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15060198CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10341 TONITA WAY CONTRACTOR: CALIFORNIA HOMES PERMIT NO: 15060198 AND KITCHEN DESIGN OWNER'S NAME: SAMADDAR SUMITRO AND SEN SUPARNA 1775 JUNCTION AVE DATE ISSUED: 06/30/2015 OWNS PHONE: SAN JOSE, CA 95112 PHONE NO: (408) 392-8200 Xr LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL REMODEL (E)190 S.F. KITCHEN, NO STRUCTURAL License Class_ Lic. # 6 �� I CHANGES /I Contractor o n:c. ,{Date_ O r W t 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 Fonoensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $16000 e rmance of the work for which this permit is issued. 11)(ave 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 A I'\ Number: 35914003.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 D RMIT 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 D CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against in consequence of the U granting of this permit. Additionally, plic under, sand will comply Issue Da e. with all non-point source regul ' s per th a unicipal Code, Section 9.18. C 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 in for inspection. ❑ OWNER UILDER 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 1, 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. 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 ha zardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use equipment or der* wh' emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area A' uality nagement District 1 performance of the work for which this permit is issued. will maintain compliance with the Cuper ' Iviunici1pliter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 5,25533 Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized age Date: permit is issued. 1 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 ONSTRUCTIO ENDING 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 COW11UNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • build ing(a)cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT ; PROJECT ADDRESS t ©�3LI j 1 ( I APN OWNER NAME (A S N /►1 ! J A WC�dWA, PHONE E-MAIL / /✓I0 A6' (4l ►lD!'�%tSLi/�ol Ki �'ti1 1 STREET ADDRESS CITY, STATE, ZIP G C^ I FAX k1 C,46 _3G1 2 _ `D IrT� CONTACT NAME /M PHONE J (--(0(; `3�1-81 E-MAIL J STREET ADDRESS i- CITY, STATE, ZIP 7 FAX El OWNER ❑ OWNER -BUILDER ❑ Ol',-R AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENAN-r CONTRACTOR NAME-�i'/2-1 O n Kr�(C l\ 1\ LICENSE NUMBER �00 C,Z3 ` LICENSETYPE BUS. LIC# COMPANY NAME E-MAIL FAX C'4-"" Mt / K1` �,�,� 1 i M tc' o I +^ .kC7 STREET AD zSSCITY, STATE, ZIP PHONE t1 'LIS $ Z Opo e\ , C ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC R COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHOIiE DESCRIPTION OF WORK S Ea7STING US PROPOSED USE CONSTR. TYPE 4 STORIES t\ a < ; USE TYPE OCC. SQ.FT. VALUATION (S) TT v Y 1 EXISTG NEW FLOOR DEMO TOTAL AREA .L O AREA k1J� . AREA NET AREA 1 PLO ` BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA L REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDETACH ❑ ATrACH I 9 DWELLING UNTIS: 1S A SECOND UNIT El YES SECOND STORY E] YES BEING ADDED? R�NO ADDITION? [,NO PRE -APPLICATION []YES IFYES, PROVIDE COPY OF IS THE BLDG AN YES RBCEIV -.. ,_` '- TOTAI-V�L%U4TIp�N. PLANNING ADPL � ❑ NO PLANNING APPROVAL LETTER I EICHLER HONIL..' - /� /9 By my signature below, I certify to each of the follolvine: I am th�propertyoN� t ized agen toact on the rty owner's be have read thisapplication and the information I have provided is correct. I have Vork�nd verify i curate. I agree to comply with A applicable local ordinances and state laws relating to building construction. I auth ino to enter the above -identified property for inspection purposes. S i --nature of Applicant/Agent: Date: SUPPLEMENTAL INFORM QUI vial. cIcxnPE.