11070160CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22706 ROYAL OAK WAY
CONTRACTOR:TBS—T&fW—
99+E-Rft�
PERMIT NO: 11070160
OWNER'S NAME:
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATIONCOM
JOB DESCRIPTION: RESIDENTIAL MERCIAL
License Class Lie. # �`b/
`
REMODEL 224 SQ FT TO KITCHEN NON-STRUCTURAL
Contractor 2t�c/l— �S (/�
O% Date 7iZ2—�
1 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
Sq. Ft Floor Area:
Valuation: $35000
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 w c th's
APN Number: 34232127.00
Occupancy Type:
permit is issued.
APPLICANT 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 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 IN PE TIO .
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
G
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non -point ce regula s per the C7rpertino Municipal Code, Section
9.18.
7�2? r
RE -ROOFS:
Signature
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtainiW an inspection, I agree to remove all new material for
inspection.
❑ OWNER -BUILDER DECLARATION
Signature of Applican• ` Date:
1 hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF C&ERINGS TO BE CLASS "A" OR BETTER
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
HAZARDOUS 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. I 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:
Health & 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 Quality Management District 1
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, .
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: 7-2� ��
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, l
CONSTRUCTION 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 Name
APPLICANT CERTIFICATION
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 inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'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
Fm-M FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 22706 royal oak dr.
DATE: 07/22/2011
REVIEWED BY: bobs.
APN:
BP#:
"VALUATION:
1$35,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1R3SFDREM
PERMIT TYPE:
WORK I
sfd kitchen remodel non structural
SCOPE
NOTF_r These fees are hated on the nreliminary information availahle and are only an estimate Contort the Dent for addn'l infer_
FEE ITEMS (Fee Resolution 11-053 Eff. 711111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
224 s.f.
$588.00
Remodel, Kitchen (<=300 so
IREMRESKIT
Suppl. PC Fee: 0 Reg. 0 OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee-0 Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Acoustical Fee: 0 Yes 0 No
$0.00
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Plannin Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
i
Trvwel DO(Ildri"'Mat i0 t
Strong Motion Fee: IBSEISMCR
$3.50
Select an Administrative Item
Bldg; Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$5.50
$588.00
TOTAL FEE:
$593.50
Revised: 07/04/2011