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14060039CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20290 PACIFICA DR CONTRACTOR: G S HOMEBUILDER PERMIT NO: 14060039 OWNER'S NAME: DWIGHT AND YUKO TANAKA 10820 MINETTE DR DATE ISSUED: 06/09/2014 OWNER'S PHONE: 6262025170 CUPERTINO, CA 95014 PHONE NO: (408) 893 -0013 I LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E] REMODEL (E) KITCHEN (158 S.F.) & REMOVE (E) License Class_ Lic. # �? 2 23 FIREPLACE (NO EXTERIOR WORK) Contractor S H2614 d 21 -Date o 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. reby 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: $12000 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: 36944012.00 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 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 DAYS FR LED 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 comply with all non -point source re ulations per the Cupertino Municipal Code, Sec 918. RE- ROOFS: Signature Date 6 V All roofs shall be inspected prior to any roofing in 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, Sectio 505, 255 ,and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized ag Date: ®R4 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 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 918. Signature Date CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building0kupertino.org b� ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS S07Ro Pa •. Dr I 1pfto' APN# -36(j_4,r _0I2 OWNER NAME PHONE // )702 -SI7V E-MAIL STREET ADDRESS 2-02 0 jf (il vl & Dr• CITY, STATE, ZIP Q,, _H'n D I C q_9D I FAX v ' t (•,(E- CONTACT NAME l l� PHONE MAII,.7(J STREET ADDRESS CITY, STATE, ZIP FAX XOWNER ❑ OWNER- BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME (I JY„„ LICENSE NLIMBERn �� 2- -3 ( LICENSE TYPE BUS. LIC # COMPANY NAME S � I�' I E -MAIL Skn 12 rmI I. � FAX STREET ADDRESS CITY, STATE, ZIP PH �) S93 -ail ARCHITECT/ENGINEER NAME /r 1 LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK m cdQ t �, .. Re-mow � y C, S Vf /�\I I iA /lit l l Simle �V �,%/j ,o ` V � (�C l of kosme'tir_ mw wo r— EXISTING USE PROPOSED USE CONSTR. TYPE I # STORIES USE TYPE OCC. SQ.F'I'. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA �ps REMODEL AREA - PORCH AREA DECK AREA TOTALDECKIPOOORC .AREA GARAGEAREA: DETACH ❑ ATTACH # DWELLING UNrFS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? 0 ADDITION? TT` ; d" �� PRE - APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN c "" _ ALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? NO y �I' 0 `^ l By my signature below, I certify to each of the following: I am the property owner or authorized age act on the property own s behalf. ILhave read this application and the information I have ded is correct. I have read the Description of Work and it is accurst to comply with all applicable local ordinances and state laws relat' g uil S ction. I authorize representatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant/Agent: Date: s'�z15 2-01 Ll SUPPLEMENTAL INFORMATION REQUIRED )I .PLrx'CaECKk =f= ROUTINcSLIP, . New SFD or Multifamily dwellings: Apply for demolition permit for RT , OYHAz B1 L GPLANREVIEW `. existing building(s). Demolition permit is required prior to issuance of building , permit for new building. EXPRESS ❑ "NINGPLANREVIEw _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 31ANDARD El PbBLIC WORKS form if any Hazardous Materials are being used as part of this project. p El T.ARGE FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ SEWER DISTRICT ' submittal of Building Permit