12090060 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1170 STAF17ORD DR CONTRACI'OR:GEPPETTO'S WORKSHOP PERMIT NO: 12090060
OWNER'SNAME: HEBSON ROIIERT T AND OPAL B TRU 227 SAN JOSE AVE DA'Z'E ISSUED:09/102012
OW'NER'S PRONE: 4082553753 SAN JOSE,CA 95125 PlIONE NO:(408)392-0600
LICENSED CONTRACTOR'S DECLARATION 30B DESCRIPTION: RESIDENTIAL U COMMERCIAL
License Class Lic.4 ( 7 KITCHEN REMODEL TO INCLUDE CABINETS,
l FLOORING,
Contractor�c n [ Datc `��/!D//Z COUNTERTOPS, UPDATED ELECTRICAL, REPLACE
hereby affirm that 1 am licensed under the provisions of,Cha/pier 9 WINDOW
(coin mencing with Section 7000)of Division 3 of the Business&Professions AND 2 SLIDING DOORS
Code and that my license is in full force and effect.
hereby affirm under penally 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 work for which this permit is issued. Sq.Ft Floor Area: Valuation:$65221
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the`,y/pr�k for which this AI•N Number:36207002.00 Occupancy Type:
permit is issued ��Yf/R/
APPLIC NT'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 agree to comply with all city and county ordinances and state 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.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, G r/O_/ Z
costs,and expenses which may accrue against said City in consequence of the /
granting of this permit. Additionally,thea icant understands and will comply Issued by: Dale:
with all non-point source regulations per a Cupertino Municipal Code,Section
9.18.
RF,-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:
hercbpp affirm that 1 am exempt from the Contractor's License Law for ung of
the folks v"ing two reasons: AL1.ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner -dre_ roperty,or my employees with wages as their sole compensation,
will do the work,mid 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 IIA%ARDOUS MATFRLUS DISCLOSURE
construct the project(Sce.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Ilealth S 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: Ilealth&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 of the Labor Code,for the air contaminants as defined by the Bay Area Air Qualit•Management District 1
performance of work for which this permit is issued. will maintain compliance with the Cupertino Munici Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&Safey Code,Sections 2 ' 3, 25534:
Section 3700 of the labor Code,for the performance of the work for which this
Owner or authorized tiger t: Date:
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 any manner so as to become subject to the Worker's
Compensation Imus of California. If,after making this cenifmcate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,1 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. w'ork's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANTCF,RT1 FIC TION 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 and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspectionpurposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCIIITECT'S DECLARA'T'ION
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
CONSTRUCTION PERMIT APPLICATION
" T f
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX (408)777-3333• buildina(cD uoerino"org O ^DObo
❑NEW CONSTRUCTION ❑ ADDITION EfALTERATIONVI'I ❑ REVISION/DEFERRED ORIGINAL PERMIT
PROJECTADDRESS \ APNa 3�a_ -00�2
' a r
OWNER NAME , PHONE E-MAIL I
{2 ✓�— ' . a S�, J uDg— L5,i, rzvulo. on] n vudtl\.Cat
STREET ADDRESS CITY, STATE.ZI FAX
AA
'So� /"fes
CONTACT NAME PHONE E-MAIL
cI a — L� ' ll3 CtaTv )dk6' Le
STREET ADDRESS CITY.STATE,Zip FAX
27 CcAqslzs7l 0 W)'010'Z
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ISCONIAACTOR ❑CONTRACTORAGENr ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME , L LICENSE NUMBER qq 6v '3 LICENSE TYPE �r BUS.LICA
COMPANY NAME F"-MAIL 5u FAX
_6 S-
STREEI'ADDRESS22 5AK (rr' �• CRi',STATE,7.IP,`TK rLJ� PHONFj�I
ARCHITECT/ENGINEER NAME CJ M LICENSE NUMBER u J BUS.LIC N
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK
Jldo
to J- d 6- r Q � l• t). lsccc t (i1b/
5 /tI%cam CDD
EXISTING UU. �
/[.v S`ICLiVI.I fn` PROPOSEDr,USE. COTYMd STORIS
OPcScbeiLal )
2 USE TYPE OCC. SQ.FI'. VALUATION(S)
ECISTG NEW PL00RonNIO TOTAL
AREA 223p AREA 2-123, AREA 232 NFT AREA
BATHROOM 4 KHCHEN oDiu
REMODEL AREA N A RLNODEL ARES n s /' ILL:NODF1 ARFA
PORCII AREA DECK ARRA TOTAL DECKMORCH ARU GARAGE"AREA: DETACH
� ) /� ATTACH
#DWELLING UNITS: ISASECON'DU. I'r ❑YU SF.CONUNTORY []YES
BF,INCADDED} ❑No ADDITION! ❑NO
PRE-APPLICATION []YES IF YES,PROVIDE COPT'01' ISILEBLDGAN [I YES RECEIVEDBY: I TorAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLF,RHOMI1r 11 NO &15
Z?--j a rJ
By my signature below,I eerily,to each of the following: I am the ropeny owner or authorized agent to act on the property ow'ner's behalf l hate read this �J
application and the information 1 have provided is correct. I have ad the Description of Wort and verify it is accurate. I agree to comply faith all applicable local
ordinances and state law's relating to buiIdin n i orize representatives of Cupertino to enter the above-i en[ led property for inspection purposes.
