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15120199CITY OF CUP ER's INO BUILdDUNG- PERMUT BUILDING ADDRESS: 10394 GLENVIEW AVE CONTRACTOR: JACK MYERS PERMIT NO: 15120199 CONSTRUCTION OWNER'S NAME: DENESHA RICHARD J TRUSTEE 970 GEST DR DATE ISSUED: 12/23/2015 OWNER'S PHONE: 4087611185 MOUNTAIN VIEW, CA 94040 PHONE NO: (408)761 -1185 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ License Class Lic. # (0 REMODEL (2) BATHS (100 SF) AND KITCHEN (96 SF), REMOVE WALL BETWEEN LIVING ROOM AND �`� 2 l Contractort�f��d f te�_Date (� KITCHEN' REMOVE (E) FIREPLACE AND INFILL WITH (N) WINDOW I hereby affirm that I am licensed under the provisions of Chapter 9 AT (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: $80000 performance of the work for which this permit is issued. l have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of thee Lab�r the performance of the work for which this APN Number: 36911021.00 Occupancy Type: permit is issued. - APPLICANT CERTIFICATION I certify that 1 have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. 1 agree to comply with all city and county ordinances and state laws relating WITjfI�1 ISO DAYS OF PERMIT 1[SS�JA1�ClE 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 ISO DAYS FROM (LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Issued by: ?Loh& D 12,17- granting of this permit. Additionally, the applicant understands and will comply ate: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature_ Date �Z J 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. ❑ 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 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 1 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 1 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 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Section 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: 2p) permit is issued. 1 certify that in the performance of the work for which this permit is issued, 1 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, 1 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 1 have read this application and state that the above information is correct. 1 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 CUPERTIN CONSTRUCTION PERMIT APPLICATION COMMUNI I Y D_VELO?IdiEN T DEPARTMENT - BUILDING DIVISION 10300 i ORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 - FAX (408) 777 -3333 - builoino(a?cuoetno.ora ❑ NEW CONSTRUCTION [J ADDITION ION TI ❑ REVISION / DEr=E ED 151'av«� ORIGFN A r PERMiT 4 ?ROiECf ADDPrSS eA✓ VJ CW `�N R '2% -obi Lf 86' C < l If 6 t I F�,x S T FEET ADDRESS b 3 V, C I CITY, S7f.TE, Z P C P .22 _� � , v � n I PriOT n Cr u.? � /- L / CONTACT xa1✓E 1v_ `C �_ C: .116 l STR= =i f-DI)R SS '� U v �� CITY. 57.47:, Z3 �e Q ft I FAX ❑ 07,MP, ❑. OWR.- 'R- BtJII.SJER ❑ Ok'h =R AG=Nr ❑ CO?.iRACTOR ❑ COI.TrLACTOR `GEN7 ❑ T_CT ❑ _ 4C_D11' —R ❑ D1%cL0°E ❑ =141.? CON —,, ACTOR xANE ` a LIC_TSETvU1J�ER I LICENSE YFc �"��n BUS. LIC C014FAh� T Aar- ��i/n�__ q /jq /� I. J A- q "� e-L) 1�0 � \. 3 -NSIL FAx STREET ADDRESS CITY, STA c, ZIP PtiON'c —��, ^ —361 (� 1,RC� rNGT= ERI;.4.1,!E LICExSFMUMBER BUS.LIC� C0110DATIY KAA:E _ --- --' E -MAIL r 'STRZET kDDKFSR I CTY. STA Z, ZIP I PHO7 _ DESC?2 T 10N OF WOP,K � ! J ► " f t� 4 k fJ 4 1 -1 - [�. _✓ Ojee a w e- v,j K-t, Jc-L, Lc-,v 1 v ( �, ►` -- E;a57D�G USE PROPOSED USE CONSTR TYPE I :' STOR -'s i Ij USE 1 TYPE OCC. I SQ.FT. I VALUATION (4) EXL7G fREA C� 7 1z iLOGR . 7 I)ZMO TOTil N T AR EA BAT:•OOM Ki7Cr.