12040034 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10746 LA RODA DR CONTRACTOR:ADVANCED HOME PERMIT NO: 12040034
IMPROVEMENT
OWNER'S NA11IF-: FISHER KATHLEEN 879 E HAMILTON AVE DATE ISSUED:04/05/2012
OWNER'S PHONE: 4082529797 CAMPBELL,CA 95008 PHONE NO:14081559-0999
❑ LICENSED CONTRACTOR'S DECLARATION 3 r r r
.LS/� BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class 1 _ I-ic.q
M ECH r RESIDENTIAL r COMMERCIAL r
Contractor &O a Jt
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMODEL KITCHEN,FIXTURES IN ORIGINAL
(commencing with Section 7000)of Division 3 of the Business&Professions LOCATIONS,
Code and that my license is in full force and effect. NEW LIGHTS,NEW GAS LINE,NEW SUBPANEL
1 hereby affirm under penally of perjury one of the following two declarations:
1 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:$30000
permit is issued.
APPLICANT CERTIFICATION APN Number:36934040.00 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 EXPIRES 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 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally.theplu t understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations p the C ertino Municipal Co S ion
Issued b r Date-0
Signature Date
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
1 hereby affirm that 1 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: Dale:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penally of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
Compensation,
and will maintain a Certificate of Consent to sell-insure for Worker's
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(x)should 1 store or handle hazardous material
Additionally,should I use equipment or devices which emit hazardous air
pcmtit is issued. contaminants as defined by the Bay Area Air Quality Management District l will
I certify that in the performance of the work farwhich 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 Ce, ections 25505,25533,and 25534.
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 O r o i agent: Wel
Z
forthwith comply with such provisions or this permit shall be deemed revoked. Dale:
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGF,NCV
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. 1 understand my plans shall be used as public records.
Signature Dale Licensed Professional
CITY OF CUPERTINO
6 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: 'Sub: Blk: Lot:
APN 36934040 . 00
DATE ISSUED. . . . . . . : 04/05/2012
RECEIPT #. . . . . . . . . : BS000016462
REFERENCE ID # . . . : 12040034
SITE ADDRESS 10746 LA RODA DR'
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER FISHER KATHLEEN
ADDRESS 10746 LA RODADR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4444.
RECEIVED FROM . . . . : MITCHELL ALVES
CONTRACTOR SHERYL KANZAKI LIC # 32514
COMPANY ADVANCED HOME IMPROVEMENT
ADDRESS 879 E HAMILTON AVE
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE (408) 559-0999
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL
____ ---------- ----------
------------- ----------
---------- ----------
1BCBSC VALUATION 30, 000 .00 2 . 00 0. 00 2 .00 0 . 00
1BSEISMICR VALUATION 30, 000.00 3 . 00 0 . 00 3 . 00 0 . 00
1EPERMITFE FLAT RATE 1 .00 44 . 00 0.00 44 . 00 0. 00
1ERT<200 UNITS 1.00 44 .00 0 . 00 44 .00 0 . 00
1PPERMITFE FLAT RATE 1.00 44 . 00 0 .00 44 . 00 0 . 00
1REMRESKIT SQ FEET 1 .00 588-.00 0 . 00 588 .00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 725 . 00 0. 00 725 ..00 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 725. 00 VISA
---------------
TOTAL RECEIPT 725.00
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 10746 La Rode Dr. DATE: 04/05/2012 TREVIEWED BY: jsg
APN: BP#: 'VALUATION: 1$30,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Remodel, Kitchen (300 s.f. max)
PRIMARY Residential PENTAMATION 1R3SFDREM
USE: PERMIT TYPE:
WORK Remodel kitchen fixtures in original locations new lights, new gas line new subpanel.
SCOPE —
FEE IDS�� " FLRs AREA
iREMRESKIT 192
r
.Wec/r. 17on C'hack Plumb. Ploa Cheek \\ lilee. Pion Check
,ll,•dr. Permit Fee: Plumh. Pcrmil r I lilec. Permit 1
Odw, Mv,h. Imp. Ocher Plumb Insp. Ocher Elec. hrsp. I�i
,P/ceh. Imp. 14rc: Plush, bray. Fere' \\ Ele.c. lnsp.Fee.
NOTE: This estimate does not includejees due to other Departments(ie.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are:based on the prefinddna information available ank are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fec Resolution /1-053 E0: 7111//1 FEE QTY/FE MISC ITEMS
Plan Check Fee:
.Sup/)/. PC Fern
PlumbJrh(ech.!li ler.
Permit Fee: $588.00
.Suppl. lusp Fee.
Pl rem b.1i1'Iec:h./EI eC.
I'lumh./d4eclr-/Elec Permit Fee:
Consiruc'tion Tor:
.I rlmiuisti cuive Fee:
Work Without Permit? O Yes 0 No $0.00
.I rhrnu ed Plarming Fees: -
Travel l)ncummttruinn Fees: �
Stron , Motion Fee: IBSEISMICR $3.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $2.00
SUBTOTALS: $593.00 $0.00 TOTAL FEE: 1 $593.00
' Revised: 1/19/2012
l
RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number:
Name of owner.
