15040191CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7628 WEST HILL LN
CONTRACTOR: DAVE'S REMODELING
PERMIT NO: 15040191
INC
OWNER'S NAME: NOONE JOHN R AND LESLYE C
6001 TOPEKA DR
DATE ISSUED: 04/27/2015
OWNER'S PHONE:
TARZANA, CA 91356
PHONE NO: (888) 216-3539
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL EJ COMMERCIAL ❑
BATHROOM REMODEL (80 SQ FT); RELOCATE LAUNDRY
License Class Lic. # � z Cf
TO
n "6 �_ jfLu ry
7 g
SECOND FLOOR; ELIMINATE ONE BATHROOM AND
,Date
Contractor tK�/'//'
BEDROOM
I hereby affirm that I am licensed under the provisions of Chapter 9
TO ENLARGE LIVING ROOM.
(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: $60000
performance of the work for which this permit is issued.
P)Iave and will maintain Worker's Compensation Insurance, as provided for by
ection 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APN Number: 36227025.00
Occupancy Type:
APPLICANT CERTIFICATION
certify that I 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
WITHIN 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,
costs, and expenses which may accrue against said City in consequence of the
Issued by: Date:
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.
RE -ROOFS:
Signature _ Date � ! ' Z q, ` ,
V
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 1 am exempt from the Contractor's License Law for one of
the following two reasons:
ALI, 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.I2 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 Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: _.
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 Iiabilities, 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
a
a
CUPERTINO
�5U��19 I
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinq(a)_cuper ino.orq
❑ NEW CONSTRUCTION ❑ ADDITION
►LI ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT 4
PROJECT ADDRESS 7 02 O , i I / l'vll
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APN # -3 6 7 2 77 C2 f
OWNERNAME ':TO / /�a
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STREET ADDRESS
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CONTACT NAME PHONE 8 / p 33 � �l3 1
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STREET ADDRESS 140
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CITY, STATE, ZIP
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❑ OWNER ❑ OWNER -BUILDER ❑ OIAINIER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME LICENSE NUMBERG/-+fir � /� ;j LICENSE TYPE
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BUS. LIC #
COMPANY NAME I% d, /C /J I t� �h C
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PHONE
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ARCHITECT/ENGINEFRNA ME �S' `� ��
LICENSE NUMBER
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DESCRIPTION OF WORK
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PROP= CONSTRTY/PE
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USE TYPE
OCC.
SQ.FT.
VALUATION
(S)
EJQSTG
AREA �/ �yM S
NEW FLOOR
.AREA -0-
DEMO [ 8
AREA , Z ? /
TOTAL
NET AREA
�v
BATHROOM
REMODEL AREA go
KITCHEN
REMODEL .AREA
OTHER
REMODEL AREA 4
PtO�RCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA. DETACH
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♦J pr 'ATTACH
h! DWELLING UITIS:
IS ASECOND UNIT ❑YES
SECONDSTORY ❑YES
BEING ADDED? []NO
ADDITION? E] NO
PRE•.APPLICATION ❑YES IF YES, PROVIDE COPY OF
PLANNING APPL# ❑NO PLANNING APPROVAL LETTER
IS THE BLDGAN ❑ -Es
EICHLERHOME' ❑NO'h-
RECr.I D BY
TOTAL VALUATIQN:
By my signature below, I certify to each of the following: I am the property owner or authorized anent 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: Zi ^
SUPPLEMENTAL RNIFORMATION REQUIRED
_ P> nNciclzT�PE}
a, ,>xolJzn.csLiP
New SFD or Multifamily dwellings: Apply for demolition permit for
OVER TJ�CO7JATER
TJII,DINGPL4N,REVIE"Fi'
existing building(s). Demolition permit is required prior to issuance of building}
permit for new building.
L EXPRESS , -_t-r
'PLAI�fiII�GPLA-N13EVZEW
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Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑TA1v ARn
❑ PUBLTcv~oRxs
form if any Hazardous Materials are being used as part of this project.
`
xA
❑
Copy of Planning Approval Letter or Meeting with Planning prior to
LARGE s
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submittal of Building Permit application.
IrL4TOR :.� -ate
❑i�.SA].\TTARI�SER'ERDISTRICT.'
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BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FM_7 FEE ESTIMATOR - BUILDING DIVISION
im
ADDRESS: 7628 WEST HILL LANE DATE: 04/27/2015
REVIEWED BY: SEAN
QTY/FEE
APN:
BP#:�_�o zq /
`VALUATION: 1$60,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Remodel, Bath (<=300 sf)
1REMRESBAT
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
WORK
BATHROOM REMODEL 80 SQ FT • RELOCATE LAUNDRY TO SECOND FLOOR; ELIMINATE ONE
SCOPE
BATHROOM AND BEDROOM TO ENLARGE LIVING ROOM.
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 hated on the nreliminary information available and are only an estimate Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff 711!13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
=s.f.
$645.00
Remodel, Bath (<=300 sf)
1REMRESBAT
Suppl. PC Fee: 0 Reg. OT
O.Q I
hrs
$0.00
PME Plan Check:
$0.00
150 1 s.f.
$431.00
Remodel, Other
1REMRESOTH
Permit Fee:
$0.00
Suppl. Insp. Fee.0 Reg. ® OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
0
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
Strong Motion Fee: 1BSEISMICR
$7.80
Select an Administrative item
Bldg,Stds Commission Fee: 1BCBSC
$3.00
SUBTOTALS:
$10.801$1,076.001
TOTAL FEE:$1,086.80
Revised: 04/01/2015
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