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13010148CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS:' 21055 FREEDOM DR CONTRACTOR: HANSON PERMIT NO: 13010148' CONSTRUCTION CORP OWNER'S NAME: STEPHENS, WENDELL 1539 EL OSO DR DATE ISSUED: 01/29/2013 OWNER'S PHONE: 4089968964 SAN JOSE, CA 95129 PHONE NO: (408)517-0300 JOB DESCRIPTION: RESIDENTIAL El COMMERCIALS LICENSED CONTRACTOR'S DECLARATION License ClasLia # 6 / __/_ r, `7 i 200SF KITCHEN REMODEL TO INCLUDE (N) CABINETS, Contractor �QW 'ts Date 1 �� /` LEDLIGHTING FIXTURES, MICRO HOOD DUCTWORK & I hereby affirm that I am licensed under the provisions of Chapter 9 RECONNECT (commencing with Section 7000) of Division 3 of the Business & Professions & REPLACE (E) SINK 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: $54800 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: 32653027.00 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 DA AST 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 1 z,!j r Date: granting of this permit.. Additionally, the applicant understands and will comply ssued b 1 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. /� RE -ROOFS: Signat 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 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(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 Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 255 , and 25534. Section.3700 of the Labor Code, for the performance of the work for which this Date: permit is issued. Owner or authorized agent 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 becornie, 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ©� 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 O 1 (408) 777-3228 - FAX (408) 777-3333 - building(akupertino.org ❑ NEW CONSTRUCTION U ADDITION U ALTERATION / Ti U REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS ��Fr OM pr ,Guy _f1 N E) I APN# /y D7 `]- vo OWNERNAME W✓-, L7rePHONEtv to W LC rn�' STREET ADDRESS n 1 O m CITY, STATE, ZIP FAX !r voV I�UC' I NU �i� 0 G� 1 CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER 6 I ( LICENSE TYPE BUS. LIC # fAZAD COMPANY NAME P� N hO t� GD N l ► ►W� I ti E-MAIL FAX 769 511 6 ✓ STREET ADDRESS1 1��M Y Dom` �® I� CITY, STAT PHONE LICENSE NUMBER BUS. LIC # L COMPANY NAME E-MAIL FAX WYc9tVTiAwIN a Po• !_ave STREET ADDRESS CITY, STATE, ZIP PHONE V1® I&V MLH5 0IN DESCRIPTION OF WORK 16""1_5144D® ' w b 1, Aq k l � �AkI �/l m s /r j�J kob v EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA BATHROOM REMODEL AREA KITCHEN REMODEL AREA 7�� OTHER REMODEL AREA TTACH # DWELLING UNITS: IS A SECOND UNIT YES SECOND STORY LJ YES BEING ADDED? NO ADDITION? XNO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES -RECE - TOT VALUATION:�- PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ANO By my signature below, I certify to each of the following: I am the property owner or authorized agent to act &TI& property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bui i struction. tho ' representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/A Date: l qh BldgApp_201 Ldoc revised 06/21/11 i CITY OF CUPERTINO VFW 1 .CTTMAT(1R—RITII,iIINf DIVIRION imADDRESS: 21055 FREEDOM DR DATE: 01/29/2013 REVIEWED BY: MELISSA FlUech. Permit Fee.. APN: 326 53 027 BP#: molmq *VALUATION: 1$54,800 ,PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE:. . SFD or Duplex Elec, Insp. Fee: PENTAMATION PERMIT TYPE: 1 R3$FDRE WORK 200SF KITCHEN REMODEL TO INCLUDE N CABINETS LED LIGHTING FIXTURES MICRO SCOPE I HOOD DUCTWORK & RECONNECT & REPLACE (E) SINK NOIE: 'Phis estimate does not include fees true to otner vepartments y.e. r[anntng, runt/c rrurns, rlre, —1-1 L,.,....4 .. 11. .. 1;...,:............! _ _4__ n nnnb/n n."I ire n..tu — acfiNfnta :^n"fart tho Dant %nr addn'l into. FEE ITEMS (Fee.Resolution 11-053 Eff 7/1/12) Xfech, Plan Check Plumb. Plem Cheek Glee. Plan Chet% FlUech. Permit Fee.. Plnrnb. Peiwnil Fee: Dec. Permit Fee: Other Hech. Inp, LLLI Other Plumb hasP. Other Elec, Insp. 111ech, Insp. Fee: plumb. Ins/). Fee: Elec, Insp. Fee: NOIE: 'Phis estimate does not include fees true to otner vepartments y.e. r[anntng, runt/c rrurns, rlre, —1-1 L,.,....4 .. 11. .. 1;...,:............! _ _4__ n nnnb/n n."I ire n..tu — acfiNfnta :^n"fart tho Dant %nr addn'l into. FEE ITEMS (Fee.Resolution 11-053 Eff 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel, Kitchen (<=300 sf) $600.00 IREMRESKIT Suppl..PC Fee: ) Reg. 0 OT 0,0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp: Fee:Q Reg. OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consirilclion Tax. _TT 1 dininistraliveFee: 0 G Work Without Permit? 0 Yes E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential E) Building or Structure 0 I i Trm>el Docznnenlufion Fees: Strong, Motion Fee: IBSEISMICR $5.48 Select an Administrative Item Blda Stds Commission Fee: IBCBSC $3.00 SUBTOTALS: $8.48 $600.00 TOTAL FEE: $608.48 1 Revised: 10/01/2012 CONTRACTOR'/ SUBCONTRACTOR LIST Building Department City Of Cupertino 1'0300 Tone Avenue Cupertino, CA 95014-3255 Telephone; 408777-3228 Fax: 408-777-3333 JOB ADDRESS: 2 / O � _ w+ P. PERMIT OWNER'S NAME: t/iE?J b �f LL PHONE # a A .5 11- 0.30 D GENERAL CONTRAC'T'ORs }-r-c Ip USINESS LICENSE # 3 p S 4 ADDRESS: !S37 FL 054 'i)R. Ste. 50sE e4 9s'Ig 4 CITY/ZIPCODE:. i '::fv.S if a 9 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license, NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL, BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors:- -- Sit;naturr — _ -_ -- _-- Date Please check applicable subcontractors and complete the following lnl"oi•Ir,ation, s/ SUBCONTRACTOR BUSINESS NAIM BUSJNESS LI( -'ENS -,, 4 I j ( (:abinets & Millwork Cument finishing Electrical c� � �%Pc��re � 13 Y2 � �l-(:ncing l`looiiitg / Carpeting Linoleum /Wood Glass Wood Glass / Glazing I {eating fFA�l��ri L a115'II� U L''l!� I.t ✓� Insulation l..andscapii>g Lathizig 'Masonry \/l'ainting/ ��allpaper --�.� 5) PaviOU r Plastcriug Plunibing 471-M -r,41 Ai Rooting — -- Septic 1<mk j Sheat Meial ✓�SheoLRock V7t,}a,ti 1^Q— —oma r�RYmlAtc� ——p�� i f, ti� ncr / C;ontracIor Signature bate. 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