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Home My WebLink About14060178CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22803 LONGDOWN RD CONTRACTOR: AMERICAN KITCHEN & PERMIT NO: 14060178 BATH INC OWNER'S NAME: MASEGIAN JOHN D AND KELLY A 1758 JUNCTION AVE UNIT D DATE ISSUED: 06/27/2014 OWNER'S PHONE: 4088737712 SAN JOSE, CA 95112 PHONE NO: (408)436-8151 Ek LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL RECONFIGURE NON -LOAD BEARING WALLS IN MASTER License Class_ _ Lic. # Si3 $� Sl BEDROOM TO CREATE (N) WALK-IN CLOSET(65 S.F.). REMODEL (E) MASTERBATH (84 S.F.) Contractor 4 M/ 42y,;k ,y yA4yN Date 4-',371-21y 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. 1 hereby affirm under penalty of perjury one of the following two declarations: 1 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: $21230 performance of the work for which this permit is issued. 1 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: 34233048.00 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. 1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAY RMIT 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 M L 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 granting of this permit. Additionally, the applicant understands and will comply by: & 6/Z-) with all non -point source regulations per the Cupertino Municipal Code, Secti 9.18. RE -ROOFS: Signature / _ Date All roofs shall be inspected prior to any rooting 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 1, 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 1 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 1 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 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this - Owner or authorized agent: Date: permit is issued. 1 certify that in the performance of the work for which this permit is issued, 1 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 1 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 1 certify that 1 have read this application and state that the above information is correct. 1 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(akupertino.org�4b ❑ NEW CONSTRUCTION ❑ ADDITION UL ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS ' APN # r OWNER NAMEPHONE ✓�� 51 �V-\- E-MAIL �" . 7 STREET ADDRESS \ „, D •S`-'�/n CITY, STATE, ZIP FAX CONTACT NAME PHONE E-MAIL / STREET ADDRESSJ-7 �� 1�A CLL j,,\ CITY, STATE, ZIP / FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR-intAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME -�VU�r" r{.. Q ICENSE NUMBER LICENSE TYPE BUS. LIC # I, Gi COMPANY NAME C_ Y i ,C^ E-MAIL FAX STREET ADDRESS t -.1 17-y- LI y� CITY, STATE, ZIP> f PHONE q4 � � �I-2) 7V ( ��,^ ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK T - - EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM REMODEL AREA G KITCHEN REMODEL AREA OTHER .� REMODEL AREA / (p PORCH AREA DE K AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH []ATTACH # DWELLING UNITS IS A SECOND UNIT []YES SECOND STORY ❑ YES BEING ADDED? [-)NO ADDITION? [3NO PRF, -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO W f By my signature below, I certify to each of the following: I am the property owner or authorize ent owner's behalf. I ha ad this application and the information I have provided is correct. I have read the Description of Work and veri y it is accurate. I agree to comply with all applicable local ordinances and state laws relating to mg construc4o I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: L —,2 SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for EJ BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building VER -THE COUNTER permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW 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 13 SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_201 Ldoe revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 22803 LONGDOWN RD DATE: 06/27/2014 REVIEWED BY: MELISSA APN: 342 33 048 BP#: O 'VALUATION: 1$21,230 `-PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: p =s.f. $626.00 PENTAMATION PERMIT TYPE: 1 R3SFDREM WORK RECONFIGURE NON -LOAD BEARING WALLS IN MASTER BEDROOM TO CREATE N WALK-IN SCOPE CLOSET(65 S.F.). REMODEL (E) MASTERBATH (84 S.F.) NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-0,53 E '7/1'13 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =s.f. $626.00 Remodel, Bath (<=300 sf) 1REMRESBAT Suppl. PC Fee: 0 Reg. 0 OT Rol hrs $0.00 PME Plan Check: $0.00 65 s. f. $418.00 Remodel, Other IREMRESOTH Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT Fo.Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 7T_ 0 Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure 0 0 i Strom Motion Fee: IBSEISMICR $2.12 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $3.12 $1,044.00 TOTAL FEE: $1,047.12 Revised: 04101/2014 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: -2 PERMIT # 6 OWNER'S NAME: PHONE # GENERAL CONTRACTOR:6yz-,. BUSINESS LICENSE # ADDRESS: J3-�- CITY/ZIPCODE: , )c,, *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: s/ 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