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13120120 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1084 DERBYSHIRE DR CONTRACTOR PERMIT NO: 13120120 OWNER'S NAME: ROBIN AND SALLY HAWORTH CHOISMITH ASSOCIATES DATE ISSUED: 12/16/2013 OWNER'S PHONE: 4087778737 1 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL License Class_ Lie.1t Gly! MOVE KITCHEN TO FAMILY ROOM AREA,REMODEL KITCHEN TO(N) 2 DINING ROOM.REMOVE(E)FIREPLACE&REPLACE WITH(1)SLIDING Contractor effO/511 / �jSQC, Date �� /(m �/ WINDOW 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 erformance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$45000 have and will maintain Worker's Compensation Insurance,as provided for by S tion 3700 of the Labor.Code,for the performance of the work for which this APN Number:36221043.00 Occupancy e: permit is issued. p y Typ APPLICANT CERTIFICATION 1 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 18 YS 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 D ALLED 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 granting of this permit. Additionally,the applicant understands and will comply Issued by: 7 Date: with all non-point source regulations p f. a Cupertino Municipal Code, ection —s— / RE-ROOFS: Signature `� Date r z 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[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 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) 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 Muni ' at Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,2 3 Mud 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen • �- Date: Z-/6 permit is issued. 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,1 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 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 V� CONSTRUCTION PERMIT APPLICATION �1 !�COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION �\ 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•buildingCcDcupertino.org CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERM+I�T# PROTECT ADDRESS cY APN# 3 Z Q OWNS N ` Pln O / V 73 Qtl ?7E E-MAI G STREET ADDRESS( / ' CITY, STATE,ZIP FAX CONTACT NAMETy C!� HO }� p ^ g E-MAIL P ST3IjRESS 5-1/�� ` CITY,$TA ^ s FAX ElOWNER (rf ElRT' OWNER-BUILDER ❑ OERAGENT CONTRACTOR E CO'N�(TfRAC,TTORRAEl ARCH]TECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR N'AMF / l LICENS N : R/ LICENSE T BUS.LIC"n coMPArrr NAME l! E N� �,d _71,0 / L rlvf 7 FAx� S` ET DRESS/ ` f �T CITYr ZIP ` PH TE �}% pO . ARCHITECT/ENGNEER NAME -7�g LICENSE NUMBER V BUS.LIC# 0 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE n STORIES rrl) nIgW t4,.15 V , �r*USE TYPE OCC. 4SQ.FFjT. VALUATION(S) �G//�//� N���"���'�� AREA /TSI, TOTAL ETAREA Sd p y.� BATHROOM KITCHEN V OTHER REMODELAREA REMODELAREA Z b J REMODELAREA ' PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: LJDETACH ❑ATTACH DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING.ADDED? ❑N'O ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVE - OTAL VALUATION: PLANINT4G APPL S ❑NO PLANNING APPROVAL LEITER EICHLER HOME? ❑NO L _570 t-^© © 0 By my signature below:I certify to each of the following: I am the property owner or authorized agent to act e r owner's behalf. I have read this application and the information I have provided is correct. 1 ve read the Description of Work and ve urate. I agree to comply with all applicable IocaI ordinances and state laws relating t ilding constru ion authorize representatives of Cupertino to enter the above-i entif property for inspection purposes. 17 Signature ofAppIicant/Agent Date: SUPPLEM TAL INTFORIMA ION REQUIRED PJA, cl cx TYPE_ ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ovER-THE-cowrER rBIDING PLAN REVIEW existing building(s). Demolition pen-nit is required prior to issuance of buildin, y permit for new building, ❑ ExPRF,ss PLANNING PLAN REVIEIV Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBIAr N17ORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ ('IRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. �La3oR i YNIT:\R1'sE��'ERnisTlilcT ❑. ENVIRONNIENTALHEALT14 B1dgApp_2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 1084 DERBYSHIRE DR DATE: 12/16/2013 REVIEWED BY: MEI-ISSA APN: 362 21 043 BP#: l 3/ L,�,0 VALUATION: 1$45,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1R3SFDREM