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11020067 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10630 S TANTAU AVE CONTRACTOR: I5f!i �2�L 4 /f„, PERMIT NO: 11020067 OWNER'S NAME: REBECCA BESBRIS �/�,'j Gj(2,-p�W% /q C._ DATE ISSUED:02/16/2011 OWNER'S PHONE: 4089961697 , PHONE NO: L LICENSED CONTRACTOR'S DECLARATION F /_t� 2 BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# (� t 3 J 3 _ MECH F- RESIDENTIALF COMMERCIAL� Contractor�� V(:i'L�iYkZu,+ P&/ -(' Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:FILL IN DOORWAY AT KITCHEN LOCATION,INSTALL (commencing with Section 7000)of Division 3 of the Business&Professions NEW Code and that my license is in full force and effect. 220V ELECTRICAL LINE&ADD NEW COOKTOP 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. Sq.Ft Floor Area: Valuation:$8000 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:37537010.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. i // Signature Date —(� – �' Issued byy/? :'. Dater OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A”OR BETTER 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 performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I 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. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or aut*rized agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, cr and expenses which may accrue against said City in consequence of the Lender's Address g g of this permit.Additionally,the applicant understands and will comply with 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 FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 10630 s.tantau ave. DATE: 02/16/2011 REVIEWED BY: bobs. APN: :0 *VALUATION: $8,000 R�PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Du lex PENTAMATION 1 RMAP1 USE: p PERMIT TYPE: WORK fill in doorway at kitchen location install new 220v electrical line add new cookto . SCOPE Mech.Plan Check Fo.0 hrs $0.00Elec.Plan Check 0.0 1 hrs $0.00 Mech.Permit Fee: IMPERMIT "E:: e'er. �,E- Elec.Permit Fee: IEPERMIT Other Mech.Insp. 0.0 hrs $42.00 of "�N �, LJ Other Elea Insp. 0.0 hrs $42.00 NOTE. Thesefees are based on the preliminaty in ormation available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 09-051 Eff. 7'1/10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Mechanical Suppl. PC Fee: 0 Reg. 0 OT 0.0 1 hrs $0.00 $63.00 1BAPPLOT Other Appliance/Equip PME Plan Check: $0.00 0 Electrical Permit Fee: $0.00 $42.00 1BREMRECEP Recep/Switch/Outlets Suppl. Insp. Fee10 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $84.00 (,'fMN1t'M1i017 T('7X Acoustical Fee: 0 Yes (F) No $0.00 Work Without Permit? 0 Yes E) No $0.00 E) Planning f;ee: $0.00 Select a Non-Residential E) Travel Documentation Fee: ITRA VDOC $42.00 Building or Structure 0 A Strong Motion Fee: IBSEISMICR $0.80 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $127.80 $105.00 TOTAL FEE: $232.80 Revised: 01/15/2011 CITY OF CUPERTINO 7 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37537010 . 00 DATE ISSUED. . . . . . . : 02/16/2011 RECEIPT #. . . . . . . . . : BS000012730 REFERENCE ID # . . . : 11020067 SITE ADDRESS . . . . . : 10630 S TANTAU AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : REBECCA BESBRIS ADDRESS 10630 S TANTAU AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : DAVID LIGUORI 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 ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BAPPLOTHE NO OF APPLIAN 1 . 00 63 . 00 0 .00 63 . 00 0. 00 1BCBSC VALUATION 8, 000 . 00 1 . 00 0 .00 1. 00 0. 00 1BREMRECEP NO. OUTLETS 1 . 00 42 . 00 0 .00 42 . 00 0. 00 1BSEISMICR VALUATION 8, 000 . 00 0 . 80 0 . 00 0 . 80 0 . 00 lEPERMITFE FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 1MPERMITFE FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 . 00 1TRAVDOC FLAT RATE 1 . 00 42 . 00 0 . 00 42 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 232 . 80 0 . 00 232 . 80 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 303 ROUGH MECHANICAL 304 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY 502 FINAL PLUMBING ENERGY 503 FINAL MECHANICAL ENERGY 505 FINAL ELECTRICAL 507 FINAL PLUMBING 508 FINAL MECHANICAL Building Department City Of Cupertino ILE] 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: t , S Z4 4, 4-'-Z PERMIT# OWNER'S NAME: gae44&4 &6 S 32c PHONE# G f-v Sy'( -c C4 3 GENERAL CONTRACTOR: w' �&��o. )weAt.:.- BUSINESS LICENSE# 6 1-(3 3 8� ADDRESS: 7 0Lt Ac2 cl,�c CITY/ZIPCODE: Z44(a Z--3 *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 SUBCONT ACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: nature Date Please check applicable subcontractors and complete the following information: V 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 r, ner/6440`0-TSignature Date CITY OF CITY OF CUPERTINO GENERAL BUILDING CUPERTIN0 PERMIT APPLICATION FORM APN# -�-5- 7 ,-� `� Date: Building Address: `Q 630 s , 7� 74 ve Mailing Address (if different from building address): Are Hazardous Materials being used as part of this project? Yes ❑ No.4�1- HOA: (Exterior work only) Yes ❑ No/Ef If yes, provide letter from HOA If Residential.is house an Eichler? Yes ❑ Noa- If yes, needs planning approval. Owner's Nam Phone#: 12§iAA 13 45S 7 Contractor* Phone: 6so c e 8s' �� .✓ L'(2� .� Z;:, Fax: dr-a y t-/ord y Contractor License Cupertino Business License #: J Contact: Phone: -� Nov LC CU'JiL( I Fax/e-mail: Residential ommercial ❑ Job Description: r/14 /A; /PJ s It W A 1Z/kc.L sx. u a/t1 J C��K Za oe Building Permit Info: Bldg Q Elect ❑" Plumb ❑ Mech ❑ Type of Construction(Usage Class): Occupancy Type: -� 1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B B-- Valuation: Square Footage: Project Size: Counter E]--Ex ress ❑ Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building/LEED Checklist& attach it to the application or if applicable, include in plan set & the sheet index. Points Achieved: -6- For help, contact Build it Green at www.buildit reen.or Revised 12/06/10