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14050118 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10240 DUBON AVE CONTRACTOR:UNITED FIELD PERMIT NO: 14050118 REMODELING DBA OWNER'S NAME: JANET GEIGER 17855 VANOWEN ST DATE ISSUED:05/20/2014 OWNER'S PHONE: 4088004038 RESEDA,CA 91335 PHONE NO:(818)402-5656 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL E] ADD(N)FRENCH DOOR IN KITCHEN AREA License Class___& __ Lic.# ��y�,��2 �/ (STRUCTURAL) Contractor �/� T,6 p �� Ua eScr�-�l// 1 hereby affirm that I 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. Sq.Ft Floor Area: Valuation:$10000 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:34214049.00 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 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 CAL PECTION. 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, a applicant understands and will comply I — Date: 7i with all non-point source regul pe rtino Municipal Code,Sectio 9.18. E-ROOFS: Signature Date S-ZO. /y 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 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. 1 will 1 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(x)should I store or handle hazardous 1 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 Q lity M en District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino ic' ode,Chapter 9.12 and 1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 255 533 nd 25534. Section 3700 of the Labor Code,for the performance of the work for which this i � permit is issued. Owner or authorized agent: Date: 20, I 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,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 liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may accrue against said City in consequence of the 1 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. Date CONSTRUCTION PERMIT APPLICATION \ COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 �0 CUPERTINO an (408)777-3228• FAX (408)777-3333• building cupertino.org \ ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION)DEFERRED ORIGINAL PERMIT# PROTECT ADDRESS APN N 32-2 I / / O y 2 y onN ffV r� L "( OWNER NAME �! PHONE y �B � E-MAIL STREET ADDRESS CITY, STATE,ZIP FAX 5�'rnG� CONTACT NAME PHONE E-MAIL STREET ADDRESS ho J C, CITY,STATE, ZIP FAX 2/o�0 70•� 1"6�� . r2 y B Boo ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �^' D^/('`_� LICENSE NUMBER` LICENSE TYPE �/f BUS.LIC# 3 S '7 (' I COMPANY NAME 'Y �� p E-MAIL �j {f FAX ✓ U icl /� DAA/,' C /�Q�'CDsrzr-ez STREET ADDRESS � CITY,STATE,ZIP PHONE/!/a�r� / ! �•-o� ARCHITECT/ENGTNEERNAME R OJ LICENSE NUMBER �� BUS.LIC# q ..r COMPANY NAME �� / ruC �P E-MAIL ✓r n/ FAX C.O ✓ T /`/ S MCli.a��' STREET ADDRESS 2lB �� `�iK _ z/ CITY,STATE,ZIP �� T //� 9 o PHONE r/�d L/'moi •��I DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR.TYPE A STORIES yJ�f nes /e 7 USE TYPE OCC. SQ.FT. VALUATION(S) EXIST/GG NEW FLOOR DEMO TOTAL C' AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDETACH ❑ATTACH k DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY []YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-'APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES CEI TOTAL VALUATION: PLANNINGAPPL4 ❑NO PLANNING APPROVAL LETTER EICHLER HOME? QD By my signature below,I certify to each of the following: he pro r or authorized a o act on the ro e o elLalf. I have read this application and the information I have provided is torr ave the Description of Work and v i is accurate. I agree to comply with all applicable local ordinances and state laws relating to building const. c n. I a orize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: .Si L Zr,'l 1 SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK-TYPE ROUTINGSLIP New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building ovER TIIE couNTEx ❑ suILDInGPLArtltEylEw permit for new building. EaPREss ❑ pLAnrrcPL w REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTMDARD ❑�r`uBLlCwoxxs form if any Hazardous Materials are being used as part of this project. :; D LARGE: ❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to El 11fAJOR- ❑ SANITARY SE�'VERDISTRICT submittal of Building Permit application. ❑ ENVIRO1Vn4ENTAL'HEALTH B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10240 DUBON AVE DATE: 05/20/2014 REVIEWED BY: MELISSA APN: 369 48 008 BP#: l)5 U 'VALUATION: j$10,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 GENRE USE: PERMIT TYPE: WORK ADD N FRENCH DOOR IN KITCHEN AREA SCOPE NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Theseees are based on the erelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E - 7%1,' FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # Window/Sliding Glass Door Suppl. PC Fee: Q Reg. Q OT O.07 hrs $0.00 $834.00 1WINMEWSTR New(Shearwall/Masonry) PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Work Without Permit? 0 Yes No $0.00 G Advanced Planning-Fee: $0.00 Select a Non-Residential 0 Building or Structure i Strong Motion Fee: IBSEISNIICR $1.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.001 1 SUBTOTALS: $2.00 $834.00 TOTAL FEE: 1 $836.00 Revised: 04/01/2014 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: ZO q '70 PERMIT# 11-10S' 1,1,6 OWNER'S NAME: '3AN r- PHONE# B GENERAL CONTRACTOR: — BUSINESS LICENSE# ADDRESS: ,. ow�sr.. S , CITY/ZIPCODE: ,??r *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCON CT 1 OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 am not using any subcontractors: S Zai Signature Date Please check applicable subcontractors and complete the following information: j/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum/Wood wit Glass/Glazing oF Heating % Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date