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12050035CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10183 DENISON AVE CONTRACTOR:-TW)--TfY1!r�— PERMIT NO: 12050035 . DLJLRA4NED OWNER'S NAIVE: WILSER WALTER T AND CAROL L TRUSTEE DATE ISSUED: 05/03/2012 OWNER'S PHONE: 4089961450 PHONE NO: ® LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDF.NTIALU COMMF,RCIAI. License Class Lic, # 6 EI ( ADD 2 OUTLETS, EXTEND GAS LINE FROM AREA OF Contractor G. ��4mV • Date 5 �3 2G'�L WATER HEATER TO STOVE LOCATION, SCAN LIGHTS, CHANGE I herebyaDirm that l am licenscaunderthe provisionsof Chame9 WINDOW IN KITCHEN, 2 OUTLETS (commencing with Section 7000) of Division 3 of the Business & P ofessions Code and that my license is in full force and effect. 1 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 whichthis permit is issued. Sq. Ft Floor Area: Valuation: $4000 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for die performance of the work for which this APN Number: 31628023.00 Occupancv 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 agrce to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to buildionstruction, and hereby authorize representatives of this city to enter ng c upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS OM RLAST CALLED INSPE I N. indemnify and keep harmless the City of Cupertino against Iiabilitics,judgmems, costs, and expenses which pray accrue against said City in consequence of the �, Date: r granting of this permit. Additionally, the applicant understands and will comply Issued by: with all pat<oint source regulations per the Cupertino Municipal Code, Section 9.18. (\ ,. ^ r_ )z RE-ROOFS:Signalure CEJ Date All roofs shall he inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agrce to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applieme Dale 1 hereby affirm that I em exempt from the Contractor's License Lew 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 (Sec7044, Business & Professions Calc) 1, as owner of the property, am exclusvcly contracting with licensed contractors to I IA'/.ARDOI IS 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. 1 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: Ileallh & Safely Cade. Section 25532(a) should 1 store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Workers material. Additionally, should 1 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 Ouality Management District 1 performance of the work for whichthis permit is issued. will maintain compliance with the Cupertino Municipal Cade. Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code. SSrtions 15505.25533. and 25534. Section 3700 of the Labor Code, for theerformance of the work for which this p c rrS Owner or authorize) agent: ( Date:k3 G� ?G t permit is issued I certify that in the performance of the work for which this permit is issued. I shall not employ any person many manner so as to become subject to the Worker's Compensation Imes of California. If, alter making this certificate of exemption, I CONSTRUCTION LENDING AGF.NC\' become subject to die 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 CJ Lender's Name APPLICANT CERTIFICATION 1-ender's Address I cerif}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 budding construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCIIITECT'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 Dale 4 ITEMS OF 4 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31628023.00 DATE ISSUED.......: 05/03/2012 RECEIPT #.........: BS000016694 REFERENCE ID # ...: 12050035 SITE ADDRESS .....: 10183 DENISON AVE SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: SylviaM COPY # : 1 METHOD OF PAYMENT ---------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 708.50 --------------- 708.50 REFERENCE NUMBER -------------------- CHK OWNER ............: