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10040154r ICITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19971 LA MAR DR I CONTRACTOR: TBD - TO BE I PERMIT NO: 10040154 DETERMINED JNER'S NAME: DAVE & LINDA WYCKOFF I I DATE ISSUED: 04/26/2010 I OWNER'S PHONE: 4082524707 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # ` Contractor I hereby affirm that 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. 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 -point source regulations per the Cupertino Municipal Code, Section 9.18. nature' l/ � Date C _i ❑ OWNER -BUILDER DECLARATION I hereby affirm that I 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 relating building construction, and hereby authorize representatives of this city to enter m 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 cc regulations per the Cupertino Municipal Code, Section 9.18. _.... .. Signature Date L—, PHONE NO: JOB DESCRIPTION: RESIDENTIAL 1J COMMERCIAL REMODEL KITCHEN CABINETS, COUNTERS AND APPLIANCES 3 OUTLETS NO LIGHTING Sq. Ft Floor Area: I Valuation: $10774 APN Number: 36910040.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: (/�i � 13 Date: 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 I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I 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 -45505, 25533, and 25534. Owner or authorized ageny., Date: `l— CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Profess CITY OF CUPEkT1NO CITY OF CUPERTINO ADDITION/REMODEL PERMIT APPLICATION FORM APN #/ ✓� o.oc) Date: l(_ `2C` ) Is a 2 nd unit being added? Yes ❑ No NIf yes, please fill out the permit application for 2" unit. Building Address: Mailing Address (if different from building address): Owner's Name: / '(("jj G. i VICXa L I� e Phone # : r7 Contractor: �^Phone #: Fax #: % '', ,,c Contractor License #: Cupertino Business License #: Contact: r`Phone -J< 1Z #: T Fax #: Building Permit Info: Bldg. ❑ Elect. Plumb. Mech. ❑ Hillside ❑ Job Description: Addition -What is being added?(Be Specific): What is being remodeled (not including addition)? K, 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 l , A3th Other Type of Construction (Usage Class): Occupancy Type: 1-A, 1-B IUIII/V-A ❑ IUIII B, IV -HT, V -B [s]� Valuation: �G �'� �� _ Please check this box if the project is a lsecond-story addition ElProject Size: Express ❑ Standard •, Large F] Major ❑ 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. ***For Office Use Only*** Over -the -Counter ❑ Revised 07/06/09 S"M11", CITY OF CUPEkTINO CITY OF CUPERTINO ADDITION/REMODEL FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type ADDITIONS 1R3SFDADD 1 PLLONGRNGR Long Range Planning/Residential PL 1 R3INSP Dwellings Inspections B 1 R3PLNCK Dwellings plan check B 1R3REPINSP Dwellings Repeat Inspection B 1 R3REPPLNC Dwellings Repeat Plan Check B 1R3HINSP Dwellings Hillside inspection B 1R3HPLNCK Dwellings Hillside plan check B 1R3HREINSP Dwellings Hillside Repeat Inspection B 1R3HREPLNC Dwellings Hillside Repeat Plan Check B 1 R3ALTINSP Dwellings Alternate Materials Inspection B 1 R3ALTPLNC Dwellings Alternate Materials Plan Check B 1 PCESS Cesspool P 1 PPRSEWG Ea. Private Sewage Disposal System P 1 PRSEWER Sewers P 1BPSPRINK Lawn Sprinkler/Backflow P 1BPWSVCS Main Water Service P 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICRE SeismicResidential B 1RER00FRES Residential Re -roof Each 100 SF B CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type 1 REMRES2 Remodel Residential Greater than 1000 sq ft B 1REMRES3 Remodel Residential Greater than 2500 sq ft. B 1REROOFRES Residential Re -roof Each 100 SF B REMODEL PLNCK 1 STPLNCK (1-3 for remodel) Standard