13050091 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 965 S TANTAU AVE CONTRACTOR:ARCA CONSTRUCTION PERMIT NO:13454091
OWNER'S NAME: RAY LINDA P ET AL 222 MILBRAE LN APT 18 DATE ISSUED:05/10/2013
OWNER'S PHONE: 4083099297 LOS GATOS,CA 95032 PHONE NO:(408)401-4049
LICENSED CON"T'RACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL LJCOMMERCIAL®
License Class--L- Lie.# r ENCLOSE FRONT PORCH(60SQ FT),BATHRM REMODEL
(54SQ FT)KITCHEN REMODEL(280 SQ FT),FRAME IN
Contractor
Date > LARGE WINDOW AT KITCHEN&REMOVE&
'
I hereby r that I am licensed under the provisions of Chap r 9 REPLACE 9 WINDOWS.
(commencing with Section 7000)of Division 3 of the Business&Professions 5/24/2013-ADD REPLACMENT OF(E)100 AMP PANEL TO
Code and that my license is in full force and effect. 200 AMP,SAME LOCATION-ISSUED 5/24/20 tl
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:$43000
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:37538053.00 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 DA 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 1.80 DAYIM 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 Is �Date:
_��b Y
granting of this permit. Additionally,the applicant understands and will comply
with all.non-point source regulations per the Cupertino Municipal Code,Section
9.1&' •. RE-ROOFS:
Signatures Date `G� 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 Date:
Signature of Applicant:
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(Sce.7044,
Business&Professions Code)
property,am exclusively g HAZARDOUS MATERIALS DISCLOSURE .
1,as owner of they contractin with licensed contractors to
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
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
Sections Code
Health&Safety H
he eay , 2 OS,2553,3 nd 5534.
I have and will maintain Worker's Compensation Insurance,as provided for by tf �
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date• , l�
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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. if,after making this certificate of exemption,i
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 andcounty 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 BUILDING PERMIT
BUILDING ADDRESS: 965 S TANTAU AVE CONTRACTOR: 7777 PERMIT NO:13050091
OWNER'S NAME- RAY LINDA P ET AL DATE ISSUED:05/10/2013
OWNER'S PHONE: 4083099297 PHONE NO:
rl LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL®
License Class Lic.# ENCLOSE FRONT PORCH(60SQ FT),BATHRM REMODEL
(54
Contractor Date SQ FT)KITCHEN REMODEL(280 SQ FT),FRAME-IN
I hereby affirm that I am licensed under the provisiZ of Cdapter 9 LARGE
(commencing with Section 7000)of Division 3 of the Business&Professions WINDOW AT KITCHEN&REMOVE&REPLACE 9
Code and that my license is in full force and effect. WINDOWS
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:$43000
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:37538053.00 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 FR IT CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 7t2ii
costs,and expenses which may accrue against said City in consequence of the t4
granting of this permit. Additionally,the applicant understands and will compl Date:
n
with all non-point source regulations per the Cupertino Municipal Code,Sectiod.
9,18.
RE-ROOFS:
n "n 1_ f
't'.
_,i,
'I he
'i
Signature rior to any roofing material being installed.If a roof is
Date All roofs shall be inspected p m
7 installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
[3 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
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,qSectis 1,=2�1� 1t5
Section 3700 of the Labor Code,for the performance of the work for which this age
Owner or authorized Date:
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 CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I
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 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
CITE' OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 985 s tantau ave DATE: 0512.40201:1 REVIEWED BY: melissa
APN: 375 3$053 BP#: .`�( ) VALUATION: Iso �
*PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration 1 Addition 1 Repair
PRIMARY PENTAMATION 1 REAP2
USE: SFD or Duplex PERMIT TYPE:
WORK add panel u rade toepermit# 13050091
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Services 1 BELEC200 204 Amps $45
TOTALS: $45.00
Wch Plan�`liera l'IunA Pluri(3ieck Elea.Plan Check 0.0 hrs $0.00
Nf ec;lr_Permit F lc>..' hlmnb.Permii t ev: Elec.Permit Fee: 1
Other Meth,Insp. C3ih -Plumb Insp.
70ther Elec.Insp. OA rs $45.00
11c:c'2;Ins .. rc: Plumb. hi.4�lr.Fee: eL.Inrl�. I�c�:c:
NATE:This estimate does not include fees due to other Departments{i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District eta). These ees are based on the erelintina information available and are onL an estimate. Contact the De Lt Lr addn't in o.
FEE ITEMS flee ResoluflLon 11-053 Lff. 7lf 1/12) FEE QTYIFEE MISC ITEMS
Plan (,,heck Fee.
Su1),r)1. PC:.Ffee --El
PME Plan Check: $0.00
Permit.Fee:
rSuppl. Insp laced
PME Unit Fee: $45.00
PME Permit Fee: $45.00
Construction Tax
Administrative Fee: IADAHN $42.00
Work Without Permit? 0 Yes, No $0.00
Idvv Laced Planning Fees:
Travel Documentation Feer 1 TRA VDOC $45.00 i
Strom Motion.Fee: $0.00 Select an Administrative Item
Bldg Stds Commission Fee: $0.00
r $177.00 $0.00 cIa $ 00
, _
Revised: 04129/2013
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 965 5 TANTAU DATE: 05/1012013 REVIEWED BY: SEAN
APN: BP#: s'1 EVALUATION: $43,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration 1 Repair
PRIMARY PENTAMATION
USE: OFD or Duplex PERMIT TYPE: 1GENRE i
WORK Enclose front porch 60 sq ft); bathroom remodel 54 sq ft); kitchen remodel 280 sq ft); frame in lar e
SCOPE windows at kitchen; remove and replace (9)windows.
'*ch. T't{xsa C:'hcrt•k E'f7rftth, Fllc,v CGwcn 1'frn(:11ac;n
vri:. 'r.1'r rttrFt T?e: 1114"rnir. Pc r n-°81;"<e e: T"tc.c.. t:rrnri Fee:
ofhej 'Vlech.Insr), o(I"cp 1"hm?b Insp, Otlier Eh.,f_Imp, EJ
lr:cla h7so.Fee: PlttrrA Tors13. Fee: Elec.Inst . ',eco,
NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District eta . These ees are based on the relimina information available and are onLy an estimate. Contact the De t or addn'l info.
FEE ITEMS ,ee Resolution 11-053 E{f.' 7/1112} FEE QTYIFEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes No $0.00 �� hours Plan Check,Hourly
Suppl.PC Fee: 0 Reg. ® OT 0.0 hrs $0.00 $133.00 ISTPLNCK
PME Plan Check: $0.00 = s.f. Remodel,Kitchen(<=300 sf)
Permit Fee: Hourly Only? 0 Yes (E)No $0.00 $600.00 1 IREMRESKIT
Suppl. Insp.Fee:(j) Reg. 0 OT 0.0 hrs $0.00 54 s.f, Remodel,Bath({=300 sf)
PME Unit Fee: $0.00 $600.00 IREMRESBAT
PME Permit Fee: $0.00 = # Window J Sliding Glass Door
Com'Iruction lax: $533.00 1WINREP Replacement
2A hours Inspections
Work Without Permit? 0 Yes 0 No $0.00 $266.00 ISTINSP Inspection,Hourly
Advanced Planning Fee: $0.00 Select a Non-Residential E)
Traveltic ,z��ne:lc9iot Fees: Building or Structure 0
A
Strong Motion Fee: IBSEISMICR $4.30 Select an Administrative Item
BlStds Commission Fee: IBCBSC $2.00
TSI IS $6.30 $2,132.00 'I OT L $2,138.30
Revised: 04/29/2013