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13110118CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10375 STERN AVE CONTRACTOR: OMEGA CONSTRUCTION PERMIT NO: 13110118 OWNER'S NAME: TRACY & SEN RO 451 FENLEY AVE DATE ISSUED: 11/19/2013 OWNER'S PHONE: 4082556708 SAN JOSE, CA 95117 PHONE NO: (408)243-0404 F-1 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 13 COMMERCIAL License Class_ Lie. # -C�— t U KITCHEN REMODEL, REMOVE AND REPLACE 18 k LIGHTS, 8 Contractor Date SWITCHES AND CIRCUITS TO INCLUDE M,E,P'S I hereby affirm that I am licensed under the provisions of hapter 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 Sq. Ft Floor Area: Valuation: $9000 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 APN Number: 37510055.00 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 WIT 80 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 DAVd FROM LAST CALLED 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 YW7 granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino. Municipal Code, Section 9.18. RE -ROOFS: Signature Date 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 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) 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. 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 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 , 25 33, and 25534. �` I Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized nt Dater 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 indemnify and keep harmless the City of Cupertino. against liabilities, judgments, ARCHITECT'S DECLARATION 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 \ Is COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 \� CUPI*RTtNO (408) 777-3228 • FAX (408) 777-3333 • buildinp(5cupertino.org \� ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS ter FeW/� -- APN # �� C O O � ^. OWNERNAME C rV „ ^4j o J �I PHONE 40%27 5— 001E -MAIL STREET ADDRESS CITY, STATE, ZIP FAX CONTACT NAME� 1 I PHONE r r,C (}I E-MAIL (rl�Ca�+/�SC `/`Ch,- STREET ADDRESS AL CITY, STATE, ZIP FAX 11 OWNER ❑OWNER-BUII,DER ❑OWNER AGENT CONTRACTOR ❑ CO CONTRACTOR El ❑'ENGINEER 11 DEVELOPER 11 TENANT CONTRACTOR NAME�-� LIC O LICENSE TYPE BUS. LIC # COMPANY NAME �3 ` kV J E-MAIL 771 C FAX STREET ADDRESS �j "�j CITY, STATkfIP ' PHONE ARCHITECT/ENGINEER NAME LICENSE NUM 3ER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS , STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTIL TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY []YES BEING ADDED? ONO ADDITION? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES i� �,� : TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LEITER EICHLER HOME? ❑ NO11 AEML2 . By my signature below, I certify to each of the following: I am the property owner or audl riz gent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Wo and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified pro rty for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REOIDTPialv�ccKT Pi Y �. ,. RoIITtivcsP , _ New SFD or Multifamily dwellings: Apply for demolition permit for R �D ❑ BUII bINGPLANREVIEW' existing building(s). Demolition permit is required prior to issuance of building permit for new building II a• 1iXP32ES8 �s ❑ PLAIIJ�INGLAI�ItEVIEW r x Z, Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 3STAAD k ru ❑ PUBLICSORKs _ form if any Hazardous Materials are being used as part of this project x� � "LA' RGE � . �❑- .FIRE D�PTT1 � ` ` z "� _ Copy of Planning Approval Letter or Meeting with Planning prior toQ submittal of Building Permit application.❑ fAJORF &� s rrAltx s� RDiC�z BldgApp_2011.doc revised 06121/11 90 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the Prelindnary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) ADDRESS: 10375 stern ave DATE: 11/19/2013 REVIEWED BY: Mendez APN: BP#: "VALUATION: 1$9,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex Other Alech-Insp. PENTAMATION PERMIT TYPE: 1 R3SFDRE WORK kitchen remodel remove and replace 18 lights, 8 switches and circuits to include m e 's SCOPE Glee. Insp. Fac: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the Prelindnary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE e MISC ITEMS Plan Check Fee: Mech. Plan Check Plumb. Plan Check Elec. Plan Check aleck. Permit Fee: Plumb. Permit fec: Elec. Permit Fee: Other Alech-Insp. Other Plumb Imp. Other Elec. Insp. :[tech. Insp. Fee: Plutnbh hasp. Fee: Glee. Insp. Fac: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee19 Reg. ® OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 [9 NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the Prelindnary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE e MISC ITEMS Plan Check Fee: Mech. Plan Check Plumb. Plan Check Elec. Plan Check aleck. Permit Fee: Plumb. Permit fec: Elec. Permit Fee: Other Alech-Insp. Other Plumb Imp. Other Elec. Insp. :[tech. Insp. Fee: Plutnbh hasp. Fee: Glee. Insp. Fac: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the Prelindnary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =s.£ $626.00 Remodel, Kitchen (<=300 sfl 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. Fee19 Reg. ® OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C,Yons1ruction Tax: Adin lni.Strative .Fee: 0 E) Work Without Permit? ® Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) i 7'1Y4vel Documentation Fees: Strong Motion Fee: IBSEISMICR $0.90 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 y 101 �g �� ®��.ra. $1.90 $626.00 a �.... Revised: 10/01/2013 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: SUBCONTRACTOR PERMIT # OWNER'S NAME: d PHONE # "8 GENERAL CONTI c*j STT BUSINESS LICENSE ADDRESS: (, CITY/ZIPCODE:a *Our municipal code requires all businekses working in the city to have a City of uupertmo Dusmess ncense. 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: / Contractor Signature 13 Date i 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 / Contractor Signature 13 Date i Date: Nov 18 2013 Address: 10375 Stern Ave Cupertino CA 95014 2 story house lot size 5529 sf property s.f.:3039 sf 5 bedrooms, 3.5 bath Project Scope Kitchen remodel Recessed light installatio - GUpEDepa�Oni 8uildmg 19 2013 COE DE ompum4G Reviewed EY Existing kitchen floor plan OFFICE COPI',,. � r 1 Proposed kitchen floor plan Date: Nov 18 2013 Address: 10375 Stern Ave Cupertino CA 95014 2 story house lot size 5529 sf property s.f.:3039 sf 5 bedrooms, 3.5 bath Project Scope 1 -Kitchen remodel --sink, range, refri existing 1 cation --change cabinet, counte —install wood floor 2 -LED recessed light Inst. 7tion in kitchen, family room, m dining room 4f-T59S � nge ) Kitchen® y --- CU PERTA& b ; auodinq Department I N REVIEWED FOR C;ODpE COMPLIANCE Ap Reviewed By: 7° 1 , (E) family room i k