11090115 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19999 STEVENS CREEK BLVD CONTRACTOR:DRAEGER PERMIT NO: 11090115
CONSTRUCTION INC
OWNER'S NAME: TRAVIGNE VILLLAS HOA 605 COMMERCIAL ST DATE ISSUED:04/18/2012
OWNER'S PHONE: 4085405055 SAN JOSE,CA 95112 PHONE NO:(408)536-0420
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ' ELECT PLUMB '
License Class Lic.#
Contractorr
r72 �/�ate
/ — `S1_�z MECH ' RESIDENTIAL ' COMMERCIAL
�Yv�/,
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:MULTI-FAMILY REPAIR&REPLACE 5 ACCESS STAIRS,
(commencing with Section 7000)of Division 3 of the Business&Professions PODIUM DECK CONCRETE COATING AT 2ND&3RD FLOOR,
Code and that my license is in full force and effect. REPLACE CONCRETE WALK WAY AT ALL COMMON AREA
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.
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 Sq.Ft Floor Area: Valuation:$500000
permit is issued.
APPLICANT CERTIFICATION APN Number:31648999.00 Occupancy Type:
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 PERMIT EXIIIES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 1 i' AYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS ,6M LAST CALLED INSPECTION.
9.18.
Sin Date Issued by: —A i '--`Date:
na
❑ OWNER-BIVDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(See.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I 1
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner nth gent:
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
///L
APPLICANT CERTIFICATION ONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19999 STEVENS CREEK BLVD CONTRACTOR:', C.6-4rf-eW91S6 PERMIT NO:11090115
OWNER'S NAME: TRAVIGNE VILLLAS HOA DATE ISSUED:04/18/2012
OWNER'S PHONE: 4085405055 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL❑
License Class Lic.# ? MULTI-FAMILY REPAIR&REPLACE 5 ACCESS STAIRS,
6a P° PODIUM DECK CONCRETE COATING AT 2ND&3RD
Contractor �/t°1 1 �� Date g?7 FLOOR
I hereby affirm that I am licensed under the provisions of Chapter 9 REPLACE CONCRETE WALK WAY AT ALL COMMON
(commencing with Section 7000)of Division 3 of the Business&Professions AREA
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:$500000
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:31648999.00 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 F LED 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 I
granting of this permit. Additionally,the applicant understands and will comply Iss V.
Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Si afore ' r Date
gin All roofs shall be inspected prior to any roofing material being installed.If a roof is
i° 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.Y 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 2553'4.
Section 3700 of the Labor Code,for the performance of the work for which this 3'
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. It 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 hammless.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
CITY OF CUPERTINO
7171�
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 19999 stvns crk blvd DATE: 09/1912011 REVIEWED BY: bobs.
AN: La -1 q BP#: 'VALUATION: 1$500,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair
PRIMARY Multi-Family Dwelling Buildina is PENTAMATION 1 GENRES
USE: >3 Stories Q Yes Q No PERMIT TYPE:
WORK �multkfamily're air and re lace 5 access stairs odium deck concrete coatin at 2nd and 3rd floorSCOPE pace concrete walk way at all common area.
E3
NOTE.This estimate does not include fees due to other Depts(L a Public Works,Sanitary Sewer District,School District,etc.).
Thesefees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'1 info,
FEE ITEMS (Fee Resolution 11-053 E(f. ?%L71) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? Q Yes 0 No $0.00 ® hours Plan Check,Hourly
Suppl.PC Fee: 0 Reg. C) OT0.0 hrs $0.00 $520.00 ISTPLNCK
PME Plan Check: $0.00 # Stairs
Permit Fee: Hourly Only? Q Yes G No $0.00 $1,111.00 ]STAIRS (Specify#of Flights of Stairs)
Suppl.Insp.Fee-0 Reg. 0 OT0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
0
Work Without Permit? O Yes G No $0.00
Advanced Planning Fee: $0.00 ® hours Inspections
_ 0
r f+` $520.00 ISTINSP Inspection,Hourly
i
Strong Motion Fee: IBSEISMICR $50.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $20.00
SUBTOTALS: $70.00 $2,151.00 TOTAL FEE: 1 $2,221.00
Revised: 09/02/2011