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15070012-DP pub1158 ELMSFORD DR 15070012 F/P GHISELLI DAVID AND RUTH A SCANNED BOX #663 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1158 ELMSFORD DR CONT�,�CT1©S �F �U�� PERMIT NO: 15070012 OWNER'S NAME: OHISELLI DAVID AND RUTH A SStU1JJ//iY�t11 11CD7�� 11 F DATE ISSUED: 07/02/2015 OWNER'S PHONE: 4082554572 PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ RELOCATE/REMODEL (E) MASTER BATH (101 S.F.) License Class Lie. #dREPLACE 3 (E) WINDOWS & 2 (E) DOORS. ADD (N) ATTIC pr� i) 2�Si y1Gf FAN, UPGRADE ELECTRICAL LIGHT FIXTURES (21), Confracto'b 0(yll7s ,V f' Date —7/ 7—/ 1.S I hereby affirm that I am licen d under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in fall 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: $15000 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: 36209013.00 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 WPIW IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 D u 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 1$0 ALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of t 2 /� granting of this permit. Additi ally, the applicant understands and wil a Da with all non-poin source re7aurthe Cupertino Municipal Code, Section 9.18. h/ 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 DECLARATION : I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of ApplicantDate: 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 (See.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 tinder penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safely 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, Secti u 2550- rL55 'mW 25534. Section 3700 of the Labor Code, for the performance of the work for which this .b—'� Owner or authorized agent: Datr. 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 leading agency for the performance of forthwith comply with such provisions or this permit shalt be deemed revoked, work's for which this permit is issued (See. 3097, Civ C.) Lender's Nmme 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, mid hereby authorize representatives of this city to enter upon the above mentioned properly for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the 1 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 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina(G cupertino.orq ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION ITI I ?U ❑ REVISION / DEFERRED ORIGINAL PERMIT N PROJECT ADDRESS//_,g � Vl \� APN # furl- OWNERNAME 1S 11 P � "Yr,+'1 ONE^ F.MAM /fry r' py STREET ADDRESS// 7D gll-f S� CW-V t � CITY, STATE,ZIP q5nk,4 CONTACTNAME ���[�f1G�6-i �O� . Y 'Fr PHONEI�01.n%;%-C-7`/Y� 6` / � STREETADDRESN CITY, STATE, ZIP 0C FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT 4ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAML- -P • ; A i LICENSE NUMBER LICENSE TYPE BUS. LIC # ...autos Vv COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/F.NGINHER NAME LICENSENUMBER G-3 ( ` A. BUS. LIC N COMPANY NAO E-MAIL �✓�!+ FAX Of STREET ADORE, S CITY, STATE ZIP DESCRIPTION OF WORK okYP 6 C 6 N w�ac-u� gym. Kirrboars 5y5T. Fc� s�o�c �`4 d ' IS'H]ROUSE PROPOSED USE CONSTR. TYPE #STORIES ,y ,�5 s p� V USE TYPE OCC. SQTT. VALUATION ($) EXIS'G 'I AREA NEWFLOOR AREA DEMO AREA TOTAL NETAAEAdD BATHILOOM KITCHEN OTHER REMODELAREA 10[5r REMODEL AREA REMODELAREA 1� 51= PORCH AREA DECK AREA TOTALDECKMORCHAREA GARAGEAREA: DETACH ❑ATTACH # DWELLING UNITS: ISASECONUUPn'r OYES SECOND STORY ❑YES MUNCADDED't ADDITIOM! NU PRE-APPGAPPL# QNO IF PLANNING OVIDE OVAL LETTER PLAN INGA'ITON []YES IPVEN,PROVIOR APPROVAL LE ISTHEBLUC EICULERRO TOT.AL.VALUATION: ,m Y VA _ ©©o By my signature below, I certify to each of the fallowing: I mn the