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12110136 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21078 MANITA Cf CONTRACTOR:SEARS I-IOME PERMIT NO: 12110136 IMPROVEMENT OWNER'SNAME: ENGLISH WILLIAM LAND GLORIA M 1024 FLORIDA CENTRAL PKWY DATE ISSUED; 11/27/2012 OWNER'S PHONE: 4082536423 LONGWOOD,FL 32750 PlIONE NO:(925)245-2000 LICENSED CONTRACI'OR'S DECLARATION' .IOBDESCRIp TION; RESIDENTIAL COMMERCIAL[] License Class CII G70 e6 Lie q 72- 7 REMOVE AND REPLACE COUNTERTOPS, KITCHEN S 1i Z J 12� CABINETS, Contractor Ehy1yW� I�PIK�J, Date 7 OUTLETS, 6 LIGHTS,2CIRCUIT UPGRADES hereby nllirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. hereby aff rat under penalty of perjury one of the following boo 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 Floor Area: Valuation:$511 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued a APN Number:36223048.00 Occul tcy 9'ype: APP LIC\NI'CF.RTI FICATION 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 laws 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 Iiabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant underslands and will comply Issued by: Date: 7 with all non-point source regulations per the Cupertino Muni ' Code,Section 9.18. RE-ROOFS: .Signature _ Date-1=14Z I.Z_ 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. ❑ 0 E IILDDR DECLARATION 1 hereby a ll am exempt from the Contractor's License Law for one of Signature of Applicant: Date: the following mo reasons: ALI,ROOF COVERINGS TO BE CLASS"A"OR[IFFIER 1,as owner of the propeny,or my employees with wages as their sole compensation, will do thework,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to IIA-/,ARDOUS 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. [will I hereby affirm under penalty of perjury one of the fullnwing three maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(x)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 Arca Air Quality Management District performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipaf Code Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code.Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for theerformance of work for which this P Owner or aulhnrizcd agent: Date:I t Z7 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 m become subject to the Worker's CON ION LENDING,\GENC1' Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirat 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 pernin is issued(Sec.3097,Civ C.) Lender's Name A1'1'LIC.\N'T CFI2'I'I FIC.\PION Lender's Address 1 certify that 1 have read this application and state that the above information is . correct. 1 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 inspection purposes.(We)agree to save ,\RCII I'I'I:CI"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 Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: -L I o-79 IM A A 17 A G7T. PERMIT# OWNER'S NAME: 6loy4A F.Jr4h5p PHONE # 461 - & Z GENERAL CONTRACTOR: CA OMC 1 USINESS LICENSE# ADDRESS:L R CITY/ZIPCODE: J 9 / *Our municipal code requires : I businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 am not using any subcontractors: I / / 27 d� ore Date Please check applicable subs ntractors a co the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum/ Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 \ u �1 CUPERTINO (408)777-3228• FAX(408)777-3333•building okuoertino.org 0M I\\ `vim -1 PLUMBING ❑MBCIIAMGAI. ELECTRICAL ❑MISCLI.LA/NFOUS PROJECT ADDRESS �J ,.r� ^ I APNN ^ -; M3 3 OWNER NAME ( (I'On I A �I V I L I I C_ PI10Non . (94 Z E-.MAILO STREET ADDRESS 21 0743 A i A C-! . c srA 711e/ti GA _ `�' S0/ rnz 6-0 CONTACT NAME BERNIE MATHESON PIIONE925-245-2013 E-NIAIL 52837 E. AIRWAY BLVD. yy.