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12080014 CITY OF CUPERTINO BUILDING PERMIT RI111AINGADDRESS: 11702WESTSHORECf CONTRACI'0R-TBV-R0 BE PF,RMITNO: 12080014 BC�f:RtbBNLD OWNI;R'S NAME: PARAIINDER KAHLON K -� PI Ll-5 DATE ISSUED:.08/032012 OWNlitt'S I'DON'E: 4083784921 Pl IONE NO: ❑ LICENSED CON1'IL\CI'OR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL LJ COMMERCIALE] License Class__ Lie.4 7 37 3 j KITCHEN REMODEL, REMOVE AND REPLACE k" n CABINETS, Contractor �C�ttt/IJl-I�s Date FS-�'Z �•Z COUNTERTOPS,APPLICANCES, FLOORING AND herebyaffnrm that l ant licensed under the provisions of Chapter9 LIGHTING 15b S-- � (commencing with Section 7000)of Division 3 of the Business S Professions Code and that role license is in full force and effect. I hereby affinu under penalty of perjuryone 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. Sq.Ft Flour Area: Valuation:$13250 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of die work for which this APP'Number.36653019.00 Occupancy Type: permit is issued. .\I'1'IJC,\N'1'Clilt'I'I FIGVI'ION 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 mid stale Imes 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 FROM LAST CALLED INSPECTION. indemnity and keep harmless the City ol'Cuperfino against liabilities,judgnments, i costs,and expenses which may accrue against said City in consequence of the r�ERN ��Gy Date: (/ granting of this permit. Additionally,rhe applican underst•mds and will comply Issued b)•: with all non-point source regulmim per the Cupertino Municipal Code,Section 9.18. 2 RE-ROOFS: Signature Date � 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. - ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: hrreby affirm that I am exempt from the Contractor's License Law fur one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR RE ITER 1,as owner of the property,or my employees with wages a their sole compensation, will do the work,and the structure is not intended or offered for sale(Sce.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to IL\-/.ARDOUS MATERIAL S DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I hate read the hazardous materials requirements under Chapter 6.95 of the California Death&Safety Code,Sections 25505,25533,and 25534. 1 will 1 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 S 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 ofdie Labor Code,for the air contaminants as defined by the tiny Area Air Quality\lanagernent District performance of the work for which this pertiit i5issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I hove and will maintain Worker's Compensation Insurance,as provided for by the I leallh S Safety Code,Sections 505 533.nr d 25534. Section 3700 of the Labor Code,for die performance of the work for which this On ner.or authorized agent- Date 54-3^ZO Z permit is issued. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in may manner so as to become subject to the Worker's Compensation laws of Califomia. If,after makine this certificate of exemption,I CONS'FRUCI'ION 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 N'anne AIT Ll CANTCERTI FICATION 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 mid 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 indemnify and keep harmless the City ofCupenino against liabilities,judgments, ARCIIITIiCI"S DECLARATION 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 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 11702 Estshore Ct DATE: 08/03/2012 REVIEWED BY: Sean 17214 APN: BPH: 'VALUATION: $13,250 *PERMIT TYPE: Building Permit PLAN CIIECK TYPE: Alteration I Repair PRIMARY SFD or Duplex PENTAMATION 1R3SFDRE USE: PERMITTYPE: Al WORK Kitchen.Remodel 150 sq ft SCOPE blech. Plan Check Phunb. Plan Check Flec. Plan Check Mech. Permit Fee: Ph,mh. Permit fee: Elec.Permit Fee: Other,lfech.Insp. Ocher Plumb Inrp. EJ Other Elec.Insp. ,Neth.hup. rte: Phtmb, hap. Fee: flee.Lisp. Few: NOTE: This winmte does not