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12070027
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22214 VIA CAMINO Cl- (:ON"I'RA(:]Oft—DAN CO,NSTRUCI ION PERNII"1'N'O: 12070027 OAA:YER'SNAME:: SOMMI:RS.SCOff 4786 GER I RUDE DIt DATE, ISM ED:07/Eli/2012 OWNER'S PHONE: 9162237273 FRE:\ION"1" CA 94536 PIIOSENU: 41)8-497-x162 ❑ LICENSED CON"I'RACI'OR'S DECLARATION � r r _ _ / sulLDmc PEaasrr euro BLDG ELECT PLUMB License Class5 Lic.d J Z 73 S �(Q r r r / �� 1 MECII RESIDENTIALCONI\IEKCL\I. Contractor DAf ) (A/J C�IZ(Q lbIJ ®Ll3NS=r— I hereby affirm Thal l am licensed under the provisions of Chapter 9 JOB DESCRIPTION: MICE IFN 168 SQI-IAND B:\'flE 33 SOFT'RIFN1ODH (commencing with Section 7000)of Division 3 of the Business&Professions Code and(hal niv license is in full force and effect. hereby affirm under penalty of perjury one of the following lin declarations: I have and will maintain a cenilicate of consent to self-insure for Worker's Compensation,as provided lou by Section 3700 of the Labor Code.for the srtormmnce of the work Ibr which this permit is issued. p Sy.PI Maar Area: v';luation:52511(1(1 I have and(rill maintain Worker's Compensation Insurance,as provided for by Section 3700 ol'the Labor Coda, for the performance of(he work for which this permit is issued APN Number:326160117.00 Occupancy type: APPI.ICANI'(TAITIFICA"ZION I ccrti l'p that I have read Ihis app icaIion.tad state that the above information is correct Imuce toconmply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of Ibis city to enter upon the above memioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnil) and keep harmIcss the Cit) ol'Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECT ION. costs,and expenses which nnay accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by: U:nr. �t Signatu �/ (jc,� l/i �' 1/ Date IIF--ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any cooling material being installed. II'a roof is installed without first obtaining an inspection,I ngrce to remove all 11Cw nl:nariols Or I hereby affirm that I an evemp(from the Contractor's License Law for one of inspection. the following wsu reasons: I,its owner of the property.or any employees with wages as their sole compensation, Signature of Applicant: Dale: will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Prol"essions Code) I.as owner of Elie propcny,ani exclusively contracting with licensed contractors to :%I.I.HOOF COVERINGS"TO ISE:CLASS 'A"Olt RE"1-Ilett construct the project(See 7014.Business&Professions Code). 1 hereby affirm under prnalfy of perjury one of the following three 11:\ZARDOUS%I It I FRI% S DISCLOSURE: declarations: 1 have read the hazardous materials requirements under Chapter 6.95 oI Elie I have and will mainlnin a Certificate 01'Consent ni sell'-insure for Worker's California lle:lth&Safets'Code,Section,25505.25533,and 25534. 1 will maintain Compensation,as provided leer by Section 3700 of the labor Code,for the compliance with(he Cupertino Municipal Code.Chapter 9.12 and the Health& performance of the work tor which this permit is issued. Safety Code,Section 25532(x)should I store or handle hazardous nrneri:l. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 ul the lahor Code,for the performance of(he work for which this contaminants as defined by the Bxy Arca Air Qualitv?lanagenu•nl District I will Permit is issued maintain compliance with the Cupertino Municipal(:ode.Chapter 9.122 and the Health&Safely Code,Sections 25505,25533,and 25534. 