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14050109 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10554 LONNA LN CONTRACTOR:ROYAL SERVICES PERMIT NO: 14050109 OWNER'S NAME: MC AULIFFE GEORGE F AND HAZEL 2253 MAYWOOD AVE DATE ISSUED:05/19/2014 OWNER'S PHONE: 9093041512 SAN JOSE,CA 95128 PHONE NO:(408)972-2452 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL ❑ REBUILD(E)CHIMNEY FROM THE SHOULDERS UP License Class_ Lic.# � Contractor b oq& _,(?ru C Date 1 _ 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 Therfiormance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$3900 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:35919017 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 D ED 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 Is v: e. with all non-point source regulations per the Cupertino Municipal Code,Section 9 18. ROOFS: Signature (�( / Date � All roofs shall be inspected prior to anyny 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. 1 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 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Dater 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 CONSTRUCTION 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.Addi ally,the applicant understands and will comply with all non-po the Cupertino Municipal Code,Section Licensed Professional 9 18. Signature Date CONSTRUCTION PERMIT APPLICATION 1 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �O 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 "\O (408)777-3228• FAX(408)777-3333• build ing(a)cupertino.Ong CUPERTINO / ❑NEW CONSTRUCTION ❑ ADDITION i&T`0/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS 105-5-1-1 05-j-1- yn �/� APN# OWNER NAME Ke R �v lJ I j,v PHONE R07-�Y/(-1 l� E-MAIL STREET ADDRESS 5v rl v CITY, STATE,ZIP r•� FAX CONTACT NAME `��I (�/� qua a�� E-MAIL STREET ADDRESS CITY,STATE, ZIP ,+� ��!� FAX ❑ OWNER ❑ OWNER-BUILDER fvl❑ OWNERAGENTIX ONTRACTOR 11 CONTRACTOR A `GENT. ❑ AARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME (],� �/ /nom/P C73 LICENSE NUMBER y 9 /��/ TICENSETYPEC-) (rj BUS.LICCOMPANY NAME El E-MAIL ! ( (0 / l FAX STREET ADDRESS 2ZS3 /(4 Q v CITY,STATE,ZIP ARCHITECTIENGINEER NAME) LICENSE NUMBER BUB.LIC#/ ',/T COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR-TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA I DECK AREA jS.- TOTAL DECK/PORCH AREA GARAGE AREA: DETACH []ATTACH #DWELLING UNITS: CONDUNIT YES SECOND STORY ❑YES BEINGADDED? NO ADDITION? No PRE-'APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ER °$y ''_ .I Y - AL VALUATION: PLANNING ADPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? .tet`" I, r !� -: x s r By my signature below,I certify to each of the following: I am the property owner or authorized act on the pro owner' ehalf. I have read th application and the information I have provided is correct. I have read the Description of W d verify it is acct' e. I a o comply with all applicable to I ordinances and state laws relating to building co truction. uthorize representatives of Cupertino to enter the�p�-i ntified property for inspection purposes. Signature of Applicant/Agent: Date: r SUPPLEMENTAL INFORMATION REQUIRED AIY� CYTYPE.,tea'^., „RouTu�csLlr r New SFD or Multifamily dwellings: Apply for demolition permit for ovERrx�IcojvTE 1 7 BUILDIxGPLANRESW T t existing building(s). Demolition permit is required prior to issuance of building permit for new building. I�ryPLAN�ING-E�.AN © EaPREss $ x Commercial Bldgs: Provide a completed Hazardous Materials Disclosure APS Commercial k r form if any Hazardous Materials are being used as part of this project. ; w� _xis I LARGE a i. FIRE DEPT i t a' _ Copy of Planning Approval Letter or Meeting with Planning Prior to �c r ,�D4AJQ � �© ANITARY SEWER DISTRICT`° � submittal of Building Permit application. £�f 3t rs�a n h BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION W�PERMIT DDRESS: 10554 LONNA LN DATE: 05/19/2014 REVIEWED BY: MELISSA PN: 359 19 017 BP#: EVALUATION: $3,900 PE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1CHIMNEY USE: p PERMIT TYPE: WORK REBUILD E CHIMNEY FROM THE SHOULDERS UP SCOPE !'/rfrnh. Tierra Chcchl P,m(trek 7T f,rrib l~-ec>: 1111rmh. f Frmit[eco:: 1 'tic t'zr t L-i Lj CJt%rr r l vh, frtirz otherPivrnrt Ins,r) 0,he? 1 u c.1,::,?. �biczc;'z.Mn p. 1v{": Pheoth. Tats/). FCC: LiC(_1;;,P,Pe(': NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . Thesein -fees are based on the relimina in ormation available and are onl an estimate Contact the De t or addn'1 o. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 11 # Chimney/Chimney Repair Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $557.00 1CHIMNEYR Chimney Repair PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee: Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 f.'onv;,twtion 1',x: Work Without Permit? 0 Yes (E) No $0.00 1 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) Building or Structure 0 Tn,w l OCrC7,1Jr2a'nfolion Ft?es: Strong-Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 37� kms " $1.50 $557.00 TOTAL FEE: $558.50 1Si7$BOTALS Revised: 04/01/2014