14050062 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7656 NORMANDY WAY CONTRACTOR:HARRELL REMODELING PERMIT NO: 14050062
INC
OWNER'S NAME: JABRI CLARICE M TRUSTEE 1954 OLD MIDDLEFIELD WAY DATE ISSUED:05/08/2014
OWNER'S PHONE: 4086740705 MOUNTAIN VIEW,CA 94043 PHONE NO:(650)230-2900
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL F]
KITCHEN REMODEL 105 SQ FT,DINING ROOM REMODEL
License ClassLic.4 TO
INCLUDE (E)275 SQ FT
ContractorDate 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.
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:$76800
1 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:36617055.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify that 1 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 --q
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS F976M LAST CALLED INSP C ION,
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 Issued by; i Date;---
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
p 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,1 agree to remove all new materials for
inspection.
❑ O 'N ALDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,SectiofrEN
and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this 5—�
permit is issued. Owner or authorized agent: Dater
I certify that in the performance of the work for which this permit is issued,1 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,1 CONSTRUDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,1 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(See.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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the 1 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 a
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �A
0�
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 0(1
CUPERTINO (408)777-3228•FAX(408)777-3333•building guoertino.org I �V/
❑NEW CONSTRUCTION ❑ ADDITION LTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS � w 1� APN# ��
OWNER NAME 'V PHONE E-MAIL f?!f
GL.,A2lC.r JfrC'aQ•1 (po'7�k. 0'70GJp�� C0 mat I • CaM
STREET ADDRESS 776 5(o WoKm�D W A-J CITC_vPEG I`�T(NO C,t� G) t L.4 FAX
CONTACT NAMEp7 t.►� ele"� PHONE ' /no�n Q n� E-MAIL.. 0m
STREET ADDRESS i9 5 4 Ouc> rtivw-cs RV-V teal CITY,STATE, ZIP mo uWP&A" V*J-0 FAX
OWNER 11OWNER-BUILDER 11 OWNER AGENT CONTRACTOR 11CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME neuDL LICEUSE N M lJ LICENSE PE BUS.LIC# /I y
19 1
COMPANY NAME LM -EE--M'AIIL FAX ` 1
�elMop61..1t4 U Ips-230 12•�rol
STREET ADDRESS CITY,STATE,ZIP PHONE
lq LD MIS 10 LJ/4 th/Ml7�h T_1" l P4 V tE U4 AyotJ S (o • 230 19 00
ARCHITECT/ENGINEER NAME �^�w n LICENSE NUMBER BUS.LIC#
COMPANY NAMEx• +�V�•y E-MAIL FAX
n�
2 E Rcwo Eunl ?.,;�o - o
STREET ADDRESS I C, O tDoLE",�JL 4)A"( MO
STATE,ZIP v) r f�"�To�3 PHONE -2 30•-2100
DESCRIPTION OF WORK R
+sy vu C,&-L, Yze+O
EXISTING USE PROPOSED USE CONSTR.TYPE 1 #STORIES
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER g
REMODEL AREA REMODE Ad�A REMODEL ARE/t
PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGE AREA: DETACH
❑ATTACH
#DWELLING UMTS, 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 RECFIVP,4-_R ; "^<,,, TQ�b�VU Ttl ION:
PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO - !/(O (6i`f�7
f
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 1 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 b di n cfon. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTA ON REQUIRED
]PLAN 6 C4 TYPEROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for "m
HE-
existing building(s). Demolition permit is required prior to issuance of buildi g QUER"T CouNTivR, ❑ BUILDING PLANREVIEV4
permit for new building. Q EXPRESS i ❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD El PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE ❑ FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 7656 Normandy way DATE: 05/08/2014 REVIEWED BY: Mendez
APN: BP#: / QS(�G7 `VALUATION: 1$76,800
PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1R3SFDRE
USE: PERMIT TYPE: i
WORK kitchen remodel 105 sq ft dining room remodel to inclue e 275 sq ft
SCOPE
ELI
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee1?esolulion l l-053 Eff7%l/l_i) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 105 s.f. Remodel,Kitchen (<=300 sf)
Suppl. PC Fee: (j) Reg. 0 OT 0.0 1 hrs $0.00 $626.00 IREMRESKIT
PME Plan Check: $0.00 275 1 s.f. Remodel, Other
Permit Fee: $0.00 $418.00 IREMRESOTH
Suppl. Insp. Feer Reg. Q OT Fo.o hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
0
Work Without Permit? 0 Yes No $0.00 E)
Advanced Plannin, Fee: $0.00 Select a Non-Residential E)
Building or Structure 0
i
Strong Motion Fee: IBSEISMICR $7.68 Select an Administrative Item
Bldg Stds Cornmission Fee: IBCBSC $4.00
SUBTOTALS: $11.68 $1,044.00 TOTAL FEE: $1,055.68
Revised: 04/01/2014
08/1812014 12:38 Harrell Remodeling, Inc.
