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13010072CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11892 PLACER SPRING CT CONTRACTOR: ERIC KALLIO PERMIT NO: 13010072 ' CONTRACTOR OWNER'S NAME: SUBRAMANIAM RAM AND GOMATHI TRUSTEE 2345 OLEA CT DATE ISSUED: 01/142013 OWNER'S PHONE: 4082532816 GILROY, CA 95020 PHONE NO: (408) 398 -5994 -' F1 11 El LICENSED CONTRACTOR'S DEECLARATION License Class . Lic. H J l ` Contractor Date I hereby affirm that I am licensed under the provision 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. 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. .. 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 '� �(- - -�"""" Dated r c JOB DESCRIPTION: RESIDENTIAL COMMERCIAL REMOVE (E) TUB /SHOWER & INSTALL NEW WALK -IN SHOWER STALL W/PAN & TILE LATH Sq. Ft Floor Area: I Valuation: $9079 . APN Number: 36655007.00 1 Occupancy Type: _ PERMIT EXPE RES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS F SLED INSPECTION. Date: RE- ROOFS: 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 DECLARATION Signature of Applicant: Date: I hereby aRrm that I am exempt from the Contractor's License Lew 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) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE concoct 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 t 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, 22/5�5533,, and 25534. `-, Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: T77�� C n Date: � X� 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 constriction, 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 - . CUPERTINO n. CONSTRUCTION PERMIT APPLICATION �'!/ B COMMUNITY DEVELOPMENT DEPARTMENT ? BUILDING DIVISION Q 10300 TORRE AVENUE ? CUPERTINO, CA 95014 -3255 (408) 777 -3228 ? FAX (408) 777 -3333 • building(ftupertino.org 07 O M M Ar TCUAII.11Tr I I nRIr.INAT. PARMITN PROJECT ADDRESSV ( J�T/1 Z u L/¢f,..L� J / V AJi C-7 APN f G 5S OD OWNER NAME �' F V MA7`) l Art PHONE $- 2S _ 2ZI61 &MAIL Yam. /na/�i STREETADDRESS.1,1 2 n/ �yD � fT� /`• CITY, STATE, ZIP l-� N� _( FAX /J �Q! CONTACT NAME PHONE &MAIL . STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OwmeR- BUDAER • ❑ OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS, LIC W T COMPANYNAME�C t &M L l l� F �7 STREET D S � ,L / VV C T TE, P ^ o `rT 7Sr lf— PH rJ ARCHITECT/EN GMEER N LICENSE NUMBER BUS. LIC k COMPANY NAME &MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DEICPPTION OF WORK MSTINJ USE PROPOSIDUSE CONSTR. TYPE aSTORIES n USE TYPE OCC. SQ.FT. VALUATION (S) S i� , w _ G` EMSTG - NEW FLOOR DEMO TOTAL AREA.,2v AREA - AREA NET AREA BATHROOM - KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECKAREA TOTALDEC ORCHAREA GARAGEAREA U DETACH ❑ATTACH I #DWELLINGUND'S: IS A SECOND UNIT -' ❑YES SECOND STORY OYES BEING ADDED? 0 N I ADDITION ?. ONO PR&APPLICATION OYES 'IFYES,PROVmE COPY OF I ISTHEBLDGAN ❑YES GENE _ TOTALVALUATION: PLANNINGAPPLM ONO - PLAMING'APPROVALLEITER EICHLER HOME? 0 N 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 relaC buildin n I authorize representatives of Cupertino to enter the a e -id tified property for inspection purposes. �opstrucC Signature of Applicant/Agent: <'C JC..