10120062 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10292 BRET AVE CONTRACTOR:AMERICAN KITCHEN& PERMIT NO: 10120062
BATH
OWNER'S NAME: GAIL JOHNSON 1758 JUNCTION AVE UNIT D DATE ISSUED: 12/10/2010
WNER'S PHONE: 4084107750 SAN JOSE,CA 95112 PHONE NO:(408)136-8151
9 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL C1 COMMERCIAL
License C2irm
Lic.# ��.3 S 3 y REMODEL 64 SQ FT TO BATHROOM
Contractor Date
I herebythat 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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$11400
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 APN Number:37510039.00 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 DAY FR M 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 r gulations per the Cupertino Municipal Code,Section
9.18.
F 2 —/4' "/D RE-ROOFS:
Signature Date / All roofs shall be inspected prior to any roofing material being installed.If a roof is
v- installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
L] 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
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)
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. 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 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 the Health&Safety Code,Sec"2,W5,255 nd 25534.
Section 3700 of the Labor Code,for the performance of the work for which this �_a/
Owner or authorized agent: Date: L'
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 CONSTRUCTION LENDING AGENCY
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 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 ARCHITECT'S DECLARATION
iemnify and keep harmless the City of Cupertino against liabilities,judgments,
sts,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- oint source egulations the Cupertino Municipal Code,Section Licensed Professional
9.18. '"�/
Signatur / `� Date
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: G'Z9 Z. i3 PERMIT# 2 d
OWNER'S NAME: CI AL- �cti-j5 CAj.-wz, PHONE# 4/0 Y3
GENERAL CONTRACTOR: .4.& c,�...� r9'�G+`� ': '3 ''Yl BUSINESS LICENSE# -/ 3 3
31/
ADDRESS: (-47 uN A �- 5%�_ S,�. q-3112- CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCO CTORS HAVE OBTAINED A CITY OF CUPERTINO
n
BUSINESS LICENSE.
IZ -Iv - jv
I am not using any subcontractor . - Date
Signature
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum/Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
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CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 10292 Bert Ave. DATE: 12/10/2010 REVIEWED BY: RDW
APN: BP#: *VALUATION: 1$11,400
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Remodel, Bath (300 s.f. max)
PRIMARYResidential PENTAMATION 1R3SFDREM
USE: i I t?<�! itl-�.': PERMIT TYPE:
WORK
SCOPE
FEE ID FLR AREA
s.f.
1REMRESBAT 64
t.ic /z 1, fur?/
E:1 Li
NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS (Fee Resolution 09-051 Elf. 7%1%10) FEE QTY/FEE MISC ITEMS
flan Chc uA
S11/ /. /,fir �1,cc
f'Iz��nh.:.1Icch. hlec l'lrao Chc'i:n:
Permit Fee: $570.00
Sill/)l. h/sp FCC" F
Plwnh-''Ilec1h.i'Elcc: !'tit 1 cue:
1'lunih.%".hPtch.-7:7��c� Permit FCC,'
C"otz-so'ia~tic 7 7'ix
r
-1c ouslac ui, I'cc':
Work Without Permit? Yes (E) No $0.00
Pl�rrrnrr,e,�> 1:c��'s:
7r-<<rc°1 /)t�ctrtttnf��;Fic�rt 1° e,:
I
Strong Motion Fee: IBSEISMICR $1.14 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $572.14 $0.00 TOTAL FEE: $572.14
Revised: 12/07/2010
CITY OF CUPERTINO
ADDITION/REMODEL
CUPERTINO FEE SCHEDULE
APN# Date:
5 / V 3 e5T-
Is a 2° unit being added? Yes ❑ No ❑ If yes, please fill out the permit a lication for 2" unit.
Building Address:
y 2
28,E-7 AJC , CA 9'5-6 /1/'
Mail.,ing Address (if different from building address):
M _
O �ner's Name: Pone#
C ntractor: Phone #:Cyd T) �'-1 3 `"I �-1
(V\tLiZt CA ,j /✓i 14, ,o &A Fax#: 1W v 0 V yJ '5-
Cupertino
5"Cu ertino Business License: z- 3 i State Contractor License#: 5 13' '3 ff
Contact: Phone ?14, - I V Z z
JtJ (A"1 6 /ILr Fax#: ' yod 316 `i 3
Landscape Ordinance Compliance:
Landscape area in sq. ft. (includes all irrigated areas): A,.
If 2,500 sq. ft. or less, compliance with the Landscape Water-Efficiency Checklist is required.
If more than 2,500 sq. ft., a complete Landscape Project Submittal is required.
Compliance Method: ❑ Plant Type ❑ Water Budget
Building Permit Info:
Bldg. Elect. Plumb. Mech. Hillside ❑
Job Description:
Addition-What is being added?(Be Specific):
What is being remodeled (not including addition)?
Remodel Includes Re-Roof. Yes ❑ No If yes list number of squares
Remodel Includes Structural: Yes ❑ No
Do you have the pre-application planning approval? Yes ❑ No ❑
If yes, please provide a copy of your planning approval letter. Planners name:
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen Bath Other
Type of Construction (Usage Class): Occupancy Type: 12-
I-A,
Z1-A, 1-B ❑ II/III/V-A 0 II/III B, IV-HT, V-B Valuation: 1 (
Please check this box if the project is a
Project Size: Ex ress Standard ❑ Large ❑ Major ❑ second-story addition ❑
Please complete relevant portion of the Green Building
Checklist& attach it to the application or if applicable, Green Building Points Achieved:
include in plan set& the sheet index.
Revised 05/18/10