15050093 (2) CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10062 FIRWOOD DR CONTRACTOR:JMB BUILDERS INC. PERMIT NO: 15050093
OWNER'S NAME: MOONEY ROBERT R AND SUSAN M TRUSTEE 6176 TUOLOMNE CT DATE ISSUED:05/15/2015
OWNER'S PHONE: 4082577535 SAN JOSE,CA 95123 PHONE NO:(408)362-9785
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL
[:]
REMODEL(E)KITCHEN(140 S.F.),NO STRUCTURAL
License Class Lic.# !d 6, i CHANGES
Contractor_ �1�,l
A Vi 14(`S Date 51 /5— I
1 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:$40000
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:34233043 00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 1 have read this application and state that the above information is PERMIT EXP C IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WIT F PE IT 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 OM CTI N.
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 Issued by: Date:
with all non-point urce�g dons p the Cupertino Municipal Code,Section
9 18. / F
�( 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
❑ OWNER-BUILDER DECLARATION inspection.
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sce.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 upe lino U 'cipaI Code,Chapter 9.12 and
]have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sectio 25 5 and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this I :
permit is issued. Owner or authorized agent: Date: j %
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.1 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
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
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
(I
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION D6.
LEE] 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 6�
CU P E RTI N O (408) 777-3228 - FAX (408) 777-3333 • buildin Cu ertino.or
❑NEW CONSTRUCTION ❑ ADDITION \
❑ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS
APN# 2 2
OWNER Q
NAME / �j ' 3 /
PHONE
Q E-MAIL
STREET ADDRESS _ S
CITY, STATE,ZIP •C
V 9 3oi
CONTACT NAME `� FAX� `v
PHONE
qoR
E-MAIL
STREET ADDRESS _
CITY,STATE, ZIP T
C 14 FAX
Cl OWNER 13OWNER-BUILDER ❑ Tok 6Z- ��rS
OWNER AGENT llid CONTRACTOR ❑CONTRACTOR AGENT 13CONTRACTORNAME ARCHITECT 13 ENGINEER [I DEVELOPER [3 TENANT
LICENSE NUMBER
C278 LICENSE TYPE BUS.LIC#
COMPANY NAME 1
E-MAIL 646411r_4 I
1 t I
STREET ADDRESS b FAX qpk 6 Z 9 8 5
C[TY,STATE,ZIP
PHONE
ARCHITECT/ENGINEER N ME d 6 g�
LICENSE NUMBER
COMPANY NAME BUS.LIC#
E-MAIL
STREET ADDRESS FAX
1
CITY,STATE ZIP.
PHONE
DESCRIPTION OF WORK
1
EXISTING--- PROPOSED USE
CONSTR.TYPE #STORIES
EXISTcUSE TYPE
NEW FLOOR DEMO OCC. SQ.FT• VALUATION(S)
AREA TOTAL
AREA
AREA NET AREA
REMODEL AREA
BATHROOM KITCHEN n
REMODEL AREA OTHER
740
, /O REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/POY RCH AREA GARAGE AREA: DETACH
ATTACH
#DWELLING UNITS: IS A SECOND UNIT
BEING ADDED? E]YES SECOND STORY 13 YES
[}NO ADDITION? QNO
PRE-APPLICATION G APPON ❑YES )F YES,PROVIDE COPY OF
PLANNING ADPL# ❑NO PLANNING APPRO VAL LETTER IS TAE BLDG AN ❑YES
EICALER ROME? ❑NOTOTAL VALUATION: ��
By my signature below,I certify to each of the following: I am the Property
application and the information I hav ro 'de P P m° au th agen o e pr` owner's be f. I have read this
P I have read the Description o ork I i s
ordinances and state laws relating to uil n n. I authorize representatives of Cupertino to ent a abov tident ed property for inspection
local
Signature of Applicant/Agent: _ P purposes.
SUPPLEMENTAL INFORMATION REQUIRED Date:
New SFD or Multifamily dwellings: Apply for demolition permit for PLAN cI>Ecx TYPE Rtilirnvc sLiP
existing building(s). Demolition permit is required prior to issuance of building VER-THE-COUNTER ❑ BUILDING PLAN REVIEW
permit for new building.
_ ❑ EXPRESS El PLANNING PLAN REVIEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ .STANDARD
form if any Hazardous Materials are being used as part of this project. ❑ PuRLIt WORKS
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ LARGE ❑ FIRE DEPT
submittal of Building Permit application. ❑ MAJOR .
❑ SANITARY SEWER DISTRICT
❑ ENVIRONMENTAL 11FALTIL,;.
B1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10062 FIRWOOD DR DATE: 05/15/2015 REVIEWED BY: MELISSA
-VALUATION: 1$40,600
APN: 342 33 043 BP#: 03
TYADDRESS:
TYPE: Building Permit PLAN CHECK TYPE: Alteration Repair
PRIMARY I SFD or Duplex PENTAMATION I R3SFDREM
USE: PERMIT TYPE: A
WORK REMODEL(E) KITCHEN (140 S.F.), NO STRUCTURAL CHANGES
SCOPE
5!,gk"j
;'z
AkCh. 1'IW7(_'heck 11oil(.7h,.,ck ("hock
mech. Perplit FeW: I PhnnI). Pf.:rozii Eve: El c. Perini!Fr.v.-
boli.boli.Other P111177,b Ing"LOr/le).1..-le(•.ie!-Alcch. Inv.01, 117sp. P"":. Ph.wib. hisp. /.'ce: Elec. Insp. Fee.
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). These-fees are based on the prelimina information available and are only an estimate. Contact the Deptjor addn'l info.
FEE ITEMS (Fee Resolution 11-053 Ef(. 711113) FEE QTY/FEE I MISC ITEMS
Plan Check Fee: $0.00 = s.f. Remodel,Kitchen(<=300 sf)
Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 $645.001 IREMRESKIT A
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
onso-uction 7'ax:
A.dininisirafiv�., 1,c(.,: 0
Work Without Permit? 0 Yes (j) No $0.00 E)
Advanced Planning,Fee. $0.00 Select a Non-Residential E)
Building or Structure 0
'1'ruvel Documenlalion hees., 'A
Stronp,Motion Fee: IBSEISMICR $5.20 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $2.00
$645.00FEE1 $652.201
Revised: 05/07/2015