Signature ofApp licant/Agent: Date: M /
SUPPLEMENTAL INFORMA" ION REQUIRED YIANCUECKTYPF ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for ❑ oYr:R=nit;coUNreR ❑ BUILDING PIAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building, ❑ EXPRESS ❑ PLANNING PIAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLICIVORKS
To-m— if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. El MAJOR ❑ SANITAR\'SEYPER pISTRICT
❑ ENVIRONMFVFALHrALDI
BldgApp_01 J.doc revised 06/21/11
CITY OF CUPERTINO �7
FEE ESTIMATOR - BUILDING DIVISION 1do90lxo
ADDRESS: 1170 Stafford Dr. DATE: 09/10/2012 REVIEWED BY: RDW
\ APN: BP#: 'VALUATION: $65,221
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD Or Duplex PENTAMATION 1R3SFDREM
USE: PERMIT TYPE:
WORK Kitchen remodel - 232 sq/ft. updated electrical and lighting. 1 new window and 2 new sliders.
SCOPE
Much. Plan Check Plumb. Plan Check Elec.Plan Check
Mede Permit Fee: Plumb.Permit Fre: rlec•. Permit Fee:
Other Alech.lnrp. Other Plumb Insp. Other Elec.Insp.
Ilech. Imp. Fee: Plumb. lnsp. Fee: Oec. lnrp.Fee:
NOTE: This esrimate doer not include jeer due to other Departments(i.e. Planting, Public Works, Fire,Sanitary Sewer District,School
District. etc. . There ees are based on the prelintinan information mailable and are only an estimate. Contact the Dept for tuldn'I info.
FEE ITEMS (Fee Resolution 11-053 Elf. 7/1/1/) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.f. Remodel, Kitchen (<=300 SO
Suppl. PC Fee: Q Reg. Q OTF0_01hrs $0.00 $600.00 IREMRESKIT
PME Plan Check: $0.00 F__37 # Window/Sliding Glass Door
Permit Fee: $0.00 $400.00 I119NREP Replacement
Suppl. Insp. Fee0 Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Conso-nction Tax
Administrative Fee: 0
Work Without Permit? O Yes 0 No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Building or Structure
Travel Documentation Fees: 10
Strong Motion Fee: /BSEISMICR $6.52 Select an Administrative Item
Bldg Stds Commission Pee: /eCBSC $3.00
SUBTOTALS: $9.52 $1,000.00 TOTAL FEE: $1,009.52
Revised: 07/01/2012
W N (n
L0 r1ti tri—In
,1 N
V a.
w
a cn
F O
1�1--1I 4lY {x^`11 CY
z 1 b
0 u C=3= (n
r r F @
a 3 E A p
N O a N
3
O
20N !y, C
2 3 O rn �. %MOP �
/a HOcw
2 0 X
O W V O
d
Cf)
I
O
tRl
F34
O
Z
Oz
11
x o0
a
n O LL 0
J
w z z Z
z
Oz
s , < H H o
xz
NZUW r ` m
0i 00 • V w
2 IXIWf_.
a F O m • 4A
�(1
a a
w O U N I l l
200 0 E m
Z O O V
hD
d
m G
qF .•
0. 0
V¢fail 41 py
• „ {l p m U
q 4IJ0 O
U V U O
p U v
4 µ m
5� p D ~ K 0 g m 5 �
�Uu , o3u Z m m w m 0• N
z
a Y Y W WW p Wy i O V a L 0 m m
O O O
O.
a u m
05 'c' 3
",yf m m
¢4 F zo a 1 ge
0 O S �� N co CC
uao o$ .1['s 1 N C m J a z<
FT 6 VC 'f] m D �m
0 8 8odr m U d C m G
S m� w
»
o �F � Ho n «8 .c mN O ?
