Loading...
14050122 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18711 HANNA DR CONTRACTOR:PATTY CONANS PERMIT NO: 14050122 OWNER'S NAME: PATTY CONANS 18711 HANNA DR DATE ISSUED:05/20/2014 OWNER'S PHONE: 4086211119 CUPERTINO,CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL 40 SQ FT REMODEL TO BATHROOM TO INCLUDE(2)SUN License Class Lie.# TUNNELS Contractor Date 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$10000 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:37529009 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 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 DAY ROM ST CALLED INSPYUTJON. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Issued by: Date-!5i�� granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section -- 918. RE-ROOFS: Signature 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. 1 OWNER-BUILDER DECLARATION 1 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) 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,Se ns 2550 533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent• permit is issued. 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I 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- oint source regulations per the Cupertino Municipal Code,Section Licensed Professional 9 18. Signatur Date C� CONSTRUCTION PERMIT APPLICATION �bl-- go COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION A) 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 ,I� CUPERT[N4 (408)777-3228• FAX(408)777-3333•building(ftupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRE///D;;; ORIGINAL PERMIT# PROJECT ADDRESS I I ��n APN ' 2� OWNER NAME Homo' 1^, ! /��n� / J^, I £-MAOct1 1 ca t^� STREET ADDRESS ©`� ' to�/�,^�/' �� TY, STAN I I ,lo, /� /S.moo � FAXY I CONTACT NAME UT( f (r, P ON/E !, J E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CffTRACT R NAMr Y L S BER LICENSE TYPE BUS.LTC# A N EStI6>< (� _ E-MAIL FAX STREET ADDRESS *G�7 CITY,STATE,ZIP PHONE ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK o ^ b a-`y EXISTING USE PROPOSED USE CONSTR TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXIST NEW FLOOR DEMO TOTAL A AREA AREA NET AREA BATHROOM TCHEN OTHER REMODEL ARE MODEL AREA REMODEL AREA CH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS I. A SECOND UNIT E]YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO PRETAPPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES 'RECEI '"+" I �� s�.a �' TOTAL VALUATION, PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO 5'" By my signature below,I certify to each of the following: I am the property owner or authori nt to act on t roperiy owner's b alf. I have read this application and the information I have provided is corn ct. I have read the Description of Work and verify it is accurate. I agree to comply all applicable local ordinances and state laws relat /0 in i i const �authorizeentatives of Cupertino to enter th ov -identifie property for ins ion purpose .._. Signature of Appl icant/Agent: ate: I - SUPPLEMENTAL INFORMATION REQUIRED x Q 1RQUTING'SL3P Ix New SFD or Multifamily dwellings: Apply for demolition permit for € �� OVER HE COLNTERb - existing AN REVIEW r existing building(s). Demolition permit is required prior to issuance of build s permit for new building. ❑1EaP ss tWIN PLtiNINPLalvitEViw _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 3,41] PlJstrcwGRxs x form if any Hazardous Materials are being used as part of this project. ,` x ���AIiG�.�xr y.:✓�^G'� �`� ,� �1 t"���IRE DEPTx 3x�.'`£. �� -� �t� _ Copy of Planning Approval Letter or Meeting with Planning Prior to submittal of Building Permit application. N azAaoRa d Y ❑ sAI�ITARY�SEWERDRICT a�a .N .�.-�'�'�c.r��'�w^�r _,_ _>❑:�ER'VIROATMENTALr'HEALTTi�,.�. ,Rr BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION IF 2TAPIDDRESS: 18711 HANNA DR DATE: 05/20/20147] REVIEWED BY: MENDEZ N: BP#: *VALUATION: $10,000 ,PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Du lex PENTAMATION 1 R3SFDREM USE: p PERMIT TYPE: WORK 40 SQ FT REMODEL TO BATHROOM TO INCLUDE 2 SUN TUNNELS SCOPE , "h 10,-ti'pit_ M?r•t W Fie: 'se: other'Piutnb IY,':S'7, E3 Li is c z fo 1°.>: f'?urirb. hut). Fee: 1 1cc.Ir 5, . 1 e: 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 onL an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F 40 s.f. Remodel,Bath(<=300 sf) Suppl. PC Fee: Q Reg. ® OT 0.0 �s $0.00 $626.00 1REMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee: Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ( t1nV1't.icf1.0R ,1OX. , F ,Idinini�znjlkv 0 Work Without Permit? ® Yes No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) Building or Structure 7rtrl cz I)c,cr.frra<sal adza n Fees: I A Strong Motion Fee: IBSEISMICR $1.00 Select an Administrative Item Bldg_ Stds Commission Fee: IBCBSC $1.00 21 $2.00 $626.00 TOTAL FEE: $628.00 Revised: 04/01/2014 OWNER-BUILDER DISCLOSURE- FORM F COfdMUNIiY DEVELOPMENT DEPARTMENT -BUILDING DIVISION 10300 TORRE AVENUE- CUPERTINO,CA 95014-3255 (408)777-3228- FAX(408)777-3333.• buildinola cuDertino.ora CUPERTIN0. Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: APN l aPj +E I OWKIER ADDRESS —DESCRIPTION OF WORK: We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. VVe will not issue a building permit until you have read, initialed your understanding of each provision, signed,and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you,the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATiON (DIRECTIONS:Please read and initial each statement below to.signiy you understand or ver' this information.) 