Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
14090032
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10102 FIRWOOD DR CONTRACTOR:ADVANCED HOME PERMIT NO: 14090032 IMPROVEMENT OWNER'S NAME: DOBASHI ARLEEN A 879 E HAMILTON AVE DATE ISSUED:09/08/2014 OWNER'S PHONE: 4082534224 CAMPBELL,CA 95008 PHONE NO:(408)559-0999 Er__ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL EJ COMMERCIALE] BATHROOM REMODEL 37.5 SQ FT TO INCLUDE M,E,P S License Class`` Lic.# r7 30 y a ContractorAajd 1ePZ) Homr_ _'JIMe. Date C. I hereby affirm that I am licensed under the provisions 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. Sq.Ft Floor Area: Valuation:$19000 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:34233035 00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EWORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 1KODAYSO ERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enterupon the above mentioned property for inspection purposes. (We)agree to save 180 DAYSLAST LLED 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 Issued by: Date: v( 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. (� RE-ROOFS: +h X Signature)! C�.�G.\J Date � J- 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. 1 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 25505,255533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized ageni�, C a nl- Date: R 8l/y 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I 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. 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 — --- ION PERMIT APPLICATION q�J COMMUNITY DEVELOPMENT.DEPARTMENT• BUILDING DIVISION (\ 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 SUPER?It10 ( � ( �408 777-3228• FAX 408 777-3333• buildinoncl Cuoerhno.org 1 ❑NEW CONSTRUCTION ❑ ADDITION ❑ALTERATION/TI ❑ REVISION/DEFERRED (�ORIGINAL PERMIT 4 PROJECT ADDRESS /'.•R woo C %Z)R API1 R OWNERNAME ✓P"&) E-M.AJL ' I HO. � _ a?s3 STRE-ETADDRESS I CITY, STATE,;P I FAX 1 T CONTACT N-,6-VE PHO\7.- E-MAIL STREET ADDRESS CITY,STATE,ZIP I F.AX [3ORq.°ER ❑ Ott '�-BLIIA�t ❑ OWNER AGENT LL�CO IRAC T OR ❑CONTRACTOR AGENT E) ARCIITECT El LT'GD r'�R El DEl cLOPER El TENANT CONTRACT RN 4E LICENSE NUMBER LICENSE TYPE I BUS.LIC CON Al`Y N'AM- E; I FAX N.r i c/hJ, STRE SDDS C- `a 'O koCITY TATE,ZIP �1 I PL109- .,1591 109- .,1C/-,, ARCHTTECCT�GINEER NA.MF I LICENSE NUMBER v s I BUS.LIC C/ COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP I PHONE DESCRIPTION OF V.4T1 i � 1 l EXISTING USE PROPOSED USE CONSTR.TYPE RSTORIES USE TYPE OCC. ( SQ.FT. VPS.UATION(S) EXISTG NEW FLOOR DEMOI TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA rlKtEh4 L AREA REMODEL AREA PORCd AREA DECK AREA • TOTALDECK/PORCH AREA I GARAGE AREA' DETACH []ATTACH ATTACH T DWELLING UNITS: ISA SECOND UNIT ❑ SECOND COND STORY ❑YES BELNGADDED? E)NO ADDITION? ❑NO �iL$r1PPLif TiOh'-0YES—L"�=S S'ROSIDELOPLOF �S THE BLDG A r11 tS y 33�EDB3 c TOTAL VALU.4TI0N: PLAA:I'ING APPL R ❑NO PLANTI1\1G APPROVAL LETTER I EICHLER HOME? ❑NO By my signature below,I certify to each of the following: I am the property owner or authorized a en rty 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 xvith all applicable local ordinances and state laws relating to building constructio . authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: ♦ GLY�t Date: t bo— SUPPLEMENTAL P\TFORMATION REQUIRED "= - CECiZTYPE y _ _,.ROI7TLG�LTPv g=t. _New SFD or Multifamilydwellings: Apply for demolition permit for � PP Y P � «Tl cocmrEx BUu� crL�'. �v 3Y . existing building(s). Demolition permit is required prior to issuance of build' g �, � 0 permit for newbuilding. 3.PREss m _ �Lq�nG�L3RRE[� Si � ,�, z _ R. Commercial BIdgs: Provide a completed Hazardous Materials Disclosure DAKtn40. � usi��3'oRy form if any Hazardous Materials are being used as part of this project. p � W � _ _Copy of Planning Approval Letter or Meeting with PIanning prior to _, fl �- RM E© MIST submittal of Building Permit application. � _ . Bldg,4pp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 10102 firwood dr I DATE: 09/08/2014 REVIEWED BY: Mendez APN: BP#: *VALUATION: 1$19,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: PERMIT TYPE: WORK bathroom remodel 37.5 sq ft to include m e 's SCO PE u A ML F t icc' P On!`hvc%r LF ,tr. P_t•rarit fire: ._.%r. /.� Y�- Other Plum( Trs;n. E3_L_ {>tr,zi' `�c(' Ifni" tl�ca h!sp. i°��<: Pha 0l. hisp. Fee: 1 lee. 112sr.f NOTE.This estimate does not include fees due to other Departments(i.a Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). Theseees are based on the prelimina information available and are onLy an estimate. Contact the Dept/or addn'l info. FEE ITEMS (Fee Resolution 11-053 Ef. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 37 s.£ Remodel,Bath(<=300 sf) Suppl.PC Fee: (j) Reg. ® OT 0.0 hrs $0.00 $645.00 IREMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.(F) Reg. C) OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 77 0 Work Without Permit? ® Yes (F) No $0.00 E) Advanced Planning F ee: $0.00 Select a Non-Residential E) Building or Structure 0 17'tJ3'{'z )ri't??i'fe't21t 17ftY{ fees. � Strom Motion Fee: IBSEISMICR $2.47 Select an Administrative Item BldgStds Commission Fee: IBCBSC $1.00 N' $3.47 $645.00 TONAL FEE: $648.47 Revised: 08/20/2014 ski ;%fe- :FDA /.,)fe /o/oa "f?WoZR . (�/Ac;c)1 nct 1 1+�1-ti D vez A-u�, Cupe-iL. i n o., �- 755 11 - 2;F6 5�� -__ PY . Fr, Co E (wo 1 � 24•• 1511 16 � 7 16 $ noY 1 v i � a M I co d. = N N �w 3 N = _ xF}i VSB24BH-,e3DV1 F334 F",rN yj TOIL.STD tiC.lUDr t� �la-l; 1 snPCif'cationi. i T be kep a the to ' , tr�c.ion. it is t� ,.- l to ma any r BATH.ALC.60-R ,hang,5 r .j :,tions on sarn , or to d�J✓ate W } r therefrom, stn �,' approval fr��muiiding Official. �hP Stampi c'this plan and spe l� y�ons SHA NOT 00 OD kr he held to r .'.•.or be an aprc; I of the via ion = f aryprov i is any City Ordlr£ J e or State Law. BY :1 DATE F i 7, "777777 77S IJ i S CLPERTINO 30 ofilla,nq Depa*nent SEP 0 92(14 5n 75-8- REVIEWED FOR CODVE UMPLIANCE Reviewed By: All dimensions-size designations This is an original design by: Designed:8/4/2014 given are subject to verification on ADVANCED HOME Printed:9/5/2014 job site and adjustment to fit job IMPROVEMENT INC conditions. and must not be released or copied unless applicable fees have been =IW544, paid or job order placed. HOME YMPROYEMENi r)nh.chihrihath0R0414 All Drawing d#: I No Scale.