14030042CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 8083 PARK VILLA CIR
CONTRACTOR: PLO",, 4L_�_ I PERMIT NO: 14030042
OWNER'S NAME: DONNELLY JOHN A AND MARY S ' I DATE ISSUED: 03/06/2014 I
OWNER'S PHONE: I , I PHONE NO:
9 LICEENSED CONTRACTOR'S DECLARATION
License Class / !�l j�,� Lic. # 61 5"1. 6 Kg _
Contractor J/ of L[. ! N', r SrvaiOVDate J
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
ISCompensation, as provided for by Section 3700 of the Labor Code, for the
J 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
permit is issued.
APPLICANT CERTIFICATION
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source re lations per the Cupertino Municipal Code, Section
9 18. N
Signature ' Date
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
JOB DESCRIPTION: RESIDENTIAL [—] COMMERCIAL
KITCHEN REMODEL (130 S.F.) REPLACE CABINETS,
PLUMBING FIXTURES, ADD BACKSPLASH, (N) LIGHT
FIXTURES & DEDICATED CIRCUIT FOR DISHWASHER
Sq. Ft Floor Area: I Valuation: $14008
APN Number: 35610077 00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS F ALLED INSPECTION:)
Date:
— RE-ROOFS:
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.
Signature of Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health &Safety Code, Section 25 05,25 J3 . nd 25534._
Owner or authorized agent: Date
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
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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
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.
Signature Date
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
�Lv
ItsCONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
GUI ERT NO (408) 777 -3228 • FAX (408) 777 -3333 • building(a_)cupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION TT_RATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS WO V3 3 Puri- k Vu i u C Ir AM # 3
r
OWNERNAME MI /I I n f, 11 U PHONE/ J /t 12S2 `�/ !� E MAII
STREET ADDRESS (`�/ �O(�� 3 P� r K kA l -1-f
(� CI �. STATE ✓.� �rJ� G s Ob`(� FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY, STATE, ZIP FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME ,�A- IR tr LICENSE NUMBER , 6 n LICENSE E BUS. LIC#
COMPANY NAME I I . E.MAIL FAX
t s�r+1G
STREET ADDRESS ) J t�. CITY, STATE, ZIP PHO I / 2-L 75
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # Ir
COMPANY NAME E -MAIL FAX
STREET ADDRESS CITY, STATE, ZIP PHONE
DESCRIPTION OF WORK J
�ilo -�'u:c41 � rtcX C&4( TS C n'i-P1's
wQE
EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES
USE TYPE OCC. SQ.FT. VALUATION ($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA 13o
BATHROOM KITCHEN OTHER'
REMODEL AREA REMODEL AREA 130 REMODEL AREA -
PORCH AREA DECK AREA TOTAL DE CK/PORCH AREA I GARAGE AREA: DDETACH
❑ ATTACH
# DWELLING UNITS: IS A SECOND UNrr ❑ YES SECOND STORY ❑ YES
BEING ADDED? ONO ADDMON? ❑NO
PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES D' OTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO O O
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act 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 ' in cons on. I authorize resentatives of Cupertino to enter the above-id nyfied r perty for inspection purposes.
Signature of Applicant(Agent: Date:
SUPPLEMENTAL INF. `ETON REQUIREDE
_ New SFD or Multifamily dwellings: Apply for demolition permit for A r�
4 �
existing building(s). Demolition permit is required prior to issuance of building
m� id f
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.
T.r
_ Copy of Planning Approval Letter or Meeting with:Planning prior to
his
submittal of Building Permit application. 9
B1dgApp 2011.doc revised 06121111
� �� w, � CITY OF CUPERTINO
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NOTE: This estimate does not inctuae fees aue to otner ueparrments (l e. ctunrnag, ruuUL .....nom, < .• ,�...• .., - -� -.
