The URL can be used to link to this page

13090119 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21185 LAURETTA DR CONTRACTOR:ANTIQUE TERMITE& PERMIT NO: 13090119 PEST OWNER'S NAME: MCKEE LLOYD S AND KU YING-WEN 1913 STONE AVE DATE ISSUED:09/17/2013 OWNER'S PHONE: 4083187642 SAN JOSE,CA 95125 PHONE NO:(408)995-6300 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL II License Class TV r0— Lic.# K S d`t a— REPAIR OR REPLACE(E)4X4 STUD&RIM JOIST AT I', 03 GARAGE SIDE OF FRONT ENTRY Contractork�"A1A@TQ,�N4� Date �• 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:$300 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:32655019.00 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 WITIIIN 180 DAY IT 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 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 d granting of this permit. Additionally,the applicant understands and will comp suee' with all non- in ce regulations per the Cupertino Municipal Code,Section 9.18. ` •]7• - RE-ROOFS: Signature Date 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,Sectio5 5,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: t Date:O-J21A 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 inspectionpurposes.(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 >� LUPI=l2"t"thEt3 (408)777-3228•FAX(408)777-3333•building(a.cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESSLo ,c i ^ APN# L6 S S — 0 I Ci OWNER NAME / PHONE40b^ '6-16 1�) E-MAIL STREET ADDRESS`'(Gd� ' r ut<_"c Or CITY, ST T�ZIP �J uwo C4\ (.C)dol kl FAX CONTACT NAME t-u t S k oe;kP��„`/211 PHONE c,v��`7��6, `� E-MAIL STREET ADDRESS i � v CITY,STATE,ZIP l7 FAX Ci vn�KW_ i ��c 1 L5 13 ORNER ❑ OWNER-BUIIDER ❑OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT 1-1ARCHITECT El ENGINEER 11 DEVELOPER 13 TENANT CONTRACTOR N `\ UL LICE TIC6 E TYPE BUS.LIC#24 4 COMPANY NAME �e 1 E-MAIL FAX STREET ADDRESS �A CITY,STATE,ZIP PHONE r✓ 61— U� X55 63 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK cfgA {.� r-1 Mt O1 S1' Sc,�e T n Ce U' Q EXISTING USE PROPOSED UM CONSTR E I #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM Kn'CHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDETACH []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 YE _ - - r �' T T.AL VALUATTON- PLANNING APPL# F1 NO PLANNING APPROVAL LETTER EICHLERHOME? ❑NO By my signature below,I certify to of the following: I am the property owner or authorized agent to act on the property owner's behalf. I nave read this application and the information I ha vided 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 ing construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes., Signature of Applicant/Agent: Date: q- 17 13 SUPPLEMEN AL INFORMATION REQUIRED s .�P1:ANCHECJKT�YPE-�' �` - ��tOi7TI11G�LIP�.€.�_ New SFD or Multifamily dwellings: Apply for demolition permit for YEWTHFCO R '.,�_BUIL 'GYM existing building(s). Demolition permit is required prior to issuance of bulldmg � � permit for new building. Is - #LORE GYLAN:REV�EPSkF _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ySTAIdDARDoRxs form if any Hazardous Materials are being used as part of this project. = . gF EP _Copy of Planning Approval Letter or Meeting with Planning prior to ” - ` - OR� � SAlmARYS RDISTRI submittal of Building Permit application. • � �� ;,,�- ,�� ,, IF BldgApp_MLdoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS:21185 LAURETTA DR DATE: 09/17/2013 REVIEWED BY: MELISSA APN: 326 55 019 BP#: 'VALUATION: $300 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION USE: PERMIT TYPE: WORK I REPAIR OR REPLACE E 4X4 STUD & RIM JOIST AT GARAGE SIDE OF FRONT ENTRY SCOPE ME I ._ ffill 7 L1ech. Plan(.''heck Plyunb. Plan Check Elec.Plan(.,heck Permit Fee: Plumb. Permit fee: Elec. Permit Dice: Other Alech.Insp. Other Plumb Insp. Li Other Elco,Insp, Li Alech. Insp. Fe".. Plunth. hap.Fee: Elcc.Insp.Tee: NOTE:This estimate does not include fees due to other Departments(La 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 . 7/1/132 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure Suppl.PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: Hourly Only? ®Yes Q No $0.00 Suppl. Insp. Fee-(j) Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consirim.1ion Tax: Administrative T'ee: Work Without Permit? O Yes O No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential G TrUvel Documentation Fees: Building or Structure Strong Motion Fee: IBSEISMICR $0.50 2.0 hrs Inspections Bldg Stds Commission Fee: 1BCBSC $1.00 $278.00 ISTINSP Inspection,Hourly � 'Q $279.50$1.50 ,l . Revised: 08/01/2013