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15040095CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19976 PRICE AVE CONTRACTOR: JS MILLER PERMIT NO: 15040095 CONSTRUCTION OWNER'S NAME: CHE HER-DAW AND JEAN Y 21701 STEVENS CREEK BLVD STE 292 DATE ISSUED: 04/14/2015 OWNER'S PHONE: 4083408454 CUPERTINO, CA 95014 PHONE NO: (408) 446-1407 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E] � REMODEL KITCHEN (180 SQ FT); BATH (200 SQ FT); License Class Lic. # THROUGH OUT (150 SQ FT) REMOVE AND REPLACE (19 ` to `1 � WINDOWS, 2 DOORS) TO MEET EGRESS IN BEDROOMS qC Contractor Date 7 —��1ti I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions ha y license is in full force and effect. firm under penalty of perjuryone of the following two declarations: Vry ill maintain a certificate of consent to self -insure for Worker's on, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: Valuation: $25000 performance of the work for which this permit is issued. 1 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 APN Number: 36904013.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAY F 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 F 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 S granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: ions per the Cupertino Municipal Code, Section with all n=-1­1 9.18.RE-ROOFS: SignatureDate 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. ❑�WNERXI R 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 I 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(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 Cupertin unicipat Code, Chapter 9.12 and 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 the Health & Safety Code, Sections 25505, 5 33, and 25534. Owner or authorized agent: Date: 14 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 CONSTRUCTION PERMIT APPLICATION 12 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION (� J 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (`I� CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • building(cDcupertino.org l� ❑ NEW CONSTRUCTION ❑ ADDITION \IKI ALTERATION / TI ❑ REVISION / DEFERRED ` ORIGINAL PERMIT # PROJECT ADDRESS ({ 1 C ` * - ` v APN q ` _ G � (;/ ( UE -(MAIL ✓h(Jv OWNER NAME ,�`y // PHONE p STREET ADDRESS CITY, STATE, ZIP` dEU FAX CONTACT NAME<��M PHONE E-MAIL STREET ADDRESS CITY, STATE, Z SAM FAX WNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER4�`,� `"'�� LICENSE E BUS. LIC q COMPANY NAME . E-MAIL �j M, l��'aLC� FAX STREET ADDRESS ;'�- \ / D CITY, STATE, ZIP V")PHONE f , ^ Lt 4 U ARCHITECT/ENG)yE+ E j �vt/1 LICENSE NUMBER C ,! i ��, 0, l� BUS. LIC k COMPANY NAME E-MAILFAX STREET ADDRESS' S �� \J�C'�J CITY, STATE, ZIP F PHONE DESCRIPTION OF WORK t- T P- c 04-1- cvv. �3 �-� f� �) 'i2 �• (mac c� 1 a EV a (a ice' EXISTING USE PROPOSED USE CONSTR TYPE q STORIES -i-3 'D -i D TT q -L �L (TOOTAL I-',- � USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA NET AREA G.,m�' BATHROOM REMODEL AREA aav KITCHEN REMODEL AREA 60 OTHER REMODEL AREA I " V oo PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH 4 U a` o f [:]ATTACH k DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? NO ADDITION? NO PR-APPLICATIO FY_S IF YES, PROVIDE COPY OF _ PLANNING APPL NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLER HOME? RECEIV BYE r�! � /'.ry �r i�' TAL VALUATION: ' ' 2— property By my signature below, I certify to each of the following: I th property owner or authorized agent to act on the property owner's behal . I have read this application and the information I have provided is correct. I h e o£ Work and verify it is accurate. I agree to comply Hath all applicable local �Description I aut es o£Cupertino to enter the above- ide ified p operty for inspection purposes. ordinances and state laws relating to b(77Z Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMA I N REQ D oyEg xccrraNTE>z'� / Ate' r New SFD or Multifamily dwellings: Apply r demolition permit for existing building(s). Demolition permit is required prior to issuance of building p Q P g permit for new building. ❑,IhPR$S$ ��f�j�°�r���s��i�r�;,��i�ii ��,`#IANNuvPGAlvitEy[EYy�;�,�,r���r��r" Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. "I..ARG$ IFS 1 ✓h I1�EF � � ��'`� � � �lIYl7J, Q (,lA`,�' C ��� �'%���� t�� C��� ( rF' PT(W��r ��� j� �, p� Copy of Planning Approval Letter or Meeting with Planning prior to rf submittal of Building Permit application. ff wr„`f ,ji` N�rlijy, r��A�xapl BIdgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FM_7 FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13) ADDRESS: 19976 price ave DATE: 04/1412015 REVIEWED BY: Mendez APN: BP#: 0 95' `VALUATION: 1$25,000 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Suppl. PC Fee: 0 Reg. © OT PENTAMATION 1 R3SFDREM PERMIT TYPE: WORK remodel kitchen 180 sq ft); bath 200 sq ft); throughout 150 sq ft remove and replace 19 windows 2 SCOPE doors) to meet egress in bedrooms NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13) FEE QTY/FEE IS I� II I=MOM Plan Check Fee: $0.00 F200 I s.f. $645.00 Remodel, Bath (<=300 sf) 1REMRESB,4T Suppl. PC Fee: 0 Reg. © OT 1 0.0 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the nreliminary information available and are onlv an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F200 I s.f. $645.00 Remodel, Bath (<=300 sf) 1REMRESB,4T Suppl. PC Fee: 0 Reg. © OT 1 0.0 1 hrs $0.00 PME Plan Check: $0.00 1 180 1 s.f. $645.00 Remodel, Kitchen (<=300 sf) 1 REMRESKIT Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.009]1 150 1 s.f. Remodel, Other $431.00 1REMRESOTH PME Unit Fee: $0.00 PME Permit Fee: $0.00 =# $717.00 Window / Sliding Glass Door 1 K/NSP Replacement fi V,,f" E) Work Without Permit? 0 Yes (j) No $0.00 Advanced Planniny Fee: $0.00 Select a Non -Residential Building or Structure E) 0 A Strong Motion Fee: 1BSEISMICR $3.25 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 'tj ALS, $4.25 $2,438.00 TOtAA(FEE: $2,442.25 Revised: 04/01/2015