1 cenifv that in the pertimnance 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 Owp j�a r d• 1: Conmpensation laws of Califbnmia. If,aller making this certificate of exemption,I hf"✓'�4 Dater (� become subject to the Worker's Compensation provisions of the Labor Code,I muss forthswi Ili comply with such provisions or this permit shall be deemed revoked CONST RUC HON LENDING AGE:NC) I hereby alfinn that there is a construction lending agencv for the perlirtmanec oI work's %PPLIC(N F CERTI FICA ZION for which this permit is issued(Sec 3097,Civ C) I certiR that I have read this application and state that Elie above information is lender's Name correct. I agree to comply with all city and county ordinances and state laws relating to building construction"and hereby authorize representatives of this cit)'to enter Lender's Address upon the above mentioned properly for inspection purposes.(We)agree to save indemnify'and keep harndcss the City of Cupertino against liabilities.judgments, .%RCI 111 J:CTS DECLARA"I ION crisis,and expenses which may accrue against said City in consequence of the graining of this permit Additionally,the applicant understands and will comply I understand nw plans shall he used as public records. With all non-point Source regulations per the Cupertino Municipal Code,Section 9.18. Licensed Professional Signature Dale ( �4' CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 �77�� (408)777-3228 • FAX(408) -3333• building(cDcuoertino.OrG 1Z71G��7 CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TS ❑ REVISION/DEFER-RED 0R:CINAL?&4.'ZT3 PAOlEL7.iDDR3 -�-�� V (A e.AtALOJo , ri �7•�3c"Z& V C-10OwNFR NAlfE �'/J`.J 1 1 �OIM M'�`.� (IE& �2 f G ( E4 1 rxE_TADDRESSJ'. 1 4 CAfVlt 1 a Y. .arot�? Eery i l� d o-A q564 FAX CONTACT NAME ry_ PHONE _ E-MAD. �C'J( t_ e✓Ow(Q'ItECZ /� GZ Z ST.4=ADDREss 4Grnv.sr TE LIP FAX I ti wNER ❑ 0w. -SUtLoaR ❑ Ow AGENT ❑ CONTRAM'OR ❑CONT =R AGENT ❑ .AR=CT ❑E- Gn= ❑ OE plus ❑ t--rA C0NTRAR00.NAME — , ID LICENSENUMBEA I LICENATYPE 9US.fIC9 4 14 tLN COMP.ANl NAME E-MAIL FAX _ STA-.R ADDRE- s CfTYSfAT�ZiP P40NE ARGTDr'C•/ENG EA NAME LICENSE NUMBER BUS.L c 4 8 COMPANY NA.aff E'MAD. FAX STREET ADDRESS CITY,STATE ZIP PHONE F.S RN 01rWOR1C ll�J L 7 ErSS, G USE PROPOSED USE CON5IA TYPE Y STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EMT G YEW'LOOR DEMO TOTAL AREA AREA AREA BATHROOM K.TCHEN OTIIEA RENS �A ' REMODEL REMODEL AAEA PORCH DECO AREA TOTAL DE . OACH AREA GARAGE A0.E< DETACH 1G ATTACH 4 DWELLING UNITS; ISASECONDUNR YES SECOND STORY ❑YES BEING ADD®' []NO ADEMONr - ❑NO PRE-APPLICATION []YES D YES.PROVIDE COPY OF IS Ttnr BLDG AN ❑YES RECEIVED BY: / TOrraa rr VALUATION: PLAN NGAPPL4 ❑NO PLA MG APPROVAL LETTER EcEtLE0A HOME' ❑NO I_ 1 _ 5C " „ By my signors-below,I c-r.:fy m each of the fpllowin I am the property owner or authorized ager[w act an:he prppm-. owner's oehai f. I have read thi`+s U application and the information I have provided is cortehave read the Description of Work and verify it is accura[e. I agree to comply with all applicable local ordinances and state jaws reating m building on t [a e f C 'erdno to mw the above-identi ied papery for inspeeion pu roses. Signature ofApp6emdAgenn / Dare: SUPPLEMENTALINF RMATIONREQUIRED PLANCRECKTYPE ROOM(;SLrP New SFD or Multifamily dwellings: Apply for demolition permit for LTovm-rBziocnnx BLmnwe PLAN REv¢vP existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ Exparm ❑ PIANPaNG PLAN Ra W _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ srmN ARD ❑ MLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ ( ,R� ❑ FM DEPT _Copy of Planning Approval Letter or Meering with Planning prior to ❑ v OR ❑ sA.YTTARY sEWER Dm-,uc-r submittal of Building Permit applicatica. ❑ E.NVDION'Lv.NT.AL U-ALH 31dg 1pp_?011.do rT,ised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION ADDRESSM214via caminoAtZ4, I DATE: 07/05/2012 REVIEWED BY: bobs. APN: I BPk: 'VALUATION: $25,000 °PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD Or Duplex PENTAMATION 1R3SFDREM USE: PERMIT TYPE: WORK sfd kitchen and bath remodel. SCOPE L6•eh. flan Check PhImb. plou CbecA E/1'[. Plan(.7rr(rk .Necb. !'until Fee: Tlrurth_PePmil Fee: /C(nc. A:rrnir Fee: Orhvr,llech. Insp. Odra Plumb Insp. Unc�n•lila. /mp. 07- Imp. /4r: Planrb. hill). Fee: Elco. hop, 1:;.,•. NOTE: This estimate does not includejees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School District,etc). These fees are based on the prefimina information available and are only an estimate Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 E/h 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 168 s.f. Remodel, Kitchen (<=300 sf) Suppl. PC Fee: Q Reg. 0 OT 0.0 1 hrs $0.00 $600.00 IREMRESKIT PME Plan Check: $0.00 F-3-3-1s.f. Remodel, Bath(<=300 sf) Permit Fee: $0.00 $600.00 IREAIRESB.4T r Suppl. Insp. Fee Reg. 00 T Q,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C mstrw rion Kn: Adhniui.wrntive Fec: 0 Work Without Permit? 0 Yes Q No $0.00 Advanced Planning Pce: $0.00 Select a Non-Residential Building or Structure 0 Trolel Dncimicntaliun Fees: Strong Motion Pce: IBSEISMICR $2.50 Select an Administrative Item 131ds;Sids Commission Fee: IBCBSC $1.00 SUBTOTALS: $3.50 $1,200.00 TOTAL FEE:T $1,203.50 Revised: 07/0112012 JUL 0 5 2012 MENT OEP N�ENj 1BY.- OOMM p�®VED usj be kept at the s aAP Pec t\catR n. 1s Mao o o ate anY .-Ns set 01 PA n ,po�StT o'nS Pn Sam he B�\\&n9 DW'p1a\%nj ob 51te dun or - a1 .. . 1 phan9S5 b "rte — w� d sPe' tlpa oS the vw a W ,herehom, an... 1 1SP� 4 Sh\d fo Pe S ott Ly1 °,,�•ar'-o' '..rzbr� ✓ .�-�-e beDov\`•p - - . of anyPLLZA gY 1, DATE % ,_. -.•h - PEPM\T'NO- - rD - •Tr�isy 4 Y 1 2.6 CS C Cr�p�R�r1t� .AO 1 C, CE C ®u11dInG�P CF'c lora Cie 032012 ,111. OMPO ►.uw E REVSEWEDFOR CD1 Rowed 6y' Q �GfIC i l p4I / M o L e�,> LE© L,Fr I �= u� I EN M c W I G,fIG I I ---------- ----------- LEo cl) �LED P I I `, I r, CUPERTINO a_ I " @ulldln® Dapartment i p 1 I 9H7 Fj y71d7 fD 0 I k � .012 L rb' .I_ oIG _r� EVIEWED FOR CODE COMPLIANCE -- :;G —i 'c/l -- 0£ — c —(4 — R�Ki d Bf—_i a M f ( Zr� AL—f-FE ,U/l1l.L L�� 'T-7 -fir, 301 � rc�j �t :v_ __ - _ -• i'• - I t 1 Suilding Department JUL 0 3 1012 - ODE CO ROWSWGd 9y. I MPLIANCE - of 04 ^ F5 GGlf tl:;n� SAttr: is : u3>, _ -*rx _ 15 Lf-: o2 1�N5-op J;;k RGA, ...tA C:.�„.� •v.0 ;F.} Or`. . .,, �; ��� �fli 1 4Lt_ buA l_�'. �.�uawE2� ��t'>=CZ nutty rfz !-I[�27i o3O asu� � _S+1-EvSE�2 ,bu-o'(Z �. '3ll-�a � ��ML�t2 Li Z.!'1-SS• I wsTALL- M,07.6.1 d ULBK tA i #At- l V-SR Y . 3 •aF 4 - -- � . <a4LL ��L`'t l�-'� ~'-• CSotti�� �!aatZ ��I Ar_\`�..__ i 6 CDJ — S4" -1-- - -- CU 9 ERYPIO / ent / DeP� i i '� - -- JUL 0 3 2012 REVIEWED FOR CODE COMPLIANCE A _ LO o CZ Pl P.r.1 Sp�P�I G C•SR�'" j k TTS— 4- - 4LL L VP , ! :P-Y. S, 43 � A UL to� PA Piz a� c� 2�� l-tA�zc�t ao 7. (� _ lN4SAL( Mof.SC t> Io�C1 p,—( PQ-L-LvJA,- ' .