( �'� Date: SUPPLEMENTAL INFORMATION REQUIRED o rs' '•T>�.co'"a _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building i( permit for new building.' _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ®sxANDAttb "" Ihai Q WO Tom if any Hazardous Materials are being used as part of this project. _ Copy of planning Approval Letter or Meeting with Planning prior to iia F pTia i. i� Ys submittal of Building Permit application. �Yo BldgApp_2011.doc revised 06121111 ,, P 7. CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION APPLIANCE / EQUIP TYPE ADDRESS: 11892 PLACER SPRING CT DATE: 01/1412013 REVIEWED BY: MELISSA UNITS APN:, 366 55 007 BP#: *VALUATION: 1$9,079 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY USE: .: SFD'or Duplex $10 PENTAMATION PERMIT TYPE: - 1RPFIX WORK REMOVE E TUB /SHOWER & INSTALL NEW WALK -IN SHOWER STALL W /PAN & TILE LATH SCOPE Elm Insp. Fee: APPLIANCE / EQUIP TYPE FEE ID ¢ d3'c . 4 I4 QTY UNITS BP FEES wfecL: Plan Check Fixture Or Trap 1BPFIXTURE hlerh..Pern,it rw. 1 # $10 Other Plumb Insp. 1.0 Ins 1 $45.00 Other Elec. Insp. SI -lech. Insp. Feet . Plumb. Insp. Fee: IPLMEINSP $133.00 Elm Insp. Fee: PME Unit Fee: $10.00 PME Permit Fee: $178.00 Construction Tax. Administrative Fee: IADMIN $42.00 Work Without Permit? O Yes Q No $0.00 TOTALS: Travel Documentation Fee:' ITRAVDOC $10.00 Strom Motion Fee: IESEISMICR p,,1 Lyyy��1:ul ¢ d3'c . 4 I4 MISC ITEMS Plan Check Fee: . wfecL: Plan Check Plumb. Plan Check 0.0 Ins $0.00 Elec. Plan Check hlerh..Pern,it rw. Plumb. Permit Fee: IPPERMIT T:(ec. Permit Fee: Other Afceh. Insp: - Other Plumb Insp. 1.0 Ins 1 $45.00 Other Elec. Insp. SI -lech. Insp. Feet . Plumb. Insp. Fee: IPLMEINSP $133.00 Elm Insp. Fee: NOTE: This estimate does not includejees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Dictdrt. ofr ) . 78oco fooe ore haeed nn the nreliminam information availahle and are only an ecdmate. Contael the Dent for addn'I info. FEE ITEMS (Fee Resolution 11 -053 Eff 711112) FEE QTY/FEE MISC ITEMS Plan Check Fee: . suppl. PC Fee PME Plan Check' $0.00 Permit Fee.- SuppI.Insp Fee PME Unit Fee: $10.00 PME Permit Fee: $178.00 Construction Tax. Administrative Fee: IADMIN $42.00 Work Without Permit? O Yes Q No $0.00 Advanced Phi11,17ing Fees: Travel Documentation Fee:' ITRAVDOC $45.00 Strom Motion Fee: IESEISMICR $0.91 Select an Administrative Item Blde Stds Commission Fee: IBCBSC $1.00 iwYEi mp $276.911 $0.00 t OAIFEE $276.91 0 Revised: 10/01/2012 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 Fax: 408-777-3333 JOB ADDRESS: (:- ` PERMIT # OWNER'S NAME: PHONE # -3 GENERAL CONTRACTOR:'. ;, .'. G /.L O BUSINESS LICENSE # ADDRESS: � CITY /ZIPCODE: S(2- *Our municipal code requires all businesles working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR:AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF UPERTINO BUSINESS LICENSE. r�o I am not using any subcontractors: w �� Signature e ate Please check applicable subcontractors and complete the following information: M. Owner / Contractor Signature &�// ate SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile M. Owner / Contractor Signature &�// ate fi�i' - Yea -wuz` .c,ress � ($-q2_ Plae�r Sp`Yf�9 e� C�� fx hr)0, �vtf- 1 L,(o $- Z�Y3 - l6 '- iZ`G� -LI O LOx'T �,�?C,RD St f `x "'ail s r. CQ'ent 124 °" a; J ia7 n r —, J: �, _ I ��a 2 13 .20 7OB S — STf1TE L � ,:11 '.� '�CCt1&F�ttP.�10E `� k_�� e�1 ac R f -- mss �ze.R 1��- �i►e>aev- v� OFFICE COP'{ I i DEVELOPMENT DEPARTM t -Jn''.DiI.G0IViSION- CUPEFLjj(y0 P_f PS®VCD is s snd specifications MUST be kept at the of struction. It is unlawful to make any alterations on same, or to devi 6 out approval from the Building cial. this plan and specifications SH NOT nit or to be an approval of the vio on of a. q provisions of any City Ordinance or Stal aw. SY VI 4 ^r PERMIT NO. AH 17