13070114 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18900 NEWSOM AVE CONTRACTOR: PERMIT NO: 13070114
OWNER'S NAME: JP MORGAN BANK DATE ISSUED:07/17/2013
OWNER'S PHONE: 4088876282 PHONE NO:
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALU
License Class_ Lia# g REMOVE(E)8 X 16 SHED IN SIDE YARD(BUILT
WITHOUT
ContractorSA lZkt-3 1?,A401�tlg Kd$iDate . ,'� PERMITS,NOT TO CODE)
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:$1200
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:37535007.00 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 WIT 180 DAYS 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 18 AYS + ALLED 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 .
granting of this permit. Additionally;the applicant understands and will comply Is by: Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
�^ RE-ROOFS:
Signatuw--! ': � Date 3 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
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
a
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION o
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228• FAX(408)777-3333•building(�
cuptktwo cupenino.org \
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS ��_„AAxAFN# C 3 -00
OWNER NAME e Ip. j I)/ PHONE e g ,� �z g EMAIL j2 a
STREET ADDRESS Q '�V�i V,a- ,i, A 60 $ CITY, STATE ZIP C�� v V FAX /J
J rV1 �2ft1J(JW !
CONTACT NAME (�A-S PHONE 6 a
STREET ADDRESS Jif` o R ��I vq- ' I tie
/� CITY,STATE,ZIP W ` & � OD FAX
LLQ(% 1'VVI• rw �u ,
13
OXTNER ❑ OWNER-BUILDER IWOWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPERS ❑ TENANT
CONTRACTORNAME LICENSE NUMBER 4 q LICENSE TYPE 5!:;P BUS.LIC#
S �
COMPANY NAME A-IZA7 1 EMAIL rS d 2 �Z FAX
STREET ADDRESS S (�
Al, // Ate` CITY,STATE,ZIP 5;x— L,�qJ I PHONE oo i `��
ARCHITECT/ENGINEER NAME l/ 7 Y LICENSE NUI,MER ` •^IYBUS.LIC# 'C
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK 040 VA-
6slad
EXISTING USE PROPOSED USE CONSTR TYPE R STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA 1 TOTAL DECK/PORCH AREA I GARAGE AREA: DETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY ❑YES
BEING ADDED? [-]NO ADDITION? []NO
PRE-APPLICATION []YES IF 1'ES,PROVIDE COPY OF IS THE BLDG AN ❑YES TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ _ �„ �
By my signature below,I certify to each of the following: I am the property owner or auth o act on roperty owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of and verify it is urate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to ent e above'-jid_entified property for inspection purposes.
Signature of Applicant/Agent: -'r_ �Q Date: 'T77a
SUPPLEMENTAL INFORMATION REQUIREDPial�crciTYPolnrlyG. LrPti
'„_'�a .--
_New SFD or Multifamily dwellings: Apply for demolition permit for - « - �
11VERHFrCOTJNTER�cBUIIDI2�G�LAI2EVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. u � �
I> I� xPREss a� ME
I AI� vLEw
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 MARD �uBI Ic�tio s � -
,e. ,�s. p�k -•,,.'3:i'.°;� mss ,s z .3�`' .
form if any Hazardous Materials are:being used as part of this project. lvn, V� - .
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. s ITY� �RDisTc `
�"��.`,'-�,�'�i.��'��`.4_«�v rr OnEA'\'IRO�'hIEI�'TIi�HEALTH��_-•.-w.
B1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 18900 NEWSOME AVE DATE: 07/17/2013 REVIEWED BY: MELISSA
APN: 375 35 007 BP#: *VALUATION: 1$1,200
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION
USE: PERMIT TYPE:
WORK REMOVE E 8 X 16 SHED INSIDE YARD BUILT WITHOUT PERMITS NOT TO CODE
SCOPE
s
10111 iiii !
_, � u s s
.kfech. Plan Check Plumb.Plan Check Tlec.Plan Check
bk>clt.Perrnit Fee Plumb.Permit hese: Elec. Permit Fee:
Olhcr.'Meeh.Insp. Other Plumb Insp, Other Elec.Insp, Li
llech. Insp. Fee: Plumb. Insp:Fee: I Fslee.Insp.Fere:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the prelimina information available and are only an estimate. Contact the Dept for addn7 in o.
FEE ITEMS(Fee Resolution 11-053 Eff. 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 Select a Misc Bldg/Structure
Suppl.PC Fee: Q Reg. O OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: Hourly.Only? Oyes O No $0.00
Suppl. Insp.Fee-.0 Reg. O OT 0,0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
Administrative Fee:
Work Without Permit? ® Yes O No $0.00 O
Advanced Planning Fee. $0.00 Select a Non-Residential O
Travel Documentation Fees. Building or Structure O
Strong Motion Fee: 1BSEISMICR $0.50 F-2.0--1 hrs Inspections
Bldg Stds Commission Fee: IBCBSC $1.00 $278.00 ISTINSP Inspection,Hourly
$278.00 $279.50
Revised: 07/01/2013