^N FEdOD_L ?REA J 6 R_- 60DEL AREA v 0lr�R REMODEL AREA PORCH A. BA DEC TOTAL DECK/-'(ORC.I . ' =A G? ZAGE P.R A: D_ A -i ❑ ATTA Ci r'DlELLDGu? 15AS£CO DMiT ❑Y =S SECOND STORY ❑:'=S BEING ADDED? EJNO I ADDITION? EINO PR=- 1PPL:CATi01.q ❑Y =S IF%r:S,PRO\VE COPY OF PLA. \MNGA?PL� ❑NO ?LAI.NFLNGAPMOVf.LL_=R IS 1- IF BLDG A.N [))SS EICHLERHOME? El NO '�,C�•].YrD$Y- ��'�:�,� �- e -_=.�� _,� }� - *° �� { =�' -: ! TA-LV ?!UATION: �/1 o Ak. - .a (/ 0c) By my signa Lure below, I certify to each of the fcllo,; ing: I am the properly owner or authorized agent to act on the prope ov, er's behalf. I have, tad this application and the information I have provided is correct. I have read the Description of Work and veriy it is accurate. Q a to comply with 2.11 applicable local Crdinar,ces and state !?N-,,s re!ating to building construction. I authori represea_t -ts'-of Cupe.r in0 t0 enter the abo; e- identified ; op >, y :or inspection purposes. Signature of„ pplica-ft/ gent: _ Date: 2 SLPPLEA-_ENTAL NT0 ZATION REQUIRED �OR SE F COLFR �IIIIDL '' GYT �� itct W �� — New SFD or?;4u!tifal?iiy dv' elli gs: Apply for de,:,o!i`iGD 7e-Ilit =or existing building S . De-molit rir: +t .S reGUi;ed pr10r i0 iS °Ua_r]Ce of building for building• - permit new ercialBldes: Provide acoi lete ?�azardo �s A�_terials I s r� r _ toP d r DIRC.G -L... Era �eT 'fie "` � rPL'"1CS4•,fOFTCS ion if a_ny Hzzzrdous Materials tee'. -ing used as part of this project. o I '- Copy of P1Eru-?ing Approval Letter or Meeting wl:h Plar-ni Ig prior to � f f WS submittal OI BLIIdinQ Per-lit application. �aF] SE�n�I�T RTCI 31dg!, ,�p_7011.doc revised 06111,11 ORME CITY OF CUP Ell TINO FEE ESTIMATOR — BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public "'arks, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'l info. FETE ITEMS (Fee Resolution 11 -053 Efl:' 7/1113) 10394 Glenview Ave t FV 1rti:. { •: e.• 1.l':'t "J" DATE: 12/23/2015 REVIEWED BY: Phuong INADDRESS: APN: 36911021 DP #: Lj "VALUATION: 1$80,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex $0.00 PME Plan Check: PENTAMATION PERMIT TYPE: 1R3SFDREI a WORK Remodel 2 baths 100 SF and kitchen 96 SF), remove wall between living room and kitchen; remove SCOPE (e) fireplace and infill with (n) window; replace (e) sliding door at nook with (n) window; enlarge closet q NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public "'arks, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'l info. FETE ITEMS (Fee Resolution 11 -053 Efl:' 7/1113) :J. 1'I;,!!B :,.' .. t FV 1rti:. { •: e.• 1.l':'t "J" MISC ITEMS �, Vii. Plan Check Fee: $0.00 F100 s.f. $645.00 Lj Suppl. PC Fee: (2) Reg. C) OT Q,Q hrs NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public "'arks, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Deptfor addn'l info. FETE ITEMS (Fee Resolution 11 -053 Efl:' 7/1113) FEE QTY /FETE MISC ITEMS Plan Check Fee: $0.00 F100 s.f. $645.00 Remodel, Bath (< =300 sf) IREVRESBAT Suppl. PC Fee: (2) Reg. C) OT Q,Q hrs $0.00 PME Plan Check: $0.00 L2KOJ s.f. $431.00 Remodel, Other IREMRESOTH Permit Fee: $0.00 Suppl. Insp. Feely Reg, C) OT Q Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 . e.If'r }rSili dd'd i�i?1 I i.E.'C, Work Without Permit? 0 Yes (DNo $0.00 Advanced. Plannin Fee: $0.00 Select a Non - Residential Building or Structure Q e r °;•. <tiz / 1 jrat, rtr? a tr:,f ,d ,' ' Strang Motion Fee: IBSEISMICR $10.40 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $4.00 f , SUBTOTALS $14.40 $1,076.00 , s I ®IALFEE $1,090.40 Revi