14020091 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19914 PORTAL PLZ CONTRACTOR=TRn-TO RF. PERMIT NO: 14020091
D
OWNER'S NAME: FRIEDMAN JOSEF AND RACHEL VAq CO
DATE ISSUED:02/13/2014
OWNER'S PHONE: 4085405429 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
REMOVE AND REPLACE DRYROT ON TRELLIS
License Class (�(—4 C ! Lic.#
/ /
Contractor 1 t 1 L� /� Date /
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:$2000
and d will maintain Worker's Compensation Insurance,as provided for by
tion 3700 of the Labor Code,for the performance of the work for which this APN Number:36945021 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 VD 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 180DAYS FRAST 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 ,R-/!� /
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-poi source regulations per the Cupertino Municipal Code,Section
9 18.
RE-ROOFS:
Signature Date 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
1,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,See ti 5505,Z 33,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Date:
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
CONSTRUCTION PERMIT APPLICATION l
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPEC<t`I INd (408)777-3228•FAX(408)777-3333•building
acupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS / P/^_ APN# q
xqaV7
OWNER NAME U'1 6Se C�/moi, y� avri(��(J g-�`S( q E-MAIL
STREET ADDRESS v ` y CITY, STATE,ZIP FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS i/ Ly OC I oje CITY,STATE,ZIP C �+U/ FAX
❑OWNER ❑ OWNER-BUILDER . 13OWNER AGENT ❑ CONTRACTOR 11 CONTRACTOR AGENT ❑ ARCHITECT 1:1ENGINEER ElDEVELOPER ❑ TE
NANT
CO OR NAME s, ah LICENSE NUMBER v'��JC� LICENSE TYP BUS.LIC#
COMPANY NAME E-MAIL �! ` FAX
t
STREET ADDRE CITY,S ATE,ZIP PHO
� &-aC G6 ` g ' �-$�f 66,6
ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAH. FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK . !'./a� �n.p p _ f /`n � .l/V-
QA
EXISTING USE PROPOSED USE CONSTR.TYPE 1 #STORIES
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
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 UNrr ❑YES SECOND STORY ❑YES
BEING ADDED? ❑NO ADDITION? []NO
PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES D. TOT V UATION:
PLANNING APPL# [:]NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO
By my signature below,I certify to each of the following: I am the property owner or authorized age to act on owner's behal. I have read this
application and the information I have rovided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating ilding c ctlon. Drize representatives of Cupertino.to.enter the above-id tified pr perry for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of buildin R% o. R tJING->nwxE
permit for new building.
Commercial Bldgs:Provide a completed Hazardous Materials Disclosure o
form if any Hazardous Materials are being used as part of this project.
_Copy of Planning Approval Letter or.Meeting withPlanning prior to I I ti n
submittal of Building Permit application.
- IN
a
BldgApp_2011.doe revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 19914 PORTAL PL DATE: 02/13/2014 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$2,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION 1GENRES
USE: p PERMIT TYPE:
WORK remove and replace drot on trellis
SCOPE
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Lf scar PionC.Itzr,Y Pfrrn;t>. Ptcrr C'hect 0("c.Mon Chaclt
' �o. ! F'?w Plum/". Permit
3rhr .t}tck. iro n. Other Pluynb 3rssp. Li 07;wi.O iec.lnvi '
rZ x t; tr;ti r.l.y`-: Tr'vruh. Ir sp. Fee:
: 1 iec.Insp. V'v:
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These _f
-fees are based on the relimina information available and are onlyan estimate. Contact the Detor addn'l info.
FEE ITEMS (Fee Resolution M-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? ®Yes Q No $0.00I 1 hours Plan Check,Hourly
Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 $139.00 1STPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? ®Yes E)No $0.00
Suppl. Insp. Feer Reg. ® OT 0,0_I hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
_vt)J'.,17t'ftf`L7Cin /rt.3:
Work Without Permit? ® Yes (F) No $0.00 G)
Advanced PlanninZ Fee: $0.00 Select a Non-Residential 0
Building or Structure 0
Strong Motion Fee: IBSEISMICR $0.50 1.0 hrs Inspections
Bldg Stds Commission.Fee: IBCBSC $1.00 $139.00 ISTINSP Inspection,Hourly
aflo 'e
$1.50 $278.00 TOTAL FEE: $279.50
Revised: 01/15/2014
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Ppl ¢ F- 2014
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Mike Bloeman <mike@raycomail.com> Reviewed By. )U A, ,12, 2014 at 9:03 AM
To: "miketb022@gmail.com" <miketb022@gmail.com>
RT"4ENT
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to im-ake any
PLOT PLASS Or
CHECKED ,By Line Building Official.
DATE
SHALL NOT
or the v,ciation
`t I.ANNII�1 �EPT. IN�.,
a:ice or State Law.
IIAT 1�3 �
M CUPERTINO
—Jiding Department
Ft- 2014
i'
REVIEWED FOR CODE COMPLIANCE
Reviewed By: �f
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CUPERTINO
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Partrnent
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Mike Bloemen
Project Manager
M: (925) 330-4321
E: mike@raycomail.com
www.raycopainting.com
In an effort to service our clients in the fastest manner possible, this message was sent from my mobile phone.
Please excuse typing errors and brevity.
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