Mo Gm
in To.ua p < w mp
zg
m
3 c m Ill O�
�) m o
.a L1 0d m O d m
w0 moo m f cn - a
H.ti m =. o '0 2
ryN _
a 2 ti
zOm (n m < 2 (Oa < O cmc- Om
0a < m o D p dd .o -zl
SOVrFm � »
aQz f Q
In o 41 y
m r W L
V
� � C
v
� v
C � b0
cq
I,
154" N C
T
30" 30.. 151. 67"
v CN
/� Q- ' 88,. , 34.1 �. 32"_ ' Q
1 t
57 I I 97" m .O
VV 7 O
O
rf C �
42.. I. 30"- _-18•• 41" 24..21• v
's
•co 0 �
7 9 D H06D.1 I I1( i I p r '�
d
1. C� S42L e D615-4 1 I Cl) U
- - - - - - - - - - - - - - - -I o a
{ I •� L
—
LL
Up rn _ _ _ _ _ _
o i I F' C Cl. O
l m
D) inp
N p O
IN
I` NCli
Cl) Cl)
CID I N >
°�
in
.Q
O A
^
�I cc oI
pp >>pcoI - _ ._A.J
m .I > U .14
- - -- -- - - - -
� J r
N � / ' � p � m
_ r \ A' s
5X34. . i iv N O
_IL I M M ✓,' Ti i
e£p m —,�—� I- •I rJ L u C x
�o• 00 �
,I
no
a i 3� J:
{ \ - _ _ _ _ _ _ _ _ _ _ _ __ _ -__ -__ - -
..OZ l I'
N
E N
r- p C
_ N
3
C EO a0 Q
L� a
0
❑ N
SIN 7 O
C J r
_ C
� O L
t
O � y
C - _
L R
T F c a O
N
LO
T � O •�
c �
+7 O C r
LnJW o 9• r
O w n fl
p N2 � = ,c
E
T L.3
b
„66
66
.,96
N
O N #
00
O
� 3
—
�N
J
co
I^
U J, � a
N N
u
(1 �/` 7 0
rI r f
C _V
CIS
rlv
_ c
M
U
U-) U 07&
L
T T z 0 na
T F c o
A
`- c
O J c
FEII- to U 0
Q) >
W O �.9 u
N CV x
_ Ecl � '_ a
N
T
..9E '
ail
,' „96
N -
r O _C
N
Nr 3
U
C 'D
L
Vri
T r
W
0
N N f
7 O
M co 0r
900
c � �
r a
_ c
0
- U
rIN C G L
T •c � � TJ
O O U
M
U U d
v
'- r (V
T T
T m
i rz
LL - f G
ir
0 0
4
M co
co u o
n G c r
co co y � ya
rIN rIN C 3 U .- OC
} :D y •f m
M M a to U z
,
„96
CONSTRUCTION PERMIT APPLICATION
• BUILDINGyy
COMMUNITY DEVELOPMENT DEPARTMENT �tSy
1jj0 q #
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
Lj
CUPERTINO I
(408) 777-3228 • FAX (408) 777-3333 • building(a)cupertinO.Org
❑ NEW CONSTRUCTION El ADDITION ❑ ALTERATION/TI REVISION/DEFERRED ORIGINALPERMITN 12070C& O
PROJECTADDRESS / / 70 S rV2 r-a,a' APNM
lI J�F'ff C 53
OWNER NAME C � f ' Oh PHONES _ &MAIL
STREET ADDRESS I/ 7J 5'.T�;,, OF. CITY, STATE,ZIP GVH Cy FAX
CONTACT NAME j\ L]Y I � 1� /1 �I/•`pzi/ PHONE 3 G•lVD lbC J E-MAIL
STREETADDRESS SJ/12,j !�-I`I� �C',r(J ✓ 7 CITY,STATE, ZIP _•J• FAX
❑OWNER ❑ OWKER-BUILDER ❑ OWNER AGENT 13 CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE- BUS.LIC tl
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECPENGINEER NAME LICENSE KUhiDER BUS.LIC q
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORE: r t
zDlSen C-tia, -�1, K•'�che— :,yt � sia., ru
ExISTIJG USE PROPOSED USE CONSSTORIEs
✓� T) IUSE TYPE OCC. SQ.FT. VALUATION(S)
MISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
P00.CH AREA DECK AREA TOTAL DECIJPORCH ARTA GARAGEAREA: DETACH
ATTACH
tl DWELLING UNTTS: IS A SECOND UNIT ❑YES SECONn STORY []YEs
BEING ADDED? ClNO ADDITION? []NO
PRE-APPLICATION ❑t'FS EYES,P0.0V1DE COPY OF ISTIIE BLDG AN (3 YES _RECEIVED ��'—'Y L R�5$tiu[,'S TOTAL VAd.'S7\1TJON:
PLANNING APPLM ANO PLANNING APPROVAL LETTER F.ICIILF.R IIOMF,^ ANO . .`Y( /r(J/r
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work,and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buil in A construct 1 authorize representatives of Cupertino to enter the above-e--'dentifitcd property for inspection purposes.
