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B-2017-0113CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PEPMIT NO: B-2017-0113 19479 ROSEMARIE PL APT I CUPERTINO, CA 95014-3452 (375 01007) MIDGLEN STUDIO 1 ASSOCIATES WOODSIDE, CA 94062 OWNER'S NAME: COHEN DAVID NAND WEISS CONSTANCE U ET AL DATE 1 ISSUED: 01/23/2017 OWNER'S PHONE: 650-766-9160 PHONE NO: (650) 366-0314 LWENSED ONT A TDR'S DECLARATION BUILDING PERMIT INFO,: License Class B Lic. #531113 { Contractor MIDGi_EN STUDIO ASSOCIATES Date 05/31/2018 X BLDG ,_ ELECT_ PLUMB MECH RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing Y _ with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. JOB DESCRIPTION: Unit #1 - 2ND FLOOR BA'IHK00M REMODEL - MASTER AND I hereby affirm under penalty of perjury one of the following two declarations: HALLWAY BATHROOMS , 1. 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 perrfarmancc 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 Sq. Ft Floor Area:, Valuation: $15000.00 permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above APN Number: Occup ncy Type: information is correct. I agree to compiywith all city and county ordinances and state laws relating to building construction, and hereby authorize 375 01007 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 PERMIT EXPIRES', IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. 180 DAYS: OF PERMIT ISSUANCE OR Additionally, the applicant understands and will comply with all non -point WITHIN source regulations per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. Signalure Date 13/2 /2017 Issued by: AbbyA egnde DE ARATION Date: 01/23/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the I11 RE -ROOF'S: following two reasons: 1. I, as owner of the property, or my employees with wages as their sole All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining anlinspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. { sale (See.7044, Business & Professions Code)' 2. 1, as owner of the property, am exclusively contracting with licensed Signature ofAppticant: contractors to construct the project (Sce.7044, Business & Professions Code). Date: 1/23/2017 I, I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 1. 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the permit is issued. s. 1 certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section' 25532(a) should I store or handle hazardous use material. Additionally, should I equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sectio 05, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall _ I be deemed revoked. Owner or authorized agent: APPLICANT CERTIFICATION u Date: 1123/2017 I certify that I have read this application and state that the above information is CONSTR CTI ENDING: AGENCY I hereby affirm that there is a cok4truction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sea 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, -costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands A CHITFCT'S DECLARATION and will comply with all non -point source regulations per the Cupertino Municipal 1 understand my plans shall be used as public records. Code, Section 9.18. i Licensed Signature Date 1/23/2017 professional i _ul4o ❑ NEW CONSTRUCTION o10 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION; 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - buildinqCcD_cupertino.org El ADDITION EIALTERATION /Tl El REVISION 1 DEFERRED ORIGINAL PERMIT # I CL1411191 PROJECT ADDRESS I&M Rosemarie Place, Unit #1 AP"" 375-01-007 OWNER NAME David Cohen PHONE 650-766-9160 E-MAIL 1 � STREET ADDRESS 460 Fairfax Ave CITY, STATE, ZIP San Mateo, Ca 94402 FAX CONTACT NAME V PHON -5(el414 60 -0 E-MAIL,, %Ae Pt I brg tow. 11,k C o STREETADDRESSe �®P4 ®,j�G%°-'� f CITY, ZIP El OWNER 1:1 OWNER -BUILDER 0 OWNER