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10110123 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10332 STERLING BLVD CONTRACTOR:BATH FITTER PERMIT NO: 10110123 NORTHERN CALIFORNIA VNER'S NAME: AUDREY ALLEN 2118 ZANKER RD DATE ISSUED: 11/18/2010 OWNER'S PHONE: 4082196950 SAN JOSE,CA 95133 PHONE NO:(408)834-1111 ❑ LICENSED CONTRACTOR'S DECLARATION1— BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# MECH RESIDENTIAL COMMERCIAL Contractor Date JOB DESCRIPTION:CHANGE WATER PIPES TO COPPER REMODEL BATHROOM I hereby affirm that I am licensed under the provisions of Chapter 9 INCLUDING SHOWER (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:$7800 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 APN Number:37524014.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 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 DAYS FROM LAST CALLED 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 Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: .nature 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 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) I,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,Sect' s 5505,25533,and 25534. Section 3700 of the Labor Code,for die 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 building construction,and hereby authorize representatives of this city to enter .)n 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-poin ource regulations per the Cupertino Municipal Code,Section Licensed Professional Sign Signature Date � � CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 10332 Sterling DATE: 11/18/2010 REVIEWED BY: jsg APN: BP#: D1 00 *VALUATION: 1$7,800 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Remodel, Bath (300 s.f. max) PRIMARYR@Sldentlal 01 tt. PENTAMATION 1R3SFDREM USE: t , (h ,f�f. f: PERMIT TYPE: t WORK Change water heater pipes to copper, remodel bathroom including shower SCOPE FEE ID FLR AREA s.f. 1REMRESBAT 50 F tier lc'I ifi.'S r< it' f) f�r !.r i . Li NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 09-051 Ej'. 7"1:70) FEE QTY/FEE MISC ITEMS Ploll (.'Ir Fec .511)111. PC 1-C, f'Izrrnh. _1h`t�'z.:�Zlc'cP/oll C.`hcci- Permit Fee: $570.00 Sa1p111. 111sp Fee f'Iurnh.:_1'tct`1z.:1_Icc t%'jl /'lttrnf7.;_l't��t'It.;I:l<c 1'c�rrrlit 1'cc; C'otz.o—liction 7'ax ,1cousticol Rcvici lc:e: Work Without Permit? Yes No $0.00 1'hlt7l1itr11Q- VC-CA ''hiT<1rcr1lkx�rltl,c°tticll;r>rr f'cc�: Strong Motion Fee: 1BSEISMICR $0.78 Select an Administrative It rr�► Bldg Stds Commission Fee: IBCBSC $1.00 1 SUBTOTALS: $571.78 $0.00 TOTAL FEE: 1.78 Revised: 11/08/2010 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 37524014 . 00 DATE ISSUED. . . . . . . : 11/18/2010 RECEIPT #. . . . . . . . . BS000012042 REFERENCE ID # . . . : 10110123 SITE ADDRESS . . . . . : 10332 STERLING BLVD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER AUDREY ALLEN ADDRESS 10332 STERLING BLVD. CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : DONNA BAER CONTRACTOR BATH FITTER NORTHERN CALIFORNI LIC # 31358 COMPANY . . . . . . . . . . : BATH FITTER NORTHERN CALIFORNI ADDRESS 2118 ZANKER RD CITY/STATE/ZIP . . . : SAN JOSE, CA 95133 TELEPHONE . . . . . . . . : (408) 834-1111 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 7, 800 . 00 1 . 00 0 . 00 1 . 00 0 .00 1BSEISMICR VALUATION 7, 800 . 00 0 .78 0 . 00 0 .78 0 .00 1REMRESBAT SQ FEET 50 . 00 1140 . 00 0 . 00 1140 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 1141 .78 0 .00 1141 .78 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 1, 141.78 430 --------------- TOTAL RECEIPT 1, 141 .78 CITY OF CUPERTINO ADDITION/REMODEL 1011 D/-�-' GUPERTINO FEE SCHEDULE OWN APN# 3 75 02Al 0/ Date: Is a 2nd unit being added? YesEplfio ❑ If yes, please fill out the permit application for 2nd unit. Building Address: -09.3.9 Mailing Address (if different from building address): Owner's Name: Phone# Contractor: Phone#: l �0 / 77"e-l� ,o, G,L i t-- Fax#: p u erti o Business License: State Contractor License#: Contact:� CD3_ ��Q /� Phone#:R"/e/�� Fax#: Landscape Ordinance Compliance: Landscape area in sq. ft. (includes all irrigated areas): If 2,500 sq. ft. or less, compliance with the Landscape Water-Efficiency Checklist is required. If more than 2,500 sq. ft., a complete Landscape Project Submittal is required. ---Compliance Method: ❑ Plant Type ❑ Water Budget Building Permit Info: Bld . ❑ Elect. ❑ Plumb. ❑ Mech. ❑ Hillside ❑ Job Description: Addition-What is being added?(Be Specific): What is being remodeled (not including addition)? Remodel Includes Re-Roof: Yes ❑ No 6T-1-)'f yes list number of squares Remodel Includes Structural: Yes ❑ No ©--" Do you have the pre-application planning approval? Yes ❑ No ❑ If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck:/ Garage: Detached Attached Remodel: Kitchen Bath / Other Type of Construction (Usage Class): Occupancy Type:, 1-A, 1-B ❑ ILIII V-A ❑ lI/III B, IV-HT, V-B ❑ Valuation: , Please check this bog if the project is a In sts,ro'ect Size: Ex ress ❑ Standard El Large ❑ Major ❑ second-story addition ❑ Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, Green Building Points Achieved: include in plan set& the sheet index. Revised 05/18/10