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14110065 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21454 SHANNON CT CONTRACTOR:BAY AREA CUSTOM PERMIT NO: 14110065 BUILDERS INC OWNER'S NAME: SAN JOSE,CA 95129 PHONE NO:(408)446-1200 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑ / u KITCHEN REMODEL 180 SQFT TO INCLDUE M,E,P'S License Class is Lic.# 9 2 o 6 _1 �1 ,-4 , —I(—( 7— ,� Contractor ,�� �� �� �a�,.e 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:$18000 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:36202020 00 Occupancy Type: permit is issued. ,S APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERM WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WIT 180 DAYS70 ERMIT 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 LAS CALLED 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 ( ✓1 granting of this permit. Additional) the applicant understands and will comply Issued by: Date: . with all non-point a regulations per the pertino Municipal Code,Section 918. RE-ROOFS: Signature Date /—�2— / Y 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,Sectio 05,-2 and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: = 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 APPLICATIONUh �0 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION I I 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINQ (408)777-3228•FAX(408)777-3333•building a0cupertino.org 1 ❑NEW CONSTRUCTION `,❑ ADDITION ❑ ALTERATIOLN/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS 2 1 L/C APN# "RU 2 02 p20• 00 OWNERNAME l / r\ r STREET ADDRESS CITY, STATE,ZIP FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUII•DER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT G � CONTRACTOR NAME N 1fS c4e1 LICENSE NUMBER LICENSE TYPE BUS.LIC# G V CA ANYNAME E-MAILn ' D w\ Fes[O STREET ADDRESS v CITY STATE,ZIP C3 C PHONE 12c5 ARCHITECT/ENGINEER NAME LICENSE NUMBER ` BUS.LIC# G COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK h t DeazI 'Z "e 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 OTHER REMODEL AREA REMODEL AREA; ' REMODEL AREA - PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH []ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY [3YES BEING ADDED? []NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YESRECEIVED#Y� ,- '` TOTAL VALUATION: PLANNING ADPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? NO �a '�'' { two By my signature below,I certify to each of the following: I am the property owner or authorized agent to t on the pro owner's behalf. I have read this application and the information I have provided is p9n:ecl-1-havetead4he Description of Work and veri it is ate. I agree to comply with all applicable local ordinances and state laws relating to bui construction. I authorize re esentatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: SUPPLEMENTAL INFO REQUIRED siht�, , CHECK TYPE, „120UTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ❑ BUILDING PLAN REv1Ew OYER THE CO�TNTER r existing building(s). Demolition permit is required prior to issuance ofbuilding permit for new building. ERE$s3 x © LANNriv PLAN REVIEW a Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑c S`TNDARD ❑ TUBLIC WORKS form if any Hazardous Materials are being used as part of this project. OLRGE {� ❑ IREDEPT _Copy of Planning Approval Letter or Meeting with Planning prior to roR` ❑ SANITARY sEwERpISTRrcT submittal of Building Permit application. '.`+r+.< ❑5 ENVIRONMENTAL HEALTH.;r BldgApp_201 1.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR— BUILDING DIVISION ADDRESS: 21454 shannon ct DATE: 11/12/2014 REVIEWED BY: Mendez APN: BP#: VALUATION: 1$18,000 ;PE;RMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: p PERMIT TYPE: WORK kitchen remodel 180 s ft SCOPE mg- f' ue rJx1 . mg-et.11 t f('a"h Pepwit Fee: ?moire 'llec h" `rts,> 01hev Pivalb Insp. E3 O iber�I icc' Insp' 1ka:fi /ra.s�. E3 Fec: P7wilb. NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc . Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 180 s.f. Remodel,Kitchen(<=300 sf) Suppl. PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 $645.00 IREMRESKIT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp:Fee-.(j) Reg. ® OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C,on f!f'iciron !'U'v: T Fe"". Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Building or Structure 7t'<tt',,1 p (i{`tt17Ze't21(d1TC)Yf Fees: � Strong Motion Fee: IBSEISMICR $2.34 Select an Administrative Item Bldy,Stds Commission Fee: IBCBSC $1.00 $3.34 $645.00 TOTAL FE $648.34 Revised: 10/01/2014 Shck n,non CN- f r- 4-^Y,'F+1 I ONAW 9VOMISHM L 'f ) �� 1� S 1 h Pr' 1».C�J� M CO- 0S 9 ZlM cl S-Z-MHa �`'sr�,� -_ p/�eS sAlN i / 40bk V OPI IT W N ca V_ C C-6s--�%JPERTINO P;,;Jr ina Department EL 2014 C N .... .. ' .: . .-r, .,.aur- COMPLIANCE 6y. " d+ v N 1, coMMUNrrY DEVELOPMENT,c p NO'TME-W 1 IfJ.�.G' t w , Plans and spec;fic o kept t the IIS AC �trL X 8�l� Alt .4 ^a oma e 1 11(18 0£9 I9£8lM r79cr Ci;W::+ aw ura c ; , a��//i/tii,•�,e , ,�r! .� .��e, or eviate,� ��� Gil t; `-c,�? , .,+ s �g Cftrcraf. 00h 4� C. 9 Wi . k £° .� ,fr� {min rtAe 'bsr SHALL NOT T aLIfi,azo a '� it}ir%ry State Lay.„91 o£ s- ..d�6 t ` 1 9 j