�,, CR1',SfATP ZIP LIVERMORE,CA 94551 FA` 925-245-2017 ❑OWNER ❑ OWNER-11UI1.OpR ❑ OWNI7R AGLNf lJ CONI"RACIOR ❑CONTRACTOR AGmw ❑ ARCHITECT ❑1 OINF.Iot ❑ INWELOPLR 0'111NANr CONTRACTOR NAME LICENSE.NUMBER 121379 LICBNSE'IYPRE,C10 BUS.LIC4 BEANIE MATHESON C17 C6 COMPANYNAME SEARS HOME IMPROVEMENT E-NIAIL FAS 925-245-2017 STRE.ETADDRESS 283 E. AIRWAY BLVD. CITY.STATE.ZIP LIVERMORE, CA 94551 PHONE 925-245-2013 11 ARCHITECDENGINEER NAME LICENSE NUMBER BUS.LIC N COMPANY NAME E-NIAIL FAX STREET ADDRESS CITY.STATE.ZIP PHONE USE OF ❑SFD.DUPLBC Cl MULTI-FAMILY PROJECT IN WILDLAND ❑ 1'13PROJECT IN ❑YES ISTHERLDGAN ❑YS BUILDING: E]COMMERCIAL URBANINIERFACB ARG ❑ NO FLOOD Z' ❑N'U EICHLER IIOMM 0N DESCRIPTION OF/W00.R IN�1Z 17C- E-N1112-C 15 - P (//M !,J A-m r C'Z7RI C- �- GCV'07UZ- l r—17 G I N1 C-A I J C-7 LIA en - 7 /,JK AXC-7 - OJe FAJC-E I�ItZIXI C IC-C 5t 1J -2I 71/J 7 1C 7S . DAJr: 2- Gr 1-7 LIGIt71 � I,Js�� I s IX C7},J 11 4-7 .TOTAL VALUATION: s r/ RF.CHIVE.DBY: 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 NVork and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction eprese upenmo to enter the above-identified property for inspection purposes. Signature ofApplicam/AgenC Date. II Z7ILZ !/SUI'1'LEMI:N'I' PO "ON REQUIRED OFFICE list,ONLY ❑ OVRR-T'1IF CUII\Tcm ❑ EXPRESS 1 ❑ SJ'ANDARD L ❑ Ld Rf F. ❑ MAJOR Hr1',W.ccA1;p_20/Ldoc revised 06/11111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 21078 manita ct DATE: 11/27/2012 REVIEWED BY: mendez APN: BP#: 'VALUATION: $511 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY PENTAMATION USE: SFDOrDuplex PERMITTYPE: 1RPFIX WORK remove and replace countertops, kitchen cabinets 7 outlets 6 lights, 2circuit upgrades SCOPE Alech.Plan Check Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check 0.0 hrs $0.00 Alech.Permit Fee: Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: IEPERAIIT Other Much. Insp. Other Plumb Insp. 0.0 hrs $45.00 Other Elec. Insp. 0.0 Mech.Imp.Pec: Plumb. lisp.Fee: Flee.hup.Fee: NOTE: This eetintate does not include fees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Sewer District,School District,etc.). These feav are baser/an fine prefinzinarl information available and are on/i,an estimate. Contact the De t or addn'I info. FEE ITEMS (Fee Resolution 11-053 F_l1 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = # Plumbing Suppl. PC Fee: b Reg. OOT 0.0 hrs $0.00 $10.00 IBPFQTURE Fixture or Trap PME Plan Check: $0.00 F 13 Electrical Permit Fee: $0.00 $45.00 1BREAIRECEP Recep/Switch/Outlets Suppl. Insp. Fee:Q Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $90.00 Consmiction Tax: Administrative Fee: IADMIN $42.00 Work Without Permit? Yes (E) No $0.00 0 Advanced Planning Fee: $0.00 Select Non-Residential t7 Travel Documentation Fee: 1TRAI DOC $45.00 Building or Structure Q A Strone Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Sids Commission Fee: 1BCBSC $1.00 SUBTOTALS: 1 $178.501 $55.001 TOTAL FEE: $233.50 Revised: 10101/2012 o 7 A A Z V p � ED O O a cn C7 V j O N , cuCD T G� co Fl m G ' O G J � Z � �- N �rem-<_1n L \M/ N O ' N Ff