15040103 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21571 REGNART RD CONTRACTOR:SEARS HOME PERMIT NO:15040103
IMPROVEMENT
OWNER'S NAME: REYNEN FRANK R AND CHRISTINA L 1024 FLORIDA CENTRAL PKWY DATE ISSUED:04/14/2015
OWNER'S PHONE: 4088994210 LONGWOOD,FL 32750 PHONE NO:(925)245-2000
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
szcuc.# '7KITCHEN MODIFICATION TO INCLUDE: REPLACE
License ClasZ-1 3 9 /c� COUNTER
i j TOPS;EXTEND GAS LINE: ADD(4)NEW GFCI OUTLETS
Contractor ��/�ZS f'� IiM t� Die AND REPLACE(5)OUTLETS TO GFCI;UNDERCABINET
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 Valuation:$13248
lecpeAformance of the work for which this permit is issued. Sq.Ft Floor Area:
ve and will maintain Worker's Compensation Insurance,as provided for by
tion 3700 of the Labor Code,for the performance of the work for which this APN Number:35622007.00 Occupancy Type:
mit is issued.
APPLICANT CERTIFICATION
teify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
ct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
ilding construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM 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 Issued by. G Date:
granting of this permit. Additionally,the applicant understands and will Com1 .
with all non-point source regulations per the Cupertino Municipal ection
918. r RE-ROOFS:
Signature Date1 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.
❑ p ILDER DECLARATION Date:
Signature of Applicant:
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) HAZARDOUS MATERIALS DISCLOSURE
I,as owner of the property,am exclusively contracting with licensed contractors to
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 Distric
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter and
the Health&Safety Code,Sections 25505,25533,and 25534.
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 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 CONSTRUCTIO LENDING AGENCY
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 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
1� ef)zjo105
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 MISC
CUPERTINO (408)777-3228.FAX(408)777-3333•building(a)cupertino.ong
PLUMBING DMECHANICAL ELECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS 7-tL7 / // P-� 7APN.
OWNER NAME Y ( tl X"T fF PHOIV q� �Z' E-MAIL vU /
STYE' S IP
7 SS I"Z ADDRE
��/r.� �� C1 U17&�ZTY,STATE,Z-71�/® e—A ! 0I FAX
CONTACT NAME BERNIE MATHESON PHONE 925-245-2013 E-MAIL
STREET
AIRWAY BLVD. }� CITY,STATE,ZIP LIVERMORE,CA 94551 FAX 925-245-2017
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT LJ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
-7
CONTRACTORNAME LICENSENUMBER 721379 LICENSE TYPEB,C10 BUS.LIC#
BERNIE MATHESON C17 C6
COMPANYNAME SEARS HOME IMPROVEMENT E-MAIL FAX 925-245-2017
STREETADDRESS 283 E. AIRWAY BLVD. CITY,STATE,ZIP LIVERMORE, CA 94551 PHONE 925-245-2013
ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ASFD or DUPLEX ❑ MULTI FAMILY PROJECT IN WILDLAND ❑ YES PROJECT IN YES IS THE BLDG AN ❑ YES
BUILDING: ❑COMMERCIAL URBAN INTERFACE AREA NO FLOOD ZONE NO EICHLER HOME? NCO
DESCRIPTION OF WORK
AJ C
L71,J
TOTAL VALUATION: I Z RBCEIUEDBY
By my signature below,I certify to each ofthe 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 constructio on epresentatives of Cue enter the above-identified fproperty
(for inspection purposes.
Signature of Applicant/Agent: Date: �l r
C_WPPLEMENTAL INFO REQUHZED OFFICE USE ONLY
W - MOVER-THE-COUNTER
w
❑ EXPRESS
D STANDARD
U
Z
a ❑ LARGE
a
Q MAJOR
MEPMiscApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 21571 Regnart Rd DATE: 04/14/2015 REVIEWED BY: Sean
APN: BP#: *VALUATION: $13,248
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY _____j_PENTAMATION 1 RPGAS
USE: SFD or Duplex PERMIT TYPE: i
WORK Kitchen modification to include: Replace counter tops; extend gas line: Add 4 new GFCI outlets and
SCOPE replace (5) outlets to GFCI; undereabinet lighting.
