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15090021II CITY OF CUPERTINO BUILDING PERMIT I I BUILDING ADDRESS: 22706 ROYAL OAK WAY I CONTRACTOR: S D BOWYER CO PERMIT NO: 15090021 OWNER'S NAME: KANDACE KLEMBA 13481 EDEN DR I DATE ISSUED: 09/03/2015 I OWNER'S PHONE: 4083313016 1 SANTA CLARA, CA 95051 1 PHONE NO: (408)247-7217 19 / LIC M SED CONTRACTORS DECLARATION License Class v� /C 33�nLiic. (# 4�Ye 917� Contractor sCJ i/C��/G Date I I hereby affirm that I am licensed under the provisions o 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: t. 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. 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 permit is issued. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source r tions per th t o Municipal Code, Sectio 19.18. Signature Date----/ ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: t. 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. 2. 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 permit is issued. 3. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REMODEL (E) HALL & MASTER BATHS (100 S.F.), NO STRUCTURAL CHANGES Sq. Ft Floor Area: I %'aluation: $19000 APN Number: 34232127.00 1 Occupancy T} PC: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FR ALLED INSPECTION. y: Date: RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or au Heed agent: Date: CON UCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO CONSTRUCTION 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 F I NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # LM PROJECT ADDRESS - / 2 APN # 3 Z7©d%,9/nA/<4,04OWNERNAME `/y�� PHONE ` . �J 7 J E-M.AIL E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME ��v_ //✓� PHONE O_ / E-MAIL �j STREET ADDRESS �?yg—/(/�Y/�J�7� FAX �� r -77, CITY, STATE, ZIP ✓�� ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONrRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER 11 TENANT CONTRACTOR NAME /�/!�' �al �/� C��Jj7✓� LICENSE NUMBER ) p �j , I / LICENSE TYP -Y 43 BUS. LIC # % 7 ! J COMPANY NAME .. /[%// �I E-MAIL FAX STREET ADDRESS,�/QJ (� /N CITY, STATE, Z[P r� �f� �4 A 9JU �J J/ (•! PHONE ARCHITECT/ENGINEERNAME LICENSENUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK /00 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 REMODEL AREA //tnr C. /DECK KITCHEN ODEL AREA OTHER REMODEL AREA PORCH AREA A TOTAL DECKMORCH AREA GARAGE AREA: 0 DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNrr ❑ YES SECOND STORY ❑ YES BEING ADDED' ONO ADDITION' ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES REC - EICHLER HOME' ❑ NO,:y,. TOTALVALUAT19Y:/ By my signature below, I certify to each of the following: I am the property owner or authors agent t on the property owner's behalf. I have read this application and the information 1 have provided is correct. I have read the Description of Work an rift' it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building constructs uthorize re es of Cupertino to enter the above-iden ie roperty for inspection purposes. Signature of ApplicanUAgent: t-� / Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TITS ROUTLNG SLIP ❑ 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 ❑ MAJOR ❑ SANITARY SEaTER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO oft, FEE ESTIMATOR - BUILDING DIVISION &a- ADDRESS: 22706 ROYAL OAK WAY DATE: 09/03/2015 REVIEWED BY: MELISSA Mech. P � w,1 i . APN: 342 32 127 BP#: `VALUATION: 1$19,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: I",lamb. Insp. Fcc, PENTAMATION 1 R3SFDRE PERMIT TYPE: WORK REMODEL E HALL & MASTER BATHS 100 S.F.),NO STRUCTURAL CHANGES SCOPE 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 Dreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E,('. 7%1%13) Alech. Plan Check Plumb. Plan Check Elec. Plan Check Mech. P � w,1 i . Plumb. A Flec. Permit I,e, Other Alech. Insp.E171- ldier Plumb Insp. Other Elec. 11.'(!7 /,?v" Fee: I",lamb. Insp. Fcc, Elec. Insp. Hee: 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 Dreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 E,('. 7%1%13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s. f. $645.00 Remodel, Bath (<=300 sf) 1REMRESBAT Suppl. PC Fee: Q Reg. Q OT0.0 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 Construction .Tax. .ldministrative Fee: 1 1 Q ED Work Without Permit? C) Yes (F) No $0.00 Advanced Plannigg Fee: $0.00 Select a Non -Residential Building or Structure E) O i 11ruvel Docurnenauiuni Strong Motion Fee: IBSEISMICR $2.47 Select an Administrative Item Bldg; Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $3.47 $645.00 TOTAL FEE: $648.47 Revised: 07/02/2015 2— 9, � q roo � / f � 5 rlW4 � 5 7/— — -, / 9 0 7;; /00 7,013 cooW C0Mh1lJNlT`.' �-. BUILDI,%J :, _,; . , `JT DEPARTMENT CUPERTINO This setofpar. ED ,, � ., . job site dunr,; :, ; :• J ; s MUST be kept at the ,`, changes or , -mlawful to make .,,, .,r; therefrom, witr,- ,, ,.,..-, any ' '�3me, or to deviate The Starnpin; m the Building Official. be held to ,.. =rfications SHALL NOT of ro. s ;:royal of the violation ance or State La,,v. DA TE — -- PERMIT # OFFICE COPY REQ'.61 V SEP 0 3 2015 guC( peRT1NQ SEP 0 3 g °ePft-hent Eve f5 EV�?OBD F OR COD Revieivea BY -- OOMPLtANOE uq ; I �-) L L 13 UT LU ;lp CL if 0 ui Q 0 0 0 LU 4) -�: 3 Z Lij Z uj Qf I L'eA_� i i CUPERTINC, FlUilding Departm�,)t 03 2015 4F_ttlmEWED Fp, t c CODE COMPLVt�IC� Reviewed E;y. it5TE4,2- '73 A-714