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13070002CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6376 MYRTLEWOOD DR CONTRACTOR: T PERMIT NO: 13070002 ' a0, VSTj2 UC -7-7 OI U.f OWNER'S NAME: LAPIN ELEANOR J TRUSTEE DATE ISSUED: 07/01/2013 OWNER'S PHONE: 4083485548 PHONE NO: JOB DESCRIPTION: RESIDENTIAL COMMERCIAL[] ❑ LICENSED CONTRACTOR'S DECLARATION KITCHEN REMODEL, NO STRUCTURAL CHANGES. License Class Lic. # UPDATE ALL Contractor rv� Date MECHANICAL, ELECTRICAL &PLUMBING, INCLUDING. _�SLf I hereby affirm that I am licensed under the provisions of Chapter 9 APPLIANCES (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: $15000 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 36919010.00 Occupancy Type: 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 PERMIT EXPIRES IF WORU&NDLISTARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAY+ RMI ANCE 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 ED INSPECTION. 1 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of theIs ued by: Date: I granting of this pe t. Additionally, the applicant understands Land will comply with all non-po' s rce regulations per the Cupertino Municipal Code, Section 9.18. J, RE -ROOFS: to material being installed. If a roof is Signature A Datel All roofs shall be inspected prior any roofing 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 (See. 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 th upertmo Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance; as provided for by the Health & Safety Code, Sect' n 25505, 255TV and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: 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 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 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUFE�t INQ (408) 777-3228 • FAX (408) 777-3333 • buildingecupertino.org \ [:]NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION/ DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS ? %L M Y weep,/ APN # 3.6 - 19- -- 01 v OWNER NAME ' 4 �r / _ PHONE lry6Q yg h�j+ (' I o E MAIL STREET ADDRESS CITY, STATE, ZIP FFAX CONTACT NAME e MCA, A0kt)0(fVV4 `b Q Logoe 8-7 E-MAIL STREETADDRESS \jfi GCONIRACTOR CITY, STATE, ZIP _FAX \ENT ❑ OWNER El OWNER-BLUDER ❑ OWNER AGENT ❑ CONTRACTOR AG ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME `. LICENSENUMBER� C / 7�o J a l LICENSE TYPE1J v BUS. LIC# COMPANY NAME E-MAIL FAX STREET ADDRESSVJ CITY, STATE, ZIP Sq� -� b5to ' �l c, PHONE u ARCHITECT/ENGINEERNAME -7 LICENSE NUMBER BUS. LIC'#( COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK p `` EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EYISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA TOTAL DECK/PORCH AREA GARAGE AREA LIDETACH f-DECICAREA I ❑ ATTACH I #DWELLINGUNITS: ISASECOND UNrr ❑YES SECONDSTORY ❑YES BEING ADDED? []NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES-_:' - ` " - -. _ -�,�' TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? []NO � 'o By my signature below, I certify to each of the following: I am the property owner or authorized agent to arJAWSe property owner's behalf. I have read this application and the information I have p ided is co ct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to ing c s tion. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: j r3 SUPPLEMENTAL INFORMATION REQ UIREDgg­i PLAN CHECKTYPE��� k' _ .. d - <; Won—LIF„ „- <� "� VEIi THE CO TER _ �Q�1 E LI BUILDINGYLAN RE _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of buildingt� permit for new building.'® XPItESs - '*� 'INGAiYI2EVi,EW= TANN _ _-PE ¢`. _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure T .*nARn - l�Kruanacwo` form if any Hazardous Materials are being used as part of this project. Copy of Planning Approval Letter or Meeting with Planning pyior to _ MAJORAN - ' SER ISTRY submittal of Building Permit application. 04.. ,. =�w ^ ®_AENVIROi�TMENT'-.:`HEA'UTH aI`� B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FF.F. FCTIMATOR — RI1ILDING DIVISION im,ADDRESS: 6376 MYRTLEWOOD DR DATE: 07/01/2013 REVIEWED BY: MELISSA APN: 369 19 010 BP#: *VALUATION: 1$15,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex p 0,0 PENTAMATION 1 R3SFDRE i USE: PME Plan Check: PERMIT TYPE: WORK KITCHEN REMODEL NO STRUCTURAL CHANGES. UPDATE ALL MECHANICAL ELECTRICAL & SCOPE PLUMBING, INCLUDING APPLIANCES tech. Plan Check Xlech, Permit Fee: Chher Alech. Insp. Aleeh. Insp. Fee: NnTF,. Thic estimate does not MEN Plumb. Plan Check Plumb. Permit Fee: Other Plumb Insp. Elec..Plan Check Elec. Permit Fee: Other Elec. Insp, IPlumb. Insp. Fee: I Elec. Insp. Fee: fees due to other Departments (Le. Planninz. Public Works, Fire, Sanitary Sewer District, School -4-1 Contact the Dent for addh 1 info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/122 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 r 1-507 s.£ $600.00 Remodel, Kitchen (<=300 sf) IREMRESKIT Suppl. PC Fee: (F) Reg. 0 OT 0,0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 : (Amstruc-tion Tax: Adlnini,strative .Fee: 0 Work Without Permit? ® Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) i Travel Documentation Fees: Strong Motion Fee: IBSEISMICR $1.50 v G %i6• Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $2.50 $600.00 w_v O E $602.50 1-614 Revised: 04/29/2013 67/8 ,� Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 LM Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIS T° "' *Our municipal code requires—all businesses working in the city to have a City of Cupertino,business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SJURCONTRACTORS HAVE OBTAINED A •C:ITY OF CUPERTINO BUSINESS LICENSE. /571 r+ I am not using any subcontractors: c / I ignature 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 Owner / Contractor Signature Date JOB ADDRESS:/ Woo 1r. PERMIT # D 1' OOO OWNER'S NAME: �j�%gq,h p jn PHONE # GENERAL CONTRACTOR: JA BUSINESS LICENSE ADDRESS: © CITY/ZIPCODE: e *Our municipal code requires—all businesses working in the city to have a City of Cupertino,business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SJURCONTRACTORS HAVE OBTAINED A •C:ITY OF CUPERTINO BUSINESS LICENSE. /571 r+ I am not using any subcontractors: c / I ignature 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 Owner / Contractor Signature Date