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11090061I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 7914 FESTIVAL CT I CONTRACTOR: ROYAL SERVICES I PERMIT NO: 11090061 OWNER'S NAME: ARQUIE LOIUS M ( 4398 NICKER CT I DATE ISSUED: 09/09/2011 I f"' NER'S PHONE: 4083734638 I_ LICENSED CONTRACTOR'S DECLARATION License Class c-, Lic. # C ntiacto I hereby affirm 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. I hereby affirm under penalty 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 the work for which this permit is issued. I 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. APPLICANT CERTIFICATION 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 inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source reguri ions per the Cupertino Municipal Code, Section 9.18. f l (/tom` L Signature � .�`\ Date f OWNER -BUILDER DECLARATION I nereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 the work for which this permit is issued. I 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. 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 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 forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, —sts, and expenses which may accrue against said City in consequence of the ting of this permit. Additionally, the applicant understands and will comply a all non -point source regulations per the Cupertino Municipal Code, Section I�.i8. Signature ' Date Ci ) — t _ SOQUEL, CA 95073 PHONE NO: (408) 972-2452 BUILDING PERMIT INFO: BLDG r— ELECT PLUMB r— MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: SFD CHIMNEY REPAIR Sq. Ft Floor Area: I Valuation: $3100 APN Number: 36213016.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. C� G Issued by17___ _ ��c— Dater! RE-ROOFS: 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 "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building cDcupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION IJ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS q. 0 APN # I OWNER NAME(� �c1 J / oV t A PHONE ) �� 3 � ( C E-MAIL STREET ADDRESS + r`_ CITY, STATE, ZIP FAX CONTACT NAMEPHONE r V1 \ (�'..�(J c� E -MATT STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ONTRACIOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME) LICENSE NUMBER LICENSE TYPE - BUS. LIC # COMPANY NAME -61 E -MAIL FAX STREET ADDRESS j CITY, STATE, ZIP PHONE ARCI=CTIENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRII'TION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET .AREA 1 J { ,� `�Y l r 3 / 0 0 J BATHROOM KITCHEN OTHER REMODELAREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKRORCH AREA GARAGE AREA: El DETACH ❑ ATTACH I # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY []YES BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION ❑YES IF YES, PROVIDE COPY OF PLANNING APPL # []NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES [17CEIVEDBY: EICHLER HOME? ❑ NO �C'✓�/ TOTAL VALUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the pr_rperty owner's behalf. II 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 building cons tructio I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: -� ^! C Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP 8— VER -THE COUNTER 9LBUMDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 171STANDARD ❑ PUBLIC WORKS form 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 _ ,ibmittal of Building Permit application. ❑ MAJOR ❑ SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH B1dg,4pp_201 Ldoc revised 06/21/11 W-W CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: DATE: 09/09/2011 REVIEWED BY: bobs. BP FEES APN: �� BP#: 'VALUATION: 1$3,100 PERMIT TYPE: Minor Building Permit 1 PL AN CHECK TYPE: Chimney/ Chimney Repair PRIMARY SFD or Duplex USE: PENTAMATION 1CHIMNEYR PERMIT TYPE: WORK repair sfd chimney. SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY BP FEES Chimney Repair 1CHIMNEYR 1 $523 TOTALS: NOTE. This estimate does not include fees due to other Depts (i.e. Public Works, Sanitary Sewer District, School District, etc.). t nese tees are oasea on the nrenminary inrormanon avaiianie ana are oniv an estimate. contact the uevt for aaan't into. FEE ITEMS (Fee Resohriion 11-053 fljf ' L'1 F FEE QTY/FEE MISC ITEMS Permit Fee: $523.00 Work Without Permit? Q Yes No $0.00 A Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item I31k Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $524.50 $0.00 TOTAL FEE: $524.50 Revised: 09/02/2011 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: c fti PERMIT # OWNER'S NAME: ( cJ q PHONE # '37-' �0" GENERAL CONTRACTOR: r2 U- y;L�c (v a S BUSINESS LICENSE # ADDRESS: ;x,25 !Ul?' �'4''� S; ` `! �% CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a amity or t-uperrnno Dusiness meuse. 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 I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date 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