14120122 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11547 FALLCREEK SPRIN CT CONTRACTOBL TRT--1Q_BE PERMIT NO: 14120122
J1EXERMINED
OWNER'S NAME:
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
^N 05 KITCHEN REMODEL 90 SQ FT TO INCLUDE M,E,P'S
License Class Lic.# (� l
Contractor&)C7\`(lU2 KU?PA 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:$12000
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:36651015 00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information isPE
RMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating IT 80 D S OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property spection purposes. (We)agree to save 180 DAY F M LAST CALLED INSPECTION.
indemnify and keep harmless the
it
of upertino agai t iabilities,judgments,
costs,and expenses which may ccrue ainst said Ci i consequence of the '12123 Lla
granting of this permit. Add nail a applicant rstands and will comply Issued by: Date:
with all non-
0 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 A it Qua' Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cup lino uric' al ode,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2;65,,;A33 d 534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent:
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
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•building(a)cupertino.org \
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTiERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS }�Irly APN f3 7 \ nD
OWNER NAME CPHONE,
FAX
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNEKAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME ��p IrIICCE%E NUMBER /� �I U LICENSE TYPE BUS.LIC k
COMPANY NAME v6 O E-MAIL "I ` FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC 9
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONEC,
DESCRIPTION OF WORK , J� 1 .. / Lo
EXISTING USE PROPOSED USE CONSTR TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN �/'� OTHER
REMODEL AREA REMODEL ARJJ J �' REMODEL AREA
PORCH AREA I DECK AREA TOTAL DECK/PORCH ARE I GARAGE AREA: DETACH
[]ATTACH
DWELLING UMTS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? ❑NO ADDITION? [],NO
PRE-APPLICATION [_1 YES IF YES,PROVIDE COPY OF IS THE BLDG AN El YES RECEIVED Y''t ° TOTAL VALUATION:
PLANNING ADPL 9 ❑NO PLANNING APPROVAL LETTER EI HOME? ❑NO
C CIS
By my signature below,I certify to each of the folio ng: I am property owner or thorized agent act on the property owner's behalf. I have read this
application and the information I have provided i correct ave read the Descriptio of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building c Ion. I authorize represent ati s of Cupertino to enter the above-identified Qperty for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
Q ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for n L
COVER T73)rCOUt�TER -- -.- UILDITG PLAT RE�ZEW
existing building(s). Demolition permit is required prior to issuance of building ag
`�. �Z i ❑- PLANTITG PLAT REVLEW
permit for new building �,ExrxEss ��
b S
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STAN7)AI3D' ❑�IIBLIcwoxxs
form if any Hazardous Materials are being used as part of this project p'L�ReE K2 r
❑ EIRE DEPS
—Copy of Planning Approval Letter or Meeting With Planning prior to
-❑ MAJOR r . ❑-SATITARY SER'ERDISTRICT
submittal of Building Permit application. s TM
S � S
❑cENI'7ROD'METTAI::AEALTH":
BldgApp_201 Ldoc revised 06/21111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 11547 FALL CREEK SPRING CT 1.DATE: 12/23/2014 REVIEWED BY: MENDEZ
APN: BP#: *VALUATION: 1$12,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM
USE: PERMIT TYPE:
WORK KITCHEN REMODEL 90 SQ FT TO INCLUDE M E P'S
SCOPE
Or
l'Ic°c:ir f lur i Check 11Iawb. Pkiti Chrufi Checj,
Fee;
ure- tech. IrtST' Odle,Plumb/nsr3. ED 0/1:,e!`1 i c task""
iIT:c;a. hlsP. 1"Ve Phewh hiss. Fe'e 1Yec.
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn7 info.
FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 F-9-6771 s.f. Remodel,Other
Suppl. PC Fee: (j) Reg. ® OT 0.0 Thrs $0.00 $431.00 1REMREsoTx
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:Q Reg. ® OT 0.0 1 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
171 C:: ;astx ttc ti<Jrz l t=::
c1Tr2tc1t,4 t"c;7 iL'c?Pe"': 0
Work Without Permit? 0 Yes (F) No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential
Ill, 'e// c7„{tl,1 /{� .c,�r Fees: Building or Structure
A
Strom Motion Fee: 1BSEISMICR $1.56 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
i $2.56 $431.00
TOTTA FSE: $433.56
Revised: 10/01/2014
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LSC Cabinetry Inc. l'1-cA'f-v(-F ��) CWC,,�
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San Jose, CA. 95111
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130 130 Lewis Rd.#9
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408- 408-363-4098 11/13/2014
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62 112 81 118
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Reviewed By //--
LSC Cabinetry Inc.
130 Lewis Rd.#9
San Jose, CA. 95111
408-363-4098 11/13/2014
Room 1 - Wall 1 Not To Scale
62 112 81 118
1 y a '.Ni
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left sectio o
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351/2 22 38 35112 3U 35112 j.
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CUPERTINO
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LSC Cabinetry Inc.
130 Lewis Rd.#9
San Jose, CA. 95111
408-363-4098 11/13/2014
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\ ( `�s� \ xr- � :x�,��ry,K\,✓'X k`rr s c F F� �� h��Y�§r x r'ck,Nr9�X�`zau��,A
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Reviewed BYE
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130 Lewis Rd.#9
San..sl.nse_...CA. 95111
4 18 11/13/2014
Room 1 - Wall 6 Not To Scale
(15 112) 92
� z
14
35 112
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2a , 51/2 ;, 51/2 Single Can trash unit pullout
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LSC Cabinetry Inc.
130 Lewis Rd.#9
San Jose, CA. 95111
408-363-4098 11/13/2014
Room 1 - Wall 1 Not To Scale
621/2 81 1/8
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