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10040086 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10062 SCENIC BLVD CONTRACTOR:AMERICAN KITCHEN& PERMIT NO: 10040086 BATH 'BIER'S NAME: NADINE CARLTON 1758 JUNCTION AVE UNIT D DATE ISSUED:04/13/2010 OWNER'S PHONE: 4088651136 SAN JOSE,CA 95112 PHONE NO:(408)436-8151 ,- LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT r— PLUMB License Class TJ Lic.# 5�3� MECH f— RESIDENTIAL f— COMMERCIAL Contractor f�S{'�`�� (%C'r Lt�/ te O JOB DESCRIPTION:REMODEL 2 BATHROOM(133SQ),NON-STRUCTURAL;NO I hereby affirm that I am licensed under the provisions of Chapter 9 RE-ROOF&NO STRUCTURAL (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:$23600 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35709041.00 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 PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Date: 9.18. n Issued bF"Y� ature Date Z v RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is I 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. 1,as owner of the property,or my employees with wages as their sole compensation, Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). 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& Safety Code,Section 25532(a)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this 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 er r a thoriz a Date: become subject to the Worker's Compensation provisions of the Labor Code,I must 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.I 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 'he above mentioned property for inspection purposes.(We)agree to save Lender's Address mify 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 Cupertino Municipal ode,Section I understand my plans shall be used as public records. 9.18. �' Licensed Professional Signature Date � r C CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 3 ITEMS OF 3 COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35709041. 00 DATE ISSUED. • • • • • • : 04/13/201 BSOOOO10104 RECEIPT # . . . . . . • . . : 10040086 REFERENCE ID # • • • SITE ADDRESS 10062 SCENIC BLVD SUBDIVISION • • • . . CUPERTINO CITY . . . . . . . . . . . . IMPACT AREA . . . . . . OWNER NADINE CARLTON ADDRESS . . . . . . . . . . : 10062 SCENIC BLVD CITY/STATE/ZIP CUPERTINO, CA 95014 RECEIVED FROM AMERICAN KITCHEN&BA CONTRACTOR WARTENBERGH, JOE LIC # 21316 COMPANY AMERICAN KITCHEN & BATH ADDRESS 1758 JUNCTION AVE UNIT D CITY/STATE/ZIP SAN JOSE, CA 95112 TELEPHONE (408)436-8151 UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL FEE ID --- ------ ---------- ---------- _ ---------- 0 . 00 ------------- 0 . 00 1 . 00 1 . 00 1BCBSC VALUATION 23, 600 .00 0 . 00 2 .40 0 . 00 240 1BSEISMICR VALUATION 23, 600 .00 0 .00 570 . 00 0 . 00 1REMRESBAT SQ FEET 133 . 00 570 . 00 -_--_--___ ____ ---------- 0 . 00 573 .40 0 .00 573 .40 TOTAL PERMIT REFERENCE NUMBER AMOUNT METHOD OF PAYMENT -- ----------------- - -------------- --------------- CHECK 573 .40 #17447 --------------- TOTAL RECEIPT 573 .40 CITY OF CUPERTINO A ADDITION/REMODEL CUPEi�TINO PERMIT APPLICATION FORM APN # i L' Date: L D f . � 1� Is a 2" unit being added? Yes ❑ No ❑ If yes, please fill out th pe 't application for 2" unit. Building Address: ;(AJ 0 64, Mailing Address (if different from building address): Ow pr's Name: P one# Contractor: Phone#: X09 -g/S Contractor License#: Cupertino Business License#: 4 / f r p Contact: Phone#� �� Z•13�v �dl� � ("f/f� /� �f)A� 1197`��-T� Fax#: r r h Building Permit Info: Hillside Bldg. Elect. Plumb. Mech. ❑ ❑ [I Job Description: Addition-What is being added?(Be Specific): What is being remodeled (not including addition)? d u( Remodel Includes Re-Roof. Yes ❑ No [ If 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- "o ttached" l fi�� Remodel: Kitchen Bath 4: > f ._ Other Type of Construction (Usage Class): Occupancy Type: _A II/III B, IV-HT,V-B e �!3 1-A, 1-B II/III/V-A ❑ Valuation �� (a pct Please check this box if the protect is a second-story addition ❑ Project Size: Express [ tandard ❑ Large ❑ Ma or El Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, Green Building Points Achieve��\ include in lan set& the sheet index. ***For Office Use Only*** Revised 07/06/09 Over-the-Counter ❑ CITY OF CUPERTINO SM' ADDITION/REMODEL CUPEkTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft ADDITIONS 1R3SFDADD 1PLLONGRNGR Long Range PL Planning/Residential 1R31NSP Dwellings Inspections B 1R3PLNCK Dwellings plan check B 1 R3REPINSP Dwellings Repeat B Inspection 1R3REPPLNC Dwellings Repeat Plan B Check 1 R3HINSP Dwellings Hillside B inspection 1R3HPLNCK Dwellings Hillside plan B check 1R3HREINSP Dwellings Hillside B Repeat Inspection 1 R3HREPLNC Dwellings Hillside B Repeat Plan Check 1R3ALTINSP Dwellings Alternate B Materials Inspection 1R3ALTPLNC Dwellings Alternate B Materials Plan Check 1 PCESS Cesspool P 1PPRSEWG Ea. Private Sewage P Disposal System 1 PRSEWER Sewers P 1BPSPRINK Lawn Sprinkler/Backflow P 1BPWSVCS Main Water Service P 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1 BSEISMICRE SeismicResidential B 1REROOFRES Residential Re-roof Each B 100 SF CITY OF CUPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type S Ft DECKS 1R3SFDADD OR 1R3SFDREM 1DECKWOOD Deck (Wood)-Each B (Each) 1 DECKRAIL Deck Railing-Each B (Each) GARAGES 1R3SFDADD OR DETACHED 1R3SFDREM 1GARDTW<=1K Wood Frame up to B 1,000 SF (each) 1GARDTM<=1K Masonry up to 1,000 SF B (each) 1BCONSTAXR Construction Tax Res (new detached arage) PATIO'S OPEN 1R3SFDADD OR 1R3SFDREM 1PATIOWOOD Wood Frame up to 300 B SF 1PATIOMETAL Metal Frame up to 300 B SF 1PATIOOTHER Other Frame up to 300 SF B PATIO'S CLOSED 1R3SFDADD OR & SUN ROOMS 1R3SFDREM 1PATIOENCLW Enclosed Wood up to 300 B SF 1PATIOENCLM Enclosed Metal up to 300 B SF 1PATIOENCLO Other Enclosed Patio up B to 300 SF 1COVPORCH Porch Covered-Each B (Each) REMODELS 1R3SFDREM IREMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan 300 SF check iREMRESBAT Bath Remodel up to 300 B " SF « :REMREOTH Other Remodel up to 300 B SF V Community Development 10300 Torre Avenue =d Cupertino CA 95014 Telephone(408)777-3228 CIN OF Fax(408)777-3333 XPERTINO BuildingDepartment JOB ADDRESS: PERMIT# l o (e ----2 sCey►i G do( U c7 ( 0 OWNER'S NAME: V AV,,, C7 nJ PHONE #Z{� GENERAL CONTRACTOR: FAX # t- I am not using any subcontractors: �p Signature ate 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 Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date