_,
ltecla. 1'larr,Check Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check 0.0 hrs $0.00
tlech. 1'erwir Fee: I Plumb.Permit Fee: IPPERMIT Elec.Permit Fee: IEPERMIT
Offer Klan h. trash. Other Plumb Insp. 0.0 hrs $48.00 Other Elea Insp.
Wcch. Gasp. kee: Phiwb. Gasp. Fee: Elec_Insp,Fee: Efn
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 prefindna information available and are only an estimate. Contact the De t or addn'1 info,
FEE ITEMS (Fee Resolution 11-053 E . 7ff /1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00F_
0.00 0 # Plumbing
Suppl.PC Fee: E) Reg. ® OT 0.0 hrs $0.00 $72.00 1 1PGASREs Piping,Gas<=4 Outlets
PME Plan Check: $0.00 9 Electrical
Permit Fee: $0.00 $48.00 IBREMRECEP Recep/Switch/Outlets
Suppl. Insp.Fee-.0 Reg. ®OT Q,Q hrs $0.00 0 Electrical
PME Unit Fee: $0.00 $72.00 IBREMF= Fixtures,Lighting
PME Permit Fee: $96.00 __T_
('011st1wetion TUX: E: 7�:]
Administrative Fee: ]ADMIN $45.00 0
Work Without Permit? ®Yes (j) No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential 0
Building or Structure
Travel Documentation Fee: ITRAVDOC $48.00 1 i
Strong Motion Fee: IBSEISMICR $1.72 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
��
. SEE
$ E$1 .00FEE191.72 $383.72
Revised: 04/01/2015
Building Department
City Of Cupertino
La 10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS:2 ? 2 )"-4) PERMIT# 15 Oc40 /03
OWNER'S NAME: VIDVA Woft7rt-r'IDPHONE# 2-10
GENERAL CONTRACTOR. I 14CM C- of 13 . BUSINESS LICENSE#
ADDRESS: 3 t /f7 f2t4c.-tJ CITY/ZIPCODE: (,fck)-W �Z
*Our municipal code requires all busi esses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CI CUPERTINO
BUSINESS LICENSE. Lf
I am not using any subcontractors: �� /r S
Signat�following
Date
Please check applicable subcontractors and completenformation:
V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
NOTES-
1.TWO OR MORE 20-AMPERE CIRCUITS FOR ALL APR y 3 2015 (1)4 LG12056 2LT UNDER-CABINET DIRECT
RECEPTACLE OUTLETS FOR ALL SMALL-APPLIANCES
COMMUNITY nlwLQP1`' A, TiF�a T LOADS,INCLUDING REFRIGERATION EQUIPMENT,IN THE i WIRE 120v 6.4w LED12(HIGH EFFICACY)
'E Q
BUILDING DWISIC)N -CUPE:R l INN KITCHEN,DINING ROOM, AND BREAKFAST ROOM
OF A DWELLING UNIT.THEE COUNTERTOP RECEPTACLE ( - N) Cr iz�a J LO
�
APPROVED OUTLETS IN THE KITCHEN MUST BE SUPPLIED BY NO (N) m rn
FEWER THAN(2)SMALL APPLIANCE BRANCH CIRCUITS. z
This set of plans and specifications MUST be kept at the THESE CIRCUITS MAY ALSO SUPPLY OUTLETS IN THE ¢ v
job site during construction. It is unlawful to make any PANTRY,DINING ROOM AND BREAKFAST ROOM,AS WELL (E)G/D \ W cc w
AS AN ELECTRIC CLOCK RECEPTACLE AND ELECTRICAL ° °
C:)
Q cc
