14020068CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10181 STERN AVE
CONTRACTOR- B"- TO' BE
PERMIT NO: 14020068
OWNER'S NAME:
DATE ISSUED: 02/12/2014
OWNER'S PHONE: 7735160812
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
KITCHEN REMODEL 130 SQ FT, (3) BATHROOM
q �3�
License Class \� Lic. # / 3�
REMODEL
//P.,i? ma" Date �
Contractor %/��Z��
210 SQ FT TO INCLUDE M. BATH, (2) HALL BATHS,
REMOVE AND REPLACE WATER HEATER M,E,P'S
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
Sq. Ft Floor Area:
Valuation: $70000
performance 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: 37511065 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 DOF 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 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
�, /p ��
Issued by: Date.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point sour re a ' ns per the Cupertino Municipal Code, Section
9 18.
RE -ROOFS:
Signa 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, Sections2550 , 5 3, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: 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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408)7 77-322 8 • FAX (408) 777-3333 • building
CaDcugertino.org
CUPERTINO
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OWNER NAME '".
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PHONE '7 / '_ �� ""(�d�(L
E-MAIL
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STREET ADDRESS
CITY, STATE, ZIP
FAX
CONTACT NAME
PHONE
E-MAIL
STREET ADDRESS
CITY, STATE, 21P
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT u CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER G
LICENSE TYPE j�
v
BUS. LIC #
COMPANY NAME
EMAIL / r/
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FAX
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STREET ADDRESS
CITY, STATE, V
PHONE4t4- 6
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y
ARCHITECT/BNGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESSCITY,
STATE, ZIP
PHONE
DESCRIPTION OF WORK
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3 o tjT le-
EXLSTIN SE
PROPOSED USE CONSTR
TYPE
11 STORIES
USE TYPE OCC.
SQ.FT.
VALUATION ($)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
REMODEL AREA
/DECK
KTTCHEN
REMODEL AREA I % b
OTHER
REMODEL AREA
PORCH AREA
AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: El DETACH
❑ ATTACH
#DWELLINGUNITS:
IS A SECOND UNIT ❑YES
SECOND STORY []YES
BEING ADDED? " ❑NO
ADDITION'. []NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
CE VED<
TOTAL VALUATION:
PLANNING ADPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
�G a
By my signature below, I certify to each of the followii am pr perry owner. or authorized agent to ac on the property owner's behalf. I have read this
application and the information I have provided is ec d th escri of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildin frac ' rep entatives of Cupertino to enter the above -identified property for inspection purposes.
JI
Signature of Applicant/Agent: _ ! ate:
SUPPLEMENTAL INFO TION REQUIRED
Civ [Nc {
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.
� �R _ s .;.-. •' N" NMEN :, ;:,IiR' �'Hr'ui"
BldgApp_2011.doe revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
liaADDRESS:
/ofgls stern ave DATE: 02/12/2014
APN: BP#:
REVIEWED BY: Mendez
*VALUATION:
1$70,000
*PERMIT TYPE: Building Permit
Plumb. Plan Check 0.0 hrs
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex
Remodel, Kitchen (<=300 sf)
IREMRESKIT
PENTAMATION
PERMIT TYPE: 1 R3SFDRE
WORK
kitchen remodel 130 s ft 3 bathroom remodel 210 s ft to include m. bath 2 hall baths m e 's
SCOPE
remove and replace water heater
PME Plan Check:
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 nreliminary information available and are only an estimate. Contact the Dept for addh7 info.
FEE ITEMS (Tee Resolution 11-053 Eff 711/13,)
a
QTY/FEE
MISC ITEMS
Plan Check Fee:
Plumb. Plan Check 0.0 hrs
$0.00
=`-c, Man Ch,clr
Remodel, Kitchen (<=300 sf)
IREMRESKIT
Plumb. Permit Fee:
IPPERMIT
f,;iFc Prr7,zr i"«e:
�h'r fr�i. 1vd,rr3
PME Plan Check:
Other Plumb Insp. 0.0 hrs
$47.00
odwl= 1 1<>r_ imp,
hr,P' f",C °
Phantb. hap. Pce'
$0.00
Ivlrc. Ins, 1` <:e'
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 nreliminary information available and are only an estimate. Contact the Dept for addh7 info.
FEE ITEMS (Tee Resolution 11-053 Eff 711/13,)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
130 s.f.
$626.00
Remodel, Kitchen (<=300 sf)
IREMRESKIT
Suppl. PC Fee: (j) Reg. 0 OT
0.0hrs
$0.00
PME Plan Check:
$0.00
= s.£
$626.00
Remodel, Bath (<=300 sf)
1 IREMRESBAT
Permit Fee:
$0.00
Suppl. Insp. Fee:Q Reg. ®OT
0,0
hrs
$0.00
0 # Plumbing
$28.00 IPRWHEATR Water Heater
PME Unit Fee:
$0.00
Permit Fee:
$47.00
//PME
L"/)nS1t'i/i"Tion T1OV.
Administrative Fee: IADMIN
$44.00
0
E)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
i
Travel Documentation Fee: ITRAVDOC
$47.00
Strong Motion Fee: IBSEISMICR
$7.00
Select an Administrative Item
Bldy, Stds Commission Fee: IBCBSC
$3.00
ri - y
$148.001$13280.00
TOTAL FEE:F
$1,428.00
Revised: 01/15/2014
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: , R- 5fe4,h
PERMIT #
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR: kffo14"BUSINESS
LICENSE #
ADDRESS: eCq7 44-, �. C—..f J
C.4fr/ TY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION($). WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
V
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
3
scope of work: k-�� -e.;YPly ka
3 bath room remodeling Y
kitchn remodeling
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a;klosgs water heater install
sturcture, change or layout change
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scope of work: k-�� -e.;YPly ka
3 bath room remodeling Y
kitchn remodeling
t I . P2,
e ipp
a;klosgs water heater install
sturcture, change or layout change
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43'1
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10181 Stern AVE
scope of work:
3 bath room remodeling
kitchen remodeling
repiping
tankless water heater install
NO sturcture change or layout change
IKEA Home Planner Printout Page 4 of 14
Stern - Plan View
0000-5685-5414
Ave -
C C, 9 4",
All measurement in inches
4 al
GO
http://kitchenplanner.ikea.com/US/UI/Pages/PrintoutsNPUISummaryPrintout.htm 1/31/2014