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14030086 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21868 GARDENVIEW LN CONTRACTOR:ABLE SEPTIC PERMIT NO: 14030086 OWNER'S NAME: KAWASHIMA RICHARD K AND BELLA P O BOX 24819 DATE ISSUED:03/14/2014 OWNER'S PHONE: 4082520582 SAN JOSE,CA 95154 PHONE NO:(408)377-9990 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ f INSTALL(N)SEWER LINE AND(N)PROPERTY LINE& License Class^C Lic.# 6 S F UND TION CLEANOUTS. �/ Contractor /� ��L� S�p� �� Date 0 t.=[�[T�/ ��Q��/! 5�� 7 C Sys /f7lCJl�9�/ 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. SAN1TARYet_.,,.._1� 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:$6000 I have and will maintain Worker's Compensation Insurance,as provided for by 5 L Section 3700 of the Labor Code,for the performance of the work for which this APN Number:32619094 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 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 LAS LLED 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 granting of this permit. Additionally,the applicant understands and will comp Date: with all non-point source regulations per the Cupertino Municipal Code,Section 918. 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 1,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,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this P� L r o permit is issued. Owner or authorized agent:tf— Date: 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 V COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O� 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 1 CUPERTINO (408)777-3228•FAX(408)777-3333•building(5)cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION/TI ❑ REVISION/DEFERRED ` ORIGINAL PERMIT# PROJECT ADDRESS US t LL APN# I 0,9 OWNERNAME K kX`� PHONE STREET STREET ADDRESS FAXLaW06 {U\ CONTACT NAME ND PT' Gei nnnloabt e`h STREET ADDRESS YA�ZIP FAX =0 Rur 'Q§- t / Z Cu Its L061 �q2• Ino ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTORNAME C� LICENSE NUMBTG-ii� �n5 LICENSE q2 BUS.LIC# 2. �D/+��.� COMPANY NAME �� J EMAIL `/`.b1e .W f Aw FIbb' L\Ct2' STREET ADDRESS ! O 1"� TY,STA ZIP Q vI` PHONE VAD 9-yi ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS_LIC# COMPANY NAME E-MAH, FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK .mit S�� !!'�/�v •��✓ /erre � �!�//-tiJ �ecs� oo S Cil Gty� EXISTING USE PROPOSED US CONSTR.TYPE .#STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH'AREA I GARAGE AREA: DETACH ATTACH #DWELLING UNITS: IS A SECOND UNIT E3YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ONO PRE•APPLICATTON ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES TOTAL VALUATIOI�T�- PLANNING APPL# ❑NO PLANNING APPROVAL.LETTER EICHLER HOME? ❑NO a y ', �' /'��© Y By my signature below,I certify to each of the following: I am the property owner or au orized agent to a 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 building nstruction. I an representatives of Cupertino to enter the above-identified property for inspection purposes. Signature ofApplicant/Agent: Date: SUPPLEMENTAL INFO TION REQ D . ;`r,rI At~rEcln?c[ce ,.. xQUrpvc sL� New SFD or Multifamily dwellings: Apply for demolition permit for y " � � � ❑ Bi J"aDnTG rLA existing building(s). Demolition permit is required prior to issuance of buildirREVIEW permit for new building. XPRESSa ❑ DyG FLAx REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure TA1vDAR[i� ❑ PSC wo>txs„ form if any Hazardous Materials are being used as part of this project. LARGE ❑ FueE vEPT _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. f M`77,R Cl srNrrAxvSEWERDISTRteS I'..EbMROriMENTA HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21868 GARENVIEW LN DATE: 03/14/2014 REVIEWED BY: MELISSA APN: 326 19 094 BP#: *VALUATION: 1$6,000 xPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1RPS WORK INSTALL N SEWER LINE AND N PROPERTY LINE & FOUNDATION SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Sewer, Sanitary 1PRSEWER 1 # $24 TOTALS: ._ $24.00 A'k,01. Plan Plumb.Plan Check 0.0 hrs $0.00 L1P,z,r l:1 Fee: Plumb.Permit Fee: 1PPERA41T Other Plumb Insp. 0.0 hrs IJ:cr Ct:st1.IE:' Pizt+trh T rsj. f'cc: ti`°c.Insp. NOTE. This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS /h;n Check Fec: PME Plan Check: $0.00 his!)1-'Cc PME Unit Fee: $24.00 PME Permit Fee: $47.00 Administrative Fee: 1ADMIN $44.00 Work Without Permit? 0 Yes (E) No $0.00 ��il'(dP7t'£:'Ct-C�tL7Yt771Yt£j/'`f?E�S': Travel Documentation Fee: ITRAVDOC $47.00 Strong Motion Fee: 1BSEISMICR $0.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 mo-r $163.60 $0.00 TOTAL FEE: $163.60 �� Revised: 01/15/2014