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13050079
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1113 STAFFORD DR CONTRACTOR:CABINET WORLD INC PERMIT NO:13050079 OWNER'S NAME: MELNICK JACK D AND TATYANA A DATE ISSUED:05/09/2013 OWNER'S PHONE: SAN CARLOS,CA 94070 PHONE NO:(650)592-8020 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11S COMMERCIAL License Class_ Lie.4 0 0 � REMODEL(2)BATHROOMS 130 SQ FT,TO INCLUDE / (M,E,P�S) Contractor(n�41�/Ci� �.tJd1L� . Date C— 7-17 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. 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. Sq..Ft Floor Area: Valuation:$20000 I have and will maintain Worker'sCompensation Insurance,as provided for by Section 3700 of the Labor Code;for the performance of the work for which this APN Number:36206009.00 Occupancy Type: permit is issued.: APPLICANT CERTIFICATION I certify that I have.read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and,county ordinances and state laws relating WITMN 80 DA OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DA FR AST CALLED INSPE TION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which.may accrue against said City in consequence of the Issued by: Date: granting of this permit. Additionally,the aMAigont understands and will comply with all non-point sourc lations upertino icipal Code,Section 17 9.18. RE-ROOFS: Signature Date s—�<� 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. ❑ OWNER-B1f1ZLDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit haz5dws Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay a Air Quality Mana en rstric I performance of the work for which this permit is issued. will maintain compliance with the ertino Municipal ter 9. and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sec' s 25505,25533,a 4. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized Date:��r 3 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 CONSTR CTION LE ING AGENCY 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 I hereby affirm that there is a construction le ding agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address - 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building .cupertino.org 0 ❑NEW CONSTRUCTION Q ADDPITON ALTERATION/TI Q REVISION/DEFERRED ORIGINAL PERMT# PROJECT ADDRESS I ' l 3 C A� Mbo2 A APN# DI ^ tf\ / OWNERNAM�/�ck'r� '3G'� E_'�raB"`�/ w STREET ADDRESS /// 03 SY(A (�,( ��. CTT Y SATE ZIP /�v C FAX ro S 9 2 3 WawCONTACT NAME 117 1IG-.�1 PjI(-C,6 -S c Z-Pb Z-3E-MAII- STREET ADDRESS ' cr�T w ZIPz 7& �`.S {�.. �1 Y0 FAX 11IL OWNER ❑ OWNER-BUDER ❑OWNERAGBNT CONTRACTOR ❑CONTRACTORAGEGEN[T ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR N LICENS NUMBER LICENS E . # a�✓<,�ef- , � ,,,,( S 30 BUS�O`1 COMPANY NAMEC �v E-yIII+E'I""'4XS' �S�G� ��.�, FAX C S'T'REET ADDRESSI�O/ PHgE Cny T;'Z C4,(O S SO ARCHTTECTlENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK 9,P- Q�� 04-4 / /Z,3CD /„c e /3A44 ! t,4A Udio-vs -ela. lLtcr AksAlelff EXISTING USE PROPOSED USE CONSTR TYPE 1 #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EMIG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA L REMODEL AREA REMODEL AREA PORCH AREA I DECK AREA TOTAL DECKNORCH AREA I GARAGE AREA: DETACH ATTACH #DWELLING UNITS: IS A SECOND UNIT OYES SECOND STORY OYES BMGADDED? ONO ADDITION? WO PRE-APPLICATION OYES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEITOTAL VALUATION PLANNINGAPPL# ONO PLANNING APPROVAL LETTER EICHLERROME? X0 My �© DOO. BY my signature below,I certify to each of the following: I am the pro owner or auth act on the property owner's behalf. I have read this application and the information I have provided is I have Description of d verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil ' tiv rtino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRE r ,TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for 41ovER-Tff COUNTER ❑ BUILDING PIAN REMW existing building(s). Demolition permit is required prior to issuance of buildine permit for new building. ❑"EXPRISS` ❑ PLANNING PIAN REVWW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC wORYS form if any Hazardous Materials are being used as part of this project. ❑'LARGE ❑ FIItE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. ❑ I�IaaoR' ❑ sANrrARY SEWER nrsTticT ❑ ENVIRONMENTAL HEALTH Bldg,4pp 2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 1113 STAFFORD DR DATE: 05/09/2013 REVIEWED BY: MENDEZ APN: BP#: "VALUATION: 1$20,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: PERMIT TYPE: WORK REMODEL 2 BATHROOMS SCOPE 46400MEu Ell 7In . r s{-,..X1ech.Plan Check Plumb.PlanElec:.Plan Check �llech.Pertnit F'ee:. Elec. Permit Fee: L1ec�h.Insp.� � Other Plum (7ther Flec.Insp. In p.f ee Plumb. hal) Elec.Insp.Fee NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the relimina information available and are onlyan estimate. Contact the Dept-for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1112) FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 130 s.f. Remodel,Bath(<=300 sf) Suppl.PC Fee: (j) Reg. 0 OT 0.0 hrs $0.00 $600.00 1REMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tear: Administrative Fee: Work Without Permit? 0 Yes iE) No $0.00 0 Advanced Planning Fee: $0.00 Select a Non-Residential 0 T i cxvel Dczcutnenturirn fees: Building or Structure Strong Motion Fee: iBSEISMICR $2.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $3.00 $600.00 $603.00 Revised: 04/29/2013 J �- I I a I I A � I j I 113 I , 7y i C\ I I I \ I I I sj I L 1� oP _ COMMUNITY DEVELO .� F!R;EN`C,0�Gi BUILDING DI'VISIflNC UPER HNO APPROVED on. ti !s MUST he kept the. M Y 9:2013 -a + Q M .�► I N u�b/�it�duan constructs ificatians A o This sed of plans;and spec ' � r j 9 Unlawful to ii ' e y rations on same,or to y sem` ill f 7? Ste © ��! fi�lchanges f an es or,alter r BY: 9 r the 6uild,ng�J,:lctal. ! _ ., a rom,without app oval from; , - OBINET �O I��D I Thfie e stamping of this plan and specifications SHALL L N 1 :i w'� .. r ev- held to permit or,to he an approval of thevil CA . of any provisions of any City Ordinance or 1501 Laurel Street San Carlos, CA 94070-5114 BY . ,r l dc. No. 302530 , (650) 592-8020 r=, DATE .,, , PERMIT NO. 06)FFICE � . ♦ b:' ..____i___-._.—_� i 4 _ I 1:'J' j ti i i J7 CIA _. ... Yom. ' .��' 'I � L y1 �^ �_i e4 , 7 309 "4Ai t , i t IE uV R N r j I � i I i. - - —'-- i S__Inn Carlgs CA 94070-5114_ I I 1 -------__ --Lk. N' . 025300 (65d 5?2-8020 f— i- Gtr: I I --r— �a gip\-\ i i c.,Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR:�LIST JOB ADDRESS: ///;53 PERMIT —07 OWNER'S NAME: PHONE# O' -8'O 4� GENERAL CONTRACTOR: BUSINESS-LICENSE#- ADDRESS: CITY/ZIPCODE: i►/ QC�S GA *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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME B..USINESS 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 f i3�; wner/CO for Signature Date