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14010054-DPI CITY OF CUPERTINO BUILDING PERMIT I 1 BUILDING ADDRESS: 11703 DOROTHY ANNE WAY I COONNTRACEOOR:-"ffl Tr "6E I PERMIT NO: 14010054 I OWNER'S NAME: SRIDHARRAMASWAMY ! MLP , ..'Itki1"M A,,— 'DATE ISSUED: 01/29/2014 OWNER'S PHONE: 4082046549 m , 1 PHONE NO: LICENSED CONTRACTOR'S DECLARATION License Class Lic.#'j®� -7f1_27 Contractor Date I I hereby affirm that I a%in under the provisions of Chapter 9 (commencing with Sect Division 3 of the Business & Professions Code and that my licenforce 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 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 1 certify that 1 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. k5p,;,014 Signature Date ❑9 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 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 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 1 certify that 1 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. Signature Date JOB DESCRIPTION: RESIDENTIAL [] COMMERCIAL REMODEL (E) KITCHEN (150 S.F.), REMODEL (E) NICHE (50 S.F.), REPLACE 5 LIGHTS, 2 TOILETS & EXTEND (E) GAS LINE TO OUTSIDE PORTABLE CONNECTION Sq. Ft Floor Area: Valuation: $60000 APN Number: 36654123.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 18"DAYSrttAST CALLED INSPECTION. Issued by: Dated. 2 � 14- 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. Owner or authorized I hereby affirm that there is a construction lelydineagency 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION r \ �\ 10300 TORRE AVENUE o CUPERTINO, CA 95014 -3255 ` x CIJPER� °INO (408) 777 -3228 ^ FAX (408) 777 -3333 ^ build iin-lg(dkupertino.org n AMlllr nATOT Tl Tn),T I-1 ATTIiTrn1AT AT I-CD A"r%M /'rI I I RRVtQIr)M / T)PPPRPPrI C)RIr.INAI. PP.RMIT 0 PROJECT ADDRESS 0 �O APN # 1.X 3 OWNERN OUN G` /�VI PHONE _ n7 ` 2O EMAIL ^ �1 'C 1 / v CY SSW I STREE )� S� n �`)SD) q STATE, IF FAX O� ` (f (e' J CONTACT N E •c in n PHONE E -MA C4�6 1'C0VJ >gc�ro� Pry STRE D \e C STATE, % ^r, Y7 �, FAX `� T 1(i7 G� '%t 5 tJ l/ ❑ OWNER ❑ OWNER- BUD..DER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGEW ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # .COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCMTECT/ENGINEERN4) E LICENSE NUMBER BUS. LIC# COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ! DESCRIPTION OF WORK vt n w r ad , IV, l �/J o�c,Ca no EXISTING USE PROPOSED USE CON%TR. TYPE # STORIIJ USE TYPE OCC. SQ.FT" VALUATION ($) " EXISTG NEW FLOOR DEMO, TOTAL AREA AREA AREA NET AREA BATHROOM REMODEL AREA KITCHEN REMODEL AREA i 576 OTHER REMODEL AREA " ' PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE DETACH ATTACH # D WELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED'. ONO ADDITION? ONO PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES REP ,� -„ , r +8�,:, TOTAL V UATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: I am the property o r or authorized agent to act on the perty owner's behalf. [ have read this application and the information I have provided is correct. I have read the Description of Work and verify it is ace ate. 1 agree to comply with all applicable local ordinances and state laws relating to btlAding consstrueti I authorize representatives of Cupertino to enter the above-identified prope for inspection purposes. p� �f��� Signature of Applicant/Agent: � /l Date: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE �- U :• s„ `, .ROUTING SLIP ❑ OVER- THH1iCOUNPER ❑ BUILDINGPLREVIEW — New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building , permit for new building.: ❑ "EXPRESS p ❑ kPI.AN,3NING PLAN ItKVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ srnxnARD ;• ",' RN K ❑ rusilcwoiucs _ form if any Hazardous Materials are being used as part of this project. ❑ , h ❑I _Copy of Planning Approval Letter or Meeting with,Planning prior to LARGE' O" E] FIRE DEPTy x r I y - ❑ submittal Of Building Permit application. AUJ9 t ° ;g SA,NJX6R SEwERDISTRIC7G� "� ❑ ENVMONINENTAL HEALTH :,•.