15050093IN
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10062 FIRWOOD DR
CONTRACTOR: JMB BUILDERS INC.
PERMIT NO: 15050093
OWNER'S NAME: MOONEY ROBERT R AND SUSAN M TRUSTEE
6176 TUOLOMNE CT
DATE ISSUED: 05/15/2015
OWNER'S PHONE: 4082577535
SAN JOSE, CA 95123
PHONE NO: (408)362 -9785
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]
REMODEL (E) KITCHEN (140 S.F.), NO STRUCTURAL
License Class Lic. 31;?- Ile
CHANGES
�s_ �#
Contractor -.1 Jt'lr� vi �'Lf Date SP �5 %
I hereby affirm that 1 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
Sq. Ft Floor Area:
Valuation: $40000
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the tabor Code, for the performance of the work for which this
APN Number: 34233043.00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
NOT
PERMIT EXP IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WIT F PE IT 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
OM CTI N.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
S
granting of this permit. Additionally, the applicant understands and will comply
Issued by:
with all non -point urce g ors p the Cupertino Municipal Code, Section
9.18.
RE- ROOFS:
Signature Date
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 1 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)
1, 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. 1 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(x) should I store or handle hazardous
I have and will maintain aCertificate 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 up tino Mu 'cipal Code, Chapter 9.12 and
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
the Health & Safety Code, Sectio 25 , 5 and 25534.
? I
permit is issued.
Owner or authorized agent: Date:
I certify that in the performance of the work for which this permit is issued, l shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of Califomia. 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
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
-
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
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 - FAX (408) 777 -3333 - buildingPcupertino.org \ "/
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❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT 4
PROJECT ADDRESS
APN H
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OWNER NAME
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PHONE
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EMAIL
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STREET ADDRESS a
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CITY, STATE, ZIP
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FAX
CONTACT NAME -
PHONE
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STREET ADDRESS
CITY, STATE, ZIP
FAX
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❑ OWNER ❑ OWNER -BUB -DER ❑ OWNER AGENT H CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBER
LICENSE TYPE
BUS. LIC H
1
COMPANY NAME
I MS Q ";' l
E-MAIL
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FAX
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STREET ADDRESS
CITY, STATE, ZIP
PHONE
6
ARCHITECT/ENGINEER N ME
LICENSE NUMBER
BUS. LIC H
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE ZIP. 1
14 9qDVJ
PHONE
1 &D7 do
DESCRIPTION OF WORK _
EXISTING USE
PROPOSED USE CONSTR.
TYPE
H STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXLSTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
"
BATHROOM KITCHEN
OTHER
REMODEL AREA REMODEL AREA IO
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECKIPORCH AREA
GARAGE AREA:
DETACH
H ATTACH
N DWELLING UNTIS.
IS A SECOND UNIT ❑ YES
BEINGADDED? ONO
SECOND STORY YES
ADDITION? ❑NO
PRE - APPLICATION []YES IF YES, PROVIDE COPY OF
PLANNING APPL N ❑ NO PLANNING APPROVAL LETTER
IS THE BLDG AN [I YES
ETCHLER HOME? ❑ NO
RE D WoA�e TOTAL VALUATION:
- / C/ / r
By my signature below, I certify to each of the following: I am the property own auth en owner's be f I have read this
application and the information I h7juMild de III read the Description o ork rfy i te. I agree to comply with all applicable local
ordinances and state laws relating n. [aut horize representatives of Cupertino to en a aboo identi T /ed property for inspection purposes.
Signature of Applicant/Agent: Date: `
SUPPLEMENTAL INFORMATION REQUIRED
PLAN CHECK TYPE
ROUTING SLrn
OVER- THE-COUNTER
❑ BUILDING PLAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN' REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
❑ NIAaOR
❑ SAN FARY SEWER DISTRICT
El' HEALTH
BldgApp_2011.doc revised 06121/11
4
F-W7 CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
10
ADDRESS: 10062 FIRWOOD DR
DATE: 05/15/2015
REVIEWED BY: MELISSA
E /ec. Plan Check
APN: 342 33 043
BP #: o 0
'VALUATION: 1$40,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Mech. Ins//. I'c'e:
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
WORK
E KITCHEN 140 S.F.), NO STRUCTURAL CHANGES
[REMODEL
SCOPE
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 hated on the nreliminary information available and are only an estimate Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 E�' 711113)
FEE
Ve4,lr. Aran (. "hack
Piwilb. Plow 01r(:6
E /ec. Plan Check
a9ech_ PernNl fee:
Numh. 011it Fee,
F, /e�c. Per;nir Fec.:
Other 1lech. Imp.
Ohher Plumb ln,p.
01/ler 1:lec. Insp,
Mech. Ins//. I'c'e:
/' UMI-J. hJS;). FCC.
Dec Insp, Fee
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 hated on the nreliminary information available and are only an estimate Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11 -053 E�' 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
F140 s.f.
$645.00
Remodel, Kitchen (< =300 sfl
IREMRESKIT
Suppl. PC Fee: (j) Reg. Q OT
0.0
hrs
$0.00
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
T_
Construction Tax.
Administrative Fee:
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non - Residential
Building or Structure
0
0
%'ruvel Uocurnen/uliurr Fees:
Strong; Motion Fee: IBSEISMICR
$5.20
Select an Administrative Item
B1dy-Stds Commission Fee: IBCBSC
$2.00
i i��iiii�
,.
7.20
$645.00
_3 iiav�,.��,��� „i o o
°� , , �
20
$652. 20
Revised: 05/07/2015