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Builder"building perrnit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner-Builder,may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 2. 1 understand building permits are not required to be signed by property.owvers unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 3. 1 understand as an"Owner-Builder" I am the responsible party of record on the permit. I understand that l may rote ct myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. m". 1 understand Contractors are required by law to be licensed and bonded in California and to list their license umbers on permits and contracts. . 1-understand if i employ or otherwise engage any persons, other than California licensed Contractors, and the notal value of my construction is at least rive hundred dollars ($500), including labor and materials, I may be considered an "employe' under state and federal law. Dc-lel understand if I am considered an "employer' under state and federal law, I must register with the state and ederal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each"employee." I also understand my failure to abide by these laws may subject me to serious financial risk. cx�7!I�understand under California Contractors' State License Lave, an Owner-Builder who builds single-family r siden'lal structures cannot legally build them with the intent to oiler them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 0'1 understand as an Owner-Builder if i sell the-property for which this permit is issued, I may be held liable for fancial or personal injuries sustained by any subsequent owner(s)that result from any latent construction defects in the workmanship or materials. 0-,v79e73'zd!derFo i 2010.doc revised 0%11?/10 F g1 VI understand I may o.btainmore information regarding my obligations as an "employer" from the Internal e Service,the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the Califomia Contractors' State License Board(CSLB) at 1-800-321-CSLB (2752)or tvrarw.cslb.ca.gov for more information about licensed contractors. 0. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that l the party legally and financially responsible for proposed construction activity at the site address listed above. �1. I agree that, as the party legally and financially responsible for this proposed construction activity, 1 will abide Pinfor�., applicable laws and requirements that govern Oviner-Builders as well as employers. 2. I agree to notifythe issuer of this form immediately of any additions, deletions, or changesto any of ti-aation I have provided on this form. Licensed contractor are regulated by lav✓s designed to protect the public. If you contract with someone who does not have a license, the Contractor' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint.Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured v✓bite working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CGNSTRUC T iON LENDING AGENCY (DIRECTIONS:Please complete the following construction lending agency information.) I hereby a7rm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued,this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy or the property owner's driver's license, ;orm notarization, or other verr7cation acceptable to the city may be required to be presented v,1hen the permit is issued I verif y the property owner's sl r . Property Owner's Signature: Date: --------------------------------------------------------------------------------------------------------------------------------------------- (NOTE. The folloia,,ing Authorization Form is required to be completed by the property owner only v✓hen designating an agent of the property owner to apply`or a construction permit;or the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNTER,S BEHALF E;cluding the Notice to Propery Owner, the execution oil which I understand is my personal responsibility, I hereby authorize the following person(s)to act as my agent(s)to apply for, sign, and file the documents necessary to obtain an Owner-Builder Pe nim it Tor my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above Information and certify its accuracy. Note:A copy of'th,e property owners driver's license, ;orm notarization, or other venTIcatlon acceptable to the city may be required to be presented when the permit is issued to veriy the property owner's signature. Property Owner's Signature: Date: Or:;;erBudderPonn 2010.doc re7dsed 04,11-4110 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RT 1 N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: S 4 1 Fa-r-)r) PERMIT# OWNER'S NAME: 414 Caners PHONE# r- GENERAL CONTRACTOR:oft 0 BUSINESS LICENSE# ADDRESS: CITY/ZIPCOD-F 3 *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: V 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 w � <f n 2114 � s rJ ._,'o Uj f T 0" cc O N or< . s � o \� .✓ ri r f! 0CCU 0 ra t 3 1 i i Q Z i� f 71NO L cs a f R 1tic�t 4 r �: .c5 � � �• � n fflllenf �L u� i.. ruhL . Kevtewecl By. UUE COM LIANCE c, O TjOT PLANS CHECKED BY 4A E �7, CC ANNIN EPT• CE c"OP" DATE ......................................................._.__...._ ...................... BLDG. DFPT-