14090033M
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21604 CASTLETON ST
CONTRACTOR: AMERICAN KITCHEN &
PERMIT NO: 14090033
BATH INC
OWNER'S NAME:
SAN JOSE, CA 95112
PHONE NO: (408)436-8151
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
❑ LICENSED CONTRACTOR'S DECLARATION
RE -TILE DOWNSTAIRS GUEST BATHROOM
,9/� 5/ 383 �
License Class `� Lic.#
Contractor, /'} r-0 4 Date
I hereby affirm that I am licensed underAhe,provisions of Cha ter 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: $7200
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 35620045 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 EXP ORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 YS OF RMIT 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 T CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
may accrue against said City in consequence of the
/
costs, and expenses which
Issued by: Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9 18.
RE -ROOFS:
Signature to 9
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 Quality Management District I
of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
performance
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
Owner or authorized �1
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 agr e to comply with all city and county ordinances and state laws relating
to building c nstruction, 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 at id keep harmless the City of Cupertino against liabilities, judgments,
costs, and a enses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting oft iis 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
CITY OF CUPERTINO
TUU UQ9P11X4 A rrnlD — RTTTT ._nTNV I1IVI4TnN
21604 castleton St
FEE
DATE: 09/08/2014
REVIEWED BY: Mendez
laADDRESS:
BP#:
*VALUATION: $7,200
APN:
Select a Misc Bldg/Structure
or Element of a Building
PERMIT TYPE: Building Permit
0.0
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
PME Plan Check:
PENTAMATION
SFD or Duplex
p
PERMIT TYPE:
USE:
Permit Fee: Hourly Only? ® Yes (E) No
$0.00
Suppl. Insp. Fee -.(D Reg. Q OT
1 0.0
hrs
WORK
re -tile downstairs quest bathroom
PME Unit Fee:
$0.00
SCOPE
$0.00
�:Jtflc r 1tEc'n. L�rsp
NnTF- Thie estimate does not
Phimb. Plan Cher. t
Plumb. Perm;i 1,ec:
C)71aer Plumb frim. /'Jh7sp'
fees due to other Departments (i. e. Planning, Public Works, Fire, Sanitary Sewer District, School
Th b ed on the relimina information available and are onlv an estimate. Contact the ue t jor aaan'i to o.
luls«<ca, el"". ese ees are as
FEE ITEMS (Fee Resolution 11-053 fff. 7/1113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
Select a Misc Bldg/Structure
or Element of a Building
Suppl. PC Fee: (E)Reg. ® OT
0.0
hr's
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? ® Yes (E) No
$0.00
Suppl. Insp. Fee -.(D Reg. Q OT
1 0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Work Without Permit? ® Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
G
�r'L C, /. <_ talc'.}i rt t(7fr171` a es.
Strong Motion Fee: IBSEISMICR
$0.94
2.0 firs
$286.00
Inspections
ISTINSP Inspection, Hourly
Bldg Stds Commission Fee: IBCBSC
$1.00
$1.94
TO FEE:'
$286.00111"
$287.94
Revised: 08/20/2014