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14070036CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20874 DUNBAR DR CONTRACTOR: UNITED FIELD PERMIT NO: 14070036 REMODELING DBA OWNER'S NAME: WOLF CALVIN J TRUSTEE & ET AL 17855 VANOWEN ST DATE ISSUED: 07/10/2014 OWNER'S PHONE: RESEDA, CA 91335 PHONE NO: (818) 402-5656 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ BATHROOM REMODEL TO INCLUDE M,E,P'S 30 SQ FT p License Class Lic. Contractor Date 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: $7500 I have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 32630143 00 Occupancy Type: 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 PERMIT E S IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 Y 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 FRO LAST CALLED INSPE TI N. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Issued by: Date: granting of this permit. Additional , the applicant understands and will comply with all non -point source reg u ,o s per the Cupertino Municipal Code, Section RE -ROOFS: 918. Signature Date O / 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 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 Q Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino M i ' al Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 the Labor Code, for the of the work for which this the Health & Safety Code, Sections 25505, 25 nd 25534. of performance Owner or authorized agent: Dater 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 9 18. Signature Date CUPERTINO n — CONSTRUCTION PERM11T APPLICATION COMMUNITY DEVELOPMENT. DEPARTMENT - BUILDING DIVISION (\ 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255aQ (408) 777-3228 - FAX (408) 777-3333 • building wDertino.org �1 I-1 ..r^n.r-rnwT,rr n DL'VrQTC1N E/n-P-PRRFT) ORTC�TNTALPERMIT4 L_I NEW NJIul.11uIV U nitLJlllvly u na as a I.0K - ----- PROJECT ADDRESS 1y n APN t? OWNERNAME d I PHONE %/� �% I E-MAIL 11 / � STREET ADDRESS I CITY, STATES, ZZIIP I FAX COXFACT LAME PHONE E MAIL STREET ADDRESS CITY, STATE, ZIP I FAX ❑ owNER ElOWNER-BL'IIAER ❑ OWNER AGENT 13 CONTRACTOR. ❑ CONIR.4CTORAGENT ❑ ARCHITECT El ENGINEER 13DE\I- PER ❑ TE- NT CONTRACTOR NAMEf ` % ; � I LICENSE NUMBER � / I LICENSE TYPE � I BUS. LIC R (/ COMPANY NAM£ - E-MAIL FAX STREETADDRESS CITY, STATE, ZIP I PHONE ARCHITECT/ENGINEER NAME I LICENSENUMBER I BUS. LIC 1; COMPANY NAME E-MAIL I FAX STREET ADDRESS CITY, STATE, ZIP' I PHONE DESCRIPTION OF WORK/7.ro� ,v o i . �t%% r�/ a3 EX^STING USE PROPOSED USE CONSTR. TYPE R' STORIES USE I TYPE OCC. SQ.FT. VALUATION (S) EXKSTG NEW FLOOR DEMO TOTAL AREA AREA NET AREA BATIIIt00'1 REMODF7. KITCHEN REMODEL AREA OTHER REMODFL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: DETACH []ATTACH T DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY El YES BEING ADDED? DNO ADDITION' ANO _�- OY1DE-COPYOF _MIU BLDG:iN yEs :_:RE &IyED$ ' - -. -I -.µ � - TOT.Al. )ALU.4TI0:�': PLA'1111IGAPPI. ❑NO PLANNING APPROVALLETTER EICHLERHOh4E? By my signature below, I certify to each of the following: I am the property owner or authorized agent o act on the prope owner's behalf. I ha-ve read this application and the information I have provided is co ct. I have read the Description of Work and veri ' . agree to comply with all applicable local for inspection fie p�rsy purposes. ordinances and state laws relating to building cons do . 1 authorize representatives of Cupertino to enter the abov -i7/, Signature of Applicant/Agent: Date: © ,71 SUPPLEMENTALRNTFORNATI0ATREQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for O\ FR THl<COUt�TER- 4 - PLAT T.E�S3� existing building(s). Demolition permit is required prior to issuance of building y�BUII�L�G permit for new building. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure p SS kms` sr D RDS` a r 'Pra.�`�`GP s;* t fltr_ _ form if any Hazardous Materials are being used as part of this project. r �� ate,— _Copy of Planning Approval Letter or Meeting with Planning prior to Permit application. -—� _ ��❑�-�4'RITARI_EEx&RDISTRICT`E submittal of Building Bldg1pp_2011.doc revised 06/21/11 V't br`v CITY OF CUPERTINO �WA ,-v -p Ucrr7nR A'rnD — RTTTT .D_tNf DIVISION rr.L 1,ki11111lX1 V1� 20874 dunbar dr L2 -- DATE: 07/10/2014 --- - REVIEWED BY: Mendez WADDRESS: PN: BP#: 30 1 s.£ Remodel, Bath (<=300 sf) $645.00 IREMRESBAT *VALUATION: $7,500 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex $0.00 PENTAMATION 1 R3SFDREM PERMIT TYPE: WORK SCOPE bathroom remodel to include m e 's 0.0 hrs $0.00 Suppl. Insp. Fee: Reg. 0 OT PME Unit Fee: $0.00 PME Permit Fee: $0.00 -T71- Work Without Permit? ®Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential E) Building or Structure >t T Strony Motion. Fee: IBSEISMICR $0.98 Select an Administrative Item Bldu Stds Commission .Fee: IBCBSC $1.00 . „ o a $1.98 $645.00 TOTAL FEE: n_. ... $646.98 J. n�In0Inn4A wk 11111olh, Plan {.hcclti E3ji�H r If'C'1{. f yTy. olhc.'T Plumb Imp I'lu 7b, l)!i%E'i` L•{S�?. k F' S ita Sewer District School NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Wor s, ire, an ry , 1bl d are on l an estimate Contact the Dept or addn'1 in o. District, etc.). These fees are based on the preliminaryin FEE ITEMS (Fee Resolution.]] -053 Ef. . 7/1113) ormation avai FEE a e an QTY/FEE MISC ITEMS Plan Check Fee: $0.00 30 1 s.£ Remodel, Bath (<=300 sf) $645.00 IREMRESBAT Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 i PME Plan Check: $0.00 Permit Fee: $0.00 0.0 hrs $0.00 Suppl. Insp. Fee: Reg. 0 OT PME Unit Fee: $0.00 PME Permit Fee: $0.00 -T71- Work Without Permit? ®Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential E) Building or Structure >t T Strony Motion. Fee: IBSEISMICR $0.98 Select an Administrative Item Bldu Stds Commission .Fee: IBCBSC $1.00 . „ o a $1.98 $645.00 TOTAL FEE: n_. ... $646.98 J. n�In0Inn4A meviseu. v! /vvJGv i y IROPAk ASTON - CUPERTINO APPROVED_ Is set of Pians and specifications MUST be kept at the • job site during constructive_ at as unfawful to-rtiake any c angel or alterations on same, or to deviate � �-- therefrom, without a r `1__-----------.-�__---------_ pa oval frim -fie Building-pffiCiaT.----- Th --- be held to ���,; an specifications SH -AL .NOT ----__ approval of the violation of any provisions 901dina Department LML-t 'i JUL In 2014 REVIEWED FOR CODE COMPLIANCE _-...-.-__ ------------- .___._--.------___..____-__.__. Reviewed By. �W-- -