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15040099I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 22832 LONGDOWN RD CONTRACTOR:ff5b—TO BE1 PERMIT NO: 15040099 nF� ED I I OWNER'S NAME: MARCUM JOHNNY P I (1// - °/ L I I DATE ISSUED: 04/14/2015 I I CWVNER'S PHONE: 4086791405 1 , /J.(i. _4.1.1,, 777—w 1 PHONE NO: 241 LICENSED CONTRACTOR'S License Class Lic. # - l -i � ( 7 Vs ContractorGw, Date Q ILf Lot S I hereby affirm that I am licensed Uder 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. hereby affirm under penalty of perjury one of the following two declarations: 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 regulations per the Cupertino Municipal Code, Section 9.18. Signaturet�. l Date o' rq2c1S a a a Rft 41" - I I ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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 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 G 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 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, Seciion 9.18. Signatu .mac '_ _ llate_ _ JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL ❑ REMODEL; (KITCHEN 109 SQ FT; (3) BATHROOMS 184 SQ FT; RELOCATE LAUNDRY ROOM 75 SQ FT, (E) THROUGH OUT Sq. Ft Floor Area: I Valuation: $100000 APN Number: 34233005.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYWF PERMIT ISSUANCE OR 180 DAYS FR ST CALLED INSPECTION. Issued by: Date: l-tS 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. - Date: CONSTRUCTION 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 Address 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(5)-cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ .ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS r;j&X_� f` /�/J� 3 •2 !' n �r �l� APN #tA ✓'/ OWNERNAME PHONE E-MAIL 0 ,1, STREET ADDRESS �n CITY, STATE, ZIP FAX O\ �K G CONTACT NAME PHONE N` E-MAIL I STREET ADDRESS ^ CITY, STATE, ZIP FAX dV-9aYNER El OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAMR, �/ r LICENSENUMBERq 5 LICENSETYPE BUS. LIC# l yqg COMPANY NAME I` E-MAIL n �� FAX t e, i't S Q Q f STREET ADDRESS t 67 CITY, ST E, ZIP � f' PHONE t ( T � � t ^ ARCHITECT/ENGINEER NVE LICENSE NUMBER BUS. LIC # C, COMP AME E-MAIL E F - Z�`( STREET ADDRESS CITY_ STATE ZIP �/1 �± PHOT -Yds El Gtwt �^ DESCRIPTION OF WORK , (�— �,(�J q tcL r e:t Vl 0,J e U VL C" ---- v S t✓ i o �� _ �l—�G'�GlG�L �7�� � � D L G�' � l/✓ �' c EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA `� AREA ,( AREA � L S NEr AREA 'O ` BATHROOM KITCHEN REMODEL AREA CI REMODEL AREA v �I ,AREA OTHER REMODEL AREA —L4S 1 PORCH AREA DECK TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNrrS: IS A SECOND UNIT ❑ YES SECOND STORY []YES BEING ADDED? ❑NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNINGAPPROVAL LETTER IS THE BLDG AN ❑ YES ['RE EICHLER HOME? ❑ NO CE[ k i '' VA J*TAL VALUATION: .r` ..+r-�- —^ 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 lding construct' I a.lit riz representatives of Cupertino to enter the above-ide ified pro erty for inspection purposes. Signature of Applicant/Agent: �. Date: 0' I SUPPLEMENTAL INFORMATION REQUIREPc>>EcxTYPE,� , yp:F .,aoviiivc,`sLiPx _ _` New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition, permit is required prior to issuance of buildings OVER TH><COUIvTER au , wl BUII DINGLANsREVIEW x k t ,3 s; rlr permit for new building." n I� p B w. ExPxEsst 4' ' * k1 s , ..�,� x -. ❑PI:AZVAINGPLSAN REVIEW n" 5 p-u, § e Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD, -D* > uBl cwoRxs E form if any Hazardous Materials are being used as part of this project.ta ��❑F1 rr r LARtaE3y DEPyT� Copy of Planning Approval Letter or Meeting with Planning prior to _ submittal of Building Permit application.t',�u� mc a , �; s + �. , vl ❑pry �� ,� ,_'� BldgApp_2011.doc revised 06/21/11 P_� M11 i CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 19 ADDRESS: 22832 longdown rd DATE: 04/14/2015 REVIEWED BY: Mendez Plumb. Pe' -Mil Fire: APN: BP#: ! "VALUATION: j$100,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: p PENTAMATION PERMIT TYPE: 1 R3SFDREM WORK remodel kitchen 109 sq ft 3 bathrooms 184 sq ft; relocate laundN room 75 sq ft e through out SCOPE $0.00 Suppl. Insp. Fee -.0 Reg. 0 OT 10.01 hrs t e �",� , �`' � 'Fad'#0111- jllech. Plan Check Phanb. Plan Check heck Elec. Plan Check- 7M11-11. Mech. Penni/ File Plumb. Pe' -Mil Fire: Elec, Permit Fee: Other Mcch. Rap. 011ier Plumb lnsp. Other E1ec. Insn, Mech. Insp. Fee: Phemb, Insp. Fee: Elec. Imp. Fee., NOTE. This estimate does not include fees due to other Departments (l. e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the nreliminary information available and are only an estimate. Contact the Dent for addn I info. FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes Q) No $0.00 109 s.f. $645.00 Remodel, Kitchen (<=300 sf) IREMRESKIT Suppl. PC Fee: 0 Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 184 s.f. $645.001 Remodel, Bath (<=300 sf) IREMRESBAT Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee -.0 Reg. 0 OT 10.01 hrs $0.00 = s.f. Remodel, Other $431.00 IREMRESOTH PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tcrv. -7-1 Aclministrative Fee: 0 Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 1 hours $143.00 Plan Check, Hourly ISTPLNCK G) i Travel Documentation Fees: Strong Motion Fee: IBSEISMICR $13.00 2.0 I hrs $286.00 Inspections 1STINSP I Inspection, Hourly Bldg, Stds Commission Fee: IBCBSC $4.00 „q r SITBTOTALS� $17.00.$2,150.00 a G.w�'OT�ALF)H}Er $2,167.00 Revised: 04/01/2015