15100139I CITY OF CUPERTINO BUILDING PERMIT I
IBUILDING ADDRESS: 7470 TIPTOE LN I CONTRACTOR: ALI'S CONSTRUCTION & I PERMIT NO: 15100139 I
I OWNER'S NAME: SARJEANT MARK P AND MAUREEN I 11011 S DE ANZA BLVD I DATE ISSUED: 10/19/2015 1
OWNER'S PHONE: 4082573175 1 SAN JOSE, CA 95129 1 PHONE NO: (408) 898-6474
,Q LICENSED CONTRACTOR'S DECLARATION
License Class 6 Lic. # C?dq Li 3 3
ContractorAli S C D -n 51'YU (-k071 Date 10/ %q
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:
1. 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.
2LI'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
permit is issued.
APPLICANT CERTIFICATION
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 relati
to building construction, and hereby authorize representatives of this city t�
upon the above mentioned property for inspection purposes. (We) agree to save
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 with
all non -point sou g lations er the Cupertino Municipal Code, Section 9.18.
Signature Date d la
IF
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
1. 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)
2. I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations:
1. 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.
2. 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
permit is issued.
s. 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
become subject to the Worker's Compensation provisions of the Labor Code, I
must forthwith comply with such provisions or this permit shall be deemed
revoked.
APPLICANT CERTIFICATION
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
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 with
all non -point source regulations per the Cupertino Municipal Code, Section 9.18.
Signature
Date
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
REMODEL (E) KITCHEN, LIKE FOR LIKE (160 S.F.)
Sq. Ft Floor Area: I Valuation: $30000
APN Number: 35932056.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAY
Issue
RMIT ISSUANCE OR
CUED INSPECTION.
-_`_/Date: d
All roofs shall be inspected prior to any roofing material'b5ing installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain
compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health &
Safety Code, Section 25532(a) should I store or handle hazardous material.
Additionally, should I use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner tglept.r'
Date: olLl
CONSTRUCTION LENDING AGENCY
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.) \
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed Profession
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-32551-100
5014-3255/ /�D
(408) 777-3228 • FAX (408) 777-3333 - building 5( cuperlino.crq � (� 6
CUPERTtNO
n NF.W C'-(INCTRT 1C:TTON n ADDITION . n ALTERATION / TT n REVISION / DEFERRED ORIGINAL PERMIT
PROTECT ADDRESS 7JJ —4.0T1 , oc Ln
APN 4 �J T 5-6
OWNER NAME , t , -' , S (� u (i
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STREET ADDRESS J
CITY, STATE, ZIP � ,� a, C � FAX
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CONTACT NAME AL
PHONE uD�/ p a � 6� � �
E-MAIL 4
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STREET ADDRESS it ail S 'k- /1,nza 8 VO
CITY, STATE, "'So-s0ofe a q ��� n /y
FAX
❑ OWNER ❑. OWNER -BUILDER ❑ O'A N -.R AGENT
11P C0?,77RACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENA-NT
CONTRACTOR NAME �] / 71, a�,
LICENSE NUI�4BERg6igq 3 3 I LICENSE TYPE f3
BUS. LIC -9
COMPANY NA1,4E / i � /" 5+r( +i O Y`1
E-MAIL /L / ,s,_ic0�
STREET ADDRESS O I S, Oe i � 13kV(�
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CITY, STATE, ZIP ` _ M f� � e q F5r� C
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PHONE (J� �jL1 / Qa ��
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ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC
COMPANY NANS
E-MAIL
FAX
STREET P.DDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
'k Ceye't.1 CG�Yn es slew S f �n 1^� , Meu itcGi�
Yveu1ueMV.?1
'44wves OZI An Sa rre ,piihCe,
EXISTING USE
PROPOSED USE I CONSTR TYPE
# STORIES
USE TYPE OCC.
1
SQ -FT.
VALUATION (S)
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
GARAGE AREA: DETACH
❑ ATTACH
TM 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 AN ❑
TOTAL VALUATION:
PLANNING .Ai ❑ NO PLANNTI GY APPROVAL LETTER
I
EICHLER HO ME? ?0 =
-
��
By my signature below, I certify to each of the following:
I am the property owner or authorized on the property owner's behalf. I have read this
application and the information I have provided is correct.
I have read the Description of'Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to i g con ction.