property own r amho gent to ct on the propel owner's behalf I ha ead this application and the information I have provi d is co reek I have read dte Description of Work an verify It is acc.Rate. gree to comply with all applicable local ordinances and state laws relating to i n. I authorize representatives of Cupertino to out r the abov dentified property for inspection purposes. Signature of ApplicanUAgent; Date: SUPPLEMENTAL P RMA ION REQUIRED PLAN CnECKTYPE ROUTING SLIP.. ❑ OVER-THE-COUNTER ❑ BUI.DINGPL.ANREYIEW _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNINGPL.ANREV1Ew _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD ❑ PUBLIC W ORKs form if any Hazardous Materials arc being used as part of this project. ❑ ❑ LARGE FIRE Derr _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ NLA.IOR R ❑s.4NITARy SEWER DISTRICT submittal of Building Permit application. El ENVIRONMENTAL HEALTH- BldgApp_201Ldoc revised 06121111 CITY OF CUPERTINO WI/II FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 1158 ELSFORD DR DATE: 07/01/2015 REVIEWED BY: MELISSA APN: 362 09 013 BP#: Zs I -VALUATION: $15,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: p PENTAMATION 1 R3SFDRE PERMIT TYPE: wom RELOCATE/REMODEL E MASTER BATH 101 S.F.. REPLACE 3 E WINDOWS. ADD N ATTIC SCOPE FAN. UPGRADE ELECTRICAL LIGHT FIXTURES (21), OUTLETS (9) & SWITCHES (10). REPLACE p Mech. Plan Check 0.0 1 hrs $0.00 11hewb. I'larr 01(', 4 Elec, Plan Check 0.0 1 hrs $0.00 Mech. Permit Fee: IMPERMIT Plumh, Pennil Fee: Elec. Permit Fee: IEPERMIT Other Mech. Insp. 0.0 hrs $48.00 other t'lumh Insp Other Elec. Insp. 0.0 hrs $48.00 Meek. Insp_ tree: Phanh. Insp, Fee: Dec. Insp, P'ee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the nreliminary information available and are on1V an estimate. Contact the Dept for atldn'l info. FEE ITEMS /Fee Resolution 11-053 E .' 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F 101 Is.f. $645.00 Remodel, Bath (<=300 sf) IREMRESaAT Suppl. PC Fee: (2) Reg. 0 OT FO.0 hrs $0.00 PME Plan Check: $0.00 5 # $431.00 Window / Sliding Glass Door t wIAIREP Replacement Permit Fee: $0.00 Suppl. Insp. Feel@ Reg. ® OT 1 0.0 hrs $0.00 = # Mechanical $25.00 1RREMVENF Ventilation Fan PME Unit Fee: $0.00 PME Permit Fee: $96.00 = # Electrical $48.00 IRREMRECEP Recep/Switch/Outlets Construction Tax: LA Administrative Fee: IADMIN $45.00 21 # $78.00 Electrical 1 1BREd4FJXT Fixtures, Lighting Work Without Permit? ® Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure i Travel Documentation Fee: TRAVDOC $48.00 Strong -Motion Fee: IBSEISMICR $1.95 Select an Administrative Item Bldg Stds Commission Fee: IrtCBSC $1.00 SUBTOTALS: $191.95 $1,227.00 TOTAL FEE:_' $1,418.95 Revised: 05/0712015 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 0 Telephone: 408-777-322 8 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS;950J4 PERMIT # (S`_D -70 O / Z OWNER'S NAME; ®0}i/19�'(ZUr E`,pfrS GL. GENERAL CONTRACTOR: 6A(Z&40-'; W46NI,= W PHONE # % - S f3 BUSINESS LICENSE # ADDRESS: r C 1 CITY/ZIPCODE: ! icgV?'yU(d&,) Arn_ *Our municipal code requires all`busine4ses 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 CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date UBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork "Z- ement Finishing Electrical TO 5 i-/-7& I G, Excavation C14-�- encing All& Flooring / Carpeting U , /o . Z1G0 7 9 moleum / Wood e4 . - -•---a - �� Glass azing 'a u / kat 3(p [ �. Heating l iCl� srz- Insulation () Landscaping Lathing Masonry 5 j ()(J 50LL) F1 dl"j �,3 10 P 'nting / Wallpaper aving--- lastering e lumbing �C�( �L1G. PTV �f vl al 1-7go Roofing S ptic Tank Sheet Metal .10 YlY r" 6 eet Rock Tile V. T l j Vt R MLV,, I -CW, 4� 5$7,1 / Contractor Signature le L5'115 Date