY,STATE,ZIP �� L PHONE! �
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ARCHITECT/ENGINEER NAME (' �'/ `(/LICENSE NUMBER BUS.LIC#
COMPANY NAME j� E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK n „ S O 'AJ
J— L x ('Qn A
C,4AA-�Z-5 e-'S (2-0 0 0
EXISTING USE PROPOSED USE CONSTR TYPE 1 #STORIES
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NETAREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
[]ATTACH
#DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY [:]YES
BEINGADDED? NO ADDITION? []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES i'RtEI =.__- ' „. -"'" ` TOTAL VALUATION:
PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO
e" . IV
By my signature below,I certify to each of the following: I am the property owner or thorized o operty owner's behalf. I have read this
application and the information I hav1!2'uzog�
ded is correct. I have read the Description of Work ven Is accur e. I agree to comply with all applicable local
ordinances and state laws relating to truction. I authorize representatives of Cupertino to enter the abo ;iden'feed pro erty for inspection purposes.,
Signature ofApplicant/Agent: Date: (d�l �L
SUPPLEMENTAL INFORMATION REQUIRED � r,T w � RoucSL>p ,
_New SFD or Multifamily dwellings: Apply for demolition permit for
HE-C UNTE � D GPZ 1tE,
existing building(s). Demolition permit is required prior to issuance of building �t
permit for new building. [ G.py H
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure - sT ua Cwoitxs
form if any Hazardous Materials are being used as part of this project. i
G E _
_Copy of Planning Approval Letter or Meeting with Planning prior to }� t
submittal of Building Permit application. t
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10141 DENISON AVE DATE: 06/12/2013 REVIEWED BY: MELISSA
APN: 316 28 026 BP#: "VALUATION: $5,500
%PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: PERMIT TYPE:
WORK REPLACE E WOODSIDING WITH N STUCCO SIDING
SCOPE
F
777
�rs ,.._ a_,�_,_�;Phimb.Plan Check Elec.Plan Check
Plumb. Permit Fee:: Elec.�. Permit Fee:
Other Afech.Insp. Other Plumb Indy. Other Elec.Imp.
'ech.Imp.Fee: Plumb. hasp.Fee: Elec.Insp.fee:
NOTE:This estimate does not include fees due to other Departments(La Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These fees are based on the prelfmina information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1,000s.f. Restucco
Suppl.PC Feer (E) Reg. ® OT 0.0 hrs $0.00 $535.00 1STUCOAP7P
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee:(F) Reg. ® OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction :T ilx:
Administrative Feer:
Work Without Permit? 0 Yes No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Building or Structure.
Travel Documentation Fees:
Strong Motion Fee: IBSEISMICR $0.55 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
$1.55 $535.00 . } 'P = $536.55
wl �..
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Revised: 04/29/2013
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C O P E RT I N O Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST ' ,
JOB ADDRESS: y PERMIT# 4Oa4-7
OWNER'S NAME: ® PHONE# 07
GENERAL CONTRACTOR BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE: ft�/t�
*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 SU O CT.ORS HAVE OBTAINED A CITY F CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: /
Siylature Date
Please check applicable subcontractors and complete the following information:
G/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass/Glazing
Heating
Insulation 5�z
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
s
Owner/Contractor Signature x Date