AGENT a'CONTRACTOR 11 CONTRACTOR AGENT B--AR�C[­JJTECT 0 ENGINEER 11 DEVELOPER 11 TENANT CONTRACTOR NAME, 1 LICENSE NUMBER 531113 B LICENSE TYPE BUS. LIC 4 L-11 COMPANY NAME The Midglen Studio Assoc E-MAILX7 . Rr cin FAX STREET ADDRESS 831 Midglen Way - CITY, STATE, ZIP 1PHONE Woodside, Ca 94062 650-369-0416 ARCHITECT/ENGINEER NAME I LICENSE NUMBER - BUS. LIC 9 A. Stevan Patrick C-17920 - — — COMPANY NAME The Midglen Studio - E-MAIL steve@midgien.com FAX STREET ADDRESS 831 Midglen Way CITY, STATE, ZIP Woodside, Ca 94062 PHONE T 650-369-0314 DESCRIPTION OF WORK Remodel two upstairs bathrooms, including new fixtures, finshes and lighting. EXISTINGUSE PROPOSEDUSE CONSTR TYPE #STORIES USE TYPE OCC. SQFT. VALUATION ($) Residential Residential 5 2 EXIST 1DARERAREAL I NET AREA 1,300 BATHROOM KITCHEN OTHER REMODEL AREA 122 sfl REMODEL AREA REMODEL AREA 0 PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGE AREA: 171DETACH 0 ATTACH A DWELLNG UNITS 11 A SECOND iFrr OyEs SECONDSTORYRY EYES BEING ADDED?[]NO ADDITION? []NO PRF -APPLICATION []YES IF YES, PROVIDE COPY OF IS THE ULDG AN [I YESr CEI.VED BY: TOTAL VALUATION: PLANNG ADPL 9 []NO PLANNING APPROVAL LETTER IN EICHLERHOAR? [] NO t I � By my signature below, I certify to each of the following: I am the property owner or authorized agent to aA on the p6perty 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 relating to bui4dingODSIftreTion. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. P?s Signature of Applicant/Ag Date: SUPPLEMENTAL IKFTION RFQUIRED PLAN CHECK TYPE I ROUTING SLIP El OVER-THE-COUNTER E7"DIJILDING PLAN RI VIEWCkMW —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. n Exppxss ❑ PLANNI.NG PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ 'STANDARD 0 OUBLIC WORKS form if any Hazardous Materials are being used as part of this project. 171 LARGE 0 FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to 0 MAJOR©SANITARY SEWER DISTRICT submittal of Building Permit application. I II I I LE❑ENVIRONMENTAL HEALTH BldgApp_2011,doc revised 06121111 CUPERTINO SANITARY DISTRICT 20863 Stevens Creek Blvd #100, Cupertino, CA 95014 Tel (408) 253-7071 - Fax (408) 253-5173 15� CUPERTINO Cupertino Sanitary District has adopted Resolution No. 1263. Building Permit Request (Over -the -Counter) ❑ Single Family Project Vej'Multi-Family Project ❑ Commercial Project Project Address: Permit Number: Scope ofWork: LDC4%,V1,A ffOAMCA Owner/Applicant Name: ge-TA Phone: Date: IT?) Prepared By: 0*A C6VVU-- City A6thorized Representative 1, as property owner or authorized agent, acknowledge that all Cupertino Sanitary District requirements will be met and all required fees will be paid prior to the approval of final inspection for proposed project. /.? Date: x,/17 Signature: Owner I Authorized Agent CUPERTINO SANITARY DISTRICT OFFICE USE ONLY F-1 Pre -inspection Require o .0/Final Inspection Required Date Scheduled: L'K District will notify owner of the required fee within 5 days after Pre -inspection has been completed and cc City of Cupertino .inspection Fee Paid Date Paid: 1-2-3 -17 Connection Permit Fees: F -I $350/unit - Single Family Residential connecting to existing late ral (CCTV & inspection included) ❑ $650/unit - Single Family Residential connecting with,new lateral (CCTV & inspection included) F-1 $100/unit up to 4 units & $65 above 5 - Housing (Multiple, hotel, condo, living units, etc.) $500/connection - Commercial & Retail (Permit only. CCTV and inspection not included) F-1 $200/each — Disconnect Permit Inspection Fees: $250/unit - Single Family Residential already connected, but new cleanout required (CCTV & inspection included) $150/unit - Single Residential already connected w cleanout (CCTV & inspection included) Date: 17 Prepared By: --- ,/Authorized - epresIntative Cupertino, nit District