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13070199 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18760 NEWSOM AVE CONTRACTOR: (L C PERMIT NO:13070199 OWNER'S NAME: ROBERT CLEMMONS DATE ISSUED:07/30/2013 OWNER'S PHONE: 4083661066 PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class_ Lic.# v/ I�S� REMODEL(E)BATH(45 S.F.),INCLUDING ADD(N) ��"" VENTILATION&CEILING FAN,NEW GFCI AT(E) Contractor/' i Qepp�.Uate 3� OUTLET I hereby affirm that I am licensed under the provisions of Chapter 9 &REPLACE(E)WINDOW WITH SMALLER(WIDTH (commencing with Section 7000)of Division 3 of the Business&Professions REMAINS 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 rformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$15000 . Ak 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:37530011.00 Occupancy Type: permit is issued. r 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 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• 3 Ej 3 granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 2 ^ RE-ROOFS: Signature Date V o 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 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,an 34. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Dater 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 �\q� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 �O CUPERTINO (408)777-3228•FAX(408)777-3333•buildinp(a)-cupertino.org [:]NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINALPERMIT# PROJECT ADDRESS /� _ 15 APN# � �� �j I` ' O 1 t O J 0 � Cao �(' ./,I'1.s4 cs&J-,,- - 3106 ' Q 6,4, E-MAII. . STREET C ST TE,ZIPFAX CONTACT NAME CJ r+c.I�.0©� STREET ADDRESS .r, C ,STATE,ZIP , �jQ� FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT D CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT NTRACTOR NAME AIL_/d '! LIC S ES LICEJ$ YPE BUS.LIC# PAW4r c F /�M /1 /' D , FAX I e c��STRE PHOAto , q'O Q � C[ 70 ARCHITECTBNGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK ` • IBJ-- 1 AA 1 10 EXISTING USE PROPOSED USE CONSTR.TYPE #STORMS USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN ,r,� OTHER REMODEL AREA REMODEL AREA.~ 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! ❑NO ADDITION! []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OFis THE BLDG AN ❑YES - _ OTAL VALUATION: PLANNING APPL# 0N PLANNINGAPPROVALLETTER EICHLERHOME? ❑NO _ )CM � I J 0, 1 By my signature below,I certify to each of the following: I am the property owner or authorized agent to ac 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 relating to i g construction.,I orize representatives of Cupertino to enter the above-7 bove entified p operty for inspection purposes. Signature of Applicant/Agent: C Date: -� SUPPLEMENTAL INFORMATION REQUIRED N MIN '' New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building 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 - submittal of Building Permit application. BldgApp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 18760 NEWSOM AVE DATE: 07/30/2013 REVIEWED BY: MELISSA APN: 375 30 011 BP#: -VALUATION: $15,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY PENTAMATION 1 R3SFDREM USE: SFD or Duplex PERMIT TYPE: WORK REMODEL E BATH 45 S.F. INCLUDING ADD N VENTILATION & CEILING FAN NEW GFCI AT SCOPE (E)OUTLET& REPLACE (E)WINDOW WITH SMALLER (WIDTH REMAINS THE SAME) tilech.flan Check K7Phimb.Plan Check Elec.Plan Cheek q" A1ech.Permif Fee: P1-1, Permit Fee; I Elec. Permit Fee: Other:llech.Insp. Other Plumb Insp. Other Elec.Insp. ,/tech.Insp.Fee: I Plumb. Insp. Fee: Elec.Insp.Pee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelimMna information available and are only an estimate. Contact the Dept for addn'1 info, FEE ITEMS (Fee Resolution 11-053 E . 711/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F45-1s.£ Remodel,Bath(<=300 s f) Suppl.PC Fee: (F) Reg. ® OT 0.0 Ihrs $0.00 $626.00 IREMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Feer Reg. 0 OT 0.0 hrs $0.00 PME Unit Feer $0.00 PME Permit Fee: $0.00 Consouction Tax: A.dtninistrative.Fee: Work Without Permit? ®Yes No $0.00 0 Advanced Planning Fee $0.00 Select allon-Residential 0 Building or Structure Travel Uocutnentation Fees: Strong:Motion Fee: 1BSEISMICR $1.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 " 4 „ O pn $2.50 $626.00 =r ' $628.50 lit ,Revised: 07/01/2013 Y Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RT 1 N O Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST .= JOB ADDRESS: N PERMIT# OWNER'S NAME: PHONE# GENERAL CONTRACTOR: ® .p /l BUSINESS LICENSE# v7'JQ�rJ ADDRESS: a� CITY/ZIPCODE;- " '_: O9 *Our municipal code requires all businesses working in the city to have a City.of Cupertino-, usiness license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILi.L;BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE E OBCITY OF CUPERTINO BUSINESS LICENSE. m not using an subcontractors' ~ / '�© I a • g y -� -� Signature Date 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 Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date cop RTINO : � ul►dinA De artrteni -R, EVILEWE Z�RIfPLI E !<S • �✓ — I -- --' - - --- �y I - C , i i tE �- I ---- ' sT� NWe W t rid COM till I p _ ION R o PLO PLANS yet of o}�►Ts and-sem ica i ns US: b e € t --__­__________7, job$1i3 durum construct!on. It i� � t DATE - - -- rfrancses nr" lYsrations on same, _Vlrllytx�% WW -- thcr�ram,witfw icia - ------ - — nb r The stamp nc_of_this_pl --- -- bc ha' to permit or to an approval of the lis 9HAUViolation -_---_---- ---- - --_— of alp Ity tdinance or State Law.' - — - ---------- ---- -- ---- - PERMIT NO. 30