11050259CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7919 AUGUST LN I CONTRACTOR: WOWTRENDS PERMIT NO: 11050259
OWNER'S NAME: 1961 CAROLA AVE I DATE ISSUED: 05/27/201 1 1
OWNER'S PHONE: I SAN JOSE, CA 95130 I PHONE NO: (408) 464-4795 I
�4 LICENSEDCONTRACTOR'S DECLARATION
License Class TZ7 Lic. #
1
ContractoryL I ZIPM �//''V I�,�, IOl-k-i Date
kI '
1 hereby affirm that I am licensed under the provisio s of CApter 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:
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.
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above inf rmanon 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.
Signatur Date
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
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
construct the project (Sec.7044, Business & Professions Code).
1 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. 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.
BUILDING PERMIT INFO: BLDG r` ELECT PLUMB r`
r- F_ F_
MECH RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: REMODEL 250 SQ FT TO KITCHEN
Sq. Ft Floor Area: I Valuation: $10500
APN Number: 36212014.00 1 Occupancy Type:
PERMIT E I S IF WORK IS NOT STARTED
WITHIN 18 S OF PERMIT ISSUANCE OR
180 DAV3 LAST CALLED INSPECTION.
Issued by:
Date• "2; �
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 Applicant: Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 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 1
will maintain compliance with the Cupertino Municipal Codes Chapter 9. and
the Health & Safety Code, SectiorytL5505, 25533, and 25534,/ , y
Owner or authorized
Da
I hereby affirm that t is a construction lending agency for the performance of
work's for which th' permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Ad
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Date
CITY OF CUPERTINO
ww FEE ESTIMATOR - BUILDING DIVISION
iaADDRESS:
7919 August Ln.
DATE: 05/27/2011
REVIEWED BY: gs
APN:
BP#:
"VALUATION:
1$10,500
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
WORK
s ft kitchen remodel
�250
SCOPE
NOTF. These fees are hated on the nreliminary information availahle and are only an estimate. Contact the Dent for addh7 info.
FEE ITEMS (Fee Resolution 09-051 Eft' 711110)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
250 s.f.
$570.00
Remodel, Kitchen (<=300 so
IREMRESKIT
Suppl. PC Fee: E) Reg. 0 OT
0.0 1
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee-0 Reg. 0 OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
('roasrrtfcfion 7�1.i
Acoustical Fee: 0 Yes (F) No
$0.00
0
E)
Work Without Permit? 0 Yes 0 No
$0.00
Planning, Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
Tr, -net J)oc tFr ew,frion F s::
Strong Motion Fee: IBSEISMICR
$1.05
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$2.05
$570.00
TOTAL FEE:
1 $572.05
Revised: 04/29/2011