13060085CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22235 VIA CAMINO CT CONTRACTOR �-' 1 S�
PERMIT NO: 13060085
Gu N
OWNER'S NAME: ZAROSI LOUIS M AND VIVIAN B
DATE ISSUED: 06/11/2013
OWNER'S PHONE: 4087323683
PHONE NO:
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL[]
C7 LICENSED CONTRACTOR'S DECLARATION
License Class�^ '
(' %�;�'
Lic. # �7
REPLACE E BATHTUB/SHOWER, SAME LOCATION E
/� �►' )
�'�JWQQ���GD
SHOWER RISER TO REMAIN. RE -TILE SAME AREA
ate ����3� " �_
Contractorfj/' 1(�/1.N
I hereby affirm that I am licensed under the provisions of Chapter 9
(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 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
Sq. Ft Floor Area:
Valuation: $4500
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
APN Number: 32646018.00
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 WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT 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
180 DAYS F CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
--
Issue Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non -p t source r ulations per the Cupertino Municipal Code, Section
9.18. r
%
�
RE -ROOFS:
,,,�
Signature Date /L� / l - /
_77t;T-
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
Signature of Applicant: Date:
I hereby affirm that I ant exempt from the Contractor's License Law for one of
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 (Sec.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. 1 will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety 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 a Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Ctiode, S ns 255 , 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agen :
permit is issued.
-Date:
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 lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
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, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
I 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
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) i77-3228 • FAX (408) 777-3333 • building(ab-cupertino.org
LJ NEW CONSTRUCTION LJ ADDITION LJ ALTERATION / Ti U REVISION / DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS 22235
I
A/N IW
APN #
3 / U / o 1
OWNER NAMEI VIAAI
VALUATION($)
I
NEW FLOOR
AREA �_
PHONE y d g 732.5&3JE-MAIL
4
TOTAL
NET AREA
STREET ADDRESS
2
! •
i0106CITY, STATE, ZIP 1�O ?56)FAX
�� KITCHEN
7 f REMODEL AREA ��
CONTACT NAME ' NPH
N 7 I
PORCH AREA
E-MAIL
STREET ADDRES ;
`
CITY, STATE, ZIP
AX
ElOWNER ❑ OWNER -BUILDER ❑ OWNER AGENT
CONTRACTOR ❑ CONTRACTOR AGENT
❑ ARCHrrECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
) %
t
LI SE D
LICENSE TYPE
BUS. LIC #
COMPANY NAME
,�
o
„/
E-MAIL '
t
7 4t�4
FAX
STREET ADDRESS
CITY, STATE, ZIP,
A //
C
PIS .0_ y,7o3
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK n
_f1'1& _ ./n/SA // Wh d /%A'C-xbr" 'd' r401- _r, l& . I'd L/ /,J11 yP 6A:P • I
41-1t,
M
f 1!t I
-ff,44 *-
I
USE TYPE
OCC. I SQ.FT.
VALUATION($)
EXISTG^ t)F
AREA / %
!_
NEW FLOOR
AREA �_
DEMO
AREA %
`
4
TOTAL
NET AREA
BATHROOM
REMODEL AREA
�� KITCHEN
7 f REMODEL AREA ��
OTHER
REMODEL AREA.. -
PORCH AREA
DECK AREA TOTAL DECKIPORCH AREA
GARAGE AREA: DETACH
I fl ATTACH
BEINGADDED? ANO ADDITION? IIO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES -` - - -
PLANNING APPL # �TOTAL VALUATION:
O PLANNING APPROVAL LEITER EICHLER ROME? 0 L VAL
UATION: IO
k [ (/ V
By my signature below, I certify to each of the following: I am the property owner ora Ized a o a n the property owner's behalf. I have read this
application and the information I have pr ded is co ect. I ave read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bu' i g con tion uthorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent: Date: Cl
SUPPLEMENTAL INFORMATION REQUIRED ' E e
_ New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building -1 permit for new building. o
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure aw sT ; Ds ! , uB, , C
formo
if any Hazardous Materials are being used as part of this project.
