13080124CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21593 LA PLAYA CT
CONTRACTOR: BROTHERS HOME
PERMIT NO: 13080124
IMPROVEMENT
OWNER'S NAME: CANTWELL BRIAN A AND VICTORIA
2510 DOUGLAS BLVD
DATE ISSUED: 08/16/2013
OWNER'S PHONE: 4089738433
ROSEVILLE, CA 95661
PHONE NO: (408)295-0680
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
Er LICENSED CONTRACTOR'S DECLARATION
License Class C (?9, Lic. # �Q
REMOVE AND REPLACE 12 WINDOWS TO MEET EGRESS
I �12o-�c-i�'Vr'S 4� (�,P
IN
Contractor Date
BEDROOMS
B
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:
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: $6694
rformance 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: 35623007.00
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
WITIIIN 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 DTLAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
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costs, and expenses which may accrue against said City in consequence of the
Issued by: Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signatu 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. I 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 2550 533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: tDate : r(p t�3
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
CONS TION 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
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 cDcupertino.org
F-1 NF.W roNSTRT TCTInN n ADDITION F 'ALTERATION / TI ❑ REVISION/ DEFERRED
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PROJECT ADDRESS 3 '/ ^ /� t
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME _ LICENSE NUMBER r� LICENSE TYPE �l
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BUS. LIC #
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ARCHITECT/ENGINEERNAME
LICENSE NUMBER
BUS. LIC#
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORKzieltz-,
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12 w L n6w1r* I
EXISTING USE
PROPOSED USE - CONSTR
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 DECKIPORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
# DWELLING UNITS:
IS ASECOND UNrr ❑YES
SECONDSCORY DYES
BEING ADDED? []NO
ADDITION? []NO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLERHOME? []NO
'REG I Br �y,�"
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TOTtjL. VtjLjjATION:
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PLANNING ADPL# []NO
By my signature below, I certify to each of the following: I am the property owner or authorized dgent to act on the property owner's behalf. I have read this
application and the information I ha v ovided is co/A}�_�ect. I have read the Description of Work and verify it is accurate. I a ee to comply with all applicable local
perry for inspection purposes.
ordinances and state laws relati to bu' ng consro(Icti I uthorize representatives of Cupertino to enter the above-iden led7t,
J
Signature of Applicant/Agent Date:
SUPPLEM REQUIRED
¢a°` ram
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_ New SFD or MAMR
ultifami d ngs: Apply for demolition permit for�'�t
OFJ¢OUNTER
BUILDING PLAN RE
existingbuilding(s). Demolition permit is required prior to issuance of building
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permit for new building.
EXPREa
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, �PLAN�1ll�iG PLAr1]REY[Ew� ; jr
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Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
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form if any Hazardous Materials are being used as part of this project.
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❑.FIRE `�
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Copy of Planning Approval Letter or Meeting with Planning prior too
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submittal of Building Permit application.`
SANITARY SEWERDISTRICTr
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r:ENVIRO4IENTAUI-IEALTH
BldgApp_2011.doe revised 06/21/11
CITY OF CUPERTINO
FM_7 FEE ESTIMATOR - BUILDING DIVISION
NOTE: This estimate does not include fees due to other Departments (i.a Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the preliminary information available and are only an estimate Contact the Deptfor addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 711112)
ADDRESS: 21593 LA PLAYA CT
DATE: 08/16/2013
REVIEWED BY: mendez
APN:
BP#:
*VALUATION: 1$6,694
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
USE: SFD or Duplex
Suppl. PC Fee: (E) Reg. 0 OT
PENTAMATION
PERMIT TYPE: 1GENRE
WORK
REMOVE AND REPLACE 12 WINDOWS TO MEET EGRESS IN BEDROOMS
SCOPE
NOTE: This estimate does not include fees due to other Departments (i.a Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the preliminary information available and are only an estimate Contact the Deptfor addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 711112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
12 #
$557.00
Window / Sliding Glass Door
1 WINREP Replacement
Suppl. PC Fee: (E) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
_BMWice
NOTE: This estimate does not include fees due to other Departments (i.a Planning, Public Works, Fire, Sanitary Sewer District, School
District. etc). These fees are based on the preliminary information available and are only an estimate Contact the Deptfor addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E . 711112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
12 #
$557.00
Window / Sliding Glass Door
1 WINREP Replacement
Suppl. PC Fee: (E) Reg. 0 OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Construction Tax:
Administrative Fee:
E)
Work Without Permit? ® Yes (E) No
$0.00
Advanced Planning Fee.
$0.00
Select a Non -Residential
Building or Structure
0
i
Travel Documentation Fees:
Strong Motion Fee: 1BSEISMICR
$0.67
Select an Administrative Item
Bldg Stds Commission Feer IBCBSC
$1.00
$1.67
$557.00
b~ ¢ :�-
$558.67
Revised: 07/01 /2013
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