12060113 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22620 RICARDO RD CONTRACTOR:DAVID&LOUISE SCHIE PERMIT NO: 12060113
OWNER'S NAME: DAVID&LOUISE SCHIE 22620 RICARDO RD DATE ISSUED:06119/2012
OWNER'S PHONE: 4085646833 CUPERTINO,CA 95014 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r
License Class Lic.N r r r
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that 1 am licensed under the provisions of Chapler 9 JOB DESCRIPTION: BATIIROOM/BEDROOM REMODEL 144 SOFT
(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 penally 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
permit is issued. APN Number:35601055.00 Occupancy Type:
APPLICANT CERTIFICATION
I ecnify that I have read this application and stale 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 properly 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, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply C
with all non-point source regulations per the Cupertino Municipal Code,Section Issued by: —J lnr Date: -(q./a,
9,18.
Signature Date
RF:ROOFS:
OWNER-BUILDER DECLARATION J All roofs shall be inspected prior to any roofing material berg installed If a roof is
installed without first obtaining an inspection.I agree to remove all new materials for
1 hereby affirm that I am exempt from the Conlraclor's License Law for one of inspection.
the following two reasons:
1,as owner ollhe property,or my employees with wages as their sole compensation. Signature of Applicant: Date:
will do the work,and the struclure is not intended or offered for sale(Sce.7044,
Business&Professions Code)
1,as owner of the properly,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: 1 have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Ccrtificalc of Consent to self-insure for Worker's California Ileallh&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Cade.Chapter 9.12 and the Health&
performance of the work for which this permit is issued. 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 1 will
permit is issued. maim n mpliance with the Cupertino Municipal Code,Chapter 9.12 and the
Ileell & afety Cnde,. lions 25505,255}},and 255}4.
1 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 OwnGuth ized a 1
Compensation laws of California. If,after making this certificate of exemption,l IJ 0Date:
become subject to the Worker's Compensation provisions of the Labor Code,I must
406
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and stale that the above information is Lender's Name
cored. 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 Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
indemnity and keep harmless the City of Cupertino against liabilities,judgments, ARCIIITF.CT'S DECLARATION
costs,and expenses w t may,accrue against said City in consequence of the
granting of this permit.A dilionally,the adNicant understands and will comply I understand my plans shall be used as public records.
with all no point smite regulations per 1 e ' rine Municipal Code,Section
9.18. / Licensed Professional
Signature Dale-��
a LoUi'se ciod 61d Scke PIFIcF�gv�
JUN 19 2012
Al Pardo Rd, Com, peri ro
1 BY:
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COMMUNITY DEVELOPMENT DEPARTMENT
I �J BUILDING DIVISION-CUPERTINO
APPROVED
This set of plans and specifications MUST be kept at the
O Job site Buri co�n!st' ction. It is unlawful to make any
I \ 8 change C r (biSjyd� —gins,or to deviate
-,zi — — therefrom, out approval from the Building Official.
w\ cp The stamping of this plan and specifications SHALL NOT
be held to permit or to be an approval of the violation
V �'hof any provisions of any City Ordinance or State Law.Poorn
113Y- /F.qn/ HAT/
DATE
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CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333 •building4cuoertino.oro
❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/Ti ❑ REVISION EUE LD ORIGA'AL PER.WT tt
PROIELT ADDRESS a / / m 71N -166
1J/ ` / -
OWNERNAME PHONE' ,, E-MAIL
e d d P o _ 56e j �ou(ses co)�cas�'.
STREETADDRESS / )�� ca c/c /I OTY, Tot FAx _
CONTACT NAME (G L U I J / PHONE (9; 6/f/- lb� E-MAIL I O LA j4rz c� a lcyn
q e �
STREET ADDRESS CITY,STATE, ZIP FAX (
❑ OwIrER 9OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGWEER CI DEVELOPER ❑TzNU
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE Bus.UC 0
COWANY NAME E-MAIL FAX
STREET ADDRESS CITY.STATE,ZIP PHONE
ARCHTTECTIENGPIEER NAME _ / UCENSENUMBER BUS.LIC 0
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK �Q-
EXISTING USE PROPOSED USE CONSTR.TYPE RSTORIES
USE TYPE OCC. JS/QQ..FFT..J VALUATION(S)
ATG/ ✓� RFEAnGDR/ AREA / NE'r�iAEA '; -3
BATHROOM K CHEM arm /
REMODELAREA /�� REMODEIAREA / REMODEI.AREA
PORCHAREA I DECKAREA TOTALDECK ORCHAREI GARAGE AREA. DETACH
ATTACH
0 DWELL G UNM1 ISASECOND UNTf YES SECONDS TRY [3 YES
/ BEN''AIMI bINO ADDITION? )4NO
PRE-APPLICATION CITES I'YES,PROVIDE COPYOF IS TBE BLDG AN l'❑YES RECEIVED BY: TOTAL VALUATION:
PLANNNGMPLO �'Ij NO PLMMP'G APPROVAL LETTER EICHLER HOME' AND
By my signature below,I certify to eacht dte following: I am the pr erty owner or authorized agent to act on the prpperty owner's behalf. I have read this
application and the informadon I have p d is correct I have e D caption of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bu' g construction. I autho ntarives of Cupertino to enter the above-idea;fled perry for inspection purposes.
Signature of Applicant/Agent Daze: '
SUPPLEMENT ORMATION REQUIRED PLIN CRECK TYPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for OVER-THE-COUNTER yy BUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ ExPRFss ❑ PLANNING PLAN REVDEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS
Tom if any Hazardous Materials are being used as part of this project.
❑ LARGE ❑ FItE DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVDtONMENT.AL Trv.r TH
31dgApp_2011.doc revised 06121111