110900931
i CITY OF CUPERTINO BUILDING PERMIT
►tt H.DIN'G ADDRESS: 21660 FITZGERALD DR
CONTRACTOR: KITCHENS 13Y
PERMIT NO: 11090093
j
MEYER
OWNER'S NAME:
278 CASTRO ST
DATE ISSUED: 09/14/2011
j OWN4.1 ., PHONE:
MOUNTAIN VIEW, CA 94040
PHONE NO: (415)968-8318
LICENSED CONTRACTOR'S DECLARATION
�— t_, (....
pro
License Class Lie. 0�,3 2 3
BUILDING PERNIIT [NEO: BLDG ELECT PLUMB
Contractor/' /�t=x4; ` j t �� Date �O�P" l
�SECH RESIDENTIAL CO\1�4ERCIAL
JOB DESCRIPTION: REMODEL 172 SQ FT TO KITCHEN TO INCLUDE
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
ELECTRICAL
LIGI ITING UPGRADE, NEW GAS PIPE TO STOVE
Code and that my license is in dill force ;rid effect,
I hereby affirm under penalty of perjury one of the following hvo declarations:
I have and will maintain a certificate of consent to self -insure for Worker's
Compenstution, as provided for by Section 3700 of the Labor Code, for the
Sq, Ft Floor Area:
Valuation: $25000
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as provided for by
S� �uon 3700 of the labor Code, for the performance of the work for which this
AM Number: 32647001.00
Occupancy Typc:
nenmit Is issued.
APPLICANT CERTIFICATION
that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
onrcct. I aerec to compp with all city and county ordinances and state laws relating
to hllddine (nnstruction and hereby authorize representatives of this city to enter
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
upc t IhC above mendon(d property for inspection proposes (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION,
j,dL,nmiN an(t ecp Illrolivss the Cith of Cupertino against liabilities, judgments,
.- -i l I eNtac. Nes whl h may accrue against said Cit in consequence ofthe
-r t„n� Oi tht� hermit Additionally. the applicant understands and will comply
Issued by: -- --- Date: — -- —
,. ph Al non•point s0m e r x, •ttions per the Cupertino Ivtunicipal Code, Section
RE -ROOFS:
L
tit
n<aturc _ _ _ _ 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.
OWN1RR-BUILDER DECLARATION
1 hereby affirm that I oro exempt Il-orn the ConU•actor's License Law for one of
Signature of Applicant: -- Date:
lhc following lsvo reasons:
ALL ROOF COVERINGS I'O BE CLASS "A" OR BETTER
I. n:: owner of the property, or niY employees with wages as their sole compensation,
will do dw work, anti 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 NIATERIALS DISCLOSURE
conNuuc! the projeci (SeC.7044, Business & Professions Code).
I have read the hazardous materials requirements under, Chapter 6,95 of the
1 hereby affirm un(ler penalty of perjury one of' tile following three
California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will
declarations.
maintain compliance with the Cupertino Municipal Cade, Chapter 9.12 and the
Health & Safety Code, Section 25532(x) should I store or handle hazardous
I haNc and will maintain a Certificate ofConsent to self -insure lur Worker's
material. Additionally, should I use equipment or devices which emit hazardous
� ompensauon. as provided for by Section 3700 of the Labor Code. for the
;u,Ilomr:uic� of the work for which this is issued.
air contaminants as defined by the Bay Area Air Quality Martagemcnt District I
will the Cupertino M Code, Chapter 9.12
permit
maintain compliance with f: pal and
Health & Safety Code, Sections
I have and will bVorker's Compensation Insurance, as provided for by
�cc(i�ni 3700.�f the Labor Code, for the performance of the work for which this
the 254515, 2 _ and 2553
pCIIIItt is Issued.
Owner or authorized agent: �� __-- Date:
I eernfy that in the perl6rinance of the :work for which this permit is issued, I shali
not employ am person to ant' manner so as to become subject to the Worker's
t'ompensauon laws of California. It, after making this certificate of exemption, I
CONSTRU070N_LENDING AGEINCt'
bccomc subject to the Worker's Compensation provisions of the Labor Code, I must
1 hereby affirm that there is a conshuction lending agency for the pettormauce of
61 thwuh comply with such provisions or this permit shall be deemed revoked.
work's fol which this permit is issued (Sec. 3097, Civ C)
Lender's Name
Lender's
APPLICANT CERTIFICATION
I certihthat 1 have read this application and state that the above information is
aired I agree to comply with all city and COLIMN otdinances and state laws relating
,o huildiug construction, and hereby authorize representatives orthts cit- to enter
.ip�ra the above mentioned property for inspection proposes. (We) agree fo saw,.
1
ndcnuai -- and keep harmless the City ofCuperttno against liabilities,judgments.
ARCIATECf'S DECLARATION
oNts. and :xpenses which may accrue against said City in consequence ofthe
I understand my plans shall be used as public records.
awnting of this permit. Additionally, the applicant understands and will comply
ilh all non -point source regulations per the Cupertino Municipal Code, Section
Lirenscd Professional___
IS
e:natwc Date
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
NOTE. This estimate does not include fees due to other Depts (i.e. Public Works, Sanitary Sewer District, School District, etc.).
These fees are based on the vreliminary information available and are onlv an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E(f. 7,-1111)
DRESS: 21660 Fitzgerald Dr.
FAPN:
DATE: 09/14/2011
REVIEWED BY: RDW
Plan Check Fee:
BP#:
"VALUATION: 1$25,000
'PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Suppl. PC Fee: (j) Reg. 0 OT
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
WORK
Remodel 172 sq/ft kitchen including electrical and lighting upgrade. New gas pipe to stove.
SCOPE
NOTE. This estimate does not include fees due to other Depts (i.e. Public Works, Sanitary Sewer District, School District, etc.).
These fees are based on the vreliminary information available and are onlv an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E(f. 7,-1111)
fe'r' t
QTY/FEE
Plan Check Fee:
$0.00
tr . ,.,, rlx,sj .
Remodel, Kitchen (<=300 sf)
1REMRESKIT
Suppl. PC Fee: (j) Reg. 0 OT
0.0
NOTE. This estimate does not include fees due to other Depts (i.e. Public Works, Sanitary Sewer District, School District, etc.).
These fees are based on the vreliminary information available and are onlv an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E(f. 7,-1111)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
F-1-72-1 s.£
$588.00
Remodel, Kitchen (<=300 sf)
1REMRESKIT
Suppl. PC Fee: (j) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. 0
OT
0.0
his
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
/3 7 s -r FSI..'.
Work Without Permit? Q Yes (E) No
$0.00)
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
A
T, a r,i I.1c t �,� t7tcfrr jrr f�'rt�, .
Strong, Motion Fee:
1BSEISMICR
$2.50
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
$3.501
$588.00
TOTAL FEE: j
$591.50
Revised: 09/02/2011