include jeee due to other Departments(i.e. Planning, Public Warks, Fire,Sanitary Sewer District.School District, etc.). These eev are based on lite preliminan information available and are onh,an estimate. Contact the Dept for addn'1 in o. FEE ITEMS (Fee Resolution 1l-053 Elf 711111) FEE QTY/FEE I D11SC ITEMS Plan Check Fee: $0.00 = s.f. Remodel, Kitchen (<=300 sO Suppl. PC Fee: (D Reg. Q OT O.0 Thrs $0.00 $600.00 IREMRESKIT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. FeeQ Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PNIE Permit Fee: $0.00 Consrntctiott Tux: Administrative Fee: Work Without Permit? O Yes (j) No $0.00 0 Advanced Plannine. Fce: $0.00 Select a Non-Residential 0 Travel Docmnentalian Fees: Building or Structure i Strong Motion Fee: IBSEISMICR $1.33 Select an Administrative Item 131(h, Stds Commission Fec: BCBSC $1.00 SUBTOTALS: $2.33 $600.001 TOTAL FEE: $602.33 Revised: 07/01/2012 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO '7 (408) 777-3228 • FAX (408) 777-3333• buildinataacuoertino.ora OD/, ❑.NEW CONSTRUCTION 110 ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERNIITp PROE ? T L APN4 OwV I AM r l�Q 4 PHO O 7</^r t^/Z E-MAIL STREET ADDRESS CI Y, STATE,ZIP '�`� FAX CONTACT NAMEPHONE E-MAIL STREET ADDRESS CITY,STATE. ZIP FAX OWNER ❑ OWNER-BUILDER Cl OWNERAGENT (CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CO O AME LI EN Nj MBER LICENSEff BUS.LIC d c / 631 1 COMP AN NAME E-MAIL FAX STREET ADODRFS)S K �y 10 C %TATE.ZIP 970 ARCHITECTIENGINEER NAME r'F LICENSE NUYMBER BUS.LIC 0 J COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTI NOF WORE EXISTING USE PROPOSE12 USE CONSTR.TXP, aST0 l U USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA 1/;193 / BATHROOM KITCHEN OTHER REMODELAREA - REMODEL AREA/ REMODEL AREA PORCH AREA DECK AREA TOTAL OECK/PORCH AREA I GARAGE AREA: DETACH C]ATTACH 4 DWELLNG UNITS: 15 A SECOND UNIT DYES SECONDSTORY nYES BEING ADDED' ClNO ADDITION} []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG A9 [3YES RECEIVED BY:- TOTAL VALUATION: PLANNING APPLM []NO PLANNING APPROVAL LETTER EICHLERHOME• E]NO ��^/ 3 ,Z �dQ so By my signature below,1 certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I ave read this application and the information I have provided' come have read the Description of Work,and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to th Irauthorize re resentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: ff Date: o ^ 3 — Zd SUPPLEMENTAL INFORIbIATIONREQUIRED PLANCIIECKTYPF. nduT16CSLiP New SFD or Multifamily dwellings: Apply for demolition permit for ,os'eR=rnt:couN't'ERRm LmNe PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building - permit for new building. ❑ .EXPRESS, - ❑' PLAN;NUNC PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD ❑-.PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑, LARGE _ ❑..Fuze DEPT - _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑' SA VTARI'SE\1'ER'OISTRICT - Submittal of Building Permit application. - _ •❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06121/11 KITCHENS PLUS o 1<a L-t LGA 1140 CHOPIN TER#105 1 70 Z V✓c S*-s hof c FREMONT,CA 94538 n 925 5953003 �Ft CE:h V 1�"D 7/21/2012 CL4per+.v-0r C`�,W01 -1 AUG 0 3 LJ Room 1 Not To Scale 30 31 36 X1617 t8';tt 24 a3tl3 33 * � - z, '0 36 9 :.R t•. 14 ,ST30 12 �' ..REF36 4 C4 1N l i 30 27 8 5 t 2 ..DWZ4 a'4 1R V� D .y S COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION-CUPERTINO APPROVED This set of plans and specifications MUST be kept at the 05 e Job site during construction. It is unlawfpl to make any 16 6° changes or alterations on same,or to deviate therefrom,without approval from the Building Official. e The stamping of this plan and specifications SINALL NOT. S -4,/O f/` , be held to permit or to bean approval of/the violation of any provisions of any City Ordinance or State law. ReV"x0 a,^� ��La� e BY DATE l Cc,6v^ _ —$ PERMR NO. APO Iti+S }c5 b al t. s 4c..-blr_0A F (�O rw�� VF1e`uE, G0rr