11030150CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19843 BAYWOOD DR I CONTRACTOI VV
--,RMIT NO: 11030150
OWNER'S NAME:
I , I PHONE NO:
LICENSED CONTRACTOR'S DECLARATION
License Class Lie. 4
Contractor Date 1�
1 hereby affirm that I am licensed under the provisions of C apter 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-po. t source regulations per a Cupertino Municipal Code, Section
9.18.
Signatu Date /
❑ OWNER -BUILDER DECLARATION
I hereby affirm that l 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).
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 reA
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 regulations per the Cupertino Municipal Code, Section
9.18.
BUILDING PERMIT INFO: BLDG r ELECT r• PLUMB r
MECH r RESIDENTIAL F COMMERCIAL r
JOB DESCRIPTION: REMODEL KITCHEN & 3 BATHROOMS, REMOVE A
STRUCTURAL
WALL, RELOCATE THE FURNACE TO THE ATTIC (247SQFT)
Sq. Ft Floor Area: I Valuation: $80000
APN Number: 31630075.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued b Date: —7 f v l
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
1 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 1 store or handle hazardous material.
Additionally, should 1 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.
:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of wrk's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Date
Licensed Professiona
�� CITY OF CUPERTINO
IVUV FCTiMATnI? _ R1T11.1F)iNG MVISION
1 LLI
ADDRESS: 19843 baywood dr.
DATE: 03/30/2011
REVIEWED BY: bob s.
1wd
APN:
I BP#:
"VALUATION: 1$80,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Du lex
USE: p
PENTAMATION 1R3SFDREM
PERMIT TYPE: 19
WORK
remodel kitchen and 3 bathrooms remove structural wall relocate furnace to attic.
SCOPE
Mech. Plan Check 0.0 1 hrs $0.00
%;=t 1?(i7l
Mech. Permit Fee: IMPERMIT
Other Mech. Insp. 1���s�$42.00
ir<<It frs.=n ctcr,
f
Irzti+ Fee.,
NOTE: These Pees are hated an the nreliminary intarmalinn availahln and aro nnly an actimato r antart tha nanl fnr add»'1 infn
FEE ITEMS (Fee Resolution 09-051 a, .. 711110)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
140 s.f.
$570.00
Remodel, Bath (<=300 sfl
1REWESBAT
Suppl. PC Fee: 0 Reg. 0 OT
f 0.0 1
hrs
$0.00
PME Plan Check:
$0.00
= s.f.
$570.00
Remodel, Kitchen (<=300 sf)
IREARESKIT
Permit Fee:
$0.00
Suppl. Insp. Feed Reg. 0 OT
0.0
hrs
$0.00
0 # Mechanical
$126.00 IMFR=<100 Furnace, Forced -Air
PME Unit Fee:
$0.00
PME Permit Fee:
$42.00
. ofistruetion Tat"
Acoustical Fee: 0 Yes (F) No
$0.00
0
0
Work Without Permit? Q Yes (F) No
$0.00
Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
0
Travel Documentation Fee: ITRAVDOC
$42.00
Strom Motion Fee: 1BSEISMICR
$8.00
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$4.00
SUBTOTALS:
$96.00
$1,266.00
TOTAL FEE:
1 $1,362.00
Revised: 01/15/2011