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13050089CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11660 REGNART CANYON DR CONTRACTOR: JACK MYERS PERMIT NO: 13050089 CONSTRUCTION OWNER'S NAME: WALKER JAMES G AND LINDA T 970 GEST DR DATE ISSUED: 06/07/2013 OWNER'S PHONE: 4084992923 MOUNTAIN VIEW, CA 94040 PHONE NO: (408)761-1185 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL0 License Class ., Lic. # - ZIV �• KITCHEN REMODEL (297 SQ FT); REMODEL BATHROOMS Contractor Date (200 SQ FT); OTHER REMODEL (114 SQ FT); REROOF I am licensed der the provisions f C Ater 9 I hereby a?with RESIDENCE (3000 SQ FT). (commencection 7000) of Division 3 of the Business & Professions Codeandcense is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 1 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 Sq. Ft Floor Area: Valuation: $90000 performance of the work for which this permit is issued. 1 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; 36633001.00 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 DA LED 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 v: Date: with all non -point source regulations per the Cupertino Municipal Code, Secti 9.18. / RE -ROOFS: Signature % Date 1 All roofs shall be inspected prior to any roofing material being installed. If a roof is 117 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) 1, 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(x) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should 1 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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Sectio s 25505, 2 33, d 5534. 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 Compensation laws of California If, after making this certificate of exemption, I CONS RUCTION LENDI G AGENCY become subject to the Worker's Compensation provisions of the Labor Code, 1 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 (See. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that 1 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 �1 U COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION O U 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) .777-3228 • FAX (408) 777-3333 • buildingCcDcu ertino.orq \ !'ION F� ADDITION F ALTERATION / TI n REVISION / DEFERRED ORIGINAL PERMIT}! PROJECT ADDU ESS 17 APN OWNER NAME a �d a p P E-MAIL. STREET ADDRESS. r CITY, STA IP �' FAX CONTACT NAME �� "� PHONE / ^r 1 'r'1 STREET ADDRESS, "p,• �y / CITY, STATE, ZIPS' FAk ❑ OWNER .❑ OWNER -BUILDER ❑ OWNER AGENT ONTRACTOR ❑ CONTRACTOR AGENT W ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR N ',� �" "' � ar l o 'v/ '*', LICENSE NUMBER . � LICENSE TYPE BUS. LIC # +r COMPANY NAMEf y d .. 1'✓ -. E-MAIL ,.^err �, . I' fie"""/ �"F'r'"Y ��'w+" „d STREET ADD CITY, AT Z [�yp�� ,f.��� PHO /6 q ARCHITECT/ENGINEER NAME J r LICENSE NUMBER ( BUS. LIC # r� COMPANYNAME +� E-MAIL FAX STREET ADDRESS _ ✓71 CI1 Y TATE, �/„ P NE DESCRIPTION OF WORK " K , EXIS1ff4GUSE PROPOSE USE CONS TYPE #STORIES / USE TYPE OCC. SQ.FT. VALUATION ($). EXLSTG AREA J �,' NER' FLOOR . AREA . ), DEMO AREA TOTAL „Fl NET AREA, � �D BATHROOM REMODEL AREA ,. r'„""� KITCHEN REMODEL AREA OTHER REMODEL AREA .PORCH AREA ECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: U DETACH ❑ ATTACH ' # DWELLING UNITS: '.. ISA SECOND UNIT UYEs SECOND STORY E] YES BEING ADDED? ❑NO ADDrrION? ❑NO PRE -APPLICATION []YES IF YES, PROVIDE COPY OF PLANNING APPL # PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES�� EICHLER HOME? NO ,, r' : y . ...... . . . ...� V : IOTA?LUATION: ONO E] By my signature below, I certify to each of the following: I am the property owner or uthor' age ton o owner's behalf. I have read this I the p fy gr comply with all applicable local application an e I nnatlon a p Description o or an en rt � e. agree to have rondecdons onze representatives of Cupertino to enter the a e-intifie ro ordinances and state laws relatm �IpL resent bov„ � -, perry for inspection purposes. "read . a � �.� �'"Date: O✓” Signature ofApphcanUAgent. f SUPPLEME IN QUIRED °r'l^N B r r SF r A I rs r m , _ New SFD or Multifali#r} dwellings:, Apply for demolition permit for `, existing building(s):. Demolition permit is required prior to issuance of buildings permit for new building. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure °! form if any Hazardous Materials are being used as part of this project.�� a Copy of Playing Approval Letter or Meeting with Planning prior to Building Permit application. F L submittal of ' I� � b /py I A y /11!)�Fi��,.G�,1��,"���Ii,"��J�/�� r l 4" l/�'✓/,"""P.' 5yy 'ryyry yy LT{,11AV T �Cl ar`"I' vs ,,��r� BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION „i,,, ADDRESS: 11660 REGNART CANYON DR DATE: 05/10/2013 REVIEWED BY: MELISSA MISC ITEMS APN: 366 33 001 BP#: 'VALUATION: 1$90,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex «rr,,,' >�,_�„��, f�((rl12 PENTAMATION 1 R3SFDREM I USE: �� /w/I7. .�fl �1 /'f c. PERMIT TYPE: WORK INTERIOR REMODEL ADD BOX CEILING & REMODEL KITCHEN MASTER & HALL BATHS & SCOPE LAUNDRY ROOM. REMOVE WALL FROM KITCHEN TO FAMILY ROOM & CREATE BEAMED „i,,, FEE FxfffNf f,J,:4'C'h' MISC ITEMS f%', V, i}+Qr`C✓ Plan Check Fee: PuMU PCV. 135 s.f. $400.00 �.�rrl�:l ��.�(�� r(, 1 sr> . «rr,,,' >�,_�„��, f�((rl12 E�Ir+�','� t<� ,�,� �_Ll 111(. ih, !�l�1fl /"v �� /w/I7. .�fl �1 /'f c. f:4t'( iV7.S'f� /'co - NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. Pin). Thv_ce fees are hated on the nreliminary information available and are only an estimate. Contact the Dent for addn'l info. FEE ITEMS (Fee Resolulion 11-053 E(f 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 135 s.f. $400.00 Remodel, Other IREMRESOTH Suppl. PC Fee: Q Reg. 0=0 0.0 hrs $0.00 PME Plan Check: $0.00 250 1 s.f. $600.00 Remodel, Bath (<=300 sf) IREMRESBAT Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT 0.0 hrs $0.00 = s.f. Remodel, Kitchen (<=300 sf) $600.00 IREMRESKIT PME Unit Fee: $0.00 PME Permit Fee: $0.00 4,000 s.f. Re -roof $600.00 IREROOFRES Q Work Without Permit? 0 Yes Q No $0.00 Advanced PlanningFee:$0.00 Select a Non -Residential Building or Structure 0 Strong Motion Fee: IBSEISMICR $9.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $4.00 $13.00 $2,200.00 T©TA'L FSE;'; $2,213.00 Revised: 04/29/2013 CUPERT"INO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: r ' PERMIT # /30,-T-008',9 OWNER'S NAME: PHONE # GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: �j , , lTY/ZIPCODE: 7 ` *Our municipal code requires all businesses working in the cityfo 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: 11 Signature ate Please check applicable subcontractors and complete the following information: Zz /Y�- 3 ate 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 Zz /Y�- 3 ate