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09030083BUILDING DIVISION PERMIT BUILDING ADDRESS: 10181 H : ARCHnECrfENGINEER: aixz O 00 LICENSED CONTRACTORS DECLARATION U I hereby of lml that I am licensed under provisions of Chapter 9 (commencing - Z with Sidon 7000) of Division 3 of tM Business and Pmfcssiom Code. and my license is <� y le te full forand effect. t z Lieemc Class Lie. i Date Contractor ARCHITECT'S DECLARATION I understand my plans shall be used as public records 5 e.o Licensed Professional y OWNER -BUILDER DECLARATION t I hereby affirm that 1 am exempt from the Contractors License Law for the 00 following reason. (Section 7031.5. Buatness and Profissiom Code: Any city or County $ which requires a permit to censuvcL alter. Improve, demolish, or repair any structure z prior to its issuance• also requires the applicant for such permitto file a signed statement _ data he is licensed pursuant to the provisions of the Contractors License Taw (Chapter 9 F• (commencing with Section 7000) of Division 3 of the Business and Professions Code) or y .. that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a purnit subjects the applicant to a civil penalty of not more than five hundred doll= (Si500). ❑ L as owner of the property, or my employees with wages as tireb sole compensation, will der the work and the structure is not intended or offered for sale (Sec.7044. Busircsa and Professions Cads The Contractors License Law does not apply to an owner of property who builds or improves thcr=, and who does such wort himself or through his ewe employees, provided that such improvements are not intended or offered for sale. If. however, the building or improvement is sold within one year of completion. the owner - builder will have the Dadra of proving that he did not build or Improve for purpose of sale.). L as caner of the property, am exclusively contracting with licensed contractors to the pmjea (Sec. 7044. Business and Professions Code:) The Coatrarmrs Li. tense Law don not apply to an owner of property who builds or improves thimmon, and who contracts for such projects with a contractor(s) licensed pmauant to the Contractors License Law. ❑ lam pr hereby .faro under penalty of perjury one of the following declarations ❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, ror die performance of the wort for which this permit Is issued ❑ I have and will maintain Workers Compensation Insurance, as requlmil by Section 3700 of the Labor Code, for the performance of the wort for which this permit is Issued. My Workers Compensation Insurance carrier and Policy number are: Carrier. Policy Ne.: CERTIFICATE OF -EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (S 100) or IML) I certify that In the performance of thew rk for which this. permit is issued. I shall not employ any person in any mesa r u become sub yect}6 tJQ corked Comoensatlon Laws of Caliromia. Date - - - - � �✓ v -�] Applicant NOTICE TT3 APPLICANT: If, after melding this Certificate of Exemption, you should become subject to the Workers Compensation previsions of the Labor Code. you must Z forthwith comply with such provisions or this permit shall be deemed revoked. O CONSTRUCTION LENDING AGENCY CA E-c ►-c I hereby affirm that therm is a construction lending agency for the performance of �.c > the work for which this permit is issued (See. 3097. Civ. C.) OWc Q Lenders Name Lenders Address U0 1 certify that I have rod this application and state that the above Inrormadon is COnecL 1 agree to comply with all city and county ordinances and state laws relating to Vbuilding crosuuedon, and hereby authorize representatives of this city to enter upon the above -mentioned popcny for Inspection purposes. (We.) ago to saw, indemnify and kcap harmless the City of Cupertino against CA 1labilities, jodtmens, costs and expenses which may in any way &cave against said City V in consequence of the granting of this permit. APPLICANT UNDER of Applicant/Conaactor ' ' Due HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future bulldog occupant atom or handle haudow material as dented by the Cupertino Municipal Code, Chapter 9.12. and the Health and Safety Code, Section 25532(a)7 ❑ Yes KN. Will the applicant or future building occupant use equipment or dcrlces which emh hriardous air contaminants is defined by the Bay Area Air Quality Mansgernent DLstrictT ❑ Yeslo I have mad the hazardous materials requirements under Chapter 6.95 of tie Caliror- nia Health & Safety Code, Sections 25505, 25533 and 25534.1 understand thct if the building does not cmKzedazcnpt� at Catiliuxm of Occupancy. Owner or fate TBD - PERMrr NO. PERMIT ISSUE DATE CONTROL NO. BURDINO PERMIT INFO BLDO ELECT PLUMB