_ Copy of Planning Approval Letter or Meeting with Planning prior to s
submittal of Building Permit application.
BldgApp_201 Ldoc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
AADDRESS:
22235 VIA CAMINO CT
QTY/FEE
DATE: 06/11/2013
REVIEWED BY: MELISSA
Plan Check Fee:
APN: 326 46 018
BP#:
=#
$10.00
*VALUATION:
1$4,500
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Addition
PRIMARY
USE: SFD or Duplex
$0.00
PME Plan Check:
PENTAMATION
PERMIT TYPE: 1RPFI i
WORK I
REPLACE E BATHTUB/SHOWER SAME LOCATION E SHOWER RISER TO REMAIN. RE -TILE
SCOPE
SAME AREA
Permit Fee: Hourly Only? ® Yes Q No
1?ech. Plan Check
Mech. Perinif Fee:
Other• .Alec h. Insp.
,ilech. Insp. Fee:
Plumb. Plan Check 1 0.0 1 hrs $0.00 1 Elec. Plan Check
Plumb. Permit Fee: 1PPERMIT Elec. Permit Fee:
Other Plumb Insp. f 0.0 hrs 1 $45.00 Other Elec. Insp,
Plumb. Insp. Fee:
Elco. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
T•:ct.:nl nf, 1 Tbnon fooc nrn hnend nn f/sn nrolisninnn� is�/brmntinn m�nilnhla and ora nnh� nn octisunto_ Contort thn 1)nnt for nddn'[ inin.
FEE ITEMS (Fee Resolution 11-053 E . 7/1112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
=#
$10.00
Plumbing
IBPF=RE Fixture set on One Trap
Supp 1. PC Fee: (D Reg. 0. OT
Mhrs
$0.00
PME Plan Check:
$0.00
Permit Fee: Hourly Only? ® Yes Q No
$0.00
Suppl. Insp. Fee:Q Reg. ® OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$45.00
Construction Tax:
Administrative Fee:
IADMIN
$42.00
0
Work Without Permit? ® Yes (E) No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
E)
0
Travel Documentation Fee: ITRAVDOC
$45.001
Stronk Motion Fee:
IBSEISMICR
$0.50
1.0 hrs
$133.00
Inspections
iSTINSP Inspection, Hourly
Bldg Stds Commission Fee: IBCBSC
-$1.00
$133.50
$143.00 ffi _
$276.50
' • Revised: 04/29/2013
JOB ADDRESS: Z Z 3.� /}
wa PERMIT # _ 6-6-OON--
OWNER'S NAME: IA -N o5 i
PHONE #
GENERAL CONTRACTOR: A/ -l-1 ,�
L ' G BUSINESS "LICENSE #'
ADDRESS: 4 8 It( �,. D
'Ag-ft q 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 SUONT OBTAIN -
ED HAVE OBTAID A C' ITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: 74,10
Signature Date
Please check applicable sub -contractors 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
D LA)Ale'r'
A,d d mss
L)
Z -2- Z.
e7li
COMMUNITY DEXIELOPMENT DEPARTMENT
BUILDING DIVISION - CUPERTINO
APPROVED
This set Of plans and specifications MUST be keot a,,' t, ,y
job site during Construction. it is unlawftj! tn
changes or alterations on same, or to
therefrom, without approval from the Buiic!ir,,(,
The s" Mping of this Plan and SPOcifications
be held t
ji,ov
f e an al of
L4
BY�
DATE _
PERMIT NO
Rit� 'Lj L4
CUPERTINO
Building Department
JUN I i 2013
REVIEWED FOR CODE COMPLIANCE
Reviewed By:
Z011
Ive'vi
(0 o
4 V,
Artisan Remodeling and Design
Customer
Project 'DA-rh
Plan f I 00p- Ald: LA)
Revisidn &-ff -13 Scale