11030069CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10101 0gANGE AVE
CONTRACTOR: TBD - TO BE DETERMINED
PERMIT NO: 11030069
OWNER'S NAME:
PHONE NO:
:
WLICENSED CONTRACTOR'S DECLARATION
r r- (—
ELECT
2
License Class_ Lic. N
BUILDING PERMIT INFO: BLDG PLUMB
r r r
MECH RESIDENTIAL COMMERCIAL
Contracto 6%mv,51)ate
I hereby affirm that I am licensed under the provision of C apter 9
JOB DESCRIPTION: REMODEL EXISTING KITCHEN(200SQFT),INCLUDES
(commencing with Section 7000) of Division 3 of the Business & Professions
LIGHTING(ELECTRICAL/ MECHANICAL/PLUMBING);
Code and that my license is in full force and effect.
NON-STRUCTURAL
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.
I have and will maintain Worker's Compensation Insurance, as provided for by
Sq. Ft Floor Area:
Valuation: $11500
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
APN Number: 35716147.00
Occupancy Type:
I certify that I have read this application and state that the above infoi
correct. I agree to comply with all city and county ordinances and state elating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
grantin permit. Additionally, the applicant understands and will comply
180 DAYS FROM LAST CALLED INSPECTION.
wit int source re ulations per the Cupertino Municipal Code, Section
916.
Si Date 10 W(
Issued bye„ Date:��/C._/�
re
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of
All roofs shall be inspected prior to any roofing material being installed. If a roof is
the following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
1, as owner of the property, or my employees with wages as their sole compensation,
inspection.
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
Signature of Applicant: Date:
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's
HAZARDOUS MATERIALS DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued.
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance, as provided for by
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Section 3700 of the Labor Code, for the performance of the work for which this
Safety Code, Section 25532(a) should I store or handle hazardous material.
permit is issued.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued, I shal I
ntain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's
H Ith & Sa Code, Sections 25505, 25533, and 25534.
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 in
Date:
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
I hereby affirm that there is a construction lending agency for the performance of work's
correct. I agree to comply with all city and county ordinances and state laws relating
for which this permit is issued (Sec. 3097, Civ C.)
to building construction, and hereby authorize representatives of this city to enter
Lender's Name
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
Lender's Address
Tiftkand expenses which may accrue against said City in consequence of the
g of this permit. Additionally, the applicant understands and will comply
ARCHITECT'S DECLARATION
w. all non-point source regulations per the Cupertino Municipal Code, Section
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
-"-- 4 CITY OF CUPERTINO BUILDING PERMIT DATE
BUILDING ADDRESS: 10101 ORANGE AVE
OWNER'S NAME:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class Lic. tl
Contractor Date
1 hereby affirm that 1 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:
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.
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
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. 1 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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
CONTRACTOR: EUROPEAN CABINETS BY PERMIT NO: 11030069
DESIGN
*64 SAN ANTONIO RD DATE ISSUED: 03/14/2011
PALO ALTO, CA 94303
PHONE NO: (650) 918-9494
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH F RESIDENTIAL F COMMERCIAL F
JOB DESCRIPTION: REMODEL EXISTING KITCHEN(200SQFT),INCLUDES
LIGHTING(ELECTRICAL/ MECHANICAL/PLUMBING);
NON-STRUCTURAL
3/29/11 -REV# 1 -REVISE STRUCTURAL WALL BETWEEN KITCHEN & DINING-
REVtII ISS'D OVER COUNTER
Sq. Ft Floor Area: I Valuation: $1.1500
APN Number: 35716147.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Signature Date Ilssued by:
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three
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.
1 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
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
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
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,
costs, and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
Date:
RE -ROOFS:
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.
Signature of Appl
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(x) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agent:
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of wrk's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I I understand my plans shall be used as public records.
Signature Date
Licensed
CITY OF CUPERTINO BUILDING PERMIT
a
BUILDING ADDRESS: 10101 ORANGE AVE
CONTRACTOR: EUROPEAN CABINETS BY
PERMIT NO: 11030139
DESIGN
OWNER'S NAME:
PALO ALTO, CA 94303
PHONE NO: (650) 918- 4
❑ LICENSED CONTRACTOR'S DECLARATION
r F r
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class_ Lie. #
I—�
���� � �
g�r� 1Y{rK.
Contracto � to "! � � �
METH RESIDENTIAL� CO RCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9
JOB DESCRIPTION: REVISE STRUCTURAL LL BETWEE HEN &
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
DINING
1
O
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: $4500
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
permit is issued.
APN Number: 35717
571 47.00
Occupancy Type:
APPLICANT CERTIFICATION
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
PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs, an penses which may accrue against said City in consequence of the
180 DAYS FROM LAST CALLED INSPECTION.
gr g of is permit. Additionally,, the applicant understands and will comply
poin4sour�ce� ions per the Cupertino Municipal Code, Section
�7
Issued b �-- Date: J'
( 4.41
❑ OWNER -BUILDER DECLARATION
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of
installed without first obtaining an inspection, I agree to remove all new materials for
the following two reasons:
inspection.
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,
Signature of Applicant: Date:
Business & Professions Code)
1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self -insure for Worker's
I have read the hazardous materials requirements under Chapter 6.95 of the
Compensation, as provided for by Section 3700 of the Labor Code, for the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
performance of the work for which this permit is issued.
