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13060100 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23200 VIA ESPLENDOR#35 CONTRACTOR:MISSION VALLEY PERMIT NO:13060100 ELECTRIC INC OWNER'S NAME: GERARD MUELLER PO BOX 3332 DATE ISSUED:06/12/2013 OWNER'S PHONE: 6509654270 FREMONT,CA 94539 PHONE NO:(510)745-8847 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIALU License Class G f D Lic.# y 26 l 3 �—" (IN KITCHEN AREA ONLY)REPLACE 8 LIGHTING FIXTURES Contractor h, �A[�ap��atq 6 — f z L 13 &3 OUTLET RECEPTACLES AT KITCHEN COUNTER 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:$3500 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:34255020.00 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 DAY 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 b Date: u /,2'1 granting of this pe .' dditionally,the applicant understands and will comply y' with all non- oint urce egulations er the Cupertino Municipal Code,Section 9.18. � RE-ROOFS: Signature Date �" Z 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 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 Cu no Mu icipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance;as provided for by the Health&Safety Code,Sections 550 ,2553 and 2553 . Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: Z 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 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 �Ub 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 f� CUPERTIINO (408)777-3228• FAX(408)777-3333•build ingQcupertino.org 1 ❑NEW CONSTRUCTION ❑ ADDMON ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS APN# (,/ 2 `�S_ O 7,0 V/, 3Zpv 1/IP . �SPLE')Jyj I� VlL�pt 3 ` OWNER NAMEII.. PHONE E-MAIL M �1 - L iZ- G So - 6 S - YZ 7Z STREET ADDRESS CITY,STATE,ZIP FAX Cu �L�=f2 f fn} C�> CONTACT NAME PHONE E-MAIL rerz�aN-fa� �fN � Sl0-76)Y- 9Z-Z3 STREET ADDRESS $ CITY,STATE,ZIP Y Sv FAX Z Z'S 3a S 1 30 -fes w 2 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC# -7D 13Z C- la 333 COMPANY NAME r E-MAIL FAX fS`576 - STREET ADDRESS C CITY,STATE,ZIP PHONE Zzs3d 3¢� wsz - G� 9YSy 1514) -7y.-s- _7 V ARCHrTECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK �o✓r FXIS�r.-� L! /f%S /lam /%Z/�fE�l �r�� JG+�fL C�N INS / EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXLSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY []YES BEING ADDED? ❑NO ADDITION? [:]NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ElD`HY YES .= µ „� - �- �°P TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO By my signature below,I certify to each of the following: I am the property owner or ed agent to act o perty owner's behalf. I have read this application and the information I have pmVided is correct. I hUve read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin to ng constructs authorize representativ f Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: • Date: SUPPLEME14TAL INFORMATION REQUIRED � �s z New SFD or Multifamily dwellings: Apply for demolition permit for R- co�ivTE ; � sIJ1i.D�NG� "lus existing building(s). Demolition permit is required prior to issuance of building A fi permit for new building. r _Commercial.Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project _Copy of Planning Approval Letter or Meeting with Planning prior to I submittal of Building Permit application. roxs s s xI r - -�. BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 23200 VIA ESPLENDOR#35 DATE: 06/12/2013 REVIEWED BY: MELISSA APN: 342 55 020 BP#: '''VALUATION: $3,500 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration/Addition/ Repair PRIMARY PENTAMATION 1REAP11 USE: SFD or Duplex PERMIT TYPE: i WORK IN KITCHEN AREA ONLY REPLACE 8 LIGHTING FIXTURES & 3 OUTLET RECEPTACLES AT SCOPE KITCHEN COUNTER APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Fixtures, Lighting 1BREMFIxT 8 # $67 Recep/Switch/Outlets 1BREMRECEP 3 # $45 TOTALS: '' $112.00 1 11-01 X-A ;11ech.Flan Check .Plumb. Plan Check Elec.Plan Check"00rs $0.00 Lfcu.h.Perrnrt Fee: Plumb.Permit t'ee: Elec.Permit Fee: IEPERAffT C1tl7er;l9ech.Ins7z Other Plumb Insp. Other Elec.Insp. 0.0 Yrs $45.00 Tech.Insp.f ee: Plumb. hisp.Fee: Elec.Insp.pose: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These&es are based on the prefindna information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. Insp I7ee PME Unit Fee: $112.00 PME Permit Fee: $45.00 C'onstruction Tax: Administrative Fee: 1ADMIN $42.00 Work Without Permit? ®Yes (j) No $0.00 Advanced Planning fees: Travel Documentation Fee: ITRAVDOC $45.00 i Strome Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item. Bldg Stds Commission Fee: 1BCBSC $1.00 . ° $245.50 $0.00 . $245.50 �� . Revised: 04/29/2013