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13070043 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22744 MAJESTIC OAK WAY CONTRACTOR:EXPRESS BUILDERS INC PERMIT NO: 13070043 OWNER'S NAME: WILLIAM WOODARD TRUSTEE 21801 STEVENS CREEK BLVD DATE ISSUED:07/08/2013 OWNER'S PHONE: 6509614506 CUPERTINO,CA 95014 PHONE NO:(408)973-8822 12r LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL[] License Class Lic.# G 3 1,71 REMODEL 2(E)BATHS(80S.F.)&REMODEL(E)KITCHEN �5S aU�c rrs Dj3 (NEW LED LIGHT FIXTURES,MOVE REFRIGERATER& Contractor U�9� ate �;8— INSTALL(N)DEDICATED CIRCUIT.ENLARGE OPENING I hereby affirm that I am licensed under the provisions of Chapter 9 TO (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:$18500 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 APN Number:34232120.00 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 WITHIN 180 DAYS 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 DAYSXALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the V granting of this permit. Additionally,the applicant understands and will comply Is ue y: Date: O with all non-point sourc�re�gujlah per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signatur T Date 7'P�3 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-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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) I,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. I 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 hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 2. 05,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agen Date:7-8-/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 Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending 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 CONSTRICTION PERMIT APPLICATION 0 COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION (l� 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228- FAX(408)777-3333•building()cupertino.orp \ [--]NEW CONSTRUCTION ❑ ADDITION EN ALTERATION/Ti ❑ REVISION/DEFERRED ` ORIGINAL PERMIT# PROJECT ADDRESS Z7z/c/ /-1J�3:lG 0,41CWA y APN# 3 (�2 - Z - 124 OWNER NAMF. wIGGi �t - aaA� Pn, C tG�frlAN�fc�Yfa� STREET ADDRESS CITY, S AT P FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑ OWNER ❑ OR'NER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME LICIa 3NU BE LICENSE TYPE BUS.LIC# S COMPANYNAMEL ,p2L 3v�G• E-MAIL FAX sTRE/ASD%s 2D ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK 2G,�o� 'Zeta /iii- �C=��G-Z /c�/�-� Goc�N7z�t, s�-�7 •L!%�7. �lVC^R a O �rV iNC, EXISTING USE PROPOSED USE CONSTR TYPE 1 #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER _ REMODEL AREA Z REMODEL AREA j REMODEL AREA PORCH AREA DECK AREA TOTALDECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECONDSTORY []YES BEING ADDED? []NO ADDITION? ❑NO PRE-APPLICAnON []YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑1'ES 1r' "'f?i fa'{E� ' .I , UATION: PLANNING APPL# ❑NO PLANNING APPROVAL L.ETITR EICHLER HOME? ❑NO ';°" € 'T w Qo By my signature below,I certify to each of the following: I am the property owner or at zed ag ,.perry owner's behalf. I have read this application and the information I have provided ct. I have read escription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to build' istructio represen Cupertino to enter the above-identified property for inspection purposes., Signature of Applicant/Agent: -► Date: SUPPLEME AL INFORMATION REQUIRED 3 P E zouT L _New SFD or Multi ily dwellings: Apply for demolition permit for � D` Ww— � VEg TH1+r9111N R;� s BUILDING EZA-N REVIER'�- �.. existing building(s). Demolition permit is required prior to issuance of building permit for new building. ©AXP s � PLANl�I_GV ALIN _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ��T A n� �7� LIGwo s form if any Hazardous Materials are being used as part of this project. ` : _Copy of Planning Approval Letter or Meeting with Planning prior to fi1OR "nom + l] SAAITARYI;R�R'.IDISTRIC"f submittal of Building Permit application. -.