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
1 have and will maintain Worker's Compensation Insurance, as provided for by
Safety Code, Section 25532(a) should I store or handle hazardous material.
Section 3700 of the Labor Code, for the performance of the work for which this
Additionally, should I use equipment or devices which emit hazardous air
permit is issued.
contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
1 certify that in the performance of the work for which this permit is issued, I shall
Safety Code, Sections 25505, 25533, and 25534.
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, l
become subject to the Worker's Compensation provisions of the Labor Code, I must
Date`I
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
1 hereby affirm that there is a construction lending agency for the performance of wrk's
certify that 1 have read this application and state that the above information is
for which this permit is issued (Sec. 3097, Civ C.)
correct. I agree to comply with all city and county ordinances and state laws relating
Lender's Name
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
Lender's Address
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
ARCHITECT'S DECLARATION
with all non -point source regulations per the Cupertino Municipal Code, Section
1 understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Date
•
•
C
FM -7 -
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
NOTE: These fees are based on the oreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 09-051 Eff 7;1/10)
ADDRESS: 10101 orange ave.
DATE: 03/14/2011
REVIEWED BY: bobs.
AN:
BP#:
-VALUATION: 1$11,500
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
)'; wl!b. !r,sp, £ ;gyp•,
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
WORK
kitchen remodel non structural include M E Ps.
SCOPE
PME Plan Check:
NOTE: These fees are based on the oreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 09-051 Eff 7;1/10)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
t1'itt�.-11c�•lr.lvtsj>.
UJir�� P-,...,
;,
Inv, bee"
)'; wl!b. !r,sp, £ ;gyp•,
f141. ,
NOTE: These fees are based on the oreliminary information available and are only an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 09-051 Eff 7;1/10)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
200 s.f.
$570.00
Remodel, Kitchen (<=300 so
/REMRESKIT
Suppl. PC Fee: 0 Reg. 0 OT
0.0 1
hs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg.
0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
('i3ust.r1!vrion To,k
Acoustical Fee:
0 Yes E) No
$0.00
Q
0
Work Without Permit? 0 Yes 0 No
$0.00
Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
0
Travel I)oc invni"Itia1.1,ct,e4
Stront; Motion Fee:
IBSEISAIICR
$1.15
Select an Administrative Item
Bldg_Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$2.151
$570.00
TOTAL FEE,
$572.15
Revised: 01/15/2011
CUPERTINO
r
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPART 'BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building(8cupertino.org
❑ NEW CONSTRUCTION ❑ ADDITION/ ALTERATION Z REVISION / DEFERRED SUBMITTAL // U (P9
PROJECT ADDI;FyS� • 1pjZ4W r,
(Jc
APN a -7/ J / V-7
OWNERNAME /'
tC
PHO
E-MAIL
SffiRksS ��
STAIF�ZIP-
FAX
APP Ned;WU fG�/`/
F aoS/6+1(AQ/�
STRE�I�4DD /� '
STATE, ZIP
L -/Z) C/,--rer
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT NTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER DEVELOPER ❑ TENANT
CVIE
LI�
LICENSE BUS. LIC a
IVr,� j�/N(i`/� Gov
' �l �J�l�� FAX
�r"iJ?'
rS , EI ADD S , v 7VllJ
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H
ARCHITECT/ENGINEER NAME
LICENSE NUMBER BUS. LIC a
COMPANY NAME
E-MAIL. FAX
STREET ADDRESS
CITY, STATE, ZIP PHONE
D'£SCRIPTIQIti.JF WO � _..
EXISTING USE
PROPOSED USE CONSTIL TYPE
B STORIES
OFFICE "t. Y
TYEF
DESCRIr ON
Fr
VALUATIONr
AREA
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
l[IL
V
"A"•"I,li
C/
BATHROOM
REMODELAREA
KITCHEN
REMODEL AREA
OTHER
REMODELAREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: ❑ DETACH
❑ ATTACH
I1
_
!DWELLING llT7f1'S
IS A SECOND UNR❑ YES
BEING ADDED? ❑ NO
SECOND STORY ❑YES
ADDrnONT ❑ NO
_ I
PRF.APPWCATION ❑ YES
MANNING APPL! NO
❑
�YERPROVmECOPY01
PLANNING APPROVAL LETTER
PLANNER'SNMiL
BY -
aLCElVEE7I1Y- .a
:{Y=
T V .1TWN
By my signature below, I certify of the following: I am the property owner or authorized agent to act on the property, owner's behalf. have read this
application and the informatio v 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 ting t ding con ioI authorize representatives of Cupertino to enter the abov identif d property for inspection purposes.
Signature ofApplicant/A ent: Date:
SUPPLE NTAL O TI REQUIRED
_ New SFD Or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materials are being used as part of this project.
_ Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application.
OFFICE
Ust o", ",Or. -
PLAN CHECK TYPE;
ROLITIN SLIP
0 0111'HE-COUNITER
0 EXPRESS
' ❑ ST:tYDARD
i7 1,,1,RCE
t] MAJOR
arl.DsvG PLA 14 REVIFw d
PLANNG :N PLAY kEvrr;'W.'; -
PUBLIC WORKS
PtHF; DEPT
Cl- i,NVIRQNMENTAL v=• ••, TH
B1dgApp_2011.doc revised 03/03/11
04