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12100018 CITY OF CUPERTINO BUILDING PERMIT BUILDINGADDRESS: 20100 LAS ONDAS CT CONfRAC'MR:DIM BUILDERS INC PERMIT NO: 12100018 OWNER'SNAME: TAKEMOTO KENNETH T AND JUDITH 1191 WHITEHALL DR DATE ISSUED: 10/022012 OWNI,R'S Pl IONI1: 4082538589 SAN JOSE,CA 95128 1.11ONE NO:(408)377-6200 ❑_� LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION; RESIDE\PIAL COMNIERCI,%Iff, License Class Z Lia 9 3 6, ;? 0 KITCHEN REMODEL, NON-STRUCTURAL Contractor A-LM 13,,'141r F Date /o --�- 1 hereby affirm that I am licensed under the provisions of Chapter!) (commencing with Section 7000)of Division 3 of the Business& Professions Code and that my license is in full force and effect. hereby affirm under penally of perjury one of the following too 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 wort:for which this permit is issued. Sq.Ft Floor Arca: Valuation:$25000 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 .\PN Number:36930039.00 Occupancy Type; permit is issued. APPLICANT CERTIFICATION' I certify that I have read this application and slate 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 WITHIN 180 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 DAYS 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 2 granting of this permit. Additionally the applicant understands and will comply Issued bg: Date: �L with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signaturej, J Dam ( �'Z•—/ Z_ 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 - hereby affirm that I am exempt from the Contractor's license howfor one of Signature of Applicant: Date: the following two reasons: ALL ROOF COVhRINGS 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 HA'LARDOUS MATERIALS DISCLOSURE, construct the project(Sce.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Ilcalth&Safety Code,Sections 25505.25533.and 25534. 1 will 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(x)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should Fuse 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[say Area Air Quality Management District performance of the work for which this permit is issued. will maintain compliance will.the Cupertino Municipal Code.Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&Safely 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:I0'2%L 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 Cali fomia. If,after making this certificate of exemption,I CONS'ITil1Cl'IONLENDING AGENCI' 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 ,\RCIII"1'ECI"S DECLARATION 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 Cade,Section Licensed Professional 9.18. Signature Date CONSTRUCTION PERMIT APPLICATION j COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 ' FAX (408) 777-3333 • building(aPcuoertino.org /1� /DO0/A- ElNEw CONSTRUCTION ❑ ADDITION Ea ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT k 8 PROJECT ADDRESS APN b 3�9 - o OWNER NAME PHONE/ — j E-NIAIL �C-�Ni C I�.,.L T� /c c i,-t„7T: \Yod��.J —RJ(l-�( STREET ADDRESS CITY, STATE,ZIP / FAX ,i z; Com ) CONTACT NAME CCVL�ty- PHONE E-NUIL STREET ADDRESS CITY,STATE, ZIP FAX DOWNER ❑ OWNER-Bun.DER ❑ O%MERAGENT O'CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINFER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME /,uv I S bA- "Wj A" LICENSE NUMBER LICENSETYPE BUS.LIC A �p rJ .i S 36 �-d � J, �/ l COMPANY NAME E-MAILu �]uv FAX W /u , 20n STREET ADDRESS CITY.S T ZIP PHONE // S/ war tiq-/ 9T r . -9— Tose PA 51'i.t Y S'vC7 c) ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORT: EXISTING USE PROPOSED USE CONMB TYRE kMRIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA �- BATHROOM KITCHEN OTHER REMODEL AREA RENIODELAREA RENIODEL AREA PORCH AREA I DECK AREA TOTAL DECKNORCHAREA I GARAGEAREA: DETACH 0 ATTACH M DWELLING UNITS: ISASCCONDUNIT OYES SF.CONDSTORY AYES nEINCADDED? ONO ADDITION? ONO PRE-APPLICATION ❑YES TYES,PROVIDE COPY OF ISTIIIIDI.DGAN ❑Y'ES IRECEI VED BY F�....v -Tx �^F'-':J!?