- . BldgApp_2011.doc revised 06121111 FM_7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta ). These fees are based on the nreliminan information available and are only an estimate. Contact the Dent for addh 7 info. FEE ITEMS (Fee Resolution 11 -053 Elf. 711113) ADDRESS: 11703 DOROTHY ANNE WAY DATE: 01/07/2014 REVIEWED BY: MELISSA AA>ch. Permit Fee: APN: 366 54 123 BP #: b `VALUATION: $60,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex Phrmh. his )). Fee: PENTAMATION PERMIT TYPE: 1R3SFDRE WORK E KITCHEN 150 S.F. REMODEL E NICHE 50 S.F. REPLACE 5 LIGHTS 2 [REMODEL SCOPE LETS & EXTEND (E) GAS LINE TO OUTSIDE PORTABLE CONNECTION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta ). These fees are based on the nreliminan information available and are only an estimate. Contact the Dent for addh 7 info. FEE ITEMS (Fee Resolution 11 -053 Elf. 711113) X/ech. Plan Check Phrnrb. Plan Check Elec. Plan Check AA>ch. Permit Fee: Plumb. Permit Fee: Elec. Permit Fee: Other htech. Insp. Other Plumb Insp. Other Elec. Insp. Lj I ,ttech. Insp. Fee: Phrmh. his )). Fee: Elec. Ins ]), Fec: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta ). These fees are based on the nreliminan information available and are only an estimate. Contact the Dent for addh 7 info. FEE ITEMS (Fee Resolution 11 -053 Elf. 711113) FEE QTY /FEE MISC ITEMS Plan Check Fee: $0.00 = s.f $626.00 Remodel, Kitchen (< =300 sf) IREMRESKIT Suppl. PC Fee: (D Reg. 0 OT 0,0 hrs $0.00 PME Plan Check: $0.00 = s.f. $418.00 Remodel, Other IREMRESOTH Permit Fee: $0.00 Suppl. Insp. Fee.-E) Reg. 0 OT F0.-01 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 _T7 Constiuction .Ta7.v: Adininistrative Fee: Q G Work Without Permit? 0 Yes E) No $0.00 Advanced Planniniz Fee: $0.00 Select a Non - Residential Building or Structure 0 i Travel Documentation Fees: Stroniz Motion Fee: IBSEISMICR $6.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $3.00 SUBTOTALS: F $9.00 $1,044.00 TOTAL FEE: 1 $1,053.00 Revised: 01/01/2014 CUPIERTONO CONTRAc 700 / SU3CO NTIIBAMOR LESS Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408-777-3333 JOB ADDRESS: 7,D PERMIT it 1A5106.5-4 OWNER'S NAME: pjj PHONE # 64dib Z 5'-z S!S GENERAL CONTRACTOR: PEER? 4Y't4o pt As BUSINESS LICENSE # 3 J5-DIa ADDRESS: igig$ P905 Pvzr X0, 115,, S cok `?fo70 CITY /ZIPCODE: 54-e- �&!� 1 fo-70 *Our munnicipnap code requires app businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR IFIIYAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature E ➢ease cheek applicable subcontractors and complete the following information: Date V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # V" Cabinets & Millwork 'PA-E- C ! &/,gkj C:k(3I M-Fu (6&( Z 74 3 Z Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock V/ Tile AVALOS h1'MZOLE 69M4 ( Owner / C ( ctur Signature 5- /2t)I(� Date . lw/20/2014 10:29 9255134265 PREC CAB &TRIM PAGE 01/01 CITY OF CUPERTINO 'PERTINO FINANCE DEPARTMENT 6 CUPERTINO, CALIFORNIA BUS. LOCATION: 145 MIDDLEFIELD CT OWNERSHIP PAUL E TAYLOR DOING BUSINESS AS PRECISION CABINETS & TRIM 145 MIDDLEFIEL,D CT BUSINESS LICENSE TAX CERTIFICATE 2 ?432 11/30/2014 EXPIRATION DATE BRENTWOOD CA 94 513 (-? �` • �^"� `^° �'-'C HIS LICENSE MUST BE POSTED IN A CONSPICUOUS PLACE ON THE PREMISES OR VEHICLE. DIRECTOR OF AOMINISTRATIVE SERVICES r. i ..p. L�. I c:. m Z /Z '3o` d 9500086806 - 31INTdf) 9 agE[HVK SOgVAi KV LZ:OT VTOZ "OZ'AUN u s w N z W a a V °e N F � Q V j�j � W y N m {X a a m �( u, ko � W ^ 01 rl� N U cc O Q U Q x M W Z M H LA O Ln g > V C W H w WA a iL a aN � o ~ d 0 W f:. rl N z �r Ln 1 Z_ w M g W m 4 U) 3 52 2 W Z N Z V a LU W 7 r. i ..p. L�. 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