14090134 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7652 WEST HILL LN CONTRACTOR:BAY AREA CUSTOM PERMIT NO: 14090134
BUILDERS INC
OWNER'S NAME: LEWIS&CAROL KIDD 1002 S DE ANZA BLVD STE Al DATE ISSUED:09/22/2014
OWNER'S PHONE: 4084460508 SAN JOSE,CA 95129 PHONE NO:(408)446-1200
61
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL
11,fc� /` REMODEL(E)KITCHEN,NO STRUCTURAL CHANGES(130
License Class_ Lic.# l�Q � `7 y S.F.)
b P1 t e
Contractor RC4 f.�1-e c% GW.-)F oK, 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:$26000
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:36227022.00 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 OF 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, -L—A� LLED 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 Z
granting of this permit. Additionally,the applicant understands and will comply Date:
with all non-point source regulations per the Cupertino Municipal Code,Section
9 18.
L RE-ROOFS:
Signature Date / T 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&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 agent: Date:ZD6 122/1
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
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 O
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 O
(408)777-3228•FAX(408)777-3333•building(a cupertino.org
CUPERTINO
[:]NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS ` ) `� �� Qr`I�r APN# Z _ �7 0 Z
f lVe D 3�
OWNER NAME C G��O ,.A _,_'PHONE /�� y j/Ll6`06 E-MAIL
STREET ADDRESS p (/1 CITY, STATE ' `� FAX
CONTACT NAME p; (? J �,n ,y PHONE'4.
J y /;- /'� (� E-MAIL
STREET ADDRESS G 1 7 CITY,STATE,ZIP ✓� �j / FAX
OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LICENSE NUMBER/� / /� ' LICENSE TYPE BUS.LIC#
G, r e o u 9 O 6 T
COMPANY NAME E-MAIL FAX
STREET ADDRESSC.9 2 S. )e h� 6(V A�f CITY,STATE,ZIP QGI h j o� e C4
ci�;r' PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK r r
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA. NET AREA
BATHROOM KITCHEN 1 OTHER
REMODEL AREA REMODEL AREA- ' w O REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCHAREA 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 ❑YESREC - i ` '" �, �" a` ="- TOTAL VALUATION:
PLANNING ADPL# E]NO PLANNING APPROVAL LETTER EICHLERHOME? NO ,t n (9
By my signature below,I certify to each of the following: I am the property owner or authorizedagent t n the erty o er'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 is accurate. agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: _�
SUPPLEMENTAL INFORMATION REQUIRED '� %AN cicK TYPE „` ,, .�� Roux>rrc"s�
New SFD or Multifamily dwellings: Apply for demolition permit for o zicoulvTER ,., L"JsUILDINGPLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. � �Rss � PLANNiric rLnx?iEv1Ew
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure l] TkAiSnn ❑`PUBLIC WORIts '
form if an HazardousMaterials are being used as part of this project. I3
any sk LAIiGTv FIRE DEPT -
_Copy of Planning Approval Letter or Meeting with Planning prior to M ` ' ❑ SANTLARY�EWERDISTRICT f
submittal of Building Permit application. ' ;� �
BldgApp_201 1.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 7652 WEST HILL LN DATE: 09/22/2014 REVIEWED BY: MELISSA
APN: 362 27 022 BP#: *VALUATION: 1$26,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1 R3SFDRE
USE: PERMIT TYPE:
WORK REMODEL E KITCHEN NO STRUCTURAL CHANGES
SCOPE
!'i,:rrt C heck Plrrtnla, Plan{'here.°k t 12��. 1'err ':}<-cis
ail.cl;. Tc'%raid Fee: ill,_b: Permit Fe¢: J r,(, t"erm
0-1_
1 kch, Inst+ C)tlaer Plumb Insp. oflwr 1 1e(: ltsh,
i(ee r. Zrsslz I�e� I'lur�alr. h?sp. Fee: Llex Its i"f(z:
NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These _f
-fees are based on the relimina information available and are onlyan estimate. Contact the Detor addn'l info.
FEE ITEMS (Fee Resolution 11-053 E . 7/1/131 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 130 s.f. Remodel,Kitchen(<=300 sf)
Suppl.PC Fee: 0 Reg. ® OT 0.0 hr's $0.00 $645.00 1REMRESKIT
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg, Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
C`E =;�r•�.a�tzotr 1'cr:r:
Work Without Permit? ® Yes (F) No $0.00 G
Advanced:Planning Fee: $0.00 Select a Non-Residential
ts'z'I Lic;c�tr�ie�FalrxtirtYt Fees: Building or Structure 0
A
Strong Motion Fee: IBSEISMICR $3.38 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $2.00
Ml
$5.38 $645.00 : TOTAL FEE: $650.38
Revised: 08/20/2014
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