14110060I CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20253 CARTWRIGHT WAY I CONTRACTOR: WEST MAX CO INC PERMIT NO: 14110060
I OWNER'S NAME:
1 SAN MARTIN, CA 95046 ] PHONE NO: (408) 623-6549 1
❑ LICENSED CONTRACTOR'S DECLARATION
License Class 7_ Lic. #
Contractor `� �'�� y O 1(^/ ,JDate Z ^-1
1 hereby affirm that 1 am licensed under 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.
I hereby affirm under penalty of perjury one of the following two declarations:
1 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 La ode, 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. 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,
costs, and expenses which may accrue against said City in consequence of the
granting ofthis permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Signature Date_J_2_-0
y
❑ OWNER-BIJILDER 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 (See.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
declarations:
1 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.
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, 1
become subject to the Worker's Compensation provisions of the Labor Code, 1 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, Section
9.18.
Date
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL
KITCHEN REMODEL (225 SQ FT); REMODEL (3)
BATHROOMS
(139 SQ FT); REMODEL OTHER (253 SQ FT); PANEL
UPGRADE (200 AMP); INSTALL (22) OUTLETS AND (23)
Sq. Ft Floor Area: I Valuation: $35000
APN Number: 31642001.00 1 Occupancy Type: I
PERMIT EXPIRES IF WORK IS NOT STARTED
WITAI-I�LF�2, PERMIT ISSUANCE OR
180 DA]t,S FROM L S CALLED INSPECTION.
Issued by:
Date: 1
RE -ROOFS:
Al I roofs shall be inspec prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25.50.5, 2.5533, 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 th@Cupertino Municipal Code, Chapter 9.12 and
the Health &Safety Code, Seep
ons 25)!,95,_25533, and 25534.
Owner or authorized agent: t L;,/ 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 Add
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Profess
CITY OF CUPERTINO
1W.0 FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 20253 Cartwright way
FEE
DATE: 11/10/2014
REVIEWED BY: Sean
APN:
BP#:
$0.00
°VALUATION: 1$35,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE:
Alteration / Repair
PRIMARY SFD or Duplex
USE:
hrs
$0.00
PME Plan Check:
PENTAMATION 1R3SFDREM
PERMIT TYPE: A
WORK
Kitchen Remodel 225 sq ft • Remodel
3 bathrooms 139 sq ft);
Remodel other 253 sq ft); Panel
SCOPE
I Upgrade (200 amp); Install (22) outlets and (23) light fixtures.
Supp/. Insp. Fee:Q Reg. Q OT
NOTE: This estimate does not include fees due to other Departments (ie. 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 Dept for addn'1 info.
FEE ITEMS (Fce Resolution 11-053 Elf' 7/1/13
FEE
QTY/FEE
Elec. Plan Check 0.0 1 hrs $0.00
Elec. Permit Fee: IEPERMIT
Other Elec. Insp. 0.0 hrs $48.00
NOTE: This estimate does not include fees due to other Departments (ie. 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 Dept for addn'1 info.
FEE ITEMS (Fce Resolution 11-053 Elf' 7/1/13
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
225 s.f.
$645.00
Remodel, Kitchen (<=300 sf)
1REMRESKIT
Suppl. PC Fee: E) Reg. Q OTI
0.0
hrs
$0.00
PME Plan Check:
$0.00
L139_j s.£
$645.00
Remodel, Bath (<=300 sf)
IREMRESBAT
Permit Fee:
$0.00
Supp/. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
253 s.f. Remodel, Other
$431.00 IREMRESOTH
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
22 # Electrical
$58.001IBREMRECEP Recep/Switch/Outlets
Administrative Fee: IADMIN
$45.00
23 #
$90.00
Electrical
1 IBREMFIXT Fixtures, Lighting
Work Without Permit? 0 Yes No
$0.00
Advanced Planninz Fee:
$0.00
200 amps
$48.00
Electrical
IBELEC200 Services
0
Travel Documentation Fee: ITRA VDOC
$48.00
Strom Motion Fee. IBSEISMICR
$4.55
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
1 $147.551$1,917.00
TOTAL FEE:
1 $2,064.551
Revised: 10/01/2014