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15090163-DP22605 RICARDO RD 15090163 F/P BARCLAY HAROLD G AND KATHRYN L TRUS SCANNED BOX # 688 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22605 RICARDO RD NO: 15090163 OWNER'S NAME: BARCLAY HAROLD G AND KATHRYN L TRUS 'S PHONE: 4086124888 Li_s"' LICENSED CONTRACTOR'S DECLARATION cense Class Lie. # � ,l ��, f� . Contracto �.;� C , ,,i Dat i' `P • I 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: 1. 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. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with al I non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature L�t {^ Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1. 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. 2. 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. 3. 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 become subject to the Worker's Compensation provisions of the Labor Code, 1 must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that 1 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, costs, 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 9.I8. s /RN �%y DATE ISSUED: 09/24/2015 H I /Cam: T PHONE NO 3�� t JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ KITCHEN REMODEL (220 S.F.) Sq. Ft Floor Area: I Valuation: $20000 APN Number: 35601010.00 1 Occupancy Type: PERMIT EXPIRES IF WORD IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM �LAST CALLED INSPECTON. Issued by: 1_00izsulI MOW Date: —1 RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Ownaathoriz ►gent:� r��-_ Dat c�ixZ -_ :i�C. _a•Via; _ _ _ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Date CUPERTINO CONSTRUCTION PERMIT APPLICATION (03 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingacupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION d ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS AL APN # 3SIo ! 0 I — (� j l�9 1 rE fl e OWNERNAME � RC&y PHONE qus. (a12' L{`b'd$ E-MAIL r t�i,sica�aol.Cow� STREET ADDRESS r •_�, 1G7d ' l w eUj • A,- CITY, STATE, ZIP ?SD I FAX CONTACT NAME �e.a� S,�vo� PHONE Hob-31y •22tZ E-MAIL STREET ADDRESS —*D 5 C 4 N tO 45' a N r� I CITY, STATE, ZIP OY a , e • 1 l nK Rw fARCCH 1ITECTl• FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME �^ Cu lower �v`S LICENSE NUMBER `t LICENSE TYPE BUS. LIC # S i V e+ b 4 2-9 1 .nt,r0. COMPANY NAME lf�i t �� E-MAIL 'Sea, S 11vo, G C FAX L_ Q \,,1 STREET ADDRESS '�wS Sa ��aas�iav� ��c2 CITY, STATE, ZIP Mbr w.� "T(1 CA `lSW4 PHONE ��- 31t4-2212 ARCHITECTIENGINEER NAME. 1Rol,�eo Caba Lar LICENSE NUMBER �q (,, BUS. LIC # COMPANYNAME 'CzC Cvxs•,Li+ tlnatvs j�c• E-MAIL �Le rd ao` , Covv\ FAX LfobtS3— STREET ADDRESS R 1 Dr. CITY, STATE, ZIP �sti9 PHONE 4�s-Z�-glss o c[A DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES K{�� Rev�flrJta� USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA rL ,P REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: UDETACH []ATTACH # DWELLING UNITS: IS A SECOND IINIT YES SECOND STORY YES BEINGADDED? []NO ADDITION? ❑NO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES IVED BY: TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO At r-� G.O �L�O C7 By my signature below, I certify to each of the following: I am the property owner or authoililed agent 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 Work 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 property for inspection purposes. Signature of Applicant/Agent: Date: q - 2-4 - l S^ SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP OVER-TH"OUNTER ❑ BUILDING PLAN REVIEW New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building , permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW i _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06121/11 CITY OF CUPERTINO RM-N. FEE ESTIMATOR — BUILDING DIVISION ADDRESS: 22605 Ricardo Rd. DATE: 09/24/2015 REVIEWED BY: PAUL APN: 356 01 057 BP#: *VALUATION: 1$20,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: PENTAMATION 1 R3SFDREM PERMIT TYPE: WORK Kitchen Remodel 220 S.f. SCOPE Mech, Plan Check Plumb. Plan Check Elec. Plan Check i tech, Permit Fee: Plumb. Permil Fee: Vec. Permit Tee: Other Alec•h. Insp. Other Plumb Insp. Other Elec. Insp. iWch. Insp. Fee: Plumb. lisp. Fee: I l.1ec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, eta). These fees are based on the preliminary information available and are only an estimate. Contact the Dept.for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 220 s.f. $645.00 Remodel, Kitchen (<=300 sf) IREMRESKIT Suppl. PC Fee: (F) Reg. Q OT 0:0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. -Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: Q E) Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning Fed: $0.00 Select a Non -Residential Building or Structure G i T rm,el.Documenlalivn Fees: Strong Motion Fee: IBSEISMICR $2.60 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 U BTOTALSc ° $3 60 $645 00 �� PTO TAL F .a EE a Revised: 07/02/2015