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13070168CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10999 RONALD WAY CONTRACTOR: CLANCY PERMIT NO: 13070168 CONSTRUCTION OWNER'S NAME: 5100 COE AVE DATE ISSUED: 07/26/2013 OWNER'S PHONE: SEASIDE, CA 93955 PHONE NO: (831) 915 -8402 JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIALU Z LICENSED CONTRACTOR'S DECLARATION License Class Lic. # V7Zf9 q REMODEL BATHROOM 132 SQ FT TO INCLUDE RELOCATION Contractor 71—, 'i l/o7eu Date '2_ e Z OF TUB, SINK AND WATER CLOSET, REMOVE A NON I hereby affirm that I am licensed under the provisions of Chapter 9 'LOAD (commencing with Section 7000) of Division 3. of the Business & Professions BEARING WALL. 76 l na 1 wf-i � /41_ , PS Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: / gi 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: $25000 performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by y %✓ Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 35618009.00 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 to building construction, and hereby authorize representatives of this city to enter WITHIN 0 DAYS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAY , F , OM LAST CALLED INSPE TION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the .y / Zb granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE- ROOFS: Signature % s% ���n�r Date i� /� 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 am 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. I 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 the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: y� ° r Dater permit is issued. 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 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10999 RONALD WAY CONTRACTOR: CLANCY PERMIT NO: 13070168 CONSTRUCTION OWNER'S NAME: ROBERT NEWHALL 5100 COE AVE DATE ISSUED: 07/26/2013 OWNER'S PHONE: SEASIDE, CA 93955 PHONE NO: (831) 915 -8402 JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALEI j� LICENSED CONTRACTOR'S DECLARATION License Class_ Lic. #_R ?1`�/%� REMODEL BATHROOM 132 SQ FT TO INCLUDE /�/ RELOCATION OF TUB, SINK AND WATER Contractor r/7> T/ _/ Date CLOSET, REMOVE A NON LOAD BEARING WALL, I hereby affirm that I am licensed under the provisions of Chapter 9 INCLUDING M.E.P.'S (commencing with Section 7000) of Division 3 of the Business & Professions REV # 1 - REPLACE (E) 100AMP SUB PANEL - ISSUED Code and that my license is in full force and effect. 8/2/2013 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. Sq. Ft Floor Area: Valuation: $25000 I ve and will maintain Worker's Compensation Insurance, as provided for by ction 3700 of the Labor Code, for the performance of the work for which this APN Number: 35618009.00 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 OM ALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, said City in consequence of the 2 3 f costs, and expenses which may accrue against Issue Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section RE- ROOFS: All be inspected to any roofing material being installed. If a roof is 9.18. �,­-/ - Date �/ Signature roofs shall prior 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 am 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) 1; 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. I 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 the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: 6 Date permit is issued. 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 CONS CTION LENDING AGENCY TRU 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 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 collect. 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 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION Nfech. Plan Check Plumb. Plan Check I I Elec. Plan Check F-1-h, Permit Fee: Plumb. Permit Fee: Elec. Permit Fee: Other Alech. Insp. Other Plumb Insp. Other Elec_ Insp. I 77L Allech. Insp. Fee: Plumb. Insp. Pee: Elec. Insp. Tee: NnTF- Thic octimato daoc not include foot due to other Denartmentc (Le. Planning. Puhlie Works. Fire. Sanitary Sewer District. Se District, etc). These fees are based on the preliminary information avattable and are only an estimate: contact the wept for aaan -i in_/o. FEE ITEMS (Fee Resolution 11 -053 E . 7111121 ADDRESS: 10999 ronald way DATE: 07/26/2013 REVIEWED BY: Mendez APN: BP #: *VALUATION: 1$25,000 *PERMIT TYPE: Building Permit 132 s.f $626.00 PLAN CHECK TYPE: Alteration / Repair PRIMARY ' SFD or Duplex Suppl. PC Fee: E) Reg. ® OT PENTAMATION 1 R3SFDRE A USE: $0.00 PME Plan Check: PERMIT TYPE: WORK remodel bathroom 132 sq ft to include relocation of tub sink and water closet remove a non load SCOPE I bearing wall. Permit Fee: Nfech. Plan Check Plumb. Plan Check I I Elec. Plan Check F-1-h, Permit Fee: Plumb. Permit Fee: Elec. Permit Fee: Other Alech. Insp. Other Plumb Insp. Other Elec_ Insp. I 77L Allech. Insp. Fee: Plumb. Insp. Pee: Elec. Insp. Tee: NnTF- Thic octimato daoc not include foot due to other Denartmentc (Le. Planning. Puhlie Works. Fire. Sanitary Sewer District. Se District, etc). These fees are based on the preliminary information avattable and are only an estimate: contact the wept for aaan -i in_/o. FEE ITEMS (Fee Resolution 11 -053 E . 7111121 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 132 s.f $626.00 Remodel, Bath (< =300 sfl IREsVIRESBAT Suppl. PC Fee: E) Reg. ® OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conso-uction Tax: Atlrninistralive Fee :® Work Without Permit? ® Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure Travel Documentation Fees: Strong; Motion Fee: IBSEISMICR $2.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 e $3.50 $626.00 _ � $.629.50 Revised: 07/01/2013 „wo77 CITY OF CUPERTINO 1VF1F 1P4Zrr MATnR — RITTTIDINf DIVIRInN aADDRESS: 10999 ,rdnald sway DATE: REVIEWED BY: Plan Cheek Fee: AP BP #: *VALUATION: $0 *PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex p PENTAMATION 1 REAP2 USE: PME Plan Check: PERMIT TYPE: A WORK rev # 1 - replace a sub panel 100 am same location SCOPE vlech. Ilan Check F lech. Permit Fee: Other Nfech. Insp. itech. Insp. Fee: NOTE! This estimate does -not Plumb. 1'lart Check I I Elec. Plan Check 10.0 1 hrs $0.00 Plumb. Permil Fee: Elec. Permit Fee: ?1EPERMIT 0ihE r Plumb Insp, Other Elec. Insp. 0.0 hrs $47.00 Plumb. Insp. Fee: Elec. Insp. Fee: fees due to other Departments ae. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution 11 -053 Eff. 711112) FEE QTY/FEE MISC ITEMS Plan Cheek Fee: 4Suppl. PC.” Fee PME Plan Check: $0.00 Perinit Fee: SZaf.7�)l. Insp 1'ee. PME Unit Fee: $47.00 PME Permit Fee: $47.00 Constrztction 2 pax. Administrative Fee: 1ADMIN $44.00 Work Without Permit? ® Yes C No $0.00 Advrancetl f lcannin�,r Fees: Travel Documentation Fee: 1TRAVDOC $47.00 Strom Motion Fee: $0.00 Select an Administrative Item Bldg Stds Commission Fee: $0.00 $185.00 $0.00 - $185.00 Revised: 07/01/2013