14090021 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 23300 VIA ESPLENDOR UNIT V54 CONTRACTOR:JESSUP PLUMBING INC PERMIT NO: 14090021
OWNER'S NAME: CLIFF LEE H TRUSTEE PO BOX 2038 DATE ISSUED:09/04/2014
OWNER'S PHONE: 6509696707 SAN LEANDRO,CA 94577 PHONE NO:(510)357-0525
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL E] COMMERCIAL E]
/y CONVERT TUB TO SHOWER IN GUEST BATHROOM
License Class C- Lic.#
Contractor _ -(11d&10; Date
`i
I hereby affirm that I a licensed under the provision�Chptr
(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:$4800
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:34255039 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 18 RMIT 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 DAYS FR LAST CALLED INSPEC ION.
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 source regulations per the Cupertino Municipal Code,Section
9 18.
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
inspection.
OWNER-BUILDER DE LARATION
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
1,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(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 Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534.
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
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.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.
grantingof this permit ally,the applicant understands and will comply
with all non in sou ere ulatio er the Cupertino Municipal Code,Section Licensed Professional
9 18.
Signature Date
-- CONSTRUCTION PERMIT APPLICATION � 1
COMMUNITY DEVELOPMENT.DEPARTMENT• BUILDING DIVISION
777-3228 �0
_ 10304TQRRE AVENUE•CUPERTINO, CA 95014-3255 I .
(408) • FAX(408)777-3333• buildino Rupert ino.org
CUPERTINO
❑1\E\11 CONSTRUCTION ❑ ADDITIONAL i ERATION/TI ❑ REVISION/DEFERRED ORIGINAL PER 6I T 4
PROJECT ADDRESS � I APN
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STREET ADDRESS I CITY, STATE,ZIP I FAX
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0 ORRdER ❑ OIANER-BUILDER ❑ OWITERAGE!,'r COX RACTOR ❑CoT,7&4CTORAGM,-, ❑ ARCHITECT ❑-_K,GLN= ❑ DEVELOPER ❑ TENANT
CONIRACTORNAME I LICENS OBER I LICENSETYPE I BUS.LIC",
COMPANY NAME E"MAIL FAX
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STREET ADDRES C STA ZIP I PHONETATE,
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ARCHITECTIENGINEER NAME I LICENSE NU7 ER I BUS.LIC R
COMPANY NAME E MAI FLIS
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CITY
STREET ADDRESS / I O v
DESCRIPTION OF WORK
EXISTII.GUSE PROPOSED USE CONSTRTYPE RSTORIES USE TYPE OCC. I SQ.FT. VALUATIONS)
EXISTG h'EW FLOOR DEMO TOTAL
AREA uilitx
AREA AREA NET AREA
REEEMOD0ELLiucrt. n(D 7
KITCHEN REMO
�� REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH
❑ATTACH
#DWELLn�'G UNITS: ISA SECOND IIIlTf ❑Yx.-S SECOND STORY ❑YES
BELNG ADDED? El-"0 ADDITION? ❑NO
—�iZ PLIC4 ON—[CIES—Ir�rS.P1tOYmi:rnp'rip S THE BLDG AN F1 YES '_ -E1VED.By';% 4 '. , TOT_ \% O
PLAMINIII`GAPPL-0 []NO PLA4NZINGAPPROVAL LETTER I EICHLERHOME? NO - m _
_h"gtik� her
By my signature belmv,I certify to each o e fo11o�I ing. the property owner or authorized agent to act on the property o\amer's behalf. I have read this
application and the information I have pro ' s �rrect. I ha read the Description of Work and verify it is accurate. I agree to comply Mth all applicable local
ordinances and state lana s relating to b ' in, 1: uction. 1 autho ' e representatives of Cupertino to enter the above-ide "fled p pe Ly for inspection purposes.
Al
S i gnature of App]icant/A2 Date:
SUPP y214ENTAL RMATION QL'I 4 `
CHECK T .:Epi _ RO7JTLNG OLTP` s
NeW SFD or Multifamily d-wellings: Apply for demolition ermit for ��«R wanTER BTvubinGPLA'�ItEN1v _
existing building(s). Demolition permit is required rior to i ance of building – "
permit for new building. €® s �� 'PLL'` L '
�--"_...�—_`- --.��` – ,.�
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ' 6t BMZ7Ay6Itl s+ ' `g
p r < � s-
= _ �
form if any Hazardous Materials are being used as part of this project.
—Copy of Planning Approval Letter or Meeting with Planning prior to
submittal of Building Permit application. �–
Bldo4pp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 23300 via esplendor villa 54 DATE: 09/04/2014 REVIEWED BY: Mendez
APN: BP#: *VALUATION: 1$4,800
'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION
USE: I I PERMIT TYPE:
WORK convert tub to shower in quest bathroom
SCOPE
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r cr't. 1 zr,rtaFee: T'tr,sn . Inc=rte:_ 1<<E: f.'..r 1'e'7„it '.
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Plun1b. h p. poet i�iec.I,r
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 prefinddna information available and are only an estimate. Contact the De t or addn'l info.
FEE ITEMS(Fee Resolution I1-053 Eff. 711/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 Select a Misc Bldg/Structure
Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 or Element of a Building
PME Plan Check: $0.00
Permit Fee: Hourly Only? ®Yes G)No $0.00
Suppl. Insp. Fee:(E) Reg. 0 OT0,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction 147,V.°
Work Without Permit? ® Yes (F) No $0.00 E)
Advanced Planning Fee: $0.00 Select a Non-Residential
Tr,rti°z7d LJo"�,r;�rte�n/rlic>f Fees: Building or Structure 0
A
Strong Motion Fee: IBSEISMICR $0.62 =hrs Inspections
Bldg Stds Commission Fee: 1BCBSC $1.00 $286.00 ISTINSP Inspection,Hourly
O�ALS; $1.62 $286.00 $
TOTAL FEE: 287.62
Revised: 07/10/2014
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;LDING DIVISION-CtJREgR "''
FtEVIEVVl:S �=v CGDE COMPLIANCE APPROVED
Reviewed By. r'►dans and specifications MUST
be keptBring construction. It is unlawful ma at the
c'anges or alt make a
2 ( erations on same, or to deviate any
C� R :afrom, without approval from the Build'— -.;a,.
Mping of tis pla nd �� s- •.
pa mit or t e UT
Ity o_�: on