/�
Signature of Applicant/Agent:Applicant/Agent: �N i Date:
SUPPLEMENTAL. INFO 1ATION REQUIRED ACY 11:zrT- '`�K`TY —" '.;,k f,'TTounMNNcS01_P:`11_`
r3, �,•,i'1.\\CIILCI:T1PFe.��.
New SPD or Multifamily dwellings: Apply for demolition permit for "'y , '$-�` S �'aaT�,��`yyw `'+ i'r x '"3 e i ,,a
O\r RTHF COU\TER }�•d ❑T BUIL UI\OPIA\RE\IFR
existing building(s). Demolition permit is required prior to issuance of building M.-
permit
permit for new building. ❑Zi�i'tiess �z'3`�= yc�# �� \,i\c Puy Rr�\ie �I,�y'.�'
yy
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure (];ST\NI RIl1 f'YF cr 4'� P❑r PUB ICwIORIKLS '_ y"Y•'� WY��
form if any Hazardous Materials are being used as part of this project. ! tg;� ," � � ? `� u k"�;fi ' '
I� IARces A rr °rr ..�p FIRE DEPT Lr \*N, 14
subm cal of Bupy of ilding Permit val Letter
Meeting With Planning prior to vtj io R.W. Arte • 4 Y� �00 1 FAR%SE\Y F.ii In.
2M .1 n
'"&i ��� ` '`�i *C�w,L �• �T E\'\'I OT�tE\'TAI HF.\LTllr ^�
BldgApp_2011.doc revised 06/21/11
O -E � D,
CL
Q N U F
LU
Z a � �
_® = a
co m 0
� FOS cQ
N U
0- O
cr
9e
W p
Lo
W m �•-rte r (6
K1 ED
It .' L1J O
N
v
N
Q
N
U
F HOIWD _
n n r W Z
x 0 3 U
14
Q
z
f
H
N
N
[1 v < N
C7 0
Z
H Qz
H Q
z
H Q CL
• W � Z
LD Tm
N z M 1 3
r y Z LL
m
1xa o Z
N
N
x
W
ov .
r1
96
W
7
H
Wa
U ❑ ,
2
C) 114 L)
H O
U] G.
W G, O
a E H
o U)
a
U) o W
CO r14
S r i U
fl_
O
Sr:
S
i
O
-O
Q)
Q)
fl_
• � f
z °
� a Q � / Fq
N
wo a. a Z
L
CL m
V E� z �, N
11J i 04 a a
m 0 a w N
W 0 O O
i 96
i
d
W d N
LJJ O
O
FM-
zo
c
C=E== i
N
f
I
N �
s I
Z
O
N I
a I
y
I
N
� N
O
0
d I Z Q
< O
x � �
v L Z
O W <
y = J
u U
Z_
cz
LL
OQ
6
n
L
9a
W m
H x F
H _ 0
ly
U ❑ v
O
O U
O0G u x4
HO
00
WG+ O � F
a < z � c
E H mo
Z V1 H
O ¢ wo
0l < xO
V1 O W
O
W ,tea Htim
0
s
N
i
0
"o
�• o
- U