=F Q_ kROUTINGSLIP New SFD or Multifamily dlvellings: Apply for demolition permit for -� P. existing building(s). Demolition permit is required prior to issuance of building O«R THZ+<CO TER- N&A. BUILDING L�A�.RE' �' eta a permit for new building. _� ExrREss£ _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. � -I� _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. �S 't ah. RDISTRI Nr Bldg-App_2011.doc revised 06/21/11 to— CITY OF CUPERTINO Fm__� FEE ESTIMATOR- BUILDING DIVISION im,ADDRESS. 10341 TONITA WAY DATE: 06/30/2015 REVIEWED BY: MELISSA btech. Permit £c, APN: 359 14 003 BP#: Cj `VALUATION: 1$16,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Plumb. hasp. Fec PENTAMATION 1R3SFDREM PERMIT TYPE: WORK REMODEL E 190 S.F. KITCHEN NO STRUCTURAL CHANGES SCOPE PME Plan Check: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the vreliminary information available and are only an estimate. Contact the Dept_for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Cf 7111131 Alech. Plan Check Plumb. Plan Check Elec. Plan Check btech. Permit £c, Plumb. Permit Fec T-I"r Pcrwir I, Other Alech. Insp. Other Plumb Insp.Li Other Elec. Insp. !�,ch. hash. Fee: Plumb. hasp. Fec klec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the vreliminary information available and are only an estimate. Contact the Dept_for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Cf 7111131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 190 s.f. $645.00 Remodel, Kitchen (<=300 sf) IREMRESKIT Suppl. PC Fee: Q Reg. 0 OT 0,0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:(D Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ' onstruction Tax. 13ministrCative Fee: Q 0 Work Without Permit? © Yes E) No $0.00 Advanced Planning Fee: $0.00 Select allon-Residential Building or Structure 0 Travel Strong Motion Fee: IBSEISMICR $2.08 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $3.08 $645.00 TOTAL FEE: $648.08 Revised: 05/07/2015 6UfLDfNO DI1/ISION'_CUENT PERTINO APPP V td, \ O J ` QA s -4iL tiol &C,;&', '. " � " ' 'IC: , fity duri , a the /� ng construction. It is unlawful to make any changes or altera�or?7gn same, or to dq2i� fq 2 31143 3/4 therefrom, without ap rov from the Building Official, - - 41 - - Iha-stacx►P+ng�fptanc9 spe s SHA N WU to 4 -- a SHA 30 - - 3/4 -- 6t- 30 - 26 24 _ t atato 36 BY K K, �-e, ^^--.. �W IN tj C'0 t<�� tj AVIINVIG_1� Kitchen cabinet; Select Maple, Revere,S panel door style, E7edge, og inside edge, light stain, Solid dovetailed soft cloos drawers, soft close doors, Garbage pullout bin, Lazy Susan, 3-1/4" crown molding; Solid dovetailed pullouts; 6 SJ�p►r vl(� � �' V vel � � �e �iy� �� Ox Suparna RZORM >Kitchen Kitchen#2/36" cooktop Room 2 Current Date: Jun 24, 2015 Scale: NTS <YOUR CITY AND STATE> Phone: <YOUR PHONE NUMBER> Fax: <YOUR FAX NUMBER> 16 N 4 M 4�= G F; D 4ker- Cr F: 1 KT L p R eXe S5-rA L 1 QN�p� L4' 't 5:���� C"' 64TILI W rim-jfe S`ccv�—' 4% r,UPERTINO N < uildina Department 15 Coco '!UN 3 0 20 - . `j+r�,:;UDE COMPLIANCE 'Veviewed By California Bath & Tile Suparna Floorplan >Kitchen Kitchen#2/36" cooktop Room 2 Current Date: Jun 24, 2015 Scale: NTS <YOUR CITY AND STATE> Phone: <YOUR PHONE NUMBER> Fax: <YOUR FAX NUMBER> CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10341 TONITA WAY CONTRACTOR: CALIFORNIA HOMES PERMIT NO: 15060198 AND KITCHEN DESIGN OWNER'S NAME: SAMADDAR SUMITRO AND SEN SUPARNA 1775 JUNCTION AVE DATE ISSUED: 06/30/2015 OWNER'S NE: SAN JOSE, CA 95112 PHONE NO: (408) 392-8200 ❑ LI SED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E]COMMERCIAL (E) 190 S.F. KITCHEN, NO STRUCTURAL QREMODEL License Class Lic. #�c� (�✓ 1 CHANGES Contractor 5, & Date ell I Revision #1 - Add (N) 125 Subpanel - ISSUED 8/21/2015 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 c6nsent to self -insure for Worker's mpensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $16000 p rformance of the work for which this permit is issued. 