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14030115 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7524 WATERFORD DR CONTRACTOR:PERFECT HOMES PERMIT NO: 140301 15 CONSTRUCTION CORP OWNER'S NAME: WORSHAM ROBERT W AND LYNN M 382 LASSENPARK CIR DATE ISSUED:03/19/2014 OWNER'S PHONE: 4083149102 SAN JOSE,CA 95136 PHONE NO:(408)972-8612 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL )CLOSE(E) BALCONY TO CREATE(N)MASTER BATH& License Class Lie.# N STUDY i Contractor �� ''" � � Date 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. 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$12000 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:36616014.00 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 T CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, p costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. �- RE-ROOFS: Signature Date 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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 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: Dale: permit is issued. 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 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 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 COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION �o 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 �O (408)777-3228• FAX(408)777-3333•bui16ng(d,)cupertino.orq CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS 752 \ 1{ ��- 7 APN 9 '�/'/' ' I /' _ OJ4 OWNER NAME 1 q �k�,M P NE E-MAIL STREET ADDRESS -7 1772_,J w IM ' ' CITY, STATE,ZIP 7 FAX 6 n"i-) CONTACT NAME ` �,A PHONE E-MAIL. 42G^a STREET ADDRESS ^ CIY,STATE, IP FAX 2 1 ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME T •D LICENSE NUMBER LICENSE TYPE BUS.LIC# T, COMPANY NAME E-MAIL FAX pa F STREET ADDRESS CITY,STATE,ZIP � �6Y a ARCHITECT/ENGINEER NAME LICENSE NUMBEg BUS.LIC k COMPANY NAME E-MAIL•[7-v� FAX STREET ADDRESS w, � �� CITY,STAT ,ZIP PHONE i TJ1 V,,JGL DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC, SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA L AREA NET AREA / BATHROOM KITCAEN OTHER ` REMODELAREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGE AREA DETACH ❑ATTACH #DWELLING UNITS: IS ASECOND UNIT E]YES SECONDSTORY ❑YES BEINGADDED7 EJNO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES EIV D TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO l�f O i I By my signature below,I certify to each of the following: I am the property owner or autho Ized age o act.-Ke pro owner's behalf. I have read this application and the information I have pro ed is correct. I have read th escription of Work and verify i s e. I agree to comply with all applicable local ordinances and state laws relating to buildi onstr tion. I authori epresentatives of Cupertino to enter the above-iden ifiie7dr pr perty for inspection purposes. Signature of Applicant/Age! Date: 15 SUPPLEMENTAL INFO ATION REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD Or Multifamily dwellingS: 14pply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT —Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BidgApp_201 1.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 7524 WATERFORD DR DATE: 03/19/2014 REVIEWED BY: MELISSA APN: 366 16 014 BP#: L� 30//5— 'VALUATION: 1$12,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY 2nd Unit? Yes No PENTAMATION SFD or Duplex __TOTC? ©Yes 1 R3SFDADD USE: No PERMIT TYPE: WORK ENCLOSE E BALCONY TO CREATE N MASTER BATH & N STUDY SCOPE OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE 1D CONSTR. s.f. R-3 (Custom) II-B,III-B,IV,V-B 174 $1,059.00 IADDPLCK $1,026.00 IADDINSP TOTALS: 174 $1,059.00 $1,026.00 MECH,HOURLY 0 Yes E) No PLUMB,HOURLY Q Yes E) No ELEC,HOURLY 0 Yes E)No Ll 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 11-053 Ef: 7.'1'13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $1,059.00 Select a Misc Bldg/Structure Suppl. PC Fee: (j) Reg. Q OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $1,026.00 Suppl. Insp.Feer Reg. Q OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? 0 Yes (j) No $0.00 E) Advanced Planning Fee: IPLLONGR $24.36 Select a Non-Residential G Building or Structure 0 i Strong Motion Fee: IBSEISMICR $1.20 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2,111.56 $0.00 TOTAL FEE: $2,111.56 Revised: 01/15/2014