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11100008 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20071 LAS ONDAS WAY CONTRACTOR: PERMIT NO: 11100008 OWNER'S NAME: MILLER THOMAS J TRUSTEE I DATE ISSUED: 10/03/2011 ,1WNER'S PHONE: 4084462171 , PHONE NO: -� LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT f— PLUMB License Class__ Lic.# 8�d�1�' i MECH RESIDENTIAL� COMMERCIAL � Contractor_CZ�7T,_Z:ArG Date /OZZI// I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SINGLE FAMILY DWELLING KITCHEN (commencing with Section 7000)of Division 3 of the Business&Professions REMODEL(132SQFT);NON-STRUCTURAL 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. 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 Sq.Ft Floor Area: Valuation:$27000 permit is issued. APPLICANT CERTIFICATION APN Number:36932030.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Signa y" Date /d s Issued by: Date: OWNER-BUILDER DECLARATION RE-ROOFS: 1 noreby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined b the Ba Area Air I certify that in the performance of the work for which this permit is issued,I shall Y Y Quality Management District I will p maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. 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 mu caner ora thorized t: forthwith comply with such provisions or this permit shall be deemed revoked. Date: is / APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address c,-^*s,and expenses which may accrue against said City in consequence of the ng of this permit.Additionally,the applicant understands and will comply �:...all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36932030 . 00 DATE ISSUED. . . . . . . : 10/03/2011 RECEIPT #. . . . . . . . . BS000014926 REFERENCE ID # . . . : 11100008 SITE ADDRESS . . . . . : 20071 LAS ONDAS WAY SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : MILLER THOMAS J TRUSTEE ADDRESS 20071 LAS ONDAS WAY CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : CDNJ, INC CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 27, 000 . 00 2 . 00 0 . 00 2 .00 0 . 00 1BSEISMICR VALUATION 27, 000 .00 2 .70 0 . 00 2 .70 0. 00 1REMRESKIT SQ FEET 132 .00 588 . 00 0. 00 588 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 592 . 70 0. 00 592 .70 0 .00 ( I ( c) t�r� �� � CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333• building(cDcupertino.org ❑NEW CONSTRUCT-ION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROTECT ADDRESS AOO I L L A ApN�. J1# 2 0 /� J OWNER NAME � 1$ / PHONE 7 T�wyi�7 /�I l��i � E-MAIL STREET ADDRESSto&'' l.�s `J v�� CITY. STATE ZIP FAX f�/I��f/ CEJ T��w_fj. CONTACT NAME �/ {/ D "�T �� 17aaeo".L 1 a.Cf�M�N • Fi`r STREET ADDRESS,OQ �/ 45 ATE ZIPQ/ FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 9?CONTRACI'OR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME Pr '00"* LICENSE NUMBER 1D Z LICENSE TYPE BUS.LIC# COMPANY NAME D� r + E-MAIL FAX �j ✓ d��i4'�/7�i .N STREET ADDRESS CITY,STATE ZIPCO. 4?5 / PHONE ^719/9 4409 ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORKAe A*"40AP A16 f► Sated` G EXISTING USE PROPOSED USE CONSTR.TYPE I #STORIES USE TYPE OCC. SQ-FT. VALUATION(S) EXLSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA �? BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA , REMODEL AREA PORCH AREA DECKAREA TOTAL DECK/POR AREA GARAGE AREA LJDETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? J,NO ADDITION? 1,1r„NO PRE-APPLICATION C]YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY. TOTAL VALUATION: PLANNING APPL# []NO PLANNING APPROVAL LETTER EICHLER HOME? [�.NO By my signature below,I certify to each o following: I am the property owner or authorized agent to act on thee✓�prpperty owner's behalf.`I have read this application and the information I have ovid d is correct I have read the D cription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to uildin construction. I a oni�rentatives of Cupertino to enter the above-ide tified property for inspection purposes. 11 Signature of Applicant/Agent: .�-� Date: 14� Znir SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTMG SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for o� - ouly r�R ❑ BUILDING PLAN REVIEW 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 ❑ STANDARD ElPUSLIC 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 ❑ ❑ 'abmittal of Building Permit application. MAJOR SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH BldgApp_201 1.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 20071 las ondas way DATE: 10/03/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$27,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: PERMIT TYPE: WORK sfd kitchen remodel non structural. SCOPE Li NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesefees are based on the prelinina information available and are onl an estimate. Contact the De t or addn'l info. FEE ITEMS (fee Resolution 11-053 Eff. ,',1%11, FEE QTY/FEE MISC ITEMS Plan Check Fee: t$0.010L$588.00 132 s.f. Remodel,Kitchen(<=300 sf) Suppl.PC Fee: Q Reg. OT 0.0 Ihrs IREMRESKI, PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp. Fee.e Reg. 0 OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Q Building or Structure i Strong,Motion Fete: IBSEISMICR $2.70 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS:' $4.70 $588.00 TOTAL FEE:'- $592.70 Revised: 10/01/2011 «s■■•�� lsuiiamg vepartment CDMJ, Inc 966 Rincon Cir SanJose, CA 96131 408-719-1991 8/29/2011 f Room 1 Not To Scale i✓DTF". MAO �Lr7'-Gth�"N ���wo4er� fes. 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