11030046 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 1141 HOLLYHEAD LN CONTRACTOR -- PERMIT NO: 11030046
-�-�— /1 Y:1C"( L_Lt QC DATE ISSUED:03/10/2011
OWNER'S NAME: PATRICIA CORNELY �-Y J
O'7.3NER'S PHONE: 4089730665 PHONE NO:
G LICENSED CONTRACTOR'S DECLARATIONr
//'' BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class F} Lic.# "- o > ^3
MECH F RESIDENTIAL F COMMERCIAL F
Contractor:5TVA t:r PH t LL(00 S Date 3'—it, — <
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:KITCHEN REMODEL(80SQFT)NON-STRUCTURAL AND
(commencing with Section 7000)of Division 3 of the Business&Professions NEW GAS
Code and that my license is in full force and effect. LINE FOR EXISTING STOVE TOP RANGE LOCATION;NO
RE-ROOF
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
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$30000
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Number:36226018.00 Occupancy Type:
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, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of thispermit. ditionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point sour regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature Date 3—lf� Issued by:�i Date: "
r
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date:
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
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
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I HealZba
Code,Sections 25505,25533,and 25534.
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. Ownriz ent:
Date: 3!0--%
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
V. and expenses which may accrue against said City in consequence of the Lender's Address
rg of this permit.Additionally,the applicant understands and will comply
w., all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
II[AADDRESS: 1141 hollyhead lane DATE: 03/10/2011 REVIEWED BY: bobs.
PN: BP#: '"VALUATION: 1$30,000
"PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM
USE: I PERMIT TYPE:
WORK sfd kitchen remodel non structural add new gas line for existing same location.
SCOPE
Plumb.Plan Check0.0 hrs $0.00
Plumb.Permit Fee: IPPERMIT
Other Plumb Insp. 0.0 hrs $42.00
NOTE: These
-fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l in o.
FEE ITEMS (Fee.Resolution 09-051 P f." 7,/1;"10) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.£ Remodel,Kitchen(<=300 sf)
Supp/.PC Fee: Reg. OT 0.0 hrs $0.00 $570.00 IREMRESKIT
PME Plan Check: $0.00 0 # Plumbing
Permit Fee: $0.00 $63.00 IPGASRES Piping, Gas<=4 Outlets
Suppl. Insp.Fee-.0 Reg. 0OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $42.00
[71
Acoustical Fee: 0 Yes 0 No $0.00 0
Work Without Permit? 0 Yes 0 No $0.00 0
Planning Fee: $0.00 Select a Non-Residential 0
Travel Documentation Fee: 1 TRA VDOC $42.00 Building or Structure 0
i
Stroup Motion Fee: 1BSEISMICR $3.00 Select an Administrative Item
Bld7 Stds Commission Fee: IBCBSC $2.00
SUBTOTALS: $89.001 $633.001 TOTAL FEE: F $722.00
Revised: 01/15/2011
CITY OF CUPERTINO
6 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36226018 . 00
DATE ISSUED. . . . . . . : 03/10/2011
RECEIPT # . . . . . . . . . BS000012873
REFERENCE ID # . . . : 11030046
SITE ADDRESS . . . . . : 1141 HOLLYHEAD LN
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER PATRICIA CORNELY
ADDRESS . 1141 HOLLYHEAD LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : STUART D PHILLIPS
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 0.0096
COMPANY TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 30, 000 . 00 2 . 00 0 . 00 2 . 00 0 . 00
1BSEISMICR VALUATION 30, 000 . 00 3 . 00 0 . 00 3 . 00 0 . 00
1PGASRES OUTLETS 1 . 00 63 . 00 0 . 00 63 . 00 0 . 00
1PPERMITFE FLAT RATE 1 .00 42 . 00 0 . 00 42 . 00 0 . 00
1REMRESKIT SQ FEET 80 . 00 570 . 00 0 .00 570 . 00 0 . 00
1TRAVDOC FLAT RATE 1. 00 42 . 00 0 .00 42 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 722 . 00 0 . 00 722 . 00 0 . 00
CITY OF
yrs
CITY OF CUPERTINO
ADDITION/REMODEL
CUPERTINO FEE SCHEDULE
APN# Date: r
Is a2 nunit being added? Yes ❑ No If yes, please fill out the permit application for 2" unit.
Is this a 2"d story Addition? Yes ❑ No M
Is this house an Eichler? Yes ❑ No ® If yes, needs Planning approval.
Building Address:
Mailing Address (if different from building address):
Owner's Name: Phone# :40?> X173 5
PA-r �c�q►Jc L'�
Contractor: Phone#: o'3 i 33'5 L5 170
5"TU A-A-'_ '?H l L_L_i PS Fax/e-mail:
Cupertino Business License: State Contractor License#:
Contact: Phone#: *'_3i 33S LS70
P it t L4,t P_sFax/e-mail: � U,
Landscape Ordinance Compliance:
Landscape area in sq. ft. (includes all irrigated areas):
'f 2,500 sq. ft. or less, compliance with the Landscape Water-Efficiency Checklist is required.
1f more than 2,500 sq. ft., a complete Landscape Project Submittal is required.
Compliance Method: El Plant Type ❑ Water Budget
Building Permit Info: Bldg. lett. g chanical Hillside ❑
Project Size: Counter Express ❑ Standard ❑ Large ❑ Major ❑
Job Description:
Addition-What is being added?(Be Specific):
What is being remodeled(not including addition)? i4J-rC.�A c-111 0�m 6,10_� '<-\W^
udd ltisL1-✓ �1 � �l ��r- P�`'S'fi'�'t�— �7TJ� -'�P �c c;J�iZ�!?
Remodel Includes Re-Roof. Yes ❑ No ® If yes list number of squares
Remodel Includes Structural: Yes ❑ No 91
Do you have the pre-application planning approval? Yes ❑ No 9
If yes,please provide a copy of your planning approval letter. Planners name:
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen D Bath Other VAi_u* i o&1 3D K
Type of Construction(Usage Class): Occupancy Type: (�--
1-A, 1-B ❑ IIMI/V-A ❑ HMI B, IV-HT, V-B Lj-` Valuation: 3a '1�--
Please complete relevant portion of the Green Building
Checklist& attach it to the application or if applicable, Green Building Points Achieved:
include in plan set& the sheet index.
KITCHEN REMODEL
APN: 362-26-018-00
Owner: Pat Cornely
Address: 1141 Hollyhead Lane, Cupertino,CA 95014
408 973 0665
Contractor: Stuart Phillips
Address: 310 EI Alamein Road, Felton,CA 95018 (p_
831335 2570 '
Lic#403369
%r
Scope of work:
Kitchen remodel including new cabinets,appliances,window,door, and removing two non-bearing
walls, install solatube in kitchen, new recessed florescent lights, GFI receptacles in kitchen.
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Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CUPERTINO Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: irk i too( Aeaek LA}rnc PERMIT# -j d
OWNER'S NAME: PA-r CaR AJC Ly PHONE# Y 3 i 3-3,5 z5 70
GENERAL CONTRACTOR: 5TuA-kT f LLtOS BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCO TRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: CZ ,
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring / Carpeting
Linoleum /Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
caner/Contractor Signature Date