12090053CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10706 PAR THREE DR
CONTRACTOR: -
PERMIT NO: 12090053
OWNER'S NAME:
11 I PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
License Class73, C—(,� Li,. N f 33- ZD /
Contractor TL6U l?UI zu!, Date /L
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.
1 hereby affirm under penalty of perjury one of the following two declarations:
1 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 Pe 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. 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.
Signature---,r /o�?Z
❑ 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,
wil I 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
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.
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.
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, 1 must
forthwith comply with such provisions or this permit shall be deemed revoked.
APPLICANT CERTIFICATION
1 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.
BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
MECH r RESIDENTIAL r COMMERCIAL r
JOB DESCRIPTION: KITCHEN REMODEL(100 SQFT) INFILL DOORWAY 6% NEW
GAS LINE, HOOD, MOVED CIRCUIT FOR OVEN AND ONE NEW
CIRCUIT.EXISTING COUNTER CIRCUITS.
Sq. Ft Floor Area: I Valuation: $20000
APN Number: 35607044.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FRO LAST CALLED INSPECTION.
-6? -/o - 12
Issued bv: 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 ofAppli _ Date: 7 /6, I'llL
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I 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(a) should 1 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.
Owo authorized agent:
Date:
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of %ork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Signature Date I Licensed Professional
CITY OF CUPERTINO
1 FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10706 Par 3 Drive
DATE: 09/10/2012
REVIEWED BY: RDW
APN:
BP#:
'VALUATION:
1$20,000
*PERMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Remodel, Kitchen (300 s.f. max)
PRIMARY Residential
USE:
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
WORK
Kitchen remodel infill doorway6' new
as line hood moved circuit for oven and one new circuit.
SCOPE
Existing counter circuits.
FEE ID FLR AREA
s.f.
1 REMRESKIT 100
L1izh. Plan Check
Plumb. Plun Check
Elec. Plan Check
lfech. Perwil Fee'
Plumb. Permit Fee:
Elec. Permit Fee:
Other Mech, Insp.
Other Plumb Insp.
Other Elec. Insp. Li
Alech. Insp. Fee:
Plumb. Asp. 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 lees are based on the Dreliminary information available and are onlv an estimate. Contact the Dent for addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/11)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
Plu1Vb.1,Vech./E1ec
Permit Fee:
$600.00
.Suppl. lash Fee
Plurnb.111ech./Elec
Plumb./Mcch./Elee Perrrrir Fee:
Construction Tax:
,4dministrative .Fee :
Work Without Permit? 0 Yes Q No
$0.00
Advuucecl Plarning Fees:
Trovel Docutnenlution Fees.,
Strong Motion Fee: IBSEISAHCR
$2.00
Select an Administrative Item
Blda Stds Commission Fee: IBCBSC
$1.00
SUBTOTALST
$603.001
$0.00 TUTAL FEE:
1 $603.00
Revised: 07/01 /2012