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11100150CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22159 RAE LN OWNER'S NAME: LAURA DEAN N'ER'S PHONE: 4083915815 ❑ LICENSED CONTRACTOR'S DECLARATION License Class cs Lic. Contractors i,S \J OUT Date G(/ I hereby affirm that I am licensed 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. 1 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 so cc regulations per the Cupertino Municipal Code, Section 9.18. Signatur Date +0 OWNER -BUILDER DECLARATION 1 hereby 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) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 1 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. 1 certify that in the performance of the work for which this permit is issued, 1 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 1 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 'emnify and keep harmless the City of Cupertino against liabilities, judgments, is, 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 regulations per the Cupertino Municipal Code, Section 9.18. Signature Date CONTRACTOR: KITCHENS BY MEYER 278 CASTRO ST MOUNTAIN VIEW, CA 94040 PERMIT NO: 1 1100 150 DATE ISSUED: 10/20/2011 PHONE NO: (415)968-8318 BUILDING PERMIT INFO: BLDG ELECT r— PLUMB MECH RESIDEN'T'IAL COMMERCIAL JOB DESCRIPTION: REMODEL KITCHEN 80 SQ FT NON-STRUCTURAL Sq. Ft Floor Area: I Valuation: $20500 I APN Number: 35607071.00 I Occupancy Type: I PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: 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. 1 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 1 will maintain compliance with the C qtino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sec t9 n 05, 3 , and 25534. Owner or authorized a n • Date: / CONSTRUCTION LENDING AGENCY 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 Add ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUP£RTINO (408) 777-3228 • FAX (408) 777-3333 • buildinggD-cupertino ora ❑ NEW CONSTRUCTION ❑ ADDITION 1 PROJECT ADDRESS 2-2-15q ^ �EF OWNER NAME �C•� Dff� L4 vt ra. STREET ADDRESS ;U/59 -126 TERATION / TI U REVISION / DEFERRED ORIGIj PHONEa ---391,5815_ --391 o l5V i 5V EMAIL CITY, STATE, ZIP 200 CA 9goC PHONE/ Co. J 02).-70&& 2) . l0&& E-MAIL CITY, STATE, ZIP Mount INN VIEW 94041 CONTACT NAME SIREETADDRESS��_r ❑ OWNER ❑ OWNER-BLMDER ❑ OWNER AGENT 11* CONTRACTOR NAME Kff o bw m fwf2 COMPANY NAME K I,' �, , t k. � MEYER.^ n STREETADDRESS CACw STp ARCH[TECT/ENGINEER NAME COMPANYNAME 14-r r _ M STREET ADDRESS �-s�D �r DESCRIPTION OF WORK (� 1I(V-\ L50 AL PERMIT # FAX k1'1 ehcn u�� con FAX &Gly, g Q • 14.,r,- TRACTOR /1r.,_ TRACTOR ❑ CONTRACTOR AGENT - ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT LICENSE NUMBER �i ) [� LICENSE TYPE a BUS. L[C # CITY, STATE, ZIPS i,,, aW YI RVf CA i LICENSE NUMBER ,3231' CITY, STATE, ZIP USE EXISTG NEW FLOOR DEMO TOTAL fy AREA AREA AREA NET AREA 7 7D 5 C BATHROOM KITCHEN OTHER V REMODEL AREA REMODEL AREA REMODEL AREA TYPE I OCC. I SQ.FT. I VALUATION (S) BldgApp_201I.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 22159 Rae Lane DATE: 10120/2011 REVIEWED BY: jsg APN BP#: "VALUATION: $0 PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: RemoddENTAchen (300 s.f. max) 1R3SFDREM PRIMARY Residential PERMIT TYPE: USE: WORK Re lace kitchen countertops and island install microwave circuit and other minor electrical SCOPE NOTE: This estimate does not tnctuaciee3 cl- Contact the Dept a District, etc). These fees are based on the relining information available and are onl an estimate FEE ITEMS (1�'ee Resolution 11-053 Eff 7,1.%11) FEE Q TY/FEE MISC ITEMS Permit Fee: $588.00 Select an Admi 'IS) Item - IIS) $0.001 TOTAL FkE:-- I $588.00 Revised: 10/01/2011