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13070146CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10395 MELISSA CT CONTRACTOR: HILL CONSTRUCTION PERMIT NO: 13070146 CO OWNER'S NAME: DAVID SMENTEK 1775 COASTLAND AVE DATE ISSUED: 07/23/2013 OWNER'S PHONE: 4085155703 SAN JOSE, CA 95125 PHONE NO: (408) 440-2831 ❑ JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIALE] LICENSED CONTRACTOR'S DECLARATION License Class Lie. # O�P�CI� KITCHEN REMODEL 150 SQ FT; TO INCLUDE DROP p� , C C��S�: C- l ' CEILING; REFRAME DOORWAY IN WAL SEPARATING Contractor Cli`i ck�o� Date DINING I hereby affirm that I am licensed under the provisions of Chapter 9 ROOM AND KITCHEN OPENING FOR 24"POCKET DOOR, (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 Sq. Ft Floor Area: Valuation: $23000 ,jxfformance 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 APN Number: 34245017.00 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 DAY F OM 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 —7 �7 granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: -20 with all non -point source regulations per the Cupertino Municipal Code, Section ROOFS: 9.18. /,� Signature `�.J Date. e�� — (� any r All roofs shall be inspected prior to y 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 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, 25533, and 25534. Section 3700 of the Labor Code, for the.performance of the work for which this � 3 �- 0 Owner Date: permit is issued. or authorized agent: V 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 O 1 (408) 777-3228 • FAX (408) 777-3333 • building(G)_cupertino.org CUPERTINO 0 ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/ TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PRQI� wC ss . \ S S �. APN # /J O f O 1(/�v� E O. J kC kkcs rm <_ �� :toot 5 ► T - 5 `� -,3 -� E-MAIL CIT,�,LTATku� � FAX S S (�� �Ol ET RES CONTACT NAME !�)A-4L, W `\ PIJQNE � � l -ll E �I��t�1(` Q., I&L '- `' d STREET ADDRESS 1*115- ,4. COOLS .I.a ,C, I 4%X0,$ +q0 ❑ OWNER ❑ OwNER-BUE,DER ❑ OWNER AGENT IKONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CO TORN ` LI -ENS�E LIC NSE TYPE BUS� Q COMPANY NAME F*Ov '40 - U;) rs I STREET ADDRES AC STATE, 7Ip '3 S �HO ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK/ U r -L ^ e �,- � ,� ✓� p � _ po U� [V \ ��� ' EXISTING USE I PROPOSW Usr. I w- ­_ iv , :" I n �=.,......, ' USE I TYPE I OCC. I SQ.FT. I VALUATION ($) ' EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER - REMODEL AREA REMODEL - REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH - # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ONO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES -- F - - TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO ©Q� By my signature below, I certify to each of the following: I am the property owner or authorip6d ag#Kp 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 an erify it is accurate. I agree to comply with all applicable local ordinances and state laws relating o bu m construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Date: Signature of Applicant/Agent: SUPPLEMENTAL INFORMATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for _ existing building(s). Demolition permit is required prior to issuance of buildin permit for new building. 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 M submittal of Building Permit application. r. BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FIRMFEE ESTIMATOR — BUILDING DIVISION im,ADDRESS: 10395 melissa ct DATE: 07/23/2013 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$23,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex 0.0 PENTAMATION PERMIT TYPE: 1 R3SFDRE i WORK kitchen remodel 150 sq ft; to include drop ceilin • reframe doorway in wal separating dining room and SCOPE kitchen opening for 24"pocket door, install 12 led Igiths under cabinet lighting, (2) 20 amp circuits; new© 7VnTl7. Thio nnii...nin dnno .-i-1-da inns duo in Mhor Donnrfmontc /i o Plnnnino_ Public Warkc_ Fir,_ .Sanitary Newer District. School T:..s..:..t ,.t.. 1 TG., ., F ., n /.nnnd ns. fhn nrnli.«i..nr,� :nfnr.nniinn nvnilnhlo and aro only nu octi»inl0_ Cnntact tho Dont fnr addn'1 Info FEE ITEMS (Fee Resolution 11-053 E . 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F_150__1 s.£ $626.00 Remodel, Kitchen (<=300 sf) IREMRESKIT Suppl. PC Fee: (D Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. ® OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conso-uction Tyra: Administrative 17ee: 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure 0 i 7i avel l�r�cumc ntutir�n Fees: Strong Motion Fee: IBSEISMICR $2.30 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $3.30 $626.00 $629.30 Revised: 07/61/20 13 vo A� r"'. 'I, U, n = Id Id eD e'V-> O Ci o x..�CD n m o a�P 9 a�Dw CD CDn f. b fD COAD 0 tTJ to tv W CD 0 CD �CD CD 0 t � Q K. yyry^9 N 2' C:) O 0 ¢ u�c o � �. � �• � O CTQ - �+ .01CD 17 ft? uq r - h. c-1 C ouC. C X411 Cl) mo � O cD � Y'CD- •, Ci A z x Q qQ r �o m D Z n o n� M Ct m . --i e'V-> o � co C m' 0 t Q n cn yyry^9 tr - L a c-1 Cl) = o -•1 A z x . --i o � co C m' 0 t Q n cn yyry^9 tJ - L a c-1 Cl) = o -•1 A z x Q O1 �o m CQ < a m o n� M Ct O ) ' 3 CD