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: 35914003.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT 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 S FROM LAST CALLED INSPECTION. indemnify and keels harmless the City of Cupertino against liabilities, judgments, consequence of the costs, and expenses which may accrue against sFrtino jl ��t ! ' ' granting of this permit. Additionall plictands and will comply �/ Issued by: i f I1 1! l �� �� ( ✓Y ' t Date: with all non -point source r ons per the unicipal Code, Section 9.18. / RE -ROOFS: Sign Date > h 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 Qu ' Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Code, C 'ter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 255 , 55 nd 534 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 CUPERTINO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org "PLUMBING LJ MECHANICAL LJ ELECTRICAL LJ MISCELLANEOUS PROJECT ADDRESS r�. APN # MEP misc OWNERNAMF �j�+� �(1 (/� (^� S to% IVN, ; •v PHONEO 7 ( ©� E-MAIL ,rte r STREET ADDRtss (� I Cr.Y, STATE, ZIP FAX CONTACT NAME CA \t �V ^i't� Y C�, i PHONE cj �Q J� Zie E-MAILQ EJ V I Ir4o /1©&0 o1M �1�/� K STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑. CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME =1� Q'✓\nn LICENSE NUMBER I ` LICENSE TYPE BUS. LIC # o r COMPANY NAME E-MAILFAX r� . C–^ STREET ADDRESS , CITY, STATE, ZIP PHONE J� ` ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME I E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or DUPLEX ❑ MULTI -FAN -PROJECT IN WILDLAND EIYES PROJECT IN ❑ YES IS THE BLDG AN E3YES -7 H BUAING: ElCOMMERCIAL URBAN INTERFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHLER HOME? ❑ NO DESCRIPTION OF WORK i-- _ 1 /-N A TOTAL VALUATION: RF IVSD B1 t By my signature below, I certify to each of the following: I roperty own thorized o act on the property owner's behalf. I have read this application and the information I have provided is c have read the De d verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to build' n n. I authoriz sen Ive I mo enter the above -id 'feed property for inspection purposes. Signature of ApplicanUAgen Date: = 21 / 1 `! TION REQUIRED MEPA7iscApp_2011.doc revised 06/21/11 CITY OF CUPERTINO 1 601gs FEE ESTIMATOR - BUILDING DIVISION `J'" APPLIANCE / EQUIP TYPE ADDRESS: 10341 Tonita Way ." htmb. Plan Check DATE: 08/21/2015 REVIEWED BY: PAUL ON APN: 35914 003 BP#: 15060198 *VALUATION: $200 °'PERMIT TYPE: Electrical Permit 125 PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: uplex Permit Fee: PENTAMATION PERMIT TYPE: 1 REAP WO N 125 Subpanel +Reyi�sion#jjAdd SCOPE APPLIANCE / EQUIP TYPE FEE ID ." htmb. Plan Check QTY UNITS BP FEES Elec. Permit Fee: I EPERMIT Services 1 ERT<200 0 hrs Other Elea Insp. 1001 125 Amps $48 Permit Fee: Suppl. Insp Fee PME Unit Fee: $48.00 PME Permit Fee: $48.00 t `onstruciirm Tax.- ax:Administrative AdministrativeFee: IADMIN $45.00 Work Without Permit? 0 Yes O No $0.00 TOTALS: TravelDocumentation Fee: 1TRAVDOC $48.00 Strong Motion Fee: IBSEISMICR 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 Preliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-033 Eft: 7,11113) ,ilech. Plea: Check ." htmb. Plan Check Elec. Plan Check 0.0 hrs $0.00 Weck Permit l•'e- Plumb. Permit tee: Elec. Permit Fee: I EPERMIT tather:ilech_ (uap. Other Plunib hasp. 0 hrs Other Elea Insp. 1001 hfech. Insp. Fee: Plumb. Insp. Fee: Elec- Insp. lee 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 Preliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-033 Eft: 7,11113) FEE QTY/FEE7 MISC ITEMS Plan Check Fee: Sitpj)l. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. Insp Fee PME Unit Fee: $48.00 PME Permit Fee: $48.00 t `onstruciirm Tax.- ax:Administrative AdministrativeFee: IADMIN $45.00 Work Without Permit? 0 Yes O No $0.00 _ dvanced .Planning Fees.- ees:Travel TravelDocumentation Fee: 1TRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $190.50 $0.00 TOTAL FEE: $190.50 Revised: 07/02/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10341 TONITA WAY CONTRACTOR: CALIFORNIA HOMES PERMIT NO: 15060198 AND KITCHEN DESIGN OWNER'S NAME: SAMADDAR SUMITRO AND SEN SUPARNA 1775 JUNCTION AVE DATE ISSUED: 06/30/2015 OWNS PHONE: SAN JOSE, CA 95112 PHONE NO: (408) 392-8200 Xr LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL REMODEL (E)190 S.F. KITCHEN, NO STRUCTURAL License Class_ Lic. # 6 �� I CHANGES /I Contractor o n:c. ,{Date_ O r W t 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 Fonoensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $16000 e rmance of the work for which this permit is issued. 11)(ave 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 A I'\ Number: 35914003.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 D RMIT 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 D CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against in consequence of the U granting of this permit. Additionally, plic under, sand will comply Issue Da e. with all non-point source regul ' s per th a unicipal Code, Section 9.18. C 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 in for inspection. ❑ OWNER UILDER 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 1, 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. 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 ha zardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally, should I use equipment or der* wh' emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area A' uality nagement District 1 performance of the work for which this permit is issued. will maintain compliance with the Cuper ' Iviunici1pliter 9.12 and 1 have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 5,25533 Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized age Date: permit is issued. 1 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 ONSTRUCTIO ENDING 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 COW11UNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • build ing(a)cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT ; PROJECT ADDRESS t ©�3LI j 1 ( I APN OWNER NAME (A S N /►1 ! J A WC�dWA, PHONE E-MAIL / /✓I0 A6' (4l ►lD!'�%tSLi/�ol Ki �'ti1 1 STREET ADDRESS CITY, STATE, ZIP G C^ I FAX k1 C,46 _3G1 2 _ `D IrT� CONTACT NAME /M PHONE J (--(0(; `3�1-81 E-MAIL J STREET ADDRESS i- CITY, STATE, ZIP 7 FAX El OWNER ❑ OWNER -BUILDER ❑ Ol',-R AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENAN-r CONTRACTOR NAME-�i'/2-1 O n Kr�(C l\ 1\ LICENSE NUMBER �00 C,Z3 ` LICENSETYPE BUS. LIC# COMPANY NAME E-MAIL FAX C'4-"" Mt / K1` �,�,� 1 i M tc' o I +^ .kC7 STREET AD zSSCITY, STATE, ZIP PHONE t1 'LIS $ Z Opo e\ , C ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC R COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHOIiE DESCRIPTION OF WORK S Ea7STING US PROPOSED USE CONSTR. TYPE 4 STORIES t\ a < ; USE TYPE OCC. SQ.FT. VALUATION (S) TT v Y 1 EXISTG NEW FLOOR DEMO TOTAL AREA .L O AREA k1J� . AREA NET AREA 1 PLO ` BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA L REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDETACH ❑ ATrACH I 9 DWELLING UNTIS: 1S A SECOND UNIT El YES SECOND STORY E] YES BEING ADDED? R�NO ADDITION? [,NO PRE -APPLICATION []YES IFYES, PROVIDE COPY OF IS THE BLDG AN YES RBCEIV -.. ,_` '- TOTAI-V�L%U4TIp�N. PLANNING ADPL � ❑ NO PLANNING APPROVAL LETTER I EICHLER HONIL..' - /� /9 By my signature below, I certify to each of the follolvine: I am th�propertyoN� t ized agen toact on the rty owner's be have read thisapplication and the information I have provided is correct. I have Vork�nd verify i curate. I agree to comply with A applicable local ordinances and state laws relating to building construction. I auth ino to enter the above -identified property for inspection purposes. S i --nature of Applicant/Agent: Date: SUPPLEMENTAL INFORM QUI vial. cIcxnPE.=F Q_ kROUTINGSLIP New SFD or Multifamily dlvellings: Apply for demolition permit for -� P. existing building(s). Demolition permit is required prior to issuance of building O«R THZ+<CO TER- N&A. BUILDING L�A�.RE' �' eta a permit for new building. _� ExrREss£ _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. � -I� _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. �S 't ah. RDISTRI Nr Bldg-App_2011.doc revised 06/21/11 to— CITY OF CUPERTINO Fm__� FEE ESTIMATOR- BUILDING DIVISION im,ADDRESS. 10341 TONITA WAY DATE: 06/30/2015 REVIEWED BY: MELISSA btech. Permit £c, APN: 359 14 003 BP#: Cj `VALUATION: 1$16,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Plumb. hasp. Fec PENTAMATION 1R3SFDREM PERMIT TYPE: WORK REMODEL E 190 S.F. KITCHEN NO STRUCTURAL CHANGES SCOPE PME Plan Check: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the vreliminary information available and are only an estimate. Contact the Dept_for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Cf 7111131 Alech. Plan Check Plumb. Plan Check Elec. Plan Check btech. Permit £c, Plumb. Permit Fec T-I"r Pcrwir I, Other Alech. Insp. Other Plumb Insp.Li Other Elec. Insp. !�,ch. hash. Fee: Plumb. hasp. Fec klec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the vreliminary information available and are only an estimate. Contact the Dept_for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Cf 7111131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 190 s.f. $645.00 Remodel, Kitchen (<=300 sf) IREMRESKIT Suppl. PC Fee: Q Reg. 0 OT 0,0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:(D Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ' onstruction Tax. 13ministrCative Fee: Q 0 Work Without Permit? © Yes E) No $0.00 Advanced Planning Fee: $0.00 Select allon-Residential Building or Structure 0 Travel Strong Motion Fee: IBSEISMICR $2.08 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $3.08 $645.00 TOTAL FEE: $648.08 Revised: 05/07/2015 6UfLDfNO DI1/ISION'_CUENT PERTINO APPP V td, \ O J ` QA s -4iL tiol &C,;&', '. " � " ' 'IC: , fity duri , a the /� ng construction. It is unlawful to make any changes or altera�or?7gn same, or to dq2i� fq 2 31143 3/4 therefrom, without ap rov from the Building Official, - - 41 - - Iha-stacx►P+ng�fptanc9 spe s SHA N WU to 4 -- a SHA 30 - - 3/4 -- 6t- 30 - 26 24 _ t atato 36 BY K K, �-e, ^^--.. �W IN tj C'0 t<�� tj AVIINVIG_1� Kitchen cabinet; Select Maple, Revere,S panel door style, E7edge, og inside edge, light stain, Solid dovetailed soft cloos drawers, soft close doors, Garbage pullout bin, Lazy Susan, 3-1/4" crown molding; Solid dovetailed pullouts; 6 SJ�p►r vl(� � �' V vel � � �e �iy� �� Ox Suparna RZORM >Kitchen Kitchen#2/36" cooktop Room 2 Current Date: Jun 24, 2015 Scale: NTS <YOUR CITY AND STATE> Phone: <YOUR PHONE NUMBER> Fax: <YOUR FAX NUMBER> 16 N 4 M 4�= G F; D 4ker- Cr F: 1 KT L p R eXe S5-rA L 1 QN�p� L4' 't 5:���� C"' 64TILI W rim-jfe S`ccv�—' 4% r,UPERTINO N < uildina Department 15 Coco '!UN 3 0 20 - . `j+r�,:;UDE COMPLIANCE 'Veviewed By California Bath & Tile Suparna Floorplan >Kitchen Kitchen#2/36" cooktop Room 2 Current Date: Jun 24, 2015 Scale: NTS <YOUR CITY AND STATE> Phone: <YOUR PHONE NUMBER> Fax: <YOUR FAX NUMBER>