WILSER WALTER T AND CAROL L TR ADDRESS ..........: 10183 DENISON AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: WALTER W. CONTRACTOR .......: TBD - TO BE DETERMINED LIC # 00096 COMPANY ..........: TBD - TO BE DETERMINED ADDRESS ..........: CITY/STATE/ZIP .... , TELEPHONE ........: FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- 1BCBSC ---------------- VALUATION 4,000.00 ------------------- 1.00 0.00 ---- 1.00 ---------- 0.00 1BSEISMICR VALUATION 4,000.00 0.50 0.00 0.50 0.00 1BUSLIC FLAT RATE 1.00 119.00 0.00 119.00 0.00 1REMRESKIT SQ FEET 1.00 588..00 ---------- ------- 0.00 588.00 ---- --------- 0.00 TOTAL PERMIT 708.50 0.00 708.50 0.00 METHOD OF PAYMENT ---------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 708.50 --------------- 708.50 REFERENCE NUMBER -------------------- CHK stn `cvw Imo J vv , (`8aN32� W1 839L W3039- teP/Q�e��,�tl ... 'role f /1e 24.DISHW B24. WALT WILSER /-KITCHEN / 408-504-0071 SB36 THOMASVILLE VALUE CABINETS 97'-. 21 "- -, W1839R 3DB 21 40 - Py DOOR STYLE: CROFTON /<i ill eZ-eq / FINISH: CAMEL L' PF,(CF,1VE1 CONSTRUCTION: ALL PLYWOOD ' �j TEP2493F1.�PDO 2 ZUti32493F1.5 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION - CUPERTINO , f /13 w O e K) APPROVED y job site and adjustment to fit job condiGcxu.-38 as„-- --; -- ---36” This set of mcfepecifications MUST be kept at the applicable has been paid orjo --- -- -- plans Job site dude construction. It is unlawful to make any 636 (3oAN.�_.., s.Y- B36SS change or alterations on same, or to deviate 32409cG9 _-_ _- -_ -_- AII__-_.-_-`-_ Drawing: I -__I Scale _ 0 1/2" = 1'� terefrom, Ithout approval from the Building Ofiiclal. PP 9 - Th) stampI40 Ian and'speclflcations SHALL NOT W3639 W3018 W3639 It P held to R e an approval of the violation ------ - Of any provi y City Ordinance or State Law. _ ,V ,��•� - 5 cyF1— f:Fell -40 36REF, 2D W362124 All d rr�ensionszkkiee desi tali ns ___ give re subjecito veri teati n on q __ This is a_ i gimal design and mini not be rele sed or copied unless sect Designed: 4/19/.012 Printed: 4/19J20' 2 job site and adjustment to fit job condiGcxu.-38 as„-- --; -- ---36” applicable has been paid orjo --- -- -- 32409cG9 _-_ _- -_ -_- AII__-_.-_-`-_ Drawing: I -__I Scale _ 0 1/2" = 1'� ��/� CITY OF CUPERTINO Imo' FEE ESTIMATOR -BUILDING DIVISION &a. ADDRESS: 10183 denison ave DATE: 05/02/2012 REVIEWED BY: larry s .11.01 ]"'.nail Pre: APN: BP#: -VALUATION: $4;000 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex lila. Insp. K a: PENTAMATION PERMIT TYPE: 1GENRE WORK add 2 outlets extend gas line from area of water heater to stove location 8 can lights kitchen change SCOPE one window in kitchen, 2 outlets NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the Preliminary information available and are only an estimate. Contact lite Dept for addn7 info. FEE ITEMS (Fee Resohoion I1-053 Efl 711/11) .1 h,: h, Nun Check Phunh. Plew C'herF- h. 'lvu. Phin Chs:k .11.01 ]"'.nail Pre: Plumb. Permit F, 0: .h.e. I'annia h'.•, Orlua' ,l/nrh. ln,yp. Ocher Ph...vh /asp. Ocher /filar. /n,vl �. .1l,:ch, hryi. Pia:: Pluurb. hr•p. Fee: lila. Insp. K a: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the Preliminary information available and are only an estimate. Contact lite Dept for addn7 info. FEE ITEMS (Fee Resohoion I1-053 Efl 711/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. 0 OT FO.OThrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -.0 Reg. 0 OT 1 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 s.f. $588,00 Remodel, Kitchen (<=300 sf) IREMRESKIT Conslrruvion Ko: A,/miuisnrnive Fec. 0 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fce: $0.00 Select a Non -Residential Building or Structure 0 0 A Trra ul Norruncnlnlinn Fees: Strong Motion I cc: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $588.00 TOTAL FEET' $589.50 Revised: 04/01/2012