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14080091 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10711 FARALLONE DR CONTRACTOR:MG CONSTRUCTORS& PERMIT NO: 14080091 ENGINEERS INC OWNER'S NAME: HERLIHY MARY ANN M AND JOHN F 15650 VINEYARD BLVD STE A 232 DATE ISSUED:08/13/2014 OWNER'S PHONE: 4082217255 MORGAN HILL,CA 95037 PHONE NO:(408)842-5599 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑ _ INTERIOR FOUNDATION REPAIR AND SUBPUMP License Class A/13 Lic.# &142-0 � Contractor N L�n S`j�h;"�v. r nry;,[apwy � 13 I 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:$12900 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:36935014.00 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 1 OFERMIT 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 1$0 DAYS OM Lij 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 granting of this permit. Additionally,the applicant understands and will comply Issued by: /x Date: v with all non-point 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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 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,Scct19J4 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this _�1311q permit is issued. Owner or authorized agent: Date: 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,l must l 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION 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 PERMHT APPLICAT[ON (1 Z_ 4 ' COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE • CUPER T INO, CA 95014-3255 (408) 777-3228 • FAX(408)777-3333• buildino(c).cuaerJno.oro CLPERTINO ❑NEW CONSTRUCTION ❑ ADDITIONALTERATIONTT/TI u REVISION/DEFERRED ORIGINAL P=R'U-1 f PF or_cr ADDRrsst9,-. 55Fol-,41101VFol-,41101VA3N G �U�711 Fol-,41101V t9,-. _L Jo' '4i" OV✓1iER 1CAME PHON `(0 ) 211-71 �Cry'�+ L �%ffF_ n�f STRE_f�DRESS il �N�� ,t}Gnt �� CA4 (T 4;JkO ATE,ZIP C/A FAX CON7i,CT NA!✓ PHONE �-3 5 �� h 1 jfi�?.t t TD 3 .✓1 C T STRE i ADDRESS ,Ci�tr Y,STA E, Z1P d V-1/ !� �'ht d� F� 6'1✓� C JAI 2� I'tor n Oil( � A `�5"o37 � ) El OA= ❑ OwME -BUILDER ❑ OW!,ER AGENT CON7RACTOR ❑CONTRACTOR AGENT ❑ ARC_=CT ❑ENGIAEER ❑ DF\'ELOPER ❑ TEhA?v f C:0N7TR,A,CTORNAME L Air( LICE NSE1\U, ,_ I LICENSE TYPE SUS. /—t f L711i�ISO.1 S CONiP.ANYN:.-T.f� / s 7- E-]✓�.IL i-.4 ���% �d Js't�llciorj 4 Gh ihee-S i et id rwl•r'c h '�rt�C�''c� - '2t �t ) *Y2_ ,-G s�" STREET ADlDR SS / p CITY,STAT E,ZIP 1 t /� PHO1\= I�V S�! ✓I1tL "77( 91,J :S'�-e A Z3 L �°tC' C/il Pti ft CA 9 SD �7 yap) ARC' cCT.ENGINEER NA' �,4 j L=N1SENL'bSER �y BUS.LIC Il ' 41,Cw H t.•- Y COA4PANY 1.AA4-. ` }� /-n r� E-MAIL L f 'S FAY C,�` l q 2+ _� L� O KG"I7J rrJ G J'�1.'1 T h t_O✓1 S •`'&L C i1 44 ) 3 STREET ADDRESS 61,,/ } /� CITY,STATE,ZIP' HOME V I V / Sac /''_ 3L �b. :�'r1 /7���/ CA qJ V 3 7 I S1 Ul DESCRIPTION OF WORK EX'ISTIN'G USP PROPOSED USE CONSTR.TYPE �,STORIEES USE TYPE OCC. SQ.FT. VALUATION(S) E:XLSTO NEW FLOOR DEMO TOTAL AREA AREA AREA Nt7 AREA BATHROOM KIT c--- REMODEL AREA REMODEL AREA REMODEL AREA PORC-1ARE.A DECK AREA TOTAL DECIJPORCH.AREA GARAGE.AREA: ❑DETACH I ❑ATTACH '---''DWELLINGUNITS: IS.ASECOND UNIT []YES SECONDSTORY ❑YES BEING ADDED? ❑NO ADDITION" ❑NO PFz-APPLICATION–(��-cs—L 1TS,�s OXIDE CDP1'DF _ISLE BLDG A'�j_ j]Sts _ TOTAL VALUATION: PLAATING F3PL m ❑NO PL.4JKNZ1.G APPROVAL LETTER E1 CHLER HO ME^. ❑NO - - R - iiw By my signature below,,I certify to each of the following: I am the property owner or authorized agent to act on the propert,ow,,er's behalf. I hzve read this application and the information I have provided is correct. I have read the Description of Work and verify it is actuate. I agee to comply with all applicable local ordinances and state laws relating t ng construction. l authorize representatives of Cupertino to enter thezbove-id>Jntifieed property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEIvIEN!AL_IFOR�7ATiON REQUIRED t �LA1 CHECKTIPE�` 1. _ ..t. .:R:ROUTZYG�LTP New SFD or l,&hifamily dwellings: Apply for demolition permit for t r xY OVEKTEi1;COUI�TER BUII�LNGPLF � existing,building(s). Demolition permit is required prior to issuance of buildin permit for neve building. © aPxEss P�x*. r.Gptni �T> _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure DSD ' iuBLic�ioRl.s form if any Hazardous Naterials are being,used as part of this project. —Copy of Planning Approval Letter or Meet:na with Plansing prior to R � �0 ��fASOR� '� -s-€0�'->`'R3T}iRI SERERbISTRICT submittal of Building Permit application. $ z Bldagpp_2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION WPERMtT DDRESS: 10711 farallone dr DATE: 08/13/2014 REVIEWED BY: Mendez PN: BP#: 'VALUATION: $12,900 PE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or DuplexT � PENTAMATION 1GENRE; USE: PERMIT TYPE: WORK interior foundation repair and ad um SCOPE Ll —I_ NOTE. This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc.). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn't info, FEE ITEMS (Fee Resolution 11-053 Eff T 113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 # Foundation Repair Suppl, PC Fee: Q Reg. Q OT Fo.0 hrs $0.00 $859.007IFOUNDREPA PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee(D Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? 0 Yes E) No $0.00 E) Advanced Planning, Fee: $0.00 Select a Non-Residential 0 Building or Structure 0 Strom Motion Fee: IBSEISMICR $1.68 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.68 $859.00 TOTAL FEE: $861.68 Revised: 07/1012014 SMOKE / CARBON MONOXIDE ALARMS ': EI OWNER CERTIFICATE OF COMPLIANCE ^ COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333• build ing(ilcupertino.orp hh Q t Permit No. Address S ` 'c3.�C a`�o a r•, #of Alarms Smoke: Carbon Monoxide: F T PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations,or repairs to existing dwelling units exceeds $1000.00,CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the X X bedroom(s) On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units,alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2.An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes.The alarms have been tested and are operational, as of the date signed below. 1 have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agent's)Name: n��� 9_j G_,u HWAri� 1�fi2U Si nature.. . ....(..................................................... . ..............................................Date:/................... Contractor Name: Signature............... ............................ Lic.#.AlQ....../11D.``.QQ.Date: Smoke and CO form.doc revised 03/18/14