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13080011 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7591 KIRWIN LN CONTRACTOR: CV&,111 PERMIT NO:13080011 So/h/S "A)S72L-1-1e—T7o10 OWNER'S NAME: PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIP'T'ION: RESIDENTIAL❑ COMMERCIALO License Class_ Lic.# 01(P o2REMODEL 2(E)BATHROOMS(95 S.F).REMOVE /� DROPPED Contractor V prw,r' , 50,(\15 Date CEILING SOFFIT FROM HALLWAY TO LIVING RM AREA I hereby affirm that I am licensed under the provisions of Chapter 9 & (commencing with Section 7000)of Division 3 of the Business&Professions REFRAME CEILING AREA AT 8'.INSTALL 6(1)RECESSED 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:$20000 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:35921008.00 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 DAYS F ED 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 .Z granting of this permit. Additionally,the applicant understands and will comply Iss Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature DateaO N!) 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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*,vill 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 wit 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 ons 25 0 25533,and 25534. Section 3700 of the Labor`Code,for the performance of the work for which this Owner or authorized agent: 0.x__ 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 7 CONSTRUCTION PERMIT APPLICATION p` COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION % •+ 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 0 CUPERTINO (408)777-3228•FAX(408)777-3333•building cDcupertino.org "1 ❑NEW CONSTRUCTION ❑ ADDITION 9ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMTI'# PROJECT ADDRESSi 1 t C APN# �� 59 - - n O C OWNERNAME I S- STREET ADDRESSY, STATE,ZIP FAX ` CONTACT NAME PHONE &MAIL ` STREET ADDRESS ` -e C �STAy`ZI �� L i 1 FAX ❑OWNER ❑ OwNER-BUJLDER ❑ owNERAGENT ig'CONTRACTOR JtiONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CO OR NAME LICENSE NUMBER LICE E TYPE BUS.LIC# COMP ^ 1`) \ Q� \ & FAX STREET CITY,STATE,ZIP PH ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK 70 e_TS;2�_A\ EXISTING USE, PROPOSED USE. ONSTR TYPBd I #STORIES USE TYPE OCC. SQ.FT. VALUATION($) gtr i EXLSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NEr AREA BATHROOM KITCHEN OTHER t REMODEL AREA CIS REMODEL AREA REMODEL AREA I 1 PORCH AREA DECK AREA TOTAL DECK&ORCH AREA I GARAGE AREA: DETACH y'_'`� Q� MATTACH #DWELLING UNITS: `l/ IS A SECOND UNIT []YES SECOND_STTOORY []YES - BEING ADDED? I&NO ADDITION? ENO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES -- - TOTAL VALUATION: PLANNING APPL# ULNO PLANNING APPROVAL LETTER EICIII.ER HOME? NO 7 o O©O By my signature below,I certify to each of the following: I am the property own or authorize act onoperty 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 ate. I agree to comply with all applicable local ordinances and state laws relati to build co traction. I authorize representatives of Cupertino to enter the/above-identified property for inspection purposes. Signature of Applicant/Agent: Date: �D'�01' SUPPLEMENTAL INFORMATION REQUIRED _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 o ' 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: 7591 KIRWIN LN DATE: 08/02/2013 REVIEWED BY: MELISSA APN: 359 21 008 BP#: -VALUATION: $20,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 R3SFDRE WORK REMODEL 2 E BATHROOMS 95 S.F . REMOVE DROPPED CEILING SOFFIT FROM HALLWAY SCOPE TO LIVING RM AREA& REFRAME CEILING AREA AT 8'. INSTALL 6 (N) RECESSED LIGHT p Vlech.Plan Check Plumb:Plan Check Elec.Plan('heck L1sch.Permit Fee. Plumb.Permit Fee: Flec. Permit Fee: Olher A9ech.Insp. Other Plumb Insp. LL] Other Elec.Insp. b:lech. Plumb.hisp.Fee: Elec.Insp.Fee: NOTE:This estimate doesnotinclude fees due to other Departments(f.