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13110180 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19711 PARKVIEW CT CONTRACTOR:SEARS HOME PERMIT NO:13110180 IMPROVEMENT OWNER'S NAME: BLACK-HOGINS WILLIAM.R AND KEIKO 1024 FLORIDA CENTRAL PKWY DATE ISSUED:11/27/2013 OWNER'S PHONE: 4089302758 LONGWOOD,FL 32750 PHONE NO:(925)245-2000 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL LJ COMMERCIAL License Class C-2-0100 Lic.# 7 7-13-7 REPLACE SINK AND FAUCET IN KITCHEN AREA, c- REMOVE Contractor vwr 1pm Date I 1 z7 AND REPLACE CABINETS I hereby affirm that I am licensed unser 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:$7270 Frti and will maintain Worker's Compensation Insurance,as provided for by n 3700 of the Labor Code,for the performance of the work for which this APN Number:31647011.00 Occupancy Type: tis issued. APPLICANT CERTIFICATION fy 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:agamst.said City in consequence of the Date: ���71 granting of this ermit. Additional( the licant unders d will comply Issued by: grg P Y, aPP�. with all non-point source regulations per the Cupert unicipal Code,Section 9.18. 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. ❑ O LDER 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 contractingwith 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 Mana t District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal ,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533, 5534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent. Dated r 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 CONS ION 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 aboveinformation 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)Agee.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 GENERAL PERMIT APPLICATION MEP is COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 `O CUPERTINO (408)777-3228•FAX(408)777-3333•building(a oupertino.o[g ` misc PLUMBING MECHANICAL [—]ELECTRICAL ❑`MISCELLANEOUS PROJECT ADDRESS 7/ / F 'c ti � APN# OWNE1j1`NL i"I I•r �G (1_� •2 C E-MAIL ` (` STREET ADDRE V I I C C-.. 0 G.AJ s©� FAX CONTACT NAME BERNIE MATHESON PHONE 925-245-2013 E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX 283 E. AIRWAY BLVD. LIVERMORE,CA 94551 925-245-2017 ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSENUMBER 721379 LICENSE TYPEB,C10 BUS.LIC# BERNIE MATHESON C17 C6 COMPANY NAME SEARS HOME IMPROVEMENT E-MAIL FAX 925-245-2017 STREETADDRESS 283 E. AIRWAY BLVD. CITY,STATE,ZIP LIVERMORE, CA 94551 PHONE 925-245-2013 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF SFD or DUPLEX ❑ MULTI-FAMILY PROJECT IN WB.DLAND ❑ YES PROJECT IN ❑YES IS THE BLDG AN ❑YES BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑NO EICHLER HOME? ❑NO DESCRIPTION OF WORK 1 Aj� r �G� _j �D_ Z l Z _jk-l) :5vQ1-- A-JI-) EAZE-C �-7 TOTAL VALUATION: 1} RECEIVED.B 6i By my signature below,I certify to each of the following: I am the property owner or authorized agent to act o th property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work it is te. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives pertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: EM$NTAL INFO I QUIRED OFFICE USE ONLY w OVER-TIE COUNTER ❑ EXPRESS ❑ STANDARD U P.,LARGE a ❑ MAJOR MEPMiscApp_201 Ldoc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 19711 parkview ct DATE: 11/27/2013 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$7,270 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 RPFIX USE: PERMIT TYPE: WORK re lace sink and faucet in kitchen area remove and replace cabinets SCOPE ;L1ech. Plan Check Plumb.PlanCheck 0.0 hrs $0.00 Elec.Plan Check Lleclt. Pe rmit Plumb.Permit Fee: IPPERMIT Dec. Permit(ee: r1fe,'h. ecFt.Insp. ther Plumb Insp. 0.0hrs $47.00 Other Elec.Insp. Insp. Fee: Insp.Fec;: Elco.Insp.Fee: NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F 2 1 # Plumbing Supp/.PC Fee: Reg. Q OT 0.0 hrs $0.00 $20.00 IBPFL TURF Fixture or Trap PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Feer Reg. 0.OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $47.00 Construction Tern: Administrative Fee: IADMIN $44.00 Work Without Permit? ®Yes Q No $0.00 0 Advanced Planning Fee. $0.00 Select a Non-Residential G Travel Documentation Fee: 1TRAVDOC $47.00 I Building or Structure ®� Strong Motion Fee: IBSEISMICR $0.73 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 m 2 RM10 $139.73 $20.00 - ' $159.73 Revised: 10/01/2013 r U Z U O �r C17) C tLO CLp rn Q Q F- = U o � w U O O :>Q CL ¢ Z (E) (E)(E) (E) (E) w (E) a I :E w O p¢C (} ([D(E)GD w o C%j co (E)PANTRY U (E)D/W TO (E)IGNITOR C) TO REMAIN D L. REMAIN (E)COOK-TOP TO REMAIN u, cn (N)SINK,SINK& (E) FAUCET HOOK-UP COMMUNITY DEVELOPMENT DEPARTMENT ,r BUILDING DMSION-CUPERTINO COUNTER-TOP (E)M/W APPROVED REPLACEMENT TO REMAIN °s Plans and specifications MUST be kept at the (E) :y job site during construction. it is unlawful to make any NJ changes or alterations on same, or to deviate (E)FRIDGE therefrom, without approval from the Building Official. TO REMAIN (E) = o e held to permit or to be an approval of th The Stamping of this plan and specifications SHALL NOT 0 CD o a be violztion Y ¢ of Any provisio sof any City Ordinance or State Law. (E) C ) w C-5 BY vt� <5 �2 o GATE._._[_2?.►3 PROPOSED °n < Fz-- PEI-,4T NO. I (f6 t KITCHEN DETAILr Q CL w CUPERTINO J l FFICE '060py Building I)enpi+tmen! T e�t OAT' 11.21.13 NOV 2 2013 SCAU NTS �'"'.•e DRAWN BY [)KW REVIEVVEi1 FOR CODE COMPLIANCE SCOPE COUNTER-TOP d06 TOP REPLACEMENT IN SAME LOCATION. 16470058A Reviewed By: INSTALL(N)SINK,(N)SINK&FAUCET HOOK-UP. S A-2 6 z U O 5 O M Q Lu C:) U C) _ O Q Lu (E) (E)(E) (E) (E) (E) LU CD o¢c (E)GD "' o (E)PANTRY --i i---i (E)D/W TO (E)IGNITOR z T N TO REMAIN i ° i REMAIN (E)COOK-TOP `" cc TO REMAIN w (E)SINK,SINK& (E) FAUCET HOOK-UP TO BE REPLACED o iJ yY s (E)MSN Lei TO REMAIN (E) y3 Z g (E)FRIDGE (E) z TO REMAIN cD o 0 c:) U � 3::mo (E) cT EXISTING eb < z KITCHEN DETAIL Q C- w J T n- cnU CUPERTINO I 9, �rml �L.,Idinc? D��partmPnt "^" 11.21.13 scuE NTS y NOV -7 2013 OMWN BY DKW SCOPE OF WORK: dI" 16470058A REVIEWED FUR CURE CGMP[_IAN('F COUNTER-TOP REPLACEMENT IN SAME LOCATION. INSTALL(N)SINK,(N)SINK&FAUCET HOOK-UP. Sxe�r A 1 /A / P