10120014 .,� CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 910 FORT BAKER DR CONTRACTOR:BEST BETT REMODELING PERMIT NO: 10120014
OWNER'S NAME: ABHAY DUBEY 1455 E FOXWORTHY AVE#214 DATE ISSUED: 12/02/2010
OWNER'S PHONE: 4085079136 SAN JOSE,CA 95118 PHONE NO:(408)230-4457
LV LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT 1- PLUMB F
License Class 13 Lic.# r7 U
MECH RESIDENTIAL COMMERCIAL
Contractor rel —7?---/
I hereby affirm that I am licensed unde a p�sions of Chapter 9 JOB DESCRIPTION:CONVERTING 1/2 BATH TO FULL BATHROOM;
(commencing with Section 7000)of Division 3 of the Business&Professions NON-STRUCTURAL(32SQFI)
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.
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:$8500
permit is issued.
APPLICANT CERTIFICATION APN Number:35611030.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Issued by: -���-- Date: � _ �--tj
Signature Date e 2 2'^l(J
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Signature of Applicant: Date:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. 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&
Safety Code,Section 25532(x)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner or a tl r' --
forthwith comply with such provisions or this permit shall be deemed revoked. Dater
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
c--•5,and expenses which may accrue against said City in consequence of the
ng of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
all non-point source regulations per the Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date Licensed Professional
RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number:
Name of owner. e-
Project address. �0dQ�Gs��LJ✓— �li P
Contact person. �C /14jZI-�,N P ` ne. 46J Ki L
Fax.
Net square footage of lot.
Existing Proposed
Square footage: First floor:
Second floor:
Garage: -- -
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces inside the garage? JN
Is privacy protection planting required for the project? L�--
Build it Green Total Points
On what floor(s) is work being done? 7—'11--7/� 7� fit/
Brief description of work. ('C)�s:�/e TZ K1 �7�y�"`� y �
Code editions:2007 CBC N)2007 CFCN)2007 CMC (3)N)
2007 CPC -N)2007 NEC N)
oiiliZ`4"t
Effective l/1/08 ,
IN A,;f JH(1A'v i .. ITY L
slGrsCt,
(his set of plans _, ;.ms MUS-1
"I Capt c v the;-;t it.,ii h f- and it is
,nlawt )r, :k, ,, i:,, r alterations 'if, -,I lie withOW .. ta, I,,;-.,ssion from
the F idinq UPpao < i (;i r:,f Cupertino.
.,r,! ;pecifications
.,r• Nf r-fit i}r to loe at
ifovisions
Plan Review Process Work Book Page-8-Revised 8/05/08
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CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 910 fort baker dr. DATE: 12/02/2010 REVIEWED BY: bobs.
APN: BP#: *VALUATION: $8,500
O;:PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY I t i !'.
7PFENTAMATION 1 R3SFDREM
USE: SFD or Duplex r',1 arc P .I s ;� PERMIT TYPE:
WORK convert 1/2 bath to full bath non structural
SCOPE
T7r ,
P .
NOTE. These fees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'l info,
FEE ITEMS(Fee Resolution 09-051 Eff. i'1,10) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 32 s.f. Remodel,Bath(<=300 sf)
Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 $570.00 IREMRESBAT
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee-.0 Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
("Onswiwiion Tax
Acoustical Fee: 0 Yes E) No $0.00 0
Work Without Permit? 0 Yes E) No $0.00 E)
PlanninuLFee: $0.00 Select a Non-Residential E)
Building or Structure 0
11-411'cl 1)oullf cilia/ioll
Strong Motion Fee: IBSEISMICR $0.85 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $1.85 $570.00 TOTAL FEE: $571.85
Revised: 11/08/2010
M.Indoor Air Quality and Fintishes
1.I]sa dvrllJia-v{C Paint 1 IAQ/Health pts y=yes p
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes p
3.Use Low/No VOC Adhesives . 3 IAQ/Health pts y=yesl' 7. 1 I p
4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 61AQ/Health pts y=yes p
B.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes p
T 10 MlE.zpmed Parficleboard or MDF 41AQ/Health. pts y=yes 0
B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes p
9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0
10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes p
1 ! 1
N.Flooring
1.Select FSC Certified Wood Flooring a Resource pts y=yes 0
2.Use Rapigy Renewable Flooring Materials 4 Resource pts y=yes p
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes p
5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes j
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes
1 ! !
Total Points Avai able: I 140 1301 57
Total Points Project Received: ;f 0 OF-71
L(
G:data/progsrgreenbuildingguiderines/remodelerslgreenpointsfina1212.WroteotedAs
CITY OF CUPERTINO
ADDITION/REMODEL
CUPERTINO FEE SCHEDULE
APN# � + 0 , Date: Z-2—
Is a 2nd unit being added? Yes ❑ NoZ If yes, please fill out the permit application for 2"d unit.
Building Address:
� 1 v Poai- 1c eu pevLv(uD
Mailing Address (if different from building address):
Owner's Name: Phone#
A I�s4A- : 4 08' S OT 12
(40
Contractor: � -rr-�•�eovv — Phone#: 09-
5�--
Fax#:
Cupertino Business License: 2--Z-Li State Contractor License#: 7 270
Contac Phone#:
ki C k-,4/1.x -�4�VT-- Fax#:
Landscape Ordinance Compliance:
Landscape area in sq. ft. (includes all irrigated areas):
If 2,500 sq. ft. or less, compliance with the Landscape Water-Efficiency Checklist is required.
If more than 2,500 sq. ft., a complete Landscape Project Submittal is required.
Compliance Method: ❑ Plant Type ❑ Water Budget
Building Permit Info:
Bldg. ❑ Elect. 5�— Plumb. Mech. ❑ Hillside ❑
Job Description:
Addition-What is being added?(Be Specific):
What is being remodeled(not including addition)?
C o ki v �/Z 10 4--4-k +rD w T>S A 4 k rook" . A Jw
Remodel Includes Re-Roof. Yes ❑ No [� If yes list number of squares
Remodel Includes Structural: Yes ❑ No JtR'
Do you have the pre-application planning approval? Yes ❑ No
If yes, please provide a copy of your planning approval letter. Planners name:
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen Bath Other
Type of Construction(Usage Class): Occupancy Type: 00
1-A, 1-B ❑ II/III/V-A ❑ II/III B, IV-HT, V-B Valuation: D 0
Please check this box if the project is a
Project Size: Ex ress Standard ❑ Large ❑ Major ❑ second-story addition ❑
Please complete relevant portion of the Green Building
Checklist& attach it to the application or if applicable, Green Building Points AchievIn.
include in plan set& the sheet index.
Revised 05/18/10