15110088CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
CONTRACTOR:
PERMIT NO: 15110088
7894 BELKNAP DR CUPERTINO CA 95014 (362 10 038)
REAL HOME DESIGN
APTOS, CA 95003
OWNER'S NAME: SOUZA KENNETH AAND MARY D TRUSTEE
DATE ISSUED: 11/13/2015
OWNER'S PHONE: (
PHONE NO: (831) 419-7423
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class B Lic. #958354
Contractor REAL HOME DESIGN Date 03/31/2019
— BLDG —ELECT _PLUMB
MECH RESIDENTIAL COMMERCIAL
I 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.
JOB DESCRIPTION:
REMODEL KITCHEN (300 S.F.); ENLARGE KITCHEN
I ere affirm under penalty of perjury one of the following two declarations:
WINDOW; REMODEL MASTER BATHROOM (25 S.F.); INSTALL
t. I have and will maintain a certificate of consent to self -insure for Worker's
8 (I.)) RECESSED LIGHT IN FAMILY ROOM
Compensation, as provided for by Section 3700 of the Labor Code, for the
REV # 1 - GUEST BATHROOM REMODEL AND DRY ROT REPAIR
performance of the work for which this permit is issued.
DUE TO WATER DAMAGE ISSUED 8/15/2017
2. 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
Sq. Ft Floor Area:
Valuation: $53306.00
permit is issued.
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
APN Number:
Occupancy Type:
and state laws relating to building construction, and hereby authorize
362 10 038
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
PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit.
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally, the applicant understands and will comply with all non -point
source regulations per the Cupertin icipal Code, Section 9.18.
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date 8/15/2017
Issued by: Legac
Date: 11/13/2015
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the
RE -ROOFS:
following two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
1. I, as owner of the property, or my employees with wages as their sole
installed without fust obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for
inspection.
sale (Sec.7044, Business & Professions Code)
2. I, as owner of the property, am exclusively contracting with licensed
Signature of Applicant:
contractors to construct the project (Sec.7044, Business & Professions Code).
Date: 8/15/2017
1 hereby affirm under penalty of perjury one of the following three declarations:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1. 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.
HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance, as provided for by
I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code, for the performance of the work for which this
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
permit is issued.
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
a. I certify that in the performance of the work for which this permit is issued, I
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections 25505, 255 and 25534.
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
Owner or authorized agent:
APPLICANT CERTIFICATION
Date: 8/15/2017
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
I hereby affirm that there is a construction lending agency for the performance
relating to building construction, and hereby authorize representatives of this city
of work's for which this permit is issued (Sec. 3097, Civ C.)
to enter upon the above mentioned property for inspection purposes. (We) agree
Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
Lender's Address
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
ARCHITECT'S DECLARATION
Code, Section 9.18.
1 understand my plans shall be used as public records.
Licensed
Signature Date 8/15/2017
Professional
October 11, 2016
7894 Belknap Drive
Cupertino CA 95014
408-446-0208
marysouzal@mac.com
City of Cupertino
Building Division
Cupertino City Hall
10300 Torre Ave
Cupertino CA 95014
To Whom It May Concern:
am applying for a continued extension to my Building Permit #15110088. The original
extension was granted due to the death of my husband, Kenneth A. Souza.
Ken died on March 22, 2016 just as we were about to begin construction. Obviously,
needed additional time to assess the feasibility/scope of construction under these new
circumstances. He and I were trustees of the Souza Family 2004 Family Living Trust. I
am now the sole Trustee and sole owner of the property.
At this time, I am requesting a further extension for several reasons:
1. It has taken the past six months to obtain a clear picture of my financial status.
could not make a responsible decision to build without this knowledge.
2. 1 still need more time due to the grieving process and responsibilities surrounding
Kenneth's death. With the approach of the first holiday season as a widow, I do
not think it is wise to bear the extra burden of a torn -apart house.
3. 1 will need to get back on the general contractor's schedule and coordinate
activities again.
According to Pat, I understand that you have approved an additional six-month
extension (until May 13, 2017) for an additional fee of $78
Thank you for your compassionate assistance.
Sincerely,
Mary Souza
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7894 BELKNAP DR
CONTRACTOR:
PERMIT NO: 15110088
OWNER'S NAME: SOUZA KENNETH A AND MARY D TRUSTEE
DATE ISSUED: 11/13/2015
W
OWNER'S PHONE: 4084460208
� . cX
PHONE NO:
21
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
REMODEL KITCHEN (300 S.F.); ENLARGE KITCHEN
License Class Lic. # g5o;5 �
WINDOW; REMODEL MASTER BATHROOM (25 S.F.);
INSTALL
Contractor. Date 1110115
8 (N) RECESSED LIGHT IN FAMILY ROOM
I hereby affirm that I am licensed under the provisions of &apter 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:
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: $53306
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: 36210038.00
Occupancy Type:
p y
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
WITBIN 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 YS 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: v Date: 61 "�✓ t/
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 �"j ' "/ Q'�Yj Date iti 7 ►t!
All roofs shall be inspected prior to y roofing material being installed. If a roof is
an
any
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
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 9.12 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 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, a d 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
011 ner or authorized agent: Date: U 1
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 (See. 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
CITY OF CUPERTINO f5►�,'�+�5
R� FEE ESTIMATOR— BUILDING DIVISION WW
f
ADDRESS: 7894 Belknap Dr.
DATE: 11/13/2015
REVIEWED BY: PAUL
APN: 36210 038
BP#:
"VALUATION: 1$53,306
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration /Repair
PRIMARY SFD or Duplex
USE:
Suppl. PC Fee: O Reg. () OT
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
WORK
Remodel Kitchen 300 S.f. ; Enlarge Kitchen Window Remodel Master Bathroom 25 S.f. ; Install 8 N
SCOPE
recessed light in family 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 based on the nreliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-033 Ff1: T1,'13)
FEE
Iz jnh. fico, Caaec-kElec.
Phew., " `t her",
?'hvu ?b Ir..cg;.
Plan Check 0.0 hrs $0.00
Elee. Permit Fee: 1EPERMIT
Other Elec. Insp.0.0 hrs $48.00
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 based on the nreliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-033 Ff1: T1,'13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
F-3007 s.f.
$645.00
Remodel, Kitchen (<=300 sf) /
1REMRESKIT
Suppl. PC Fee: O Reg. () OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
F 1 #
$431.00
Window / Sliding Glass Door /
1WINREP Replacement
Permit Fee:
$0.00
Suppl. Insp. Fee -0 Reg. Q OT
0.0
1 hrs
$0.00
= s.f. Remodel, Bath (<=300 sf)
$645.00 1REA11RESBAT
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
® # Electrical
72.00 IBREMFIXT Fixtures, Lighting
r�fr t.
Administrative Fee: IADMIN
$45.00
0
Work Without Permit? Yes E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
Travel Documentation Fee: ITRA VDOC
$48.00
Strom Motion Fee: IBSEISMICR
$6.93
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$3.00
SUBTOTALS:
$150.93
$1,793.00
TOTAL FEE -.F$1,943,931
Revised: 10/01/2015