changes or alterations on same, Or t0 deviate LOADS ASSOCIATED W/GAS FIRED APPLIANCES,BUT 2
therefrom, without approval from the RUilding Cifl,;cial. THESE CIRCUITS ARE NOT PERMITTED TO SERVE ANY (UP-GRADE) � m C
OTHER OUTLETS,SUCH AS MIGHT BE CONNECTED TO (E)DISH-WASHER (UP-GRADE) w CCo LU
'J
The Stamping of this plan and specificet.! S ,k.L NOT EXHAUST HOODS OR FANS,GARBAGE DISPOSAL AND (N) (NO CHANGE) o
be he id to pCrfilit 0( t0 be an a rGa'ai !{ : �, ti i:,is iGn DISHWASHER.RECEPTACLES IN KITCHEN SHALL BE GFCI z
¢ ,, y pro y a,' r, PROTECTED. (N)COUNTER-TOPS,
o �I � ISIWs of an Ci I✓rit' % � Dr «i0 mow. (N)SINK, cn
/�f-� E LIGHTING (N)SINK FAUCET HOOK-UP
�,( - .�__ 2.SEPARATE BRANCH CIRCUITS SUITABLE FOR THE LOAD j ( ) ,1,7
ARE REQUIRED FOR EACH APPLIANCE;DISHWASHER t
T f `fp _a (20amps)GARBAGE DISPOSAL(20amps),TRASH y (NO CHANGE) ( -r'�
COMPACTOR,ETC.PROVIDE DISCONNECTING MEANS ��� w w CD (UP-GRADE)
If
WITHIN THE LOCATION OF THE UNIT.THEY MAY BE CORD i �� (E)LIGHTING (E)LIGHTING z z o z
( ) R1
CONNECTED RECEPTACLES OR A SWITCH WITHIN THE ' NO CHANGE (NO CHANGE) = v y-0$
LOCATION OF THE UNIT. (E) / wow
z (UP-GRADE)
z<
3.A RECEPTACLE SHALL BE INSTALLED AT EACH SPACE i� T
THAT IS 12 INCHES OR WIDER.RECEPTACLE OUTLETS (E)LIGHTING (E)LIGHTING (E)LIGHTING
SHALL BE INSTALLED SO THAT AT NO POINT ALONG THE (NO CHANGE) (NO CHANGE) (NO CHANGE)
WALL IS MORE THAN 24 INCHES MEASURED (E)LIGHTING
HORIZONTALLY FROM A RECEPTACLE OUTLET IN THAT (NO CHANGE) --- _ y
SPACE.OR 48 INCHES FROM RECEPTACLE TO
RECEPTACLE.
4.RECEPTACLE OUTLETS SHALL BE LOCATED ABOVE, (E)FRIDGE
(E)OVEN ,
BUT NO MORE THAN 20 INCHES ABOVE THE (NO CHANGE) (NO CHANGE) ��� < CD
COUNTERTOP.RECEPTACLE OUTLETS SHALL BE >- O LO
PERMITTED TO BE MOUNTED NOT MORE THAN 12 INCHES =
BELOW THE COUNTERTOP,IT SHALL BE PLACED NOT IN A 11
FACE-UP POSITION ON THE COUNTERTOP. (
UP-GRADE) (N) (UP-GRADE) (E) (N)
5.ALL 125V 15 AND 20 amps RECEPTACLES IN THE Q CD W Z
KITCHEN AND DINING ROOM SHALL BE LISTED AS 1=
TAMPER RESISTANT RECEPTACLES. KITCHEN = 180 > L j cc
^W
6.IF ADDING OR REPLACING LIGHTING IN THE KITCHEN,A PROPOSED N
MINIMUM OF 50%OF THE TOTAL RATED WATTAGE OF KITCHEN DETAIL C,
PERMANENTLY INSTALLED LIGHTING IN KITCHEN SHALL
BE HIGH EFFICACY.ALL LOW EFFICACY LUMINARIES IN
SCOPE OF WORK: °A k 04 11.15
THE KITCHEN ARE CONTROLLED BY MANUAL-ON INSTALL(N)IN SAME LOCATION AS(E); _SIA
OCCUPANCY
NTS
OCCUPANCY SENSOR,DIMMER OR AMULTI-SCENE (N)COUNTER-TOPS,(N)SINK,(N)SINK FAUCET HOOK-UP. °--w Y DKW
PROGRAMMABLE CONTROL SYSTEM.SWITCHED INSTALL(4)(N)GFCI OUTLETS ON(E)LINE& UP-GRADE
SEPARATELY FROM ANY HIGH EFFICACY LIGHTING. 06 18420349
REMAINING (E)OUTLETS.INSTALL(1)4 LG12056 2LT
UNDER-CABINET DIRECT WIRE 120v 6.4w LED12(HIGH EFFICACY). see, A 1