USE: PERMIT TYPE: WORK MOVE KITCHEN TO FAMILY ROOM AREA REMODEL KITCHEN TON DINING ROOM. REMOVE SCOPE (E) FIREPLACE & REPLACE WITH (N) SLIDING WINDOW Mech. Permit Fee: Phrr,<<. Elec. Permit Fee. Other dlech. Insp. Ea7__ Other Plumb Insp. "'T.Insp. Lj Mech.Insp.Fee: Plumb. Insp.Fee: hLec.Insp. Fee- NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School Distric4 etc). Thesefees are based on the prefintina information available and are only an estimate Contact the De t or addn I info, FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 285 1 s.f. Remodel,Kitchen(<=300 sf) Suppl. PC Fee: Q Reg. O OT 0.0 r hrs $0.00 $626.00 IREMRESKIT PME Plan Check: $0.00 136 1 s.f. Remodel,Other Permit Fee: $0.00 $418.00 1 IREMRESOTx Suppl. Insp. Fee:Q Reg. OOT 0,0 hrs $0.00 = # Window/Sliding Glass Door PME Unit Fee: $0.00 $418.00 I WINREP Replacement PME Permit Fee: $0.00 Construction Tax., T Adininistrative Fee: O Work Without Permit? O Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Tiwvel Documentation Fees: Building or Structure O i Strong Motion Fee: IBSEISMICR $4.50 Select an Administrative Item BidaStds Commission Fee: IBCBSC $2.00 SUBTOTALS: $6.50 $1,462.00 TOTAL FEE: 1 $1,468.50 Revised: 10/01/2013 Building Department City,Of Cupertino La 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: / H-�J t/ t'r. PERMIT# OWNER'S NAME: ' ;•�f s It PHONE# VC?S? 77 ? C 7 3 GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: E �.- �'�` CITY/ZIPCODE: Mk) S� *Our municipal code requires all businesses working int a 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 ALUSUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: I" � Signature Date Please check applicable subcontractors and complete 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 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION CITY HALL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 C U P E RT I N O (408)777-3228• FAX(408)777-3333 SCOPE OF WORK: Kitchen Remodel. Project shall comply with the 2010 California Building (Base code 2009 IBC), 2010 Residential (2009 IRC), Plumbing (2009 UPC), Mechanical (2009 UMC), Electrical (2008 NEC), Fire (2009 IFC) and Energy Codes (2008 Building Energy Efficiency Standards) Energy code mandatory lighting measures: 1. All permanently installed high efficacy luminaires shall be switched separately from low efficacy luminaires. (150(k)(7)) 2. Permanently installed lighting in Kitchens shall be high efficacy luminaires. Up to 50% of the wattage of permanently installed lighting in kitchens may be in lights that are not high efficacy. (150(k)(8)) Plumbing plan notes: 3. Faucets in kitchens, wet bars, lavatories, laundry sinks, etc shall have a water flow not to exceed 2.2 gallons per minute. (CPC 402.1.2) Electrical Plan Notes: 4. The installation of smoke alarms in all of the following areas shall be provided: (R314.3) a. On the ceiling or wall outside of each separate sleeping area in the immediate vicinity of bedrooms. b. In each room used for sleeping purposes. 5. The installation of carbon monoxide alarms in the following areas shall be provided: (R315.1) a. Approved carbon monoxide alarms shall be installed outside of each separate sleeping area in the immediate vicinity of the bedrooms and on every level including basements in dwelling units that have fuel-fired appliances or attached garages. 6. A minimum of two 20 amp small appliance branch circuits shall be provided for all receptacle outlets in the kitchen, dining room, pantry, or other similar areas. (CEC 210.11(C)(1)) 7. In every dwelling unit, fixed appliances such as food waste grinders, dishwashers, washing machines, dryers, laundry tray locations, built-in refrigerators or freezers, furnaces, AC units, built-in heaters or any other fixed appliance with a motor of'/ h.p. or larger shall be on a separate 20 amp. branch circuit. 8. All receptacles in bathrooms, garages, accessory buildings, outdoors, crawl spaces, unfinished basements, kitchens (where receptacles serve counter top surfaces), laundry, utility, wet bar sinks (within 6 feet of the edge of the sink), shall have ground-fault circuit interrupter (GFCI) protection. (CEC 210.8) 9. In all areas specified in 210.52, all 125-volt, 15-and 20-ampere receptacles shall be listed tamper-resistant receptacles. (CEC 406.11)