14090167CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7998 WOODLARK WAY CONTRACTOR: RICHIE CONSTRUCTION PERMIT NO: 14090167
INC
OWNER'S NAME: TT INVESTMENT PROPER TIES 1261 S ALMADEN DATE ISSUED: 09/25/2014
OWNER'S PHONE: 4085091425 SAN JOSE, CA 95110 PHONE NO: (408) 531 -7165
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT I— PLUMB
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.
MECH r— RESIDENTIAL f— COMMERCIAL r—
JOB DESCRIPTION: REMODEL BATH (100 SQ FT); KITCHEN (150 SQ FT) TO
INCLUDE M,E,P'S
I have and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area:
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
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,
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 regulations per the Cupertino Municipal Code, Section
9.18.
Date
❑ OWNER- BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
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
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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,
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 regulations per the Cupertino Municipal Code, Section
9.18.
Signature.
Date
APN Number: 36204034.00
O \1D
Valuation: $20000
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by:
Date:
RE- ROOFS:
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.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent:
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Professional
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CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7998 WOODLARK WAY
CONTRACTOR TB�BE
PERMIT NO: 14090167
QED
OWNER'S NAME: BRADLEY JACK TRUSTEE & ET AL
I +� FCS
DATE ISSUED: 09/25/2014
OWNER'S PHONE: 4085091425
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class _ Lic. # 1 (�
REMODEL BATH (100 SQ FT); KITCHEN (150 SQ FT) TO
INCLUDE M,E,P'S
f
Contractor Date '� !
G A
I hereby affirm that I m 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.
hereby affirm under penalty of perjury one of the following two declarations:
ave and will maintain a certificate of consent to self - insure for Worker's
ompensation, as provided for by Section 3700 of the Labor Code, for the
Sq. Ft Floor Area:
Valuation: $20000
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: 36204034 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 AV" 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 DAY ROM LAST CALLED INSPE TION.
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: Date:
with all non -point source regulations per the Cupertino Municipal Code, Section
9 18.
Signat f G /
Date
RE- ROOFS:
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
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 & Safe ions 5Q6, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized a (/ 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
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
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
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
CUPFERTINO
r —I
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 FAX (408) 777 -3333 • building(a1cupertino.org
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PROJECT ADDRESS A
APN #
OWNER NAME P
PHONE
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CITY, STATE, ZIP F
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CONTACT NAME/ P
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❑ OWNER ❑ OWNER- BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
NT ACTOR NAME L
LICEN 1 R L
LICENSE PE B
BUS. LIC #
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E-MAIL y C C F
FAX
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STREET ADDRESS C
CITY, STATIVZI P C P
PHONE /�
ARCHITECT/ENGINEER NAME L
LICENSE NUMBER B
BUS. LIC #
COMPANY NAME E
E -MAIL F
FAX
STREET ADDRESS C
CITY, STATE, ZIP P
PHONE
DESCRIPTION OF WORK i /' c. /�j /�
T �
I
EXISTING USE 1
ED USE 7
# STORIES U
USE T
TYPE O
OCC. S
SQ.FT. V
VALUATION (S)
EXISTG
1 D
DEMO T
TAL
AREA y s
s�' A
AREA E
ET AREA
1PROPOSED E
AREA 4 P
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�lY
7RE #
P RCH AREA T
TOTAL DECK/P ORCH -E A
AREA: I
# DWELLING UNICOND UNIT DY S
STORY ❑YES
ADDED,? ❑NN? -
-]NO
PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF L
LDG AN ❑ YES '
'RE iVE}j $ ,� "' `' ". `
`` Mzg" T
TOTAL VAIN:
PLANNING APPL #
[]NO PLANNING APPROVAL L
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the pro Re s behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it i rate. I agree to co ly with all applicable local
laws relati 1k ding con tion. I authorize representatives of Cupertino to enter the above- identl le property for inspection purposes.
ordinances and state l
Signature of Applicant/A ent: Date:S
SUPPLEME TAL INFORMAT N REQUIRED 7
7Lms-
BldgApp_2011.doe revised 06121111
FM_7 CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 7998 Woodlark way
DATE: 09/25/2014
REVIEWED BY: Mendez
APN:
BP #:
*VALUATION: 1$20,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex
Other Numb Irup,
Ll
PENTAMATION
PERMIT TYPE: 1 R3SFDRE
WORK
remodel bath 1001s ft); kitchen 150 sq ft to include m e 's
SCOPE
$0.00
ism
a
/c -oir. f'ir rr ( ='h<zc k
I'/tw7b. Nan C heel'4
Elec. Plan Check 0.0 hrs $0.00
�9c>cFr_ 1'ernlit Fee:
1'tumb. I'c:rrnft Tue.
Elec. Permit Fee: IEPERMIT
C)rher h9e °c lr. Irtsj =_
Other Numb Irup,
Ll
Other Elec. Insp. 0.0 �rs$48.00
(rash Ve
I1hen1b, Trrsp. Fee:
L>is'c'. Its tie:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the preliminary information available and are only an estimate. Contact the Dept /or addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 Eff. 711113,1
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
F-1-007 s.f.
$645.00
Remodel, Bath (< =300 sf)
1REMRESBAT
Suppl. PC Fee: Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
L-12-0-i
$448.00
Electrical
1BREMRECEP Recep /Switch/Outlets
Permit Fee:
$0.00
Suppl. Insp. Fee: Reg. OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
Consirttction Tct:r:
Administrative Fee: IADMIN
$45.00
0
E)
Work Without Permit? ® Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
0
0
i
Travel Documentation Fee: ITRAVDOC
$48.00
Strong Motion Fee: IBSEISMICR
$2.60
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
..
$144.60
$1,093.00 ' TOIL FEE:
$1,237.60
Revised: 08/20/2014
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RUildinq Department
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