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FEE ITEMS (Fee Resolution 11 -053 Eff 7/1/13)
ADDRESS: 8083 PARK VILLA CIR
DATE: 03/06/2014
REVIEWED BY: MELISSA
Plan Check Fee:
APN: 356 10 077
BP #:
*VALUATION: 1$14,008
YPERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Du lex
p
PME Plan Check:
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
USE:
Permit Fee:
$0.00
WORK
KITCHEN REMODEL 130 S.Fj REPLACE CABINETS PLUMBING FIXTURES ADD BACKSPLASH
SCOPE
(N) LIGHT FIXTURES & DEDICATED CIRCUIT FOR DISHWASHER
Ak":T. !'lrzt'r Chc: k
4iPch. i'Prrttrt P'ee:
Phunh. Alert Checl,
I�ifIt?2 J?. ry,.�PiZei t''c'E':
Other plumb /PtsF?
? l° w Chcck
Thirnh. �'CV
NOTE: This estimate does not inctuae fees aue to otner ueparrments (l e. ctunrnag, ruuUL .....nom, < .• ,�...• .., - -� -.
__1_i7_ ..._,t . ..t.. f;....t, ! ntitnnt tho Dont fnr addn'L infix
"Istrlct, etc. ). / neXL leva ure uu3eu vic snc
FEE ITEMS (Fee Resolution 11 -053 Eff 7/1/13)
FEE
- - - - -- -
QTY /FEE
-- -- - - -- - -
MISC ITEMS
Plan Check Fee:
$0.00
130 s.f. Remodel, Kitchen (< =300 sf)
$626.00 IREMRESKIT
Suppl. PC Fee: E) Reg. ® OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee: Reg. ® OT
0.0
[hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
C012StrWC11. on, -ct :,:
,r r,�irli.4Frrrritie FCC,:
0
Work Without Permit? ® Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure 0
�
�t °L,t s_'t �)O, i?fl' ?e';7ftrlt)Yt /`t'.(;S':
Strong: Motion Fee: IBSEISMICR
$1.40
Select an Administrative Item
Bldg Stds Commission .Fee: IBCBSC
$1.00
$2.40
$626.00 TOTAL FEE:
$628.40
Kevisea: u it,z)tzu i4
NAME -
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Ca�iwcs% CO
MAR 0 6 2014
BY
CUPERTINO
f3uildinq
Denartment
REVIEWED FOR CouF: COMPLIANCE
Reviewed By.
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Tt O1, F\CE
07/11/14 02:14PM PDT '9166470483' -> 4087773333 Pg 3/3
Building Department
City OfCuhertino
10300 Torre Avenue
Cupertino, CA 91014 -325.5
Telephone: 408- 777 -3228
C U P E RTI NO Fax: 408- 777 -3333
CONTRACTOR / SUBCONTRACTOR LIST
.SS: 809 -fir - i l i t r ii7
Or J013 ADDRESS:
OWNER'S NAME: eK
PERMI "I` fa 7�%�fC�
PI.1ONE # C7c? - .2 0S_
BUSINESS NANIE — _
BUSINESS LICENSE #
GENERALCONTRACTO. 'n e �Or'I _ YuC !bn
ADDRESS: 13y;r 6tir! UP. - SIC -t1v rV 9S
BUSINESS LICENSE-'# 95-96 1e6
CITY /LIPCOUL: yS
"Our municipal code requires all businesses work Ing in the city go have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL, THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS 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:
✓
SUBCONTRACTOR
BUSINESS NANIE — _
BUSINESS LICENSE #
Cabinets & Millwork
YIX -�
Cement Finishing
Electrical
Excavation
Fencing
�L/A
( I
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
t t
Insulation
t �
Landscaping
- -...w. - _.. ............... , ........ , .
d
Lathing
t
Masonry
( l
--
Painting / Wallpaper
t t
_..._...._.
Paving
, i _...._,
.._._
Plastering .�_.
9 � _.._._._......_..,.,_
Plumbing
I r
Roofing
t
--
—
Septic Tank
- - -- -- . -- .......�._
-
Sheet Metal
t 1
Sheet Rock
< /
..__.,.
Tile.._..._��...__._T-
`•(--- ,__...._......._�_..._._...__
Owner J Contractor Signature Date