Signature Applicant/Agent:
I authorize representatives of Cupertino to enter the above 'dentif d property for inspection purposes.
Date: lU�l
of
SUPPLEMENTAL INFO ZATION REQUIRED
New SFD or Multifamily d«,ellings: Apply for
demolition permit for
�. -. See.
4`�
❑ OVERTCOTJI<TER ���BUILDLR'GP�LANREVIEIY
..z3..` r^•�t -+c. N . 'E*0-s-7..+,.w�->.,�,.
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h
existing building(s). Demolition permit is required prior to issuance of building
- _F
.
MOM �
permit for new building.
Exss Y
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.
-PLAI�� PLS_ w
.
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�
Commercial Bldgs: Provide a completed Hazardous
Materials Disclosure
sTaNnARn �a ='t�
�PusLTcwoxxs �`
form if any Hazardous Materials are being used as part of this project.
rn
D #
Letter
a L ARG
a F7R1:�EI?�^` �s '
Copy of Planning Approval or Meeting with
Planning prior to
� WOR x
N wig
SA 'IT}�RI�.SE� ER DIST RICA ti
Q
submittal of Building Permit application.
sfl y
B1dgApp_2011.doc revised 06/21/11
a
CITY OF CUPERTINO
1 ' 1 FFF F CTIM A TOR — RT TILDINr DIVISION
y
ADDRESS: 7470 TIPTOE LN DATE: 10/19/2015
REVIEWED BY: MELISSA
Lien. Plan (..heck
APN: 59 32 056 BP#:
*VALUATION: 1$30,000
PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Du lex
p
Other Elec. Insp.
PENTAMATION 1 R3SFDREM
PERMIT TYPE:
USE:
0.0
hrs
$0.00
PME Plan Check:
WORK
REMODEL E KITCHEN LIKE FOR LIKE 160 S.F.
SCOPE
Permit Fee:
NOTE: This estimate does not includefees due to other Departments (i.e. manning, Yubuc Works, fire, aantrary.ewer'Utstrict, acifuuL
L . . / /t.Contact the Dent for addn l info.
"1311 LLL, GLI. 1 /LGJG ccu w• c, •iuua.w v• .. r... , ....,.......
FEE ITEMS jee Resolution 11-053 Elf' 7/L1132
;Wech. Plan Check`lrwlhl
Plan (.`heck
Lien. Plan (..heck
11r>clr. Perrrrit Fee:
Plumb. Permit [c`
Elec. Permit Fee'
Other Hech. Insp.
ltlter Plumb Insp.
Other Elec. Insp.
;:tech. Inch. Fee:
Suppl. PC Fee: (j) Reg. 0 OT
0.0
NOTE: This estimate does not includefees due to other Departments (i.e. manning, Yubuc Works, fire, aantrary.ewer'Utstrict, acifuuL
L . . / /t.Contact the Dent for addn l info.
"1311 LLL, GLI. 1 /LGJG ccu w• c, •iuua.w v• .. r... , ....,.......
FEE ITEMS jee Resolution 11-053 Elf' 7/L1132
.' .. - ---'---" -- --- -------
FEE
- - --- - --
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
=s.f.
$645.00
Remodel, Kitchen (<=300 sf)
IREMRESKIT
Suppl. PC Fee: (j) 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:
dininistrotive l-ee:
0
Work Without Permit? 0 Yes No
$0.00
Advanced Planning, Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
_
Strong Motion Fee:
IBSEISMICR
$3.90
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$2.00
SUBTOTALS:
t $5.901
$645.00
TOTAL FEE:
1 $650.90
Revised: 10/01/2015
CUPERTINO
Building Department
L CM—I !��`OCT 19 2015
REVIEWED FOR CODE COMPLIANCE
Reviewed By.
7H 7�0 -Tlp�oe, L-A
,vt-'aT6e MAul-e-er,
5=
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C /1XJ � 1 � 1'1'1 6U� (- v �� LYt
N�tJ �`eC'f't,
5a -n -e 10( 64f
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION - CUPERTINO
APPROVED
This set of plans .ind specifications k1UST be kept at the
;(,,b site during c,Dr.struction. It is unlawful to make any
changes or alterations on same, or to deviate
therefrom, without approval from the Building Official.
The Stamping plan and specifications SHALL NOT
:)e held to [)err lit or to be an a of the violation
of any provis ,-' or State Law.
)ATF �Q l /
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