13080194 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20304 GILLICK WAY CONTRACTOR:BERINGER PERMIT NO: 13080194
CONSTRUCTION
OWNER'S NAME: KEARNEY PATRICIA AND DAVID M E PO BOX 3917 DATE ISSUED:08/26/2013
OWNER'S PHONE: 9254570698 SAN JOSE,CA 95150 PHONE NO:(408)835-5883
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL❑
License Class Lic.# qK *4-PLEX*NEW COUNTER TOPS IN EACH KITCHEN,
RETILE ALL SHOWERS(TERMITE DAMAGE)
Contractor 1/ 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
eerfo7ance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$2200
have and will maintain Worker's Compensation Insurance,as provided for by
ection 3700 of the Labor Code,for the performance of the work for which this APN Number:36936011.00 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 FROM L IlfiP +CTION.
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 I 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
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)
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 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,Sections25 05,255 3 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.
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 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
MY OF CU PIER'II NO BUMINNG ]PIEI[8MffT
BUILDING ADDRESS: 20304 GILLICK WAY CONTRACTOR:BERINGER PERMIT NO: 13080194
CONSTRUCTION
OWNER'S NAME: KEARNEY PATRICIA AND DAVID M E PO BOX 3917 DATE ISSUED:08/26/2013
OWNER'S PHONE: 9254570698 SAN JOSE,CA 95150 PHONE NO:(408)835-5883
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class Lic.# *4-]P1LEX*NEW COUNTER TOPS IN EACH KITCHEN,
RE'IITI LE ALL SHOWERS(TERMITE DAMAGE)
Contractor A Lxya! DateIREVISION# I -REBUILD TWO STORY WALL AT REAR&
I hereby affirm that I am licensed under the provisions of Chapter 9 J REPLACE BEAM IN UNITS 3&c 4—ISSUED 9/3/2013
(commencing with Section 7000)of Division 3 of the Business&c 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:$2200
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:36936011.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT][gMIT]EXPIRES IDF WORK IS NOT STARTED
EIlD
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN IIS®���� ®�������ISSUANCE ®�
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 FRO ]_,LED 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
L1_3
granting of this permit. Additionally,the applicant understands and will comply a
with all non-point source reg I tions er the Cupertino Municipal Code,S
9.18.
,�l RE-ROOFS:
Signature Date b� 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&c 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&c Safety Code,Section 25532(x)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 uni ' I Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&c Safety Code,Section�205,25 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: Date:
1 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
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 20304 GILLICK WY DATE: 08/26/2013 REVIEWED BY: MELISSA
APN: 369 36 011 BP#: *VALUATION: 1$2,200
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY Multi-Family Dwelling Building is PENTAMATION 1 R2REM
USE: 1 >3 Stories ® Yes ® No PERMIT TYPE:
WORK UGE)
EX* NEW COUNTER TOPS IN EACH KITCHEN RETILE ALL SHOWERS TERMITE
SCOPE
qg_
, w
a
�`' x
Mech.Plan('heck Plumb. Plart Check Elec.Pian Check
iL1iu;/t. Permit Fee: Plumb.Pe1mi7 Fee: Elec. Permit Fee:
Other a9ec:h.Insp. Other Plumb Insp, Oiher Elec.Insp.
Allech.Imp. Fee: Plumb. Insp.Fee: Elec.Insp.Fee:
NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on the prellmin information available and are only an estimate Contact the De t or addn'1 info.
FEE ITEMS(Fee Resolution 11-053 E . 7� FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 140 s.f Remodel,Bath(<=300 s f
Suppl.PC Fee: 0 Reg. ® OT 0.0 hrs $0.00 $626.00 1REMRESBA7T
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Fee-.0 Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee:, $0.00
PME Permit Fee: $0.00
Construction Tax:
Administrative.Fee:
Work Without Permit? ® Yes iq No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Fees: Building or Structure
i
Strom Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldp,Stds Commission Feer IBCBSC $1.00.
�fsv
$1.501 $626.00r3m OL $627.50
Revised: 07/01/2013
MY OF cCUIFER'I'M
FEE 1EMMA'I R—BUILDING I.VISION
ADDRESS: 03,QV t17C DATE: � � /� REVIEWED B1':
APN: IBP#: -VALUATION: Iso
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex PENTAMATION 1GENIRES
USE: PERMIT TYPE: A
WORK
SCOPE4% v
�lw
ch. Plan Check Muni . Plan Check Elec.Plan Check
r�fitch. Penni!Fee' Plumb. Permit Fee: lsler..•. Perrnir Fee:
Orher•Meeh. Insp. Other Plumb Insp. Other Elec.Insp.
1/cch.Aup. Fire: Plumb. Insp, Tee: F,lec.Insp. kee:
NOTE.This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). TheseLees are based on the prelimina information available and are onl an estimate. Contact the De t or addn'l in o.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: Hourly Only? 0 Yes (E) No $0.00 = hours Plan Check,Hourly
Suppl. PC Fee: E) Reg. ® OT0.0 hrs $0.00 $139.00 1STPLNCK
PME Plan Check: $0.00
Permit Fee: Hourly Only? 0 Yes (D No $0.00
Suppl. Insp. Fee-0 Reg. C) OT Q,Q hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction .Tax: C
Administrative Feer: 0
Work Without Permit? 0 Yes (D No $0.00 G
Advanced Planning Fee. $0.00 Select a Non-Residential E)
Trcn;el Docuinentation fees: Building or Structure 0
Strom Motion Fee: $0.00 1.0 hrs Inspections
Bldg Stds Commission Fee: $0.00 $139.00 iSTiNSP Inspection,Hourly
SUBTOTALS: $0.00 $278.00 TOTAL FEE: $278.00
Revised: 07/01/2013