Plan Check B NOT FOR OVER THE COUNTER PLAN CKS. WINDOW/SLIDING 1R3SFDREM GLASS DOOR 1 WINREP Replacement windows (ea 8 windows) B 1 WINNEWNSTR New Window (non- structural) B 1 WINMEWSTR New Window (Structural Shear Wall/Masonry) B 1 WINBAYSTR Bay Window (Structural) B SKYLIGHTS 1R3SFDREM 1 SKYL<10 SF Skylight less than 10 sf B 1 SKYL>10SF Skylight greater than 10 sf or structural B 1STAIRS Stairs -first flight/ea addt'l B / 1 EPERMITFEE Electrical Permit Fee E 1 MPERMITFEE Mechanical Permit Fee M ' 1PPERMITFEE Plumbing Permit Fee P 1 ELCPLNCK Stand Alone Electric Pln Ck (hourly) E CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type 1 MECPLNCK Stand Alone Mechanical Pln Ck (hourly M 1PLMPLNCK Stand Alone Plumbing Pln Ck (hourly) P 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICRE Seismic Residential B 1TRAVDOC Travel & Documentation B 1BUSLIC Business License B 7 ITEMS OF 7 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36910040.00 DATE ISSUED.......: 04/26/2010 RECEIPT #......... BS000010262 REFERENCE ID # ...: 10040154 SITE ADDRESS 19971 LA MAR DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER DAVE & LINDA WYCKOFF ADDRESS 19971 LA MAR DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: SylviaM COPY # : 1 RECEIVED FROM E. C. BUILDERS 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 ---------- 10,774.00 ---------- 1.00 0.00 1.00 0.00 1BREMFIXT NO. FIXTURES 1.00 63.00 0.00 63.00 0.00 1BREMRECEP NO. OUTLETS 1.00 42.00 0.00 42.00 0.00 0.00 1BSEISMICR VALUATION 10,774.00 1.10 .0.00 1.10 0.00 1BUSLIC FLAT RATE 1.00 114.00 0.00 114.00 0.00 1EPERMITFE FLAT RATE 1.00 42.00 0.00 42.00 0_00 1PPERMITFE FLAT RATE 1.00 42.00 ---------- 0.00- ---42.00 - - - TOTAL PERMIT ---------- 305.10 0.00 305.10 0.00 METHOD OF PAYMENT AMOUNT REFERENCE ----------- NUMBER ----------------- CHECK --------------- --------------- 305.10 4878 TOTAL RECEIPT 305.10 CUPERTINO JOB ADDRESS: CONTRACTOR / SUBCONTRACTOR LIST PERMIT # Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 OWNER'S NAME: , J , to 4 PHONE # S_.373 ^ (S;p �Z) GENERAL CONTRACTOR:6,141-17— Lki BUSINESS LICENSE # ADDRESS: . 50C1v fit. 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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: ' ��igrrature Date Please check applicable subcontractors and complete the following information: Owner / Contractor Signature Date 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 RESIDENTIAL PROJECT COVER SHEET 1. Assessor's Parcel Number: Name of owner. Project address. 1 Ct q r 1 f it,c, Mai- ,A Contact person. LL r In ice. �:-%v �' �G Phone. W'7C:7 Fax. Net square footage of lot. Square footage: First floor: Second floor Garage: TOTAL: Existing Proposed Are there at least two 10 foot by 20 foot clear spaces inside the garage? -Y-�_ Is privacy protection planting required for the project? ;uild it Green Total Points On what floor(s) is work being done? Brief description gf work. Code editions: 2007 CBC 2007 CPC Effective 1/1/08 (Ifs. oye - N)2007 CFC - N)2007 CMC (Y- N)`�`� N)2007 NEC - N) A: k f I I V I) ll. Ai i .., 1 � t 1 Fit t.ITY OF CUPI H I iN,) 1 A A )f ANI i( .HDINANCES DATE _ Z C— to SIGNED This set of plans and spec ifications MUST be kept on the job at ali tv1,ps and it is unlawful to make any changes or alterations on same without NrMerl permission from the Building Department, City of Cupertino. The stamping of this jd,w and specifications SHALL. NOT be. held to pern)it or to be an approval of the violation :.)f any provisions of any Crty Or(fin,ift( • ,,r ;tate Law. Plan Review Process Work Book Page -8-Revised 8/05/08 RL/£L d L 00 kv '-V Cl) AN �51 ort ,.6Z• - ---- co) RL/£L d L LL;LO R-O-OLOZ ort LL;LO R-O-OLOZ