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Theseees are based on the prefindna information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS(Fee Resolution 11-053 E f 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel,Bath(<=300 sf) Suppl.PC Fee: Q Reg. ® OT 0.0 hrs $0.00 $626.00 1REMRESBAT .PME Plan Check: $0.00 F 111 s.f. Remodel,Other Permit Fee: $0.00 $418.00 1REMRESOTH Suppl. Insp.FeelD Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Con. ltwction :7 ux: Administrative fi ee: Work Without Permit? 0 Yes (j) No $0.00 G Advanced Planning Fee: $0.00 Select a Non-Residential E) TrUvel Documentation Fees: Building or Structure Strong Motion Fee: IBSEISMICR $2.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $3.00 $1,044.00 $1,047.00 Revised: 07/01/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone:408-777-3228 C U P E RT I N O Fax: 408=777-3333 CONTRACTOR/ SUBCONTRACTOR LIST. JOB ADDRESS: --) 15(11 i(-,,j ,J LA P,3 e. PERMIT# (. b 0 b ( OWNER'S NAME: e PHONE GENERAL CONTRACTOR: pal v;N ,n '`j % BUSINESS LICENSE# ( 1 u GSCi ADDRESS: q 6 L-\ L CIT Y/zI-PCODE..: y: l *Our municipal code requires all businesses working in the city to have,.a City of Cupertinobusiness license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S). 'WILL'BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND AL SUBCONTRACTORS.HAVE OBTAINED ACITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: _ co Signature Date Please check applicable subcontractors and complete the4ollowing:inf6irmatfi on SUBCONTRACTOR BUSINESS-NAME BI7SINESS 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 C� �- -..1 ' 30. Q f,? i :.._'.y � �...... ±— I I i 1 ori R I 4 _ K o I ..._ i I 1nl ( I i .... ! 1 . i. �. I i I t m I i I i ._.._ . I h _.- — - t► r4r ........ . _ h= i._:.__. _.... _..C- 1 ., ! 1_. ._ ....i.. ! ! _ I a..� _-._. .... i � - �.. i... I 1 ! 1 _.. _.__.. �..-....-.. . ... - -...._ l .......i. - - 1 _ ; I V1 + �...._ _ ..._ Va°�N1 (C_l .lo.... 1 ' c!� ` I 1 ►J CAC 1 1 I 1 1 _i I ! { rn i- k; L. ..... EIOM , LIN TY DEVLLOPtVENT 1 ..-..._ D ,_ RT ENT., .. i-._...., BUl INOi DrvilOi E " l I ER NO : { 1 I ..... hes set puns s Q aha _ v + i_. Jobs` .. ._ cifiie flans wiUST be kept at t..e j ur ction Itis urlla wf I t _ .. i. efros�n ia....o maks.an _ Ia eS d� �tC ra'ttOnS OCS T.. .._...-_ _ . I , w"�tho J sr I yt a ame,or to deviate tap r am ' st in h's pi In be s ¢f t , '�tfitatu �, t Ior o b an .a ;��..-.�..,,_...�..: .......�., to Building Department of any prov PProval of the violation 9 P rtment ity Ordinance or State Law. AUG 01 2013 DATE 7— / U � PERMIT NO. /3 REVIEWED FOR CODE COMPLIANCE 3 8o U/� Reviewed By: vl. P7 CJ� vJ+nv---N G> � �'� 4' 1Cat1J07 -—- — r t'-.\ —\ x Add W L - l`1r YSl 3 5 O - - -- .-� - _ - - TV I O COT 0 ! THE ART Of Bl I � "fir _ ...... -- - --�--- DECK LIU. J-1 � i I 1 Ct r. _- c aJ - I 2—t _ ._._ -- _........... _.._. 1 � t �"s''�AEiL@bn[ es .• .._.... -_ _ ........ I _....._...... . .. .___.. ___ ...... i LS I �y 1 i ' f deck pro c }-- s 2I 1 -� - --- --- - --- -• - --- .. _