Project address. I07�/CD L/1 040504 ue� �c 2rL%7No
Contact person. /Gly! ( S Phone. 76 -5-5-9 9 .� 9
Fax.
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces inside the gar N APR o 5 2012
Is privacy protection planting required for the project?—
Build it Green Total Points LL
On what floor(s) is work being done? / /S7 / /y
Brief ascription of wor . K t[�C fig/ ��/?G;d /9917//1
/. 02 'b'?$ •�
y "TT ..J /-
Code editions: 2010 CBCN)2010 CFC 4DN)2010 CMC �N)
2010 CPC SN)2040NEC *-N)
California Gree&�NA ,% FWs9T
BUILDING DIVISION-CUPERTINO -
APPROVED
Effective 1/01/11
This set of plans and specifications MUST be kept at the
job site during construction. It is unlawful to make any
changes or alterations on same,or to deviate
therefrom,without approval from the Building Official. m
The stamping of this plan and specifications SHALL NOT �r nasim
be held to permit or to be an approval of the violation U "
of any�ity�Ordinance or State Law.
of any proiv5io�ns �}
BY
DATE
PERMIT NO.
Plan Review Process Work Book Page-8- Revised 12/21/10
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All dimensions Size designations 7/1 'ZQ'� This is an original design and must Designed: 1/17/2012
given are subject to verification on 2 n 20tOGIES[�P not be released or copied unless Printed:4/3/2012
job site and adjustment to fit job TICapplicable fee has been paid orjob
conditions. order placed.
�� fisher 2 All(no dims) Drawing q: 1 No Scale.
tj v
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE CUPERTINO,CA 95014-3255
(408)777-3228- FAX(408)777-3333- buildine(rlcuoertino ora
CUPERTINO
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ -REVISION/DEF= ORlrrNAL PERMIT p
PROJECT D AFN• !�
i V
OWNER NAAIB PHONE T- it) Ly IVA oonui,-
Asa B-MAR
STREET ADDRESS A /U� CRY' v .��NL FAX
CONTACr NAME PHONE E-MAIL
STREET ADDRESS CRT.SPATE,LIP FAX
❑owNER ❑ OwNER-EmmER ❑ OWNER AGENT COWMAcmit 13coNiRACTORAGEz4T ❑ Aacarx cr ❑ENGrNEER ❑ DEVELOPER ❑24ANr
CON I A RNAME EL BUS.LLC R
v a �
COMPANY E-MAIL FAX
- «-v mT ATELEP .e/ 554 a 9 9 9
ARCEiTTECTIENGEYEERNAME LICENSE NUMBER HUS.IICR_
COMPANY NAME E-MAIL FAX
STR=ADDRESS Q1T.STATE:MP PHONE
DFS, WOEtE .
L Q
EXATBIG USE PROPOSED USE CONS ILTYP6 I #3TORXS
USE TYPE OCG SOFT. VALUATION(5)
=0 NEW FL OOR � DEND TOTAL
AREA AREA AREA NET AREA
BATHROOM K1rcxO1 OTHER
REMODELAREA REMODELAREA /O� REMODEL AREA
PORCKAREA I DECXAREA TSRALDECTOPORCHAREA I GARAGEAREA ADETACH
A TACH
I DWELLJNG UNrM H A SECOND EMT YESSECOND STORY YES
= 1 BEING ADDED? ONO ADD[rr0.. ❑NO
PREY-APPLICATION DYES LF=PROVmECOFYOF ISTERBIDGAN ❑YES RECEIVED BY: TOTAL VALUATION:
PLANNING ADPL a. DNO PLANNING APPROVAL LETTER ffirOr[maOMat []M `.
B7 my sigoan=below,I certify to each of the foBowmg: I am the property owner or amhorized aeent m as on rhe I; Wertyowneei behalf'l have read this
application and the�o�on I have provided is correcL I the Description of Work and verify it u acL,sam. rag=to comply with all applicable local
ordinances aad state Ia Wa n1sang[o buil rize represe amvei of Cupertino to eater the
above-V property for inspection pnrpases.
Siga-tamofApplieedAgew: rt_ Dam: �012 —
SUPPLEMENTAL INFORMATION REQLTIRED FLAN CBXCKTYPE ROUMG SLIP
New SM or Multifaa my dwellings: Apply far demolition permit far ❑ ova-TTM.Comrra ❑ BUILDING PLAN REVIEW
eAsting building(s). Demolition permit is required prior to issuance of building
permit far new building. ❑ »ss ❑ PLAN7WGPLAN RRVI
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ SUMARD ❑ FTr C WOBTs
form if any Runrdoas Materials are being used as part of this project ❑ LARGE ❑ PmR bur
Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SA,ttrear SXWER DaMCr
submittal ofBuilding Permit application.
❑ ENVMONMRNfAL RR.ALTH.
Bld&4pj(ll L dec revised 06/2I/11