� TOTAL VALUA777ION: PLANNING APPL9 ONO PLANNING APPROVAL LETTER EICHLERHONIE? ONO �}., By my signature below,I certify to each of the following: I am the property owner or authorized 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 Applicanl/Agene /_ Date: AD -.2 -1 1_ SUPPLEMENTAL] --ORNIAT REQUIRED n ";Y' P:r.N ECHTPEG,.ir _ . -6'=NGmscM ;:x4s:_.:_. _,,, v��rI r?-y.d`r 6[ xrs .'V'1 w ¢; r New SPD or Mululamihv dwellings: Apply for demolition permit for �' Fi .� sS. � y ��pY ER-Ti1F COUNTF,R4Y^ jItUILDI\C I'I:A\RF\IFW{-, i ¢.:! existing building(s). Demolition permit is required prior to issuance of building permit for new building. p❑I 1 x.I[Re'ssL . - t ©kl IA\u\oI LA\REY lew'�"�,. _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure y2'-STA�iYRDn��.T, � +� f❑�Vi uh"IC Term if am•Hazardous Materials are being used as art of this rdect. `)'` R '" "'r P P J t❑3i tRcet%� .` {?rIMP-3�a"` ❑" HIIiFL'uF1 'R � 'e' ^;Y`�t; _Copy of Planning Approval Letter or Meeting with Planning prior to 'tNtTh '�g„Fi�'Hs .. g Permit pp ❑fiIAJON ,� h' 4, N Ifs �©. SA\ITA R I'S EN FR DISTRICrjN T+i submittal of Buildin ermit application. yr u . ,r „t n��L\\IRONNIENTALIIEAETHY WLL. BldgApp_IOI I.doC revised 06/71/11 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION :0 12 hADDRESS: 20100 las ondas ct. DATE: REVIEWED BY: bobs. BP#: 'VALUATION: $25,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY PENTAMATION USE: SFD.orDuplex PER1111TT1'PE: 1R3SFDREM WORK kitchen remodel non structural SCOPE ,tlech. Plan Check Plumb.Plan Cheek Elec.Plan Check b/ech. Penna Fee: Plumb. Permit Fee: Elec.Permit Fee: Ocher M ch. Insp. Other Plumb/my. Ll I Other Elec.Imp. L1 I ,beth.hnp.Fee: Plumb. losp. Fee: F.lec.htsp. Fee: NOTE: This estimate does not includejees due to other Departments(i.e. Planting, Public Il orks. Fire,Sanitary Server District,School District,etc.). These ccs are based on the prefinsinan•information available and are onh,an ectinente. Contact the Dept for addn'I info. FEE ITEMS (Fee Resolution 1l-053_L-ff. 7/1/11) FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 200 s.f. Remodel, Kitchen (<=300 sf) Suppl. PC Fee: Q Reg. Q OT0.0 hrs $0.00 $600.00 /REMRESKIT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. FeeQ Reg. Q OT 0.0 [-its- $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: Work Without Permit? Yes Q No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) Travel Dorutnentarinn Fags: Building or Structure O Strong Motion Fee: IBSEISMICR $2.50 Select an Administrative Item 131dg Stds Commission Fec: IBCBSC $1.00 SUBTOTALS: $3.50 $600.001 TOTAL FEE; $603.50 Revised: 07/01/2012 S U.1 - ✓ N \, \•� 0 n Q �1a N W D d v fl �4 4 d ° O ` u ' ` U ♦ m N OwI (�^ LL -2z ISL - w W d l W . p ( \ m ; V 3 y IT o v .ti 4 ti T A �v 3 % H ., a . x -. e o a u IV r-, r� n� a _ ro v QJ tu i u ro Zo3 m � � amm O a �- E op O r W w c m 0C $mzv J: C1 cr- p„ m 03 $ a o W .. , .. It �'7 � , ._ . . -; - j '_Q-g ymmCL you C3m � t° 7L° E o - � m CL ao o. i 7' C. 51 o cc. O Ym W< 0 OW. 1 f r I ,. - LU f •a �. s l VA JL l ql.