14060105 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10535 MADRONE CT CONTRACTOR:GR8WORK BUILDERS PERMIT NO: 14060105
OWNER'S NAME: SALLY CRAWFORD TRUSTEE 3570 HAVEN AVE DATE ISSUED:06/17/2014
OWNER'S PHONE: 8772284707 REDWOOD CITY,CA 94063 PHONE NO:(650)369-9675
XLICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIALE]
REMODEL(E)KITCHEN&REPLACE(E)ISLAND,NO
License Class_ Lic.# //lam STRUCTURAL CHANGES(204 S.F.)(SEE PLANS)
Contractor /JDate (J
I hereby affirm that I am licensed under the provisions of C pter 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
k
Eole
pensation,as provided for by Section 3700 of the Labor Code,for the
rmance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$117000
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:34261039 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 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 LA 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 co ssued b Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
r RE-ROOFS:
Signature Date 10 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.
F1AR
OWNER-BUILDER DEC ATION
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)
1,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, 3,and 2 534.
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 C„ O
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION \
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 \ ,
(408) 777-3228• FAX(408)777-3333•building cDcuperbno.org \�'\
CUPERTINO
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTER/A�TION/TIIjj ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROTECT ADDRESS /� `�/ / ® ! /'a e, - 4PN I �f
OWNER NAME A. / PHO - E-MAIL Q� OfAivl��>14611 A401;'#rA4t44 �/C
STREET ADDRESS CrrY, S TE,zip"'
I I FAIJ
CONTACT NAME 4k
PHONE
A _,_? Lj E-MAIL
STREET ADDRESS / � �} CITY,STATE,ZIP j- /< FAX
OWNER ❑ OWNER-BUII-DER ❑ OWNE)RAGENT CONTRACTOR CONTRACTOR A���GyyyENT ElARCHrrECT ❑sssENGINEER 1:1 DEVELOPER 13 TENANT
CONTRACTOR NAME iiW PY fi LICENSE NUMBER G/��sLICENSE TYPE ```��� BUS.LIC
COMPANY NAME /fJ( e1 '`E E-MAIL r le FAX
STREET ADDRESS �'te 4V`�� CITY,STATE,ZIP PHOt� / -/o—D�,7�
ARCHrrECT/ENGINEER NAME Vr LICENSE NUMBER BUS.L`IIC K b 7
COMPANY NAME E-MAIL FAX
STREET ADDRESS yyy CITY,STATE,ZIP . ! PHONE
DESCRIPTION OF WORK
f &
EXISTING USE PROPOSE USE CONSTR TYPE 1 #STORIES USE TYPE OCC. SQ.FT. VALUATION(S)
EXIST0 NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA /
BATHROOM &U CHEN OTHER
REMODEL AREA REMODEL AREA/ REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
ATTACH
�DWELLING UNITS: 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 ❑YESrCEIVED B ,,.x -fi TOTAL VALUATION: -
PLANNING APPLk E]NO PLANNING APPROVAL LETTER EICHLERHOME? ❑NO � M
a a v
By my signature below,I certify to each of the following: I am the pr�the
authorized aEter
n operty owne' ehalf. I have read this
application and the information I have provi is cone have read escription of Work an veccurate. I a o comply with all applicable local
ordinances and state laws relating to buil ' I a thorize r sentati of Cupertino to gntified property or nspec on purposes.