CUPERTINO
TAX) P.001
CONTRAC'T'OR /SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Tone Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS:
9
PERMIT # /vp Y—o o G
OWNEB.'S NAME: ge
- e 1,.-,•d
PxoNB # 4�p3 v Lo
GEMM A.L CONTRACTOI :
j r a R -C
BUSINESS LICENSE #
ADDRESS: 1
/�'�t�lLt �'ia L✓ c,,
CITY/ZIPCODE: 9T V3
*Our municipal code requires -all businesses workingin the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULXD 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 subcoAtractors and complete the following information:
✓
SUBCONTRACTOR
BUSMSS NAME
BUSINESS LICENSE#
Cabinets & Millwork
Cement Finishing
Electrical
-S'¢°S �'��c7t-��
3 y V►r�d' �y
Excavation
_
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
,, , •
oZ d 4 3
Insulation
Landscaping
Lathing
Masonry
,/'Painting
/ Wallpaper
TA.,, i4 i,,,yj - ��p� : r C•
�c b'YA3i-/.C,r S` f r
Paving
Plastering
Plumbing�-
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
FILE
INSULATION CERTIFICATE Zi IC-1
NumS
city
County Subdivision Lot Number
Description of Installation
1. ROOF
Material Brand Name
Thickness(inches) Thermal Resistance(R-Value)
2. CEILING
Batt or Blanket Type_ C4 �r _ Brand Name
Thickness(inches) 9 1p ,P j� Thermal Resistance (R-Value) Ra
Loose Fill TypeBrand
Contractor's min installed weight/ft2 Ib. Minimum thickness inches
Manufacturer's installed weight per square foot to achieve Thermal Resistance(R-Value)
3. EXTERIOR WALL
Frame Type
A. Cavity Insulation
Material Brand Name
Thickness (inches) Thermal Resistance (R-Value)
B. Exterior Foam Sheathing
Material Brand Name
Thickness(inches) Thermal Resistance (R-Value)
4. RAISED FLOOR
Material Brand Name
Thickness(inches) Thermal Resistance(R-Value)
5. SLAB FLOORIPERIMETER
Material Brand Name
Thickness (inches) Thermal Resistance(R-Value)
Perimeter Insulation Depth(inches)
6.FOUNDATION WALL
Material Brand Name
Thickness (inches) Thermal Resistance(R-Value)
Declaration
I hereby certify that the above insulation was installed in the building at the above location in conformance with the current
Energy Efficiency Standards for residential buildings (Title 24, Part 6, California Code of Regulations)as indicated on the
Certificate of Compliance,Ahere applicable.
Wen h4x,7tz";-k�
Item#s Signature Date Installing Subcontractor(Co. Name)OR
General Contractor(Co.Name)or Owner
Item#s Signature Date Installing Subcontractor(Co.Name)OR
General Contractor(Co.Name)or Owner
Item#s Signature Date Installing Subcontractor(Co.Name)OR
General Contractor(Co.Name)or Owner
09/16/2011