Job Description REMODEL 1900'-DOUBLE GLAZED WINDOWS TO.REPLACE EXISTING -NEW BEAM & FOOTING. KITCHEN (180') BATH (165') & OTHER (1,555). Sq. Ft. Floor Area Valuation APN Number I Occupancy Type 32616050.00 Required Inspections Issued by: Re -roofs Type of Roof Date '�Ki zj 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. Signature of Applicant Date All roof coverings to be Class'n' or better CITY OF CUPEKrINO CITY OF CUPERTINO ADDITION/REMODEL FEE SCHEDULE APN # ` + - O � Date: '3- -0 -6 Building Address: to (e>l4� (Wet- . br`7t1, Yyko) clo- �s�l Mailing Address (if different from building address): Owner's Name: 11�d S Tr FA k/IC H ,46 Phone # : qo - 2-1 6 9 9 , I Z HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA Contractor, )M1',`6/ �% �o% a��� Phone #(4`, g) 3q 3 �lJ Fax # Contractor License #: Cupertino Busine s License #: Contact: Ma(/ i16�0 /�a�-� ' f+ Phone #:( Rio S) 3q0�+, �7 a ,`'L//� Fax #: Building Permit Info: 9 V_ao Bldg. P� Elect. 0— Plumb. Eir Mech. ❑ Hillside ❑ Job Description: Addition -What its being added?(Be Specific): at re- What being remodeled not including addition)? 1 Remodel Includes Re -Roof: Yes ❑ No ❑ If yes list number of squares Remodel Includes Structural: Yes TS No ❑ Do you have the pre -application planning approval? Yes ❑ No ❑ If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen &6;h QF Bath__ Other Type of Construction (Usage Class): Occupancy Type: - 3 I -A, I -B II/III/V-A ❑ II/III B, IV -HT, V-B Valuatio / ig o O O r 00 `' Please check this box if the project is a second -story addition ❑ Project Size: Express ❑ Standard ❑ Large ❑ Major ❑ Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, Green Building Points Achieved include in plan set & the sheet index. ***For Office Use Only*** Over -the -Counter ❑ Revised 02/05/09 CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type ADDITIONS 1R3SFDADD PLLONGRNGR Long Range Planning/Residential PL 1 R31NSP Dwellings Inspections B 1R3PLNCK Dwellings plan check B 1R3REPINSP Dwellings Repeat Inspection B 1R3REPPLNC Dwellings Repeat Plan Check B 1R3HINSP Dwellings Hillside inspection B 1 R3HPLNCK Dwellings Hillside plan check B 1 R3HREINSP Dwellings Hillside Repeat Inspection B 1 R3HREPLNC Dwellings Hillside Repeat Plan Check B 1 R3ALTINSP Dwellings Alternate Materials Inspection B 1R3ALTPLNC Dwellings Alternate Materials Plan Check B 1PCESS Cesspool P 1 PPRSEWG Ea. Private Sewage Disposal System P 1PRSEWER Sewers P 1 BPSPRINK Lawn S rinklerBackflow P 1BPWSVCS Main Water Service P 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICRE SeismicResidential B 1REROOFRES Residential Re -roof Each 100 SF B CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Sq Ft Group DECKS 1R3SFDADD OR 1R3SFDREM 1 DECKWOOD Deck (Wood) -Each B (Each) 1 DECKRAIL Deck Railing -Each B (Each) GARAGES 1R3SFDADD OR DETACHED 1R3SFDREM 1 GARDTW<=1 K Wood Frame up to B 1,000 SF (each) 1 GARDTM<=1 K Masonry up to 1,000 SF B (each) BCONSTAXR Construction Tax Res (new detached garage) PATIO'S OPEN 1R3SFDADD OR 1R3SFDREM 1 PATIOWOOD Wood Frame up to 300 B SF 1PATIOMETAL Metal Frame up to 300 B SF 1 PATIOOTHER Other Frame up to 300 B SF PATIO'S CLOSED 1R3SFDADD OR & SUN ROOMS 1R3SFDREM 1 PATIOENCLW Enclosed Wood up to B 300 SF 1 PATIOENCLM Enclosed Metal up to B 300 SF 1 PATIOENCLO Other Enclosed Patio up B to 300 SF 1 COVPORCH Porch Covered -Each B (Each) REMODELS 1R3SFDREM - �+ /O 1 REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan d 300 SF check 1REMRESBAT Bath Remodel up to 300 B GG SF 1 REMREOTH Other Remodel up to 300 B SF CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type 1 REMRES2 Remodel Residential Greater than 1000 sq ft B 1REMRES3 Remodel Residential Greater than 2500 sq ft. B 1REROOFRES Residential Re -roof Each 100 SF B REMODEL PLNCK 1 STPLNCK (1-3 for remodel) Standard Plan Check B NOT FOR OVER THE COUNTERMAN CKS. WINDOW/SLIDING 1R3SFDREM GLASS DOOR 1 WINREP Replacement windows (ea 8 windows) B 1 WINNEWNSTR New Window (non- structural) B 1 WINMEWSTR New Window (Structural Shear Wall/Masonry) B 1 WINBAYSTR Bay Window (Structural) B SKYLIGHTS 1R3SFDREM 1 SKYL<10 SF Skylight less than 10 sf B 1 SKYL>10SF Skylight greater than 10 sf or structural B 1STAIRS Stairs -first flight/ea addt'l B r 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M 1 PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E /72F-< Z no Doorzs��C)V- CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type 1 MECPLNCK Stand Alone Mechanical Pln Ck (hourly M 1 PLMPLNCK Stand Alone Plumbing Pln Ck (hourly) P 1 BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES ` 1 BSEISMICRE Seismic Residential B / 1 TRAVDOC Travel & Documentation B 1 BUSLIC Business License B