Signature of Applicant/Agent: Date: //
r
SUPPLEMENTAL INFORMATION REQUIRED PLhRCHECKZYPEw'i ,_ ouTmesL� '-
10New SFD or Multifamily dwellings: Apply for demolition permit or R TFI1lc0unTER � BIm Dir��LAr xEz�vi
existing building(s). Demolition permit is required prior to issuance i bulldmg s4 a' x � _" y x <�
permit for new building. �:L�? E pLANI�ING PLMJZEVT.E t; "
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure MWpusiLCwoxxsIMF
_ F
form if any Hazardous Materials are being used as part of this projects " � sc �mE DFPT R r
_Copy of Planning Approval Letter or Meeting with Planning prior to TAY sEvisTiucT
submittal of Building Permit application. � � x
��.�`.-`fes.' �-a";�, ..��,._:,�� �.. .�"-l.,s ENS'IROi\B1EAT:AT.,:HEA3yTF1... _�• t:
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10535 MADRONE CT DATE: 06/17/2014 REVIEWED BY: MELISSA
APN: 342 61 039 BP#: -VALUATION: $117,000
vPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM
USE: p PERMIT TYPE: A
WORK REMODEL E KITCHEN & REPLACE E ISLAND NO STRUCTURAL CHANGES 204 S.F.
SCOPE
p it
r t
th�tr. Plan Che, c Plrasrh. Plan t:kr�rel �let.1'ff� <.Yects
if_ch. I'' rwi(Fee: 11114,n/r. per;nit Fee,:
CJtir€ j=eclr. fr,,Vn_ C1t1rci Plumb Insrl. oihez°Liec.inn
11°cit. laa�r). Vee C'Ttarzr/r. Insp. 71cle. I;lec. lmso E Ie:
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 Dept for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.£ Remodel,Kitchen(<=300 sf)
Suppl.PC Fee: Reg. 0 OTO.D hrs $0.00 $626.00 IREMRESKIT
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-.(F) Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction )"UX.,
Alln ri4'trativc 1`''.. 0
Work Without Permit? 0 Yes (F) No $0.00 1 E)
Advanced Planning Eee_ $0.00 Select a Non-Residential G
Building or Structure 0
i'i t-�¢ tar t'fYe;'2f�X1t iY7
Fees:
Strong Motion Fee: IBSEISMICR $11.70 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $5.00
cm
a $16.70 $626.00 TOTAL FEE: $642.70
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: 1lJ & PERMIT# d O
OWNER'S NAME: PHONE# 3
GENERAL CONTRALTO BUSINESS LICENSE#
ADDRESS: fill CITY/ZIPCODE:
*Our municipal code requires a businesses working in the city to have a City of Cupertino busines icense.
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:
j/ 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
i�
Owner/Contractor gnature ate
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CONTILAETOR / SUBCONTRACTOR LIST
BuildiT,gDeparfnxent:
City of;cupeftina
10300 Torre Avenue.
Cupertino, CA 9501.4-3255
Telephone: 408-777-32281
Fax:408-777-33333
PERMIT 0 0'
IT
')B.,�,DDI: ESS: PERMIT
M �E: NE4
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14� =7
3-7)qERAI- CONTP-ACTOR: BIUJ S R,�ES S LICEN-S E
4 W1111f �-, 7
CIT� Zfj
,ZIPCODE: or, Cf f,
CITY' A
�DDRESS:
Dur municipal rode requires all businesses worl6ng in the ,city to have a Cjq of C.Rpertino businea jeense.
0 B(1,11,I)ING FINAL OR FINIAL OCCUPANCY INSPECTION(S) WI1,L BE SCHEDULED 'UNTIL THE
'ED A CITY OF CUPERTINO
NEIZ -ALL SUBCONTRACTORS HAVE OBTAIN
-41, CONTRACTOR AND
;IJSINESS LICENSE.
ain not using any subcontractors:
Signature Date
tv
i,l P n Q r, e-h t--r ic ann I irable subcontractors .a.nd complete the following information:
SUBCONTRACTOR
BUSINESS NAAIE
BUSINESS LICENSE
Cabinets & Millwork
Cement FL-ushin-
Excavation
,Flooring /Carpeting
Inc) h:=ii /Wood
Glass i Gtazing
Heating
Insulation
Landscaping
Lathing
\/Iasonry
Painting /'Wallpaper
Paving
Inc
flumbi
T: Y- A, P
S L4 D I
Roofincy
DD Is
Septic Taa-
I Sheet Metal
Sheet Rock
-Psni 0h-'%
Q;,14 401
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l'd . LL96 69C 099
bate'
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