14060178 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22803 LONGDOWN RD CONTRACTOR:AMERICAN KITCHEN& PERMIT NO: 14060178
BATH INC
OWNER'S NAME: MASEGIAN JOHN D AND KELLY A 1758 JUNCTION AVE UNIT D DATE ISSUED:06/27/2014
OWNER'S PHONE: 4088737712 SAN JOSE,CA 95112 PHONE NO:(408)436-8151
Ek LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL
RECONFIGURE NON-LOAD BEARING WALLS IN MASTER
License Class_ _ Lic.# BEDROOM TO CREATE(N)WALK-IN CLOSET(65 S.F.).
Contractor 4 M/ 42y,;k ,y yA4yN Date 4-',371-21y REMODEL(E)MASTERBATH (84 S.F.)
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.
1 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:$21230
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
APN Number:34233048.00 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. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAY RMIT 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 DA M L 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 6/Z-)granting of this permit. Additionally,the applicant understands and will comply by: &
with all non-point source regulations per the Cupertino Municipal Code,Secti
9.18.
RE-ROOFS:
Signature / _ Date All roofs shall be inspected prior to any rooting 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(a)should 1 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,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Owner or authorized agent: Date:
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,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must 1 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
1 certify that 1 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 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 IQD
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333• building(akupertino.org
CUPERTINO I \
❑NEW CONSTRUCTION ❑ ADDITION YLL ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS Z ' APN#2 �0 3 (�n4 awn ;
OWNER NAME �/� PHONE E-MAIL
( w `C( 5) GC.✓L
STREET ADDRESS \ „, D CITY, STATE,ZIP FAX
CONTACT NAME •S`-'�/ n PHONE E-MAIL
STREET ADDRESS J� � � 1.)A CLL V n 1� " CITY,STATE,ZIP FAX
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❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR -intAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME I, Gi -�VU�r" r{..��Q ICENSE NUMBER LICENSE TYPE BUS.LIC#
COMPANY NAME C_ Y i ,C^`�� E-MAIL FAX
STREET ADDRESS t-.1 17-y- ( ��fi/,^ LI y� CITY,STATE,ZIP > f PHONE q4��
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
W'PERMIT
DDRESS: 22803 LONGDOWN RD DATE: 06/27/2014 REVIEWED BY: MELISSA
PN: 342 33 048 BP#: O 'VALUATION: $21,230
PE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM
USE: PERMIT TYPE:
WORK RECONFIGURE NON-LOAD BEARING WALLS IN MASTER BEDROOM TO CREATE N WALK-IN
SCOPE CLOSET(65 S.F.). REMODEL (E) MASTERBATH (84 S.F.)
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-0,53 Ef 7'/1:13FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.f. Remodel,Bath (<=300 sf)
Suppl. PC Fee: 0 Reg. 0 OT Fo.0 hrs $0.00 $626.00 1REMRESBAT
PME Plan Check: $0.00 L_L5�j s.f. Remodel, Other
Permit Fee: $0.00 $418.00 IREMRESOTH
Suppl. Insp. Fee:Q Reg. 0 OT Fo.Q hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
7T_
Work Without Permit? 0 Yes 0 No $0.00 0
Advanced Planning Fee. $0.00 Select a Non-Residential 0
Building or Structure 0
i
Strom Motion Fee: IBSEISMICR $2.12 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.001 1
SUBTOTALS: $3.121$1 ,044.001 TOTAL FEE: 1 $1,047.12
Revised: 04101/2014
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
C O P E RT I N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: -2 PERMIT# 6
OWNER'S NAME: PHONE#
GENERAL CONTRACTOR: 6yz- ,. BUSINESS LICENSE#
ADDRESS: J:F7 �- CITY/ZIPCODE:
*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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
s/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
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
Tile
Owner/Contractor Signature Date