application. MAJOR SANITARY ❑.F"NVIRONMENTALHEALTH BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO VUU' UcmTn4 A rPnu — RTTTT .n1NC DIVICION LaADDRESS: 20290 PACIFICA DR DATE: 06/09/2014 REVIEWED BY: MELISSA APN: 369 44 012 BP #: "VALUATION: 1$12,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENMIT A ON 1 R3SFDREM PERMIT TYPE: i USE: $0.00 PME Plan Check: WORK REMODEL E KITCHEN 158 S.F. & REMOVE E FIREPLACE NO EXTERIOR WORK F-407 s.f. $418.00 Remodel, Other 1REMRESOTH SCOPE Permit Fee: NOTE: This estimate does notinetudejees uue to otheruepartments (i.e. rianning, r"MIG rrulna, 161G, 11-1.y -., !__ ____ .__1'__.___....._ ....,.,1..7.7.....,..7 nrn .,., 1.. n.i acfiwrnto /'nnfn/'f f%1P t)Pnl for addnl info. 1JWtrtt:t, Gtl+ . 1t[GJG a.. w/G Vwu.:w V.. w... .v..........• FEE ITEMS (Fee Resolution 11 -053 E . 711113) -•- .-- ••- . - - - - -- - -- --- FEE - - - - -- -- - QTY/FEE MISC ITEMS Plan Check Fee: $0.00 158 s. f. $626.00 Remodel, Kitchen (< =300 sf) 1REMRESKIT Suppl. PC Fee: (D Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 F-407 s.f. $418.00 Remodel, Other 1REMRESOTH Permit Fee: $0.00 Suppl. Insp. Fee :(E) Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 r'1s;?'TY11I71t1! "ctfi�'c' t'c,'E:" E) Work Without Permit? ® Yes No $0.00 Advanced Plarzning Fee: $0.00 Select a Non - Residential Building or Structure 0 Strong Motion Fee: 1BSEISMICR $1.20 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 fi _S $2.20 $1,044.00 TOTAL FEE: ` $1,046.20 Revised: 04/01/2014 /_ : � .. _ Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 C U P E RT I N O Fax: 408- 777 -3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: �� c�' �' '7>j,, ' -1'vtV PERMIT # . 1'10L003,9, OWNER'S NAME: 77VWkW we. PHONE # 4gP — 2/` - v GENERAL CONTRACTOR: &44e u Y BUSINESS LICENSE #, . ADDRESS: 2,0 tie CITY /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(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: Owner / Contractor Signature eG��2 ®ice Date 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 eG��2 ®ice Date Navr,es Wayne Nu � Lulu Uv� P�ddre�s 2s)2-go �bcif 6 Dr., no I �e -move c�ubfe ove►� �ho �V � r � 1� wa�� riven a� ��►) _Pace -fo S F�,-P-p lace (cos>rn��c, ally, no sfinlctuy-c-1 Nvov ) - Exists ( E ) •1a � l 04w Cox CU ERTIN UOPf iuildinq D °r?artment REVIEWED FOR (;()DE C;OMf LIANC'E AK i V / �.t V Kim CAIDX+ CUPERTINO X PI" uilding Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 .Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: 20a * pact' 6' 7>1-1 PERMIT NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) 1- (1'L;-1`B1k--fSGA1 ULED UNTIL THE -"7 OWNER'S NAME: 7"1)VV4e4 WA e H" PHONE 4 4;v Uff'r, 0 -f- 5? GENERAL CONTRACTOR: go "4 e J'. -BUSINE,�&Lt I am not using any subcontractors: ADDRESS: /q?—) 0 CA41) ,e CITY E V f "t—l" qn *Our municipal code requires all businesses working in the city to have;a: Ct irtj&'J0.',,usmess license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) 1- (1'L;-1`B1k--fSGA1 ULED UNTIL THE -"7 GENERAL CONTRACTOR AND ALL SUBCONTRACTORS DAVE CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: S t igna ure4 Date Please check applicable subcontractors And complete M6 following ,hl "t—l" qn SUBCONTRACTOR BUSINESS NAA1E LI CENSE Cabinets & Millwork 4awe- (d'; 4, -r'&' - 71,,2,� 431-t t -j,e- - k,;� � Cement Finishing Al Electrical /-f (d le'r Excavation 7, Fencing "'N Flooring Carpeting Linoleum Wood Glass Glazing Heating Insulation Landscaping .Lathing Masonry Painting Wallpaper Paving Plastering p Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner Contractor Signature.. Date