13070147 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21091 RAINBOW DR CONTRACTORr9 8E PERMIT NO:13070147
D
OWNER'S NAME: MARTY GUNTHER ®� r,r DATE ISSUED:07/24/2013
OWNER'S PHONE: PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL❑
License Class
IZI Li..# ,-�C<'! Z. 'Ll INSTALL GAS LINE FOR NEW BBQ GRILL,ADD 3
&24ELECTRICAL CIRCUITS,8 OUTLETS FOR BBQ ISLAND,
Contractor . ' Date I �� REMOVE CONCRETE AND ADD PAVER IN PATIO AREA
I hereby affirm that I ani 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:
11 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:$4000
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:36223052.00 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 DAY M LAST 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
granting of this permit. Additionally,the applicant understands and will comply Issued by: Date:
with all non-point sour esegulations per the Cupertino Municipal Code,Section
9.18.
J _F RE-ROOFS:
Signature Date 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
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)
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 2545 25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date:7/2Y/
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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE® CUPERTINO, CA 95014-3255
(408) 777-3228- FAX(408) 777-3333- bUldin 9
CUPERTINO 119�cU_�Ftlno mr
r_1 NEW CONSTRUCTION El ADDITION ❑ALTERATION/Ti El REVISION DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS
? APN# 5 d,— c,c,
OWNER NAME PHONE E-MAIL
STREET ADDRESSCTI-Y, STATE,ZIP L4�,rboQo CA FAX
CONTACT NANIEV,-F(,-7 PHONE�_(,,�,_)�CC( E-MAIL,_
0,�_ Z,j (_
STREET ADDRESS C7CnTATE,ZIP FAX-3 CLL C4-
11 OWNER 0 OWNER BUILDER El OWNERAGENT a-C-01,11CTOR 0 CONTRACTOR AGENT 0 ARCHITECT 11 ENGINEER 0 DEVELOPER 0 TENANT
LICENSE NUMBER LICENSETYPEBUS.LIC 9
C!71M 9,14, 7 ,
COM[PANYNAME FAX
U
CIUA�
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STREET ADD" PHONE
ARCHITECT/ENGINEERNANIE LICENSE NUMBER BUS.LIC
COMPANY NAME E-MAII FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DES TIO
V0
EXISTING USE PROPOSED USE CONSM TYPE If STORES USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NETAREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODELAREA
PORCH AREA DECK AREA:TTOTAL DECK/PORCH AREA GARAGE AREA. ODETACH
OATTACH
#DWELLINGUNITS: IS A SECOND UNIT OYES SECOND STORY OYES
I BEINGADDED? ONO ADDITION? ONO
PRE-APPLICATION 0 YES IF YES,PROVIDE COPY OF IS THE BLDG AN 0 YES RECEI VALUATION,
PLANNING APPL# M NO PLANNING APPROVAL LETTER EICHLER HOME? 0 NO Xr/ I—"—
By my signature below,I certify to each of the following: I am the property owner or author" t to act on the property owner's behalf. I have read this
application and the information I have provided iF.,correct. I have read the Description of Work aid verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to buildi6g co#struction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent. Date: 712Y11
SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit forTHE-THE-COUNTER DING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building-
permit for new building. ❑ EXPRESS ❑ G PLAN REVIEW
IP
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 171 STANDARD r❑I PUBLIC WORKS
Form if any Hazardous Materials are being used as part of this project LARGE ❑ FM DEPT
—Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR SANITARY SEWER DISTRICT
submittal of Building Permit application. ENVIROMYMNTAT HEALTH
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
kAPN:
DDRESS: 21091 Rainbow dr DATE: 07/24/2013 REVIEWED BY: Mendez
BP#: / 3'74 0/ *VALUATION: 1$4,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair,
PRIMARY SFD or Duplex PENTAMATION 1 REAP10
USE: PERMIT TYPE:
WORK install as line for new BBQ grill, add 3 electrical circuits 8 outlets for BBQ island
SCOPE
"Uech. Pian G%'ecA Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan Check 0.0 hrs $0.00
,jIT,/I Pe mit Ft e: Plumb.Permit Fee: IPPERMIT Elec.Permit Fee: IEPERMIT
;'rhe,-,W ch.7,gar. Other Plumb Imp. 1 0.0 hrs $47.00 Other Elec.Insp. 0.0 hrs $47.00
Alech.Insp.Fae: Plzrnrh. /nsp. 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.). These ees are based on the prelimina information available and are only an estimate Contact the De t or addn'linfo.
,FEE ITEMS 6Fee Resolution 11-053 E . 7/1/121 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 ® # Electrical
Suppl.PC Fee: 0 Reg. Q OT 0.0 1 hrs $0.00 $47.00 1BREMRECEP Recep/Switch/Outlets
PME Plan Check: $0.00 = # Plumbing
Permit Fee: $0.00 $70.00 IBPGAS Piping, Gas>4 Outlets
Suppl. Insp.Feer Reg. Q OT 0 0 hrs $0.00 20 amps Electrical
PME Unit Fee: $0.00 $47.00 IBELEC200 Services
PME Permit Fee: $94.00
Constmezion Tax:
Administrative Fee: IADMIN $44.00 Q
Work Without Permit? 0 Yes (F) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
e 0ct
St
Building or Structure Travel Documentation Fee: ITRA VDOC $47.00 Bu �
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
F_ SUBTOTALS: $186.50 $164.00 TOTAL FEE: $350.50
Revised: 07/01/2013
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21091 Rainbow Drive
Cupertino,-CA 9501
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