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11050167 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7439 HEATHERWOOD DR CONTRACTOR PERMIT NO: 11050167 OWNER'S NAME: KENNEDY YVONNE O TRUSTEE ��../�1�� C` DATE ISSUED:05/20/2011 O°"ER'S PHONE: 4082538304 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATIONr BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lic.# `SZ MECH RESIDENTIAL COMMERCIAL Contractor / iG�C�tLf Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:BATHROOM FLOOR WATER DAMAGE DRYROT,NO (commencing with Section 7000)of Division 3 of the Business&Professions PLUMBING, Code and that my license is in full force and effect. NO MECHANICAL&N O ELECTRICAL 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 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1500 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:35926046.00 Occupancy Type: 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. / Signature ��G Date ' Issued b Date.-J-- OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. 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. Owner or authorized agent: p y p p Date: �Z APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, and expenses which may accrue against said City in consequence of the Lender's Address ng of this permit.Additionally,the applicant understands and will comply witn all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 4 ITEMS OF 5 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35926046. 00 DATE ISSUED. . . . . . . : 05/20/2011 RECEIPT #• • • • . • • • • : BS000013516 REFERENCE ID # . . . : 11050167 SITE ADDRESS . . . . . : 7439 HEATHERWOOD DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : KENNEDY YVONNE O TRUSTEE ADDRESS . . . . . . . . . . : 7439 HEATHERWOOD DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5823 RECEIVED FROM . . . . : DAI-ICHI ENTERPRISE CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- -ADMIN HOURS 0 .50 39. 00 0. 00 39.00 0. 00 1BCBSC VALUATION 1, 500 . 00 1. 00 0. 00 1. 00 0. 00 1BSEISMICR VALUATION 1, 500 .00 0 .50 0 . 00 0.50 0. 00 1INSPMIS HOURS 1 .00 126 . 00 0 . 00 126 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 166. 50 0. 00 166 .50 0. 00 // 0�5 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)77 3333•building a cugertino.org CMPERTINO ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS Q1,. APN# OWNERNAME �Cy) / PHOT-5-3- E-MAIL STREET ADDRESS v CITY, STATE,ZIP / FAX CONTACT NAME /'2 PH O �jt�Z-' E Cie 1/2:;b ,1 +- STREET ADDRESS / �J A CITY,STATE, ZIP`, _ — C 5 FAX ❑ OWNER ❑ OWNER-BUILDER 1:1!0 uWNERAGENT /❑COCONTRACTOR ❑CONTRACrORAGENr ❑L ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME`= LI� �_ LICENYPE BUS.LIC# t� COMPANY NAME E-MAIL FAX STREET ADDRESS / Z = CITY,STATE,ZIPG�S,/L ' PHONE �y ARCHTTECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMP ANY NAME -E-MAIL FAX STREET ADDRESS — CITY,STATE,ZIP PHONE DESCRIPTION OF WORK EXISTINGUSE PROPOSED LSE CONSTR.TYPE #STORIES < " w EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER ,$ REMODEL AREA REMODEL AREA REMODEL AREA wig In�k mk PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA:❑ DETACH ❑ ATTACH ,: N DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES HEINC ADDED? ❑NO ADDITION? ❑NOOR ,:: 21 PRE-APPLICATION ❑ YES IF YES.PROVIDE COPY OF PLANNER'S NAME: jGEy - . PLANNING APPL N NO PLANNING APPROVAL LEITER By y signature certify g property owner or authorized agent to act on the property owner's behal . I have read this B m si afore below,I certi to each of the following: I am the ro 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 building construction. I authorize representatives of Cupertino to enter the above identified property for inspection purposes. Signature of Applicant1Agent: &L Date: 'S ��` ' �� 04 3aa SUPPLEMENTAL INFORMATION REQUIRED . ..6 New SFD or Multifamily dwellings: Apply for demolition permit for M existing building(s). Demolition permit is required prior to issuance ofbuilding ` j{ � permit for new building. b � _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure �� tbeRD pV4rE3 form if any Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with Planning Prior to C� n�J'ox•w� submittal of Building Permit application. _ 3� $ s r BldgApp 2011.doc revised 03/16/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 7439 heather wood dr. DATE: 05/20/2011 REVIEWED BY: bobs. APN: BP#: ''VALUATION: 1$1,500 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY SFD or Duplex PENTAMATION USE: PERMIT TYPE: WORK re air bathroom floor due to water damage and dryrot. SCOPE Li NOTE. These ees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS (Fee Resolution 09-05I I:ff. ' .-"10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure Suppl.PC Fee: G Reg. 0 OT 0.0 hrs $0.00 or Element of a Building PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp.FeeO Reg. 0 OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 F Acoustical Fee: 0 Yes 0 No $0.00 0 Work Without Permit? 0 Yes 0 No $0.00 0 Planning_Fee: $0.00 1 hours Inspections,Hourly 0 $126.00 IINSPMIS Standard Inspections Stron:Motion Fee: IBSEISMICR $0.50 0.5 hrs Admin./Clerical Fee Bldg Stds Commission Fee: IBCBSC $1.00 $39.00 ]ADMIN SUBTOTALS: $1.50 $165.00 TOTAL FEE: $166.50 Revised: 04/29/2011 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# '- OWNER'S NAME: !ro-.ice/` ,, PHONE# GENERAL CONTRACTOR: �l ��'-'c.�,r, BUSINESS LICENSE# ADDRESS: /3—'- Io•t�.c f1✓ -5�-1'-1`'�/�Z CITY/ZIPCODE: *Our municipal code requires all businesses 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 Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum /Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting /Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date