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15090163 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22605 RICARDO RD C NTRACTOR: PERMIT NO: 15090163 OWNER'S NAME: BARCLAY HAROLD G AND KATHRYN L TRUS Y65 3W PJ_pfI OWNER'S PHONE: 4086124888 DATE ISSUED:09/24/2015 Iv PHONE Ni� LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL KITCHEN REMODEL(220 S.F.) License Class_ Lic.# 12 11 3 K Contractor 5'1v" Cu s�uI . I sl Date ` 2Y 1 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: Sq.Ft Floor Area: Valuation:$20000 �. 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 APN Number:35601010:00 Occupancy Type: 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 EXPIRES IF WORK IS NOT STARTED permit is issued. PLICANT CERTIFICATION WITHIN 180 DAYS OF PERMIT ISSUANCE OR AP I certify that I have read this application and state that the above information is 180 DAYS FROM LAST CALLED INSPECT ON. 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 Issued by: 1— Date: upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep hamiless 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 RE-ROOFS: all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 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 Signature Date 2-K-13 inspection. Signature of Applicant: Date: r OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License.Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER the following two reasons: t. I,as owner of the property,or my employees with wages as their sole HAZARDOUS MATERIALS DISCLOSURE compensation,will do the work,and the structure is not intended or offered for I have read the hazardous materials requirements under Chapter 6.95 of the sale(Sec.7044,Business&Professions Code) California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain 2. I,as owner of the property,am exclusively contracting with licensed contractors to compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& construct the project(Sec.7044,Business&Professions Code). Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air I hereby affirm under penalty of perjury one of the following three declarations: contaminants as defined by the Bay Area Air Quality Management District I will �. I have and will maintain aCertificate of Consent to self-insure for Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation,as provided for by Section 3700 of the Labor Code,for the Health&Safety Code,Sections 25505,25533,and 25534. performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance,as provided for by Owne eauthoriz Section ent_— 3700 of the Labor Code,for the performance of the work for which this Date: `( q -15- permit Spermit is issued. s. I certify that in the performance of the work for which this permit is issued,I shall CONSTRUCTION LENDING AGENCY not employ any person in any manner so as to become subject to the Worker's I hereby affirm that there is a construction lending agency for the performance of work's Compensation laws of California. If,after making this certificate of exemption,I for which this permit is issued(Sec.3097,Civ C.) become subject to the Worker's Compensation provisions of the Labor Code,I Lender's Name must forthwith comply with such provisions or this permit shall be deemed Lender's Address revoked. APPLICANT CERTIFICATION ARCHITECT'S DECLARATION I certify that I have read this application and state that the above information is I understand my plans shall be used as public records. 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 Licensed Professional 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. Signature Date CONSTRUCTION IAPPLICATION COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION 20300 TORRE AVENUE®CUPERTINO, CA 95024-3255 G TI.N (408)777-3228-FAX(408)777-3333 a blliidilltlCc�cuo�rlirl0 orct ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT PROIECTADDRESS T77�_3�Jb"�� '- OWNER NAME QSf JF PHONE E-MAIL '�u�. (012• ��`�3 -��-�+st�-�Ad1 .�ow� STREET ADDRESS TCITY STA ,ZIP10 _ i,, FAX CONTACT NAME PHONE 'T Sia S�tv� y��_^� 'u 7 E-MAIL STREET ADDRESS �t C 4 CITY,STATE,ZIP LL s 5 ac 1rJ 4 S�i o+n I i OY tt v� }'k+')t C►S I FAX ❑OWNER ❑ OWNER-BUILDER 13 OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC S;Ivb. Cu,%+4 C�.s� . q2 013 V>- Zk COMPANY NAME �ea.� S i 1 vim. E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE `s SaM Seto e•s�,G t lam;t( CA a sD3 8%- 3l'1{-2'L t 2 ARCHITECTIENGWEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL R C Cvus•,t}• t1n¢¢v s )K v- y^d cx o Cow\ FAx t job-27-9-`S tS3-- STREET ADDRESS CITY,STATE,ZIP PHONE C3C3 R2Gtwc yr. # -3 osc CIA c?SII Lf vg. 22S{ "$15S DESCRIPTION OF WORK , S f� : EXISTING USE T�'�OSED USE CONSTR.TYPE #STORIES �Ci�Clq�t+n -j G G�¢v� i?��,,,flt USE TYPE OCC. SQ FT. VALUATION($) EXISTG R DEMO TOTAL AREA AREA NETAREA BATHROOM CHEN OTHER REMODEL.AREAMODELAREA S2.01y REMODELAREA PORCH AREA DECK AREA - TOTAL DECK/PORCH AREA. GARAGE AREA: DETACH - - ❑ATTACH #DWELLING UNITS: - IS A SECOND UNIT ❑YES SECOND STORY ❑YES _ BEINGADDED? ❑NO ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES LVED$Y: TOTAL VALUATION: PLANNINGAPPL# []NO PLANNINGAPPROVALLETTER EICHLERHOME? [3NO By my signature below,I certify to each of the following: I am the property owner or autho ' ed 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 construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: 9.-2-4- i S -- SUPPLEMENTAL INFORMATION.REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for OVER-T]IF-COUNTER CI BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ FmREss ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure I] STANDARD 11 PUBLIC WORKS To-nn if any Hazardous Materials are being used as part of this project. Q LARGE ❑ ME DEPT —Copy of Planning Approval Letter or Meeting with Planning prior to MAJOR © SANrIABY SEWERDISTRICT submittal of Building Permit application. El' ENviRoNMENTAL HEALTH BldgApp 2011.doc revised 06/21/11 CITY OF CUPERTINO ON0163 FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 22605 Ricardo Rd. DATE: 09/24/2015 REVIEWED BY: PAUL APN: 356 01 057 BP#: EVALUATION: $20,000 MPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration 1 Repair PRIMARY SFD or Duplex PENTAMATION PERMIT TYPE: 1 R3SFDREM WORK Kitchen Remodel 220 S.f. SCOPE ;leech. flan(heck Pfrirrl?. f'lart C:%ac<H I.iec'Plarr Ched( tlecft. Pc Wait Fee: ph"'Mb. Perm Fee: 11<:c•. Pernd Fee: t�her:llec°�r. Insp. other P;