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12100082CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7623 ELDERWOOD CT CONTRACTO PERMIT NO: 12100082 OWNER'S NAME: CONNIE LAITINEN �� I DATE ISSUED: 10/10/2012 OWNER'S PHONE: 4082529972 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIPINTIAL 11 COMMERCIAL r� ri > LicenseClassLic. #�-r -= / REMODEL KITCHEN 169 SQ FT / Contractor �L, (o (;ePI2AL 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 Sq. Ft Floor Area: Valuation: $30000 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 APN Number: 35929018.00 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 WITHIN0 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 DA OM LAST CALLED INSTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, City in the costs, and expenses which may accrue against said consequence of ' Issued by: Date:/L17/6 granting of permit. Additionally, the applicant understands and will comply with all non- t sou a regulations per the Cupertino Municipal Code, Section 777 9.18. 1--Y/,Date Signator RE -ROOFS: 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. 13OWN R- 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 Cuper • Muni 'pal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, do s 3550 553 d 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agen . Date 77�r r 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 (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 CITY OF CUPERTINO I/JI FEE ESTIMATOR - BUILDING DIVISION ialADDRESS: 7623 Elderwood Ct DATE: 10/10/2012 REVIEWED BY: Sean A•1ech. Permit Fee: APN: BP#: *VALUATION: 1$30,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: E'lirrnb. In,>, /ice: PENTAMATION PERMIT TYPE: 1 R3SFDREC; WORK Remodel the kitchen 169 sq ft). SCOPE 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 preliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 711112) Ifech. Plan Check Plumb. Plan Check Elec. Plan Check A•1ech. Permit Fee: Phimb. Permit Pee: Elec. Permit Fee: Other A4ech. Insp. Mier Plumb Insp.Li Other Elco. Insp. 1, , h /nsp. Fee: E'lirrnb. In,>, /ice: Floc Inch, Fco: 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 preliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =s. f. $600.00 Remodel, Kitchen (<=300 sf) IREMRESKIT Suppl. PC Fee: Q Reg. 0 OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (:;onstruction .TtL. . :Idlninistrative Fec: 1 1 E) Work Without Permit? Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure I G i Trawl Documentation Fees: Strom Motion Fee: IBSEISMICR $3.00 Select an Administrative Item 1 Bldg Stds Commission Fee: IBCBSC $2.001 SUBTOTALS: $5.00 $600.00 TOTAL FEE: 1 $605.00 Revised: 10/01/2012 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ((--�� 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 �v (408) 777-3228 • FAX (408) 777-3333 • buildin-g a�cupertino.org CUPERTiNA ❑ NEW CONSTRUCTION ❑ ADDITION LTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS_ APN �,. 2Z, OWNER NAME(, PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIPCI FAX , CONTACT NAME PHONE E-MAIL C STREET A S Com^ CITY, STA ZIP ' FAX OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPp rr BUS. LIC # COMPANY NAME E-MAIL _ L[ C I p ,` , 17TH `Y1(,e Kit FAX STREET ADDRESS TTY, STATE,ZID PHONE _ 49 ARCHITECT/ENGINEER N LICENSE NUMBER BUS. LTC # COMPANY NAME E-MAIL FAX STREET ADDRESS CI Y, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSW US�� CONSTR. 6y� #ST IES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG AREA NEW FLOOR AREA DEMO TOTAL AREA NET AREA ^ /f BATHROOM KITCHEN n OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UN -.IS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? E]NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVEb BY: / TOTAL. VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information ftvc pro 'ded is correct. I have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relati g bilildi nstr ion. I a Iorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agen Date:=F SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP y�� OVER-THE-COUNTER BUILDING PLAN REVIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for 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 BldgApp_201 Ldoc revised 06/21/11 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: —15 PERMIT # OWNER'S NAME:PHONE # 90 r GENERAL CONTRACTOR: USINESS LICENSE # ADDRESS ~%aaf CITY/ZIPCODE: (71 *Our municipal code require"ll 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 SU CONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: nature Date Please check applicable subcontractors and c IS mplete the following information: V 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