14100199 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10206 ENGLISH OAK WAY CONTRACTOR:HSBC BROTHER CO PERMIT NO: 14100199
OWNER'S NAME:
SAN JOSE,CA 95120 PHONE NO:(408)644-3112
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL ❑
REMODEL KITHCEN(120 SQ FT); BATH(40 SQ FT)TO
License Class_p _ Lic.#%/17J INCLUDE M,E,P'S
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. 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:34212080 00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMI WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WIT 180 DAYS OF 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 DA M LAST 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
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,
RE-ROOFS:
Signature Datebl 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 C de,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 34.
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 APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION `�U
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 \� v
CUPERTINO (408)777-3228•FAX(408)777-3333•building(a�,cugertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI - ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS pM / oak I APN# 2. 0&0-00
OuOWNER
STREET ADDRESS CITY, STATE,ZIP FAX
CONTACT NAMEI PHONE r)&#_�&d. 1 (/j� //� E-MAIL
STREET ADDRE I CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME , Aq, LICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME ` ^, n E-MAIL FAX
STREET ADDRESS J a► CITY,STATE,ZIP 1 PHONE
QoMeSC/J
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# '
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK I
I
n
M0 S'
EXISTING USE PROPOSED USE CONSTR.TYPE' ORIES
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
_fo
PORCH AREA DECK A TOTAL DECK/PORCEfAREA GARAGE AREA: LJDETACH
❑ATTACH
#DWELLING UMTS: IS A SECOND UNrr ❑YES SECOND STORY []YES
BEING ADDED? ❑NO ADDITION? ❑NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIV 'BY: _ TOTAL VALUATION:
PLANMNG APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? []NO
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner'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. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identifie property for inspection purposes.
Signature of Applicant/Agent: G..-Zt Date: O
SUPPLEMENTAL INFORMATION REQUIRED P , eHEcx TYPE ROUTING stir
New SFD or Multifamily dwellings: Apply for demolition permit for ovER-TIiE couNmER ❑ BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of bui ng '
permit for new building. ❑ EaPRESS ❑ PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD ❑ ]PUBLICWORKS
form if any Hazardous Materials are being used as part ofthis project. 0 LARGES ❑ FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑'MAaoR', ❑ SANITARY SEWER nlsTRrcT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doe revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR— BUILDING DIVISION
ADDRESS: 102060 english oak DATE: 10/31/2014 REVIEWED BY: Mendez
APN: BP#: "VALUATION: 1$18,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1 R3SFDRE
USE: PERMIT TYPE:
WORK remodel kithcen 120 s ft ; bath 40 s ft
SCOPE
_.
P:un t 6 v,it F"hunh. Plan('h�(°l;
I_-:1;_ i _until Fee: }'lamb. Ile-mil Fee.
of;err Plumb lnsn. Li
PI17anh. h7q). l'cc:
NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Thesefees are based on the prelinddna information available and are only an estimate. Contact the De t or addn'1 info,
FEE ITEMS (Fee Resolution 11-053 E f 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.f. Remodel,Kitchen(<=300 sf)
Suppl. PC Fee: Reg. ® OT 0.0 hrs $0.00 $645.00 IREMRESKIT
PME Plan Check: $0.00 = S. Remodel,Bath(<=300 sf)
Permit Fee: $0.00 $645.00 1REMRESBAT
Suppl. Insp. Fee: Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
tc;�1J=i1'17.tiLi"c7Jti'c' Lr 'i.`;
Work Without Permit? 0 Yes (F) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Ii^, ,,F>l 1)rlc•tt.'rtcralltztioyt Fc?Bs:
Building or Structure 0
Strong Motion Fee: IBSEISMICR $2.34 Select an Administrative Item
Bldg,Stds Commission Fee: 1BCBSC $1.00
. ,�: s ; ; :,...
$3.34 $1,290.00 TOIL FEE: $1,293.34
Revised: 10/01/2014
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24"
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Reviewed By:
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All dimensions-size designations given are This is an original design and must not be Designed: 10/12/2014
subject to verification on job site and 20 20%
TECHNOLOGIES released or copied unless applicable fee has Printed: 10/31/2014
adjustment to fit job conditions. been paid or job order placed.
Kitchen lFp 1 Drawing#: 1
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CUPERTINO
►anent
UODE COMPLIANCE
85-:2-
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52P F>J F>J P
C C C C
V V V V
F SVA24 F SVA24 D F SVA24 F
3 3 3 3
CBF30 CBF30
Master Bath
All dimensions_size designations given are This is an original design and must not be Designed: 10/12/2014
subject to verification on job site and TECHNOLOGIES released or copied unless applicable fee has Printed: 10/31/2014
adjustment to fit job conditions. been paid or job order placed.
MBath Fp 1 Drawing#: 1