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10090275 CITY OF CUPERTIN O BUILDING PERMIT BUILDING ADDRESS: 10305 EL PRADO A%Tz:r CONTRACTOR:S.P.HOME DECOR PERMIT NO:10090275 OWNER'S NAME: ERNA JACKMAN 1169 CHESS DR STE L DATE ISSUED:09/30/2010 c ER'S PHONE: 4088651339 FOSTER CITY,CA 94404 PHONE No:(650)2744384 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG f— ELECT r— PLUMB r License Class c.# MECH _RESIDENTIAL� COMMERCIAL Contractor a O�i- Date I hereby affirm hat I am li ensed under the provisions of Chapter 9 DOD DESCRIPTION:WATER LINE FOR A REFRIGERATOR,&3 NEW CATED (commencing with Section 7000)of Division 3 of the Business&Professions CIRCUITS FOR COUNTER TOP RECEPTACLES&DISHWASHER Code and that my license is in full force and effect. &REMODEL KITCHEN(100SQ);NO RE-ROOF&NO 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 Valuation:$10000 permit is issued. Sq.Ft Floor Area: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:34230015.0 O 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 this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date �v Issued bya����Z ate: g ❑ 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 1,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 stricture is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain 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 Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,1 mus Ow r or au orized a t: l 010 forthwith comply with such provisions or this permit shall be deemed revoked. Date: l 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; [hereby affirm that there is a constriction 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.) un-n the above mentioned property for inspection purposes.(We)agree to save Lender's Name .nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address 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 ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION Its ADDRESS: DATE: REVIEWED BY: APN: BP#: "VALUATION: $10,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY PENTAMATION 1GENRES USE: SFD or Duplex f i C)<)< ; .;E_�,� PERMIT TYPE: WORK SCOPE r11 ,J) t', Flt .............. NOTE. These fos are based on the preliminary in ormation available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS(Fee Resolution 09-051 Eff. 71/1( FEE q7� MISC ITEMS Plan Check Fee: 50.00 Kitchen(<=300 sf) Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs : 0.00 $570.00 1REMRESKIT PME Plan Check: 50.00 Permit Fee: :>0.00 Suppl. Insp.Fee-0 Reg. 0 OT 0.0 hrs 50.00 PME Unit Fee: 30.00 PME Permit Fee: 50.00 C`otz�orrcti�n 7t�.� Acoustical Fee: 0 Yes 0 No 60.00 Work Without Permit? 0 Yes 0 No $0.00 Planning Fee: 50.00 Select a Non-Residential 0 Building or Structure 0 Taavc/1)o� Strong.Motion Fee: IBSEISMICR $1.00 Select an Administrative Item BldP Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $2.00 $570.00 TOTAL FEE: $572.00 Revised: 9/29/2010 CITY OF CUPERTINO 3 ITEMS OF 3 PERMI`C RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blt: Lot: APN 34230015.B DATE ISSUED. . . . . . . : 09/30/2010 RECEIPT #. . . . . . • • • : BS000011602 REFERENCE ID # . . . : 10090275 SITE ADDRESS . . . . . : 10305 EL PRADO APT B SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . . ERNA JACKMAN ADDRESS . . . . . . . . . . : 10305 EL PRADO WAY APT B CITY/STATE/ZIP . . . : CUPERTINO, CA 95070-6025 RECEIVED FROM . . . . : WN BOREN CONTRACTOR . . . . . . . : SPEED PAYMOZD LIC # 29117 COMPANY . . . . . . . . . . : S.P. HOME DECOR ADDRESS . . . . . . . . . . : 1169 CHESS DR STE L CITY/STATE/ZIP . . . : FCSTER CITY, CA 94404 TELEPHONE . . . . . . . . : (E50) 274-4384 P FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ----- 1BCBSC VALUATION 10, 000 . 00 1 .00 0 . 00 1.00 0 .00 1BSEISMICR VALUATION 10, 000 .00 1. 00 0 .00 1. 00 0 . 00 1REMRESKIT SQ FEET 1. 00 570 .00 0 .00 570 . 00 0 .00 - --------- ---------- ---------- ---------- TOTAL PERMIT 572 . 00 0 . 00 572 . 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- --------------- CREDIT CARD 572 .00 VISA --------------- TOTAL RECEIPT 572 .00 Ulna. D..........T._____♦Ts t r . .. .. _ _ • r 77., 0 o o `o' Y 981" d l o I 4 174 7416 I r ac of Q v 49 1311- —361 � I a 8 � 2 U' Jl_ I�L'4 ♦I V N ^I O m c) I mM - g y m I N C11 I V W � �I• � a b G z I C o I I m °f i C3 o � d I I I I �� I I I I rig rp�'I ry QGi- Ni ,ISI icol 6/5 d << SlIVISNI 1£:8l 92-60-OLOZ Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CU PERTI NO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: Q �' �Jo�� ^n�T PERMIT# g 2 OWNER'S NAME: yyn a PHONE# S a 1 3�� GENERAL CONTRACTOR: "DEC BUSINESS LICENSE# 2. tttl ADDRESS: a el 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 AL SUBCONTRACTORS HAVE OBTAINED A CITY OF CU ERTINO BUSINESS LICENSE. 2 / 0- I QI am not using any subcontractors: ;nature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINE,i�S 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 Date caner/Contractor Signature C � © � CITY OF C UPERTINO ADDITION.IREMODEL FEE SCHEDULE CUPERTINO APN# ' Date: 3 a t o pp lication for 2" unit. Is a 2" unit beingadded? Yes No If es, lease fill out the pi it a C) Building Address: V• Mailing Address (if differenttom bwlding addr ss): Owner's Name: Phone# J�� VIA : �✓�� ¢'S ���� /,. VIA Con'r4"' or: Phone #: tg (��' C�- �� `•S Fax#: Cu ino Bu iness icense: State Contractor License#: S U'7 Contact: Phone#:( r� Fax#: I� Landscape Ordinance Compliance: Landscape area in sq. ft. (includes all irrigated areas): If 2,500 sq. ft. or less,compliance with the Landscape Water-Efficiency Checklist is required. If more than 2,500 sq. ft., a complete Landscape Project Submittal is required. Compliance Method: ❑ Plant Type [] Water Budget Buildinp Permit Ir o: Hillside El Elect. Plumb. Mech. ❑ ❑ Job Description: Addition-What is beiy added. Be ecific : , 4Word G What 10itremodel(d(not incl ding ad it}on ? �- Remodel Includes Re-Roof. Yes ❑ No�j If yes list number of squares Remodel Includes Structural: Yes ❑ No� Do you have the pre-application planning app roval? Yes ❑ No , If yes,please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen Bath Other Type of Construction(Usage Class): Occupancy Type: ,Ot9 W -A, 1-B ❑ II/11IN-A ❑ II/III B, IV-HT, V B Valuation: c, (i Please check this box if the proje is a Project Size: Express Standard ❑ Large ❑ ?Aa'or❑ second-sto addition El 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. Revised 05/18/10