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09110077 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10294 DEMPSTER AVE CONTRACTOR:KITCHENS BY MEYER PERMIT NO:091 10077 OWNER'S NAME: HANS&KATY PERRY 278 CASTRO ST DATE ISSUED: 11/13/2009 "WNER'S PHONE: 4082523610 MOUNTAIN VIEW,CA 94040 PHONE NO:(415)968-8318 Li LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL License Class Lic.# LJz3 67C/ J REMODEL 200 SQ FT TO KITCHEN WITH NEW CABINETS, Contractors N✓1?e ///Tty Date II I 4 APPLIANCES ELECTRICAL NON-STRUCTURAL 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. Sq.Ft Floor Area: Valuation:$2200 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 APN Number:32647072.00 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 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 Date: grantingof this permit. Additionally,theapplicant understands and will complyIssued by: -- 3.-- Z� with all non-point source regulati ns per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date �3 g All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection,1 agree to remove all new materials for inspection. OWNER-BUILDER DECLARATION Signature of Applicant: Date: 1 hereby affirm that 1 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) 1,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 1 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 the Health&Safety Code,Sections 25505 255)3,and 255 4. Section 3700 of the Labor Code,for the performance of the work for which this 1 Owner or authorized agent: 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,1 CONSTRUCTION LENDING AGENCY 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION As,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. .sting 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 a Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT# 00 -e— 69 'Fll e2O 77 OWNER'S NAME' e,r 5-0) PHONE # G ti GENERAL CONTRACTOR: FAX # I am not using any subcontractors: /113162,3, Signature ate 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 32647072 . 00 DATE ISSUED. . . . . . . : 11/13/2009 RECEIPT #. . . . . . . . . BS000009190 REFERENCE ID # . . . : 09110077 SITE ADDRESS . . . . . : 10294 DEMPSTER AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER HANS & KATY PERRY ADDRESS 10294 DEMPSTER AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : KITCHENS BY MEYER CONTRACTOR MEYER, ROMOND P LIC # 19637 COMPANY KITCHENS BY MEYER ADDRESS 278 CASTRO ST CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94040 TELEPHONE (415) 968-8318 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 2, 200 . 00 1 . 00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 2, 200 . 00 0 .50 0 . 00 0 . 50 0 . 00 1REMRESKIT SQ FEET 200 . 00 570 . 00 0 . 00 570 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 571 .50 0 . 00 571 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 571 .50 9520 --------------- TOTAL RECEIPT 571 . 50 CITY Of CITY OF CUPERTINO ADDITION/REMODEL C U P E RT I N O PERMIT APPLICATION FORM 4� APN# Date: 3z(o -47- o-7�- 11-1,3--D Is a 2" unit being added? Yes ❑ NoZ If yes, please fill out the permit application for 2° unit. Building Address: 1029/` Z-1" 1CKa V n Mailing Address (if different from building'address): Ow er's Name: y,._ Phone# Contractor- Phone#: /� 1tcne �e �f Fax#: (�'lfo K�f�he�sb me �r cvm Contractor License#: 323LX?1 Cupertino Business License#: Contact: ��) , Phone#: igl. a 14 p K� Fax#: Building Permit Info: Bldg. � Elect. 0' 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 Q' If yes list number of squares Remodel Includes Structural: Yes ❑ No 2— Do you have the pre-application planning approval? Yes ❑ No 0" If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen QOO Bath Other Type of Construction(Usage Class): Occupancy Type: I-A, 1-B ❑ IVlivv-A ❑ IVIII B, iv-HT, v-B Valuation: Please check this box if the project is a second-story addition ❑ Project Size: Express ❑ Standard ❑ Large ❑ 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 CITY OF CITY OF CUPERTINO ADDITION/REMODEL CUPERTIN© FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft ADDITIONS 1R3SFDADD 1 PLLONGRNGR Long Range PL Planning/Residential 1 R31NSP Dwellings Inspections B 1 R3PLNCK Dwellings plan check B 1R3REPINSP Dwellings Repeat B Inspection 1 R3REPPLNC Dwellings Repeat Plan B Check 1R3HINSP Dwellings Hillside B inspection 1 R3HPLNCK Dwellings Hillside plan B check 1R3HREINSP Dwellings Hillside B Repeat Inspection 1 R3HREPLNC Dwellings Hillside B Repeat Plan Check 1R3ALTINSP Dwellings Alternate B Materials Inspection 1 R3ALTPLNC Dwellings Alternate B Materials Plan Check 1PCESS Cesspool P 1PPRSEWG Ea. Private Sewage P Disposal System 1 PRSEW ER Sewers P 1 BPSPRINK Lawn Sprinkler/Backflow P 1BPWSVCS Main Water Service P 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1 BSEISMICRE SeismicResidential B 1REROOFRES Residential Re-roof Each B 100 SF CITY Of CITY OF CUPERTINO ADDITON/REMODEL CUPERTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft DECKS 1R3SFDADD OR 1R3SFDREM 1DECKWOOD Deck(Wood)-Each B (Each) 1 DECKRAIL Deck Railing-Each B (Each) GARAGES 1R3SFDADD OR DETACHED 1R3SFDREM 1GARDTW<=1K Wood Frame up to B 1,000 SF (each) 1GARDTM<=1K Masonry up to 1,000 SF B (each) 1 BCONSTAXR Construction Tax Res (new detached garage) PATIO'S OPEN 1R3SFDADD OR 1R3SFDREM 1PATIOWOOD Wood Frame up to 300 B SF 1 PATIOMETAL Metal Frame up to 300 B SF 1 PATIOOTHER Other Frame up to 300 SF B PATIO'S CLOSED 1R3SFDADD OR & SUN ROOMS 1R3SFDREM 1 PATIOENCLW Enclosed Wood up to 300 B SF 1PATIOENCLM Enclosed Metal up to 300 B SF 1 PATIOENCLO Other Enclosed Patio up B to 300 SF 1 COVPORCH Porch Covered-Each B (Each) REMODELS 1R3SFDREM 1 REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan �d 300 SF check 1 REMRESBAT Bath Remodel up to 300 B " SF 1 REMREOTH Other Remodel up to 300 B 66 SF ?.tN y n TCD CDi 7� Q. a \V O O y a o r-11I. 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