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15060150 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21673 CASTLETON ST CONTRACTOR:LARRABEE& PERMIT NO:15060150 ASSOCIATES INC OWNER'S NAME: WILLIAM&JENNY WRIGHT 3002 SCOTT BLVD DATE ISSUED:06/23/2015 OWNE PHONE: 4155086031 SANTA CLARA,CA 95054 PHONE NO:(408)364-9000 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL FOUNDATION REPAIR License Class_ Lic.# a 7 Contractor 4,14 ZlT ";Z9443-5_5/mte 7F 3 / I hereby affirm that I am licensed under the provisions f Chap er 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:$7000 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:35618065 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 WITFIIN 180 DAYS + UANCE OR to building construction,and hereby authorize representatives of this city to enter AST C INSPECTION. upon the above mentioned property for inspection purposes. (We)agree to save 180 D Y indemnify and keep harmless thCity of Cupertino against liabilities,judgments, costs,and expenses which in accrue agai t said City in consequence of the i51 1110111, Da e: granting of this permit. Ad 'ionally, a licant understands and will comply with all non-point source gulation er t e Cupertino Municipal Code, ectio 918. �3 . / RE-RO Signature Date ('� All roofs shall be inspected p m- or oofing 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 Date: Signature of Applicant: 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) HAZARDOUS MATERIALS DISCLOSURE 1,as owner of the property,am exclusively contracting with licensed contractors to 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 Mu ic'pal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)sho ld 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 equi ent or ces which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the ay rea Air lity Management District I performance of the work for which this permit is issued. will maintain compliance with the u rtino M i ipal Code,Chapter 9.1 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 05,255 , nd 25534. Z� Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: 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 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 work's for which this permit is issued(Sec.3097,Civ C.) forthwith comply with such provisions or this permit shall be deemed revoked. 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERT INQ (408)777-3228•FAX(408)777-3333•buildina(acupertino.org �v ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS73 `5/ZLI_�_ 7-0'W /' APN# OWNE!7— C ' O A.J E-MAIL l� STREET ADDRESS //� CITY,STATE,ZIP _ C/ FAX CONTACT NAME/ LZ/) ONE E-MAH STMET ADDRESS CITY,STATE,ZIP FA ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CQNTTRAC 0 �l ® LICENSE NU�DER �. LICENSE TY BUS.LIC#' E-MAIL �� FAX rEST frJ)pDRES�� ,r/ �/ C 1 STATE,�IgHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# PANY 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 DECK AREA TOTAL DECKIPORCH AREA I GARAGE AREA: DETACH ❑ATTACH H DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY []YES BEING ADDED? []NO ADDITION? ❑NO PRE-APPLICATION []YES IF YES,PROVIDE COPY OF IS THE BLDG YES EIVELI 1 ;°_' y ,a., TOTAL VALUATION: PLANNING APPL k ❑NO PLANNING APPROVAL LETTER EICHLER HOME? By my signature below,I certify to each of the following: I am the property owner or a act on the perty o s behalf. I ha a read this application and the information I have provide is correct. I have read the Descri ' -and verify it is rate. I e to corn y with all applicable local ordinances and state laws relating to b 'ldi construction. I tho ize representatives of Cupertino to ent a ab ntifii prop for inspection purposes. Signature of Applicant/Agent: e: �✓ SUPPLEMENTAL INFORMATION REQUIRED acittt,Isi�Pi r New SFD or Multifamily dwellings: Apply for demolition permit for t3� �I1 COUNIR i£UILDINCrF A1'IVIRVt' existing building(s). Demolition permit is required prior to issuance of building3st rr ' permit for new building. FXPRlS As1 _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure fly 'STDARiIU t ��WOkK5 < form if any Hazardous Materials are being used as part of this project. �"� , Copy of Planning Approval Letter or Meeting with Planning prior to , f, �SDIST>tICT s x URS submittal of Building Permit application. W B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 21673 CASTLETON ST DATE: 06/23/2015 REVIEWED BY: MELISSA APN: 356 18 065 BP#: 1,50&0 .� 'VALUATION: $7,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY PENTAMATION 1 GENRES USE: SFD or Duplex PERMIT TYPE: WORK FOUNDATION REPAIR SCOPE Ifecl;. Nlrarr('heck Phuttb."'an C'h,,,1, f lec.flan(.'hec(c L12ch, Permit Fete: Phanb. Permit T ee;: 1slec, Permit Fee: Offer rllerh. /nsp. other Plumb lY7,S;?. 01her I:•lec.Inst?. 1dech.Insp. Fee: Pl nth. hisp. Fcz<: lns��. I ee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff.' 7/1/131 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 L J # Foundation Repair Suppl.PC Fee: Q Reg. Q OT 0.0 his $0.00 $859.00 IFOUNDREPA PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-0 Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (.'ottstruction :lax: Administrative Fee Work Without Permit? 0 Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select allon-Residential Building or Structure 0 Travel Documenlatirn Tees: A Strome Motion.Fee: IBSEISMICR $0.91 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SIIBTOTALSi $1.91 $859.00 _ TOTAL FEE $860.91 Revised: 05/07/2015