„��.,-- a� ��r5y:,.,.. •�:� EN17R0^'MENTA�.HEAS.3'H �-�.. B1dg-App_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 22744 MAJESTIC OAK WAY DATE: 07/08/2013 REVIEWED BY: MELISSA APN: 342 32 120 BP#: "VALUATION: 1$18,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: PERMIT TYPE: WORK REMODEL 2' E BATHS 80S.F. & REMODEL E KITCHEN NEW LED LIGHT FIXTURES MOVE SCOPE REFRIGERATER& INSTALL (N) DEDICATED CIRCUIT. ENLARGE OPENING TO KITCHEN :Leech.Plan Check Plutnb.Plan Check Elec.Plan Check lyc>c- /, Permit Fee: PhImb.Permit Fee: Ekec. Permit Fee: Llle,h. ;Uecrh. Insp. Other Plumb Insp. Other Eke.Insp. Insp. Fee: Plumb. Insp. Fec• Elec.Insp.Pee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Thesefees are based on the prelimWdina information available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (Fee Resolution 11-053 Eff.' 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel,Bath(<=300 sf) Suppl. PC Fee: (j) Reg. ® OT 0.0 hrs $0.00 $626.00 1REMRESBAT FINE Plan Check: $0.00 116 s.f. Remodel,Kitchen(<=300 s) Permit Fee: $0.00 $626.00 IREAMESKIT Suppl. Insp. Fee-0 Reg. ® OT 0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conslntction Tax: Administrative l ee: Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Travel Documentation ntation Fees: Building or Structure Strong Motion Fee: 1BSEISMICR $1.85 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 .x $2.851$1,252.00 1 � x 4 `� .� =� $1,254.85 Revised: 07/01/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RT 1 N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: ZZ hc O c 14,Ity PERMIT# '130. 3 OWNER'S NAME: PHONE# Sa 4G/ — YS-04 GENERAL CONTRACTOR: &;ji /LC Ul4,0SKS' BUSINESS LICENSE# 0.5'1 ADDRESS: /99/ CITY/ZIPCODE's�+^?�vq,�,Ligv�si� �•¢ 9sos� *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY-INSPECTI.ON(S) WELL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONT TORS HAVE OBTAINED *-''CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: 7 `'�"5 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 Owner/Contractor Signature Date - Z2.7N�-/ "AJLST/G oA►C W* GuPe2Ti�v� GA a� ' KITCHE ' 11'x 10- M MASTER s BEDROOM -/wv 13 X 13-6 L — — �?7i4¢rw%�s — L' L�?c'�ST/NL OPea✓nNinil I �� ��°�r�rufF�6��,►� DINING n� wod � 4./41*1S iw N AVAREA , ATN��. AREA BATHMR 0 �y m n =+ o � r. �e a `° o y. c4? o =a LIVING ROOM 'L PLO:fop 7 !31 C C r L;� t I p��jQq^ (a10 (aN rz 16X136 1 . Or ow a fp . . m A > 6)0 F, B-ED a' m -� o ROOM M, n � Q ,Q o? j p�� OOo _ p� �/ t I Y- oro ° ° vi °3 z ` * m w3 c c_{ O ° off• � CDa g3 ni ;,. O _ � � � -�� Bf O 7 c. O c -d G...{ O m o cot m O m �. > 0 <_•3 � Z .. P &j(T4Q FL2 Pc�9.J `� PLAN 21017 Y W�G�r►�1� 2Es i�Mc.G O. �. � .. I i KITCHEN 11X 10-6 MASTER r , BEDRC�M [" i 1013=6r �o DINT .AREA � a - "TH Lem r : BEDRQONI SND PLAN 21017 W,c,-fr�/�� 2E�IbCTaGE 0 i KITCHEN 11'X ld-C MASTER BEDR00M t , I 13x13-6` f �,A�1 .1 ncC ap IJEcU-4 No Gds DINING AREA 8 6"X 11 vAeJIT� '' ui�TN l RAS 1170- 70P i AT,H I � � -7c C� BATH Nom+✓ } urror*Gue ��✓. 1.Z8 �aAC 7a►C.(:1 BEDIZQOM �. � r i �q OR COQ CO 94 q PLAN 21:017 3 OF(o w►GMr�A�J 2C=3r�E�c�' � . o ITCH �= 6Aa 1:1`x 10 6v MASTER c , B'EDR04M wm I 13X13 DINING ► cL AREAz . 6%.ex, 11 Lt�/ING ROOM , s f CIO. UL EcAL PLAN 21:017 t ��° eUidvp� s 1-1X17 i v7�jz I r7 I I r TI Com!2�7a."�d. V-o.. O.G . is E G Ti ( it N� L4 x Z DF C 1rx=z I C� ,c„moi s>vn (� X? ` �V� ✓ QU/�of/q� �rI U s ri i f� eheaey. copF T o�A�fgN sli CF 3, Yxc c- o �G J9Pr—ycf 5 'S