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13060041 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22800 STONEBRIDGE ST CONTRACTOR:FARBEX PERMIT NO:13060041 CONSTRUCTION SERVICES OWNER'S NAME: BILL&JOAN BONIN 1093 KELLY DR DATE ISSUED:06/06/2013 OWNER'S PHONE: 4083430842 SAN JOSE,CA 95129 PHONE NO:(408)590-5410 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL[] License Class &2-624 Lie.# 1 R'__> REMOVE AND REPLACE 3 LIGHT FIXTURES,2 r rt SWITCHES, Contractor '\ Date FAN,2 FAUCETS IN BATHROOM I hereby affirm that 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:$8000 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:34213046.00 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 1 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 DAV LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, /n costs,and expenses which may accrue against said City in consequence of the Issued b W granti g of ermit. Additionally,the applicant understands and will comply Y Date: with 1 no of t source re ations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signatu�e Date'U b l 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. ❑ 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 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 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, s 5 5533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen Date. 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 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,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-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CONSTRUCTION.PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �" 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 5b CUPERTINO (408)777-3228•FAX(408)777-3333•building a)cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECTADDD©SS e APN# 2 -3 \t L 7T `l \n O ER NAME PHON E-MAIL �.� Lt ter.. %qZ 0a 4z STREET ADDRESS CIT ,STATE,ZIP CA FAX p 22800 �t ct>` CONTACT NAME PHON (cII E-MAIL '0 6 STREET ADDRESS CY, y4TE,ZIP FAX "OW R ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT ONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# ,QOMP4NY NAME E-M IL (^�,,�_�,• r X- q<-7 Q`',,�� J STREET ADDESS r �1�Y,STATE,ZIP t �rl P4H N - ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK Gf IC i A So V11q►Z;S EXISTING USE PROPOSED USE CONSTR.TYPE 1 #STORIES / USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA / AREA - AREA NET AREA 0 a 0 BATHROOM KITCHEN OTHER REMODEL.AREA REMODEL AREA REMODEL AREA PORCH AREA I DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY ❑YES BEING ADDED', I'N15— ADDITION? PRE—APPLICATION S IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES R'ECE "'" a = TOTAL�UATION; PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? N � �', a v v '"' F By my signature below,I certify to each of the following: I am the property owner or authorized ag to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin In In J—nstyction. I authorize r sentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: Q 01( SUPPLEMENTAL INFORMATION REQUIRED IF _New SFD or Multifamily dwellings: Applyfor demolition permit for OVER TE COUNTER` BIJtLp1VGFL§AN VIEWFs existing building(s). Demolition permit is required prior to issuance of build' ` a �� permit for new building. Ross' ` v rLAriNavrirxvP„ . _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure n D7 pLiCw�oiucsa form if any Hazardous Materials are being used as part of this project. _Copy of Planning Approval Letter or Meeting with Planning prior to $ � f submittal of Building Permit application. � MA1oR suvcTnRYSEwERDIsTR>C � � � �" �� � `' ��ENNVIRONMENTpI:'FIEA�`fil�a�?�€Y'•'' BldgApp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 22800 stoneridge DATE: 06/06/2013 REVIEWED BY: mendez APN: BP#: *VALUATION: 1$8,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Du lex PENTAMATION USE: p PERMIT TYPE: 1 REAP 1 WORK remove and replace 3 light fixtures 2 switches fan 2 faucets SCOPE REM Xfech.111a,-i Check Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check 0.0 hrs $0.00 1111/1.I}eralit Fee Plumb.Permit Fee: IPPERMIT Elec.Permit Fee: IEPERMIT Ocher•,Wc h.Insp. Other Plumb Insp. 0.0 hrs $45.00 Other Elec.Insp. 0.0 hrs $45.00 zW.ech. Msp. Fee: 1'lumib. hrsp.Fee: Elec.Insp.Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These-w are based on the prelimina information available and are only an estimate- Contact the De t or addn7 info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 0 # Electrical Suppl.PC Fee: Q Reg. 0 OT 0.0 I hrs $0.00 $45.00 1BREMRECEP Recep/Switch/Outlets PME Plan Check: $0.00 = Electrical Permit Fee: Hourly Only? ®Yes (E)No $0.00 $67.00 1 1BREMFIXT Fixtures,Lighting Suppl.Insp.Fee.0 Reg. 0 OT 0.0 1 hrs $0.00 2 # Plumbing PME Unit Fee: $0.00 $20.00 IBPFIXTURE Fixture or Trap PME Permit Fee: $90.00 Co nso-action Tax: Administrative Fee: IADMIN $42.00 Work Without Permit? 0 Yes (F) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) Travel Documentation Fee: 1TRAVDOC $45.00 Building or Structure i Strong Motion Fee: 1BSEISMICR $0.80 =hrs Inspections Bldg Stds Commission Fee: IBCBSC $1.00 $0.00 Inspection,Hourly $178.80 $132.00 _. �.. ��� $310.80 Revised: 04/29/2013 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION-CUPERTINO APPROVED This set of plans and specification UST be kept at the 2�-C,- job site durince o6iNMM!on"Ris`Gn7awful to make any _ chanops or alterations on same,or to deviate T11-1tWIfeftm, without approval from the Build*ng Official. of this plan and specifications SHALL NOT 1� F hold to permit or to be an approval of theviolation of any pr visions of any City Ordinance or Stat`L&A" "'%— DATE PERMIT NO. 2-9 3I4", 3-T' 8'-'10 314" / powl { - 60 r 9 I �- L ! �—i�ca : m y ?ote a Pcbe tco 31'\DC7 ��,,• r� z LIVING AREA C0PERTINO 179 sq ft Building Department Mt.. JUN 0 6 2013 REVIEWED FOR CODE COMPLIANCE Reviewed By: �°j�'