The URL can be used to link to this page

13080119 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10138 MYER PL CONTRACTOR: PERMIT NO: 13080119 OWNER'S NAME: I-11GDON MARY D TRUSTEE DATE ISSUED:08/15/2013 OWNER'S PHONE: 4085041084 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT {— PLUMB r License Class_ Lie. F F ..yy�� ./� MECH RESIDENTIAL COMMERCIAL Contractoralar-'sayh—S _t1_1L Date 4 3 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: BATHROOM REMODEL(70 SQP"t) (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. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$13500 ection 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:31623045.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. Wanting ofthis permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by: ��/✓ /q�G Date: Signature A Date ��3 ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1 hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date: 13usiness&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 Ow cor t z�d agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: ^— forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above`information is for which this permit is issued(Sec.3097,Civ C.) correct. 1 agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments; costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CONSTRUCTION PERMIT APPLICATION �( 10 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION v 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 13 I� CUPERTINO (408)777-3228•FAX(408)777-3333•building(crDcupertino.org ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS to 6 L APN OWNERNAME PHO r E-MAIL J t cw� o STREET ADDRESS V V CITY, STATE,ZIP P 7�N / FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME/,jQ.0J - LICENSE NUMBER �Q LICENSE E BUS.LIC# COMPANYNAME I,_ t E-MAIL , AX STREET ADDRESS / / r CITY,STAATE,ZIP 6` /� �j"�/ PHONEY2 7g�1p ZQ� ARCHITECT/ENGINEER NAME LICENSE NUMBER (y�1 b BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK �.�Iroaw..�e�toua.�-•w• — e. �� .S�lowe L�fiyt �6/L�� EXISTING USE PROPOSED SE CONSTR.TYPE 1 #STORIES A'x- ♦/ USE TYPE OCC. SQ.FT. VALUATION($) EXISTG •/ NEW FLOOR DEMO V TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL ARE REMODEL AREA REMODEL AREA PORCH AREA I DECK AREA TOTAL DECK/PORCH ARE I GARAGE AREA: U DETACH V ❑ATTACH it DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ONO ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES ".1M. IME TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO By my signature below,I certify to each of the following: I am the property owner or authorized agent to act 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 bu ing c struction. authorize repres ntatives of Cupertino to enter the above Q-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMEN At INFORMATION QUIRE ;y p e�ci E _New SFD or Multifamily dwellings: Apply for demolition permit for d1,yi'C�EOEp�XVPE�1 RRETSHS��>iiCt Oya��rx r B NbNwUNTER existing building(s). Demolition permit is required prior to issuance of building �VPlApermit for new building. wIl�gGPr LrA4NI2pEYs�btro k`r�d a r x x PLAN REV[E VII { r� 1, Q.'�"'t ",. � `24 _Commercial Bldgs: Provide a completed Hazardous Materials DisclosureCIrr5TnxnnRn s fusiTCWORxs r form if any Hazardous Materials are being used as part of this project. fi H,LARGE 3 �z� :- � ❑ FIRE DEPT. r *x �� s� �, '�r S, Copy of Planning Approval Letter or Meeting with Planning prior to ❑ �ox ❑ sAZAK NITnRY sEwER DY$TRICT� r submittal of Building Permit application. ,, „-.;, - ❑-ENVIROI�IMENTAL AEALTA' " Bldgvlpp_201 1.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10138 Myer PI DATE: 08/15/2013 REVIEWED BY: Sean APN: BP#: *VALUATION: 1$13,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDRE USE: PERMIT TYPE: WORK Bathroom remodel 70 sq ft SCOPE Xfec:h. Plan Check Plumb.Plan Check Elec.Plan Check hfech.Pertnit Fee: Plumb. Permit Fee: Flec. Permit Pec:: Other,Rech.Insp, Other Plumb Insp. Other Elec.Insp, Hec•h.Insp.Fite: Plumb. Insp.Fee: Elec.Insp,Fee: Ei�L] NOTE.This estimate does not include fees due to other Departments(L e.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 E . 7/1112) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel,Bath(<=300 sf) Suppl.PC Fee: Q Reg. Q OT0.0 hrs $0.00 $626.00 IREMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Feer Reg. ® OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 t:onsiruc:tion.Tax: Adininistrative.Fee: Work Without Permit? ®Yes 0 No $0.00 1 1 E) Advanced Planning Fee: $0.00 Select a Non-Residential E) Building or Structure Travel Documentation Fees., � Strong Motion Fee: IBSEISMICR $1.35 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 $2.35 $626.00 „ $628.35 Revised: 07/01/2013 CABINET FLO jPLAN LAYOUT j 6 G �( kr? 1l # 4. ..,. .. PcPu`), a✓� cU .' A/!� �kS` .R: H.. In�. � l 00 x C ' 756f 4 t r e ' aOG _ A ,.2013, Y i , C rwr., r ; , ' x L � 4 i _ � (� , 4.1 { J T 3 f 4 ` G f 4 eviLaI aN c T' o E ERTINO �j�, 114ml, __ijttli _4. a nt""' 77 IF VE g i - This set hof plans-Ond icati�ns-�I be kept�t ,T � 213 tMe . . s � .� �s _� . .. _._,. � �.Cu 11 Of_ fte On " tt1 Or d 3t> :. RE-w-WS-U, � f3 RL E. .< s z__ ! #r m e B iidi g i s �' 4 � ._.;,..� .•- - Bry fag 'nCfi a d cat ns NO vlry p Llmwq s 9 f B r @ pq s v oT � 4 i... s,....... { i,..... .,. r , 6A f , 41 � l rEsnro: _ ;� � r , b , P , 9 � r 4 i 4 4 t DATE STYLE STAIN DRAWER CUSTOMER OR JOB# DRAWN BY SHOWPLACE° wooa ��a,�atg 1 � Form 700.001 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 C O P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR .M.T. JOB ADDRESS: ( Q 4et— L PERMIT# z. OWNER'S NAME: H PHONE,# GENERAL CONTRACTOR: G t o S BUSINESS LICENSE# ADDRESS: 11177 13 ayd- le.-e— CITY/ZIPCODE *Our municipal code requires all businesses working in the city to have a City of"Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WII;L BE SGHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL S BCONTRACTORS HAVE OBTAINED.A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: " Sig ature Date Please check applicable subcontractors and complete the following information: 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 Owner/Contractor Signature Date