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15050056 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22424 RAMONA CT CONTRACTOR:PRUDHON BUILDERS PERMIT NO: 15050056 OWNER'S NAME: FOLKNER TROY R AND LAURA L 307 S NAVARRA DR DATE ISSUED:05/11/2015 OWNER'S PHONE: 4082556148 SCOTTS VALLEY,CA 95066 PHONE NO:(408)390-7251 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL ❑ KITCHEN REMODEL(140 SQ FT). License Class �.� ,-�_-� .,.t_;,;Lic;<#J�,=.x7.�.!�!,:,,7 2�1�.-�,, Contracto_ go�) I hereby affirm that I am licen ed 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 0Cmsation,as provided for by Section 3700 of the Labor Code,for the ance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$35000 n wi maintain Worker's Compensation Insurance,as provided for by 3700 of the Labor Code,for the performance of the work for which this APN Number:35701061.00 Occupancy Type: pe is issued. APPLICANT CERTIFICATION ' c® ify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED orrect.I agree to comply with all city and county ordinances and state laws relating WITfIIN 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 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, l costs,and expenses which may accrue against said City in consequence of the �� / ��G� granting of this permit. Additionally,the applicant understands and will comply Issued by i� Date: with all non-point source gulations p e Cupertino Municipal Code,Section 918. RE-ROOFS: Signature=:_-r <'=--1 • ``err= Dat '�3 �'T_ 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 Mun, ipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code;Sections 25 5,2553 d 25534. Section 3700 of the Labor Code,for the performance of the work for which this «�- �_= '` "' Owner or authorized agent: ° ti_ 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 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE o CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333-building(a1cupertino.org CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION tj ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT PROJECT ADDRESS 61t OWNER NAME rC, &CLLv CL,- F0 6 � -et PHONa�6�f'f E-MAIL STREET ADDRESS CITY, STATE,ZIP ( FFAX Celt qS_0 IV/ CONTACT NAMEHONE E-MAIL Cly 2-5 STREET ADDRESS CITY,STATE,ZIP FAX ❑ OWNER ❑ OWNER-BUII.DER ❑ OWNER AGENT CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR/N'A �� LIC E NUMBERn��37� LICENSE TYPE BUS.LIC# COMPANY N ` U E- L CC FAX STREET ADDRESS CITY,STATE,ZIP �� O ARCHITECT/ENGINEFR NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK EXIS e USE PROP U� CONSTR T #STORIES �js`/`�Z�J{ 7/� 12I USE TYPE OCC. SQ.FT. VALUATION($) EXLSTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA -- BATHROOM - KITCHEN OTHER REMODEL AREA REMODEL AREA 11% REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: LJ DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? OVO ADDITION? l�.IacS PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN s-E❑YES RECEIVE Y a .-� s Mx PLANNING APPL#�4i0 PLANNING APPROVAL LETTER EICHLER HOME? rv0 � TOTAL VAL/UA�\TION: fru ate' 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 buildin ccn c I I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: 5 SUPPLEMENTAL INFORMATION REQUIRED T New SFD or Multifamily dwellings: Apply for demolition permit for OVER THE t OT1hTER BUII DING PLANREVIEW existing building(s). Demolition permit is required prior to issuance of building , permit for new building c• � EXPRESS g P�A]�INGPLAIVREVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sTANnARD PUBLIcwoRres z 4 IN form if any Hazardous Materials are being used as part of this project. 'g 3 ` LARGE ti x © FIRE DEPTti _Copy of Planning Approval Letter or Meeting with Planning prior to x t tk submittal of Building Permit application. MA? R L 3 1 Psdt�rralz�sEwERDtsTRrcrw B1dgApp_2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 22424 Ramona Ct DATE: 05/11/2015 REVIEWED BY: Sean APN: BP#: `VALUATION: 1$35,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 R3SFDREM WORK Kitchen Remodel 140 sq ft). SCOPE Xfech. Plan Check Plumb. Plan Check Elec.Plan Check mech. Permit Fee: Plumb. Permit Fee: flee. Permit Fee: Other ilfech. Insp. Other Plumb Insp. E1__1_ Other Elec.Insp. Ilech.Insp. Fee: Plumb. h:sp.Fee: I Elec.Insp. Fee: NOTE:This estimate does not include fees due to other Departments(f.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These ees are based on the prelimina 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: $0.00 140 s.f. Remodel,Kitchen(<=300 sf) Suppl.PC Fee: 0 Reg. 0 OT FO.0 I hrs $0.00 $645.00 IREMRESKIT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: 0 Work Without Permit? 0 Yes (F) No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential Travel Documenlation Fees: Building or Structure i Strong Motion Fee: IBSEISMICR $4.55 Select an Administrative Item .Bldg Stds Commission.Fee: IBCBSC $2.00 u `, SUBTOTALS. $6.55 $645.00 �.'. TOTAL FEE:° $651.55 Revised: 04/01/2015 RECEIVED SCOPE OF WORK MAY BY Kitchen Remodel: Troy and Laura Folkner 2242IRamona Ct. Cupertino, CA 95014 1.) Remove and replace cabinets 2.) Install four new circuits to update electrical to meet current code requirements. 3.) Install new gas line (home run to meter) 4.) Replace sheet rock where needed 5.) Paint 6.) Remove existing exterior door and repair stucco COP✓IMUNITY DEVELOP%✓IENT DFPARTMENT BUILDING DIVISION - CUPERTINO APPROVED This set of plans a-a soecf cations INIUST be kept a;the job site during cor ;ruction. It is un,iv,fui to make any changes or ,n aerations on same, or to deviate therefrom, without aporoval from the Building Official. The Stamping cf thrs plan and s,ecif-cai;ons SHALL NOT be held to pernut or to be an approval cf the violation of aE3 Yny provis o; s of any City Ordinance or State Law. DATE .�� 5.9Tc�/l / l PERMIT ��e UFFIUL'0W& WWA= P i 1 i } n At I (AJJ) I New G;rc-m-A-g Gd��►:� SNS �x g C � a� � of.9 sa.) � ® I ®veva 1 LC ! j. ! i i 0N i o A-AV a I~ i ' I -