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080201457 G CFFY OF CUPERTINO PERNUTWX BUILDING DIVISION BUILDING ADDRESS: PERMIT NO. 22330 HOMESTEAD RD #213 TBD - TO BE DETERMINED 08020145 : SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER. BUILDING PERMIT INFO KITCHEN REMODEL REPL BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION of Chapmr 9 CABINETS,COUNTET110Pr Ob Description I hereby affirm that I am licensed under provisions (commencing with section 70D(Y) orDivislon 3 of the Business and Professions Code, and my license is -.. - . _- - in run and License e Class T 1� Led. tr L Date Contractor ARCHn-FcrS DECLAItAI11514 1 understand my plans shall be used as public retards Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from We Contractoes License Law for the following mason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter. improve• demolish. or repair any structure prior to its issuance, also requires the applicant for such permit to rde a signed awtment that he is licensed pursuant to the provisions or the Contractors License Law (Chapter 9 Sq: Ft. Floor Area Valuation (commencing with Section 70DIn of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation or Section 7031.5 by any applicant for ■ pe,mll subjects the appscartt to a civil penalty or APN Number Occupancy e P y TyP not more than rive hundred dollars (5500). . ❑ L as owner or the property, or my employees with wages as their sole compensation, will do the wort, and the structure is not intended or offered for sale (sec. 7044, Business and Professions Conte: The Contracmrs I-;== Law doer mot apply to an owner or Required Inspections property who builds or improves thereon, and who does such work himself or through his own employers, provided that such improvements ate not intended or offered for sale. If. however, the building or improvement is sold within one year of completion• the owner - builder win have the burden of proving that he did not build or improve for purpose or sate.). ❑ I. as owner of the property. am exciumvely contracting with licensed contractaa to construct the project (Sea 7044. Business and Professions code:) The Comnctoes LI- cense Law does not apply to an owner or property who builds or improves theeon, and. who convects for such projects with a comraetor(s) licensed pursuant to the Contractor's License Law. ❑ I am exempt under Sec B & P C for this mason Owner Date . WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ I rive and will maintain a Certificate of Consent to self -insure forworkees Compen- sation, 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 Workoes Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance or the work for which this permit is Issued My Wo ati s Compenaoa tinnier and Policy number are: r Carrier cue W r r.. Policy No.: I 6 jc 3�-7 7 CERT IRCATE OF EXEMPTION FROM WORKERS . COMPENSA77ONINSURANCE (this season need not be completed it the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this permit is issued 1 shall not employ airy person in any maw= so as to become subject to the Werkmrs' Compensation Laws or California. Date Applicant NOTICE TO APPLICANT: If, after making this Cartificatc or Exemption, you should become subject to the WorktYs Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this pawnit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sex. 3097, Civ. C.) Lender's Name Lender's Address . 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 foisting to building construction, and hereby authorize representatives of this city o 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 In any way accrue against said City Of the granting this permit A APPLICPLIC ANTNT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by; Date SOURCE REGULATIONS. Re -roofs Type of Roof signatures or r ttuatwr Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant afore of handle hazardous material as defined by the Cupertino Municipal Code. Cbapter 9.12. and the Health and Safety Code, Section25532(a)7 All roofs shall be inspected prior to any roofing material being installed. [:]Yes 9314o If a roof is installed without first obtaining an inspection,agree to remove Win the Applicant Of rmttm building occupant use equipment or devices which amlt hazardous air contaminants as defined by the Bay Area Air Quality Management .I all new materials for inspection. Disuict7 ❑ Yes �lo I have mad the hazardous materials requirements under CLapter 6.95 of the Califor- miaEWthdeSafeyCodr:.Seaions255(15,25533uW25534.lurd =dthatirthe building does not currently have a natant. that it is my responsibility to notify the occupant or the . requirements which must be met pri r of Certificate: of ty_ Signature of Applicant Date VO� All roof coverings to be Class "B" or better Owner DatteeG .ed agent CUPEkTINO CITY OF CUPERTINO ADDITION/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft ADDITIONS 1R3SFDADD PLLONGRNGR Long Range PL Planning/Residential 1 R3INSP . Dwellings Inspections B 1R3PLNCK Dwellings plan check B 1R3REPINSP Dwellings Repeat B Inspection 1R3REPPLNC Dwellings Repeat Plan B Check 1R3HINSP Dwellings Hillside B inspection 1R3HPLNCK Dwellings Hillside B lan check 1R3HREINSP Dwellings Hillside B Repeat Inspection 1R3HREPLNC Dwellings Hillside B Repeat Plan Check 1R3ALTINSP Dwellings Alternate B Materials Inspection 1R3ALTPLNC Dwellings Alternate B Materials Plan Check 1PCESS Cesspool P 1PPRSEWG Ea. Private Sewage P Disposal System 1PR.SEWER Sewers P 1BPSPRINK Lawn P S rinklerBackflow 1BPWSVCS Main Water Service P 1BSEISMICRE SeismicResidential B DECKS 1R3SFDADD OR 1R3SFDREM 1DECKWOOD Deck (Wood) -Each B (Each) 1DECKRAIL Deck Railing -Each B (Each) CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft GARAGES 1R3SFDADD OR 1R3SFDREM 1GARDTW<=1K Wood Frame up to B 1,000 SF 1GARDTM<=1K Masonry up to 1,000 B SF BCONSTAXR Construction Tax Res (new detached garage PATIO'S OPIEN 1R3SFDADD OR 1R3SFDREM 1PATIOWOOD Wood Frame up to 300 B SF 1PATIOMETAL Metal Frame up to 300 B SF 1PATIOOTHER Other Frame up to 300 B SF PATIO'S CLOSED 1R3SFDADD OR 1R3SFDREM 1PATIOENCLW Enclosed Wood up to B 300 SF 1PATIOENCLM Enclosed Metal up to B 300 SF 1PATIOENCLO Other Enclosed Patio . B up to 300 SF 1 COVPORCH Porch Covered -Each B (Each) 1REROOFRES Residential Re -roof B Each 100 SF REMODELS 1R3SFDREM 1REMRESKIT Kitchen Remodel up to 300 SF B (Deduct "$"for ea plan check 1REMRESBAT Bath Remodel up to B " 300 SF 1 REMREOTH Other Remodel up to B " 300 SF REMODEL PLNCK 1 STPLNCK (1-3 for Standard Plan Check . B NOT FOR OVER THE remodel) ICOUNTER PLAN CKS. 3 of 3 CITY OF CUPERTINO ADDITON/REMODEL FEESCHEDULE SCHEDULE Quantity Sq Ft Fee ID Fee Description Fee Group Permit Type WINDOW/SLIDING 1R3SFDREM GLASS DOOR 1 WINRFP Replacement windows (ea 8 windows B 1 WINNEWNSTR New Window (non- structural B 1 WINMEWSTR New Window (Structural Shear Wall/Masonry) B 1 WINBAYSTR Bay Window (Structural) B SKYLIGHTS 1R3SFDREM 1 SKYL<10 SF Skylight less than 10 sf B 1SKYI>10SF Skylight greater than 10 sf or structural R, 1STAIRS Stairs -first flight/ea addt' 1 B 1BUSLIC Business License, B 4 of 3