11030025CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22306 RANCHO DEEP CLI DR
CONTRACTOR: JACK MYERS
PERMIT NO: 11030025
OWNER'S NAME:
MT, VIEW, CA 94040
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALS
License Class l7 Lic. ti 6
REMODEL KITCHEN 100 SQ FT, BATH 200 SQ FT
y
REPLACE
Contracto
12 WINDOWS NON-STRUCRURAL
1 hereby a that I am license under the provisi s of hapter 9
(comme g with Section 7000) of Division 3 of the Bus' ess & Professions
Code a 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: $50000
performance of the work for which this permit is issued.
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.
APN Number: 35602044.00
Occupancy Type:
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. 1 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 liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Issued by: Date:
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.
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.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1, 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
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. 1 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
1 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 I
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
Section 3700 of the Labor Code, for the performance of the work for which this
the Health & Safety Code, Se 'ons 25505, 25533, a 25534.
Owner
:
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, 1
CO RUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, 1 must
1 hereby affirm that there is a construction lending agency for the performanc 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
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
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—,7 FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 22306 rancho deep cliff dr.
DATE: 03/04/2011
REVIEWED BY: bob s.
ME
APN:
BP#:
"VALUATION: 1$50,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
remodel kitchen 2 baths and replace 12 windows non structural
Esfd
Phimb. c k;;z C l;ccG
l_Jec. Plan Cheek
Lhch. I':°rt�iit F.a:
Plumb. Pcrmi" Fr t_
Flee. Permit Fee:
Other Heck Insh.
Other Plumb Insp.
Other Elec. Imp.
dlech. Imp. Fee:
Plumb. Insp. Fee:
Elec, Insp. Fec
NOTE: These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn7 info.
FEE ITEMS (Fee Resolution 09-051 a. 7i1/10)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
100 s.f.
$570.00
Remodel, Kitchen (<=300 sf)
1REMRESKIT
Suppl. PC Fee: 0 Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
200 s.f.
$570.00
Remodel, Bath (<=300 sf)
/REMRESBAT
Permit Fee:
$0.00
Suppl. Insp. Fee10 Reg. 0 OT
0.0
hrs
$0.00
12 # Window / Sliding Glass Door
$506.00 I WINREP Replacement
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax
Acoustical Fee: Yes O No
$0.00
Q
E)
Work Without Permit? Q Yes 0 No
$0.00
Plannin& Fee:
$0.00
Select a Non -Residential
Building or Structure
Travel Documentation Fees.
Strong Motion Fee: IBSEISMICR
$5.00
Select an Administrative Item
Bldj; Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
$7.00
$1,646.00
TOTAL FEE:
1 $1,653 00
Revised: 03/01 /2011