13100092 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20045 DE PALMA LN CONTRACTOR:GRAND NEST PERMIT NO: 13100092
CONSTRUCTION
OWNER'S NAME: BILL RASSIEUR 13428 CHRISTINE DR DATE ISSUED:10/14/2013
OWNER'S PHONE: 4083162850 SARATOGA,CA 95070 PHONE NO:(408)891-8059
13 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL
License Class # % BATHROOM REMODEL(50 S.F.)TO INCLUDE(N)
SHOWER
Contractor � P4efDate =t7 / FROM TUB,(N)LIGHTING&EXHAUST FAN,REPLACE 2
I hereby affirm that I am licensed under the provisions of Chapter 9 SINKS
(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
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$5000
., ave and will maintain Worker's Compensation Insurance,as provided for by
S ction 3700 of the Labor Code,for the performance of the work for which this APN Number:36932056.00 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 D RMIT 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 D + OM 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 `o
granting of this permit. Additionally,the applicant understands and will comply y'
Date with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
� l� RE-ROOFS:
�
Signature �'? 7 Date 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 thisZ Date: / 0
permit is issued. Owner or authorized agent: Q
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 inconsequence 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
V
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION (l�
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinglacupertino.orq 01
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS -L-00g,45,
-0 Q F &,ANc APN# 3 6 I -40S
W
ONERNAME PHONE / E-MAIL,J
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STREET ADDRESS CITY,STFAX
o S 1)E A Z -rl A10 CA J
CONTACT NAME SS U PHONED E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME i LICENSE NUMBER LICENSE TYPE BUS.LIC#
c� 1 0AIG
COMPANY NAME E-MAIL FAX
i
STREET ADDRESS - TTY,STATE,ZIP PHONE U
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK /
!2020, UPadA:Z�-
a e_ - D two
hew
EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES
— P117 USE TYPE OCC. SQ.FT. VALUATION($)
r ' —
EXISTG NEW FLOOR DEMO TOTAL
AREA - AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA 1 MODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTALDECK/PORCH AREE I GARAGE AREA:! DETACH
[J ATTACH
#DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY []YES
BEING ADDED? (&NO ADDITION? [RO 000l
PRE-APPLICATION [:]YES IF YES,PROVIDE COPY OF IS THE BLDG AN '❑YES '1 j:""',� '" ' �Tddi
VALUATION:
0T, 11IBM
PLANNING APPL# EkNO PLANNING APPROVAL LETTER EICHLER HOME? '
By my signature below,I certify to each of the following: I am the property owner or agen o�ctn� a property owner'sbehalf. I have read this
application and the information I have provided is correct I have read the Description of Work and rift' rate. Iagree to comply with all applicable local
ordinances and state laws relating to building constru tion. I authorize representatives of Cupertin oe ve-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIREDAy`1CYI' ,�" aouTli�cs
_New SFD or Multifamily dwellings: Apply for demolition permit for
� 1' COU1VTEl2 xB LDING LANRE�Ew'.�x�• r� ,
existing building(s). Demolition permit is required prior to issuance of building "
.e
permit for new building.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure T gtls TctrRxs r t r
fo_rm if any Hazardous Materials are being usedas part of this project. g
Copy of Planning Approval Letter or Meeting with Planning prior to �
submittal of Building Permit application., i a
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 20045 DE PALMA LN DATE: 10/14/2013 REVIEWED BY: MELISSA
APN: 369 32 056 BP#: "'VALUATION: 1$5,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION 1 R3SFDREM
USE: SFD or Duplex PERMIT TYPE: i
WORK BATHROOM REMODEL 50 S.F. TO INCLUDE N SHOWER FROM TUB N LIGHTING &
SCOPE EXHAUST FAN, REPLACE 2 SINKS
n,
uzi
--lap
Mech.Plan Ckieck Phuub.Plan Check I:lec,Plan Chczek
;-tech.Permit Fee; Plumb.Permit Fee: Elec. Permit Fee:
—L-1 _2��j
(Jzhe;r Mech.Insp, 0111er Plumb Insp. Other Elec.Insp.
tic:ch. Insp.Fee: Plumb. hap.Tee: Glec,Insp,Fee:
NOTE:This estimate does not include fees due to other Departments(Le,Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc.). These fees are based on the prelimina information available and are only an estimate. Contact the Det fiv addn 11 info.
FEE ITEMS(Fee Resolution 11-053 Eff. 7/1113) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 50 1 s.£ Remodel,Bath(<=300 sfl
Suppl.PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $626.00 1REMRESBAT
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
( onsiruction Tax:
,1 dininistrative Fee:
Work Without Permit? ® Yes ,Q No $0.00 0
Advanced Planning Feer $0.00 Select a Non-Residential
Building or Structure
Travel Docunnentation Fees:
Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg_Stds Commission Fee: 1BCBSC $1.00
_ ,
$1.501 $626.001 FSE: $627.50
Revised: 10/01/2013
Building Department
City Of Cupertino
10300 Torre Avenue
+' Cupertino,CA 95014-3255
`:Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: Z d � �� PA6MA L 1V_(jPERMIT#
OWNER'S NAME: ' L C PHONE#'
GENERAL CONTRACTOR:C4C — BUSINESS LICENSE
ADDRESS: Z 0{Q , TWIPCODE
*Our municipal code requires all businesses working in the city to ave a City of Cupertino`business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL"BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A-CITY OF CUPERTINO
BUSINESS LICENSE. I-rI * l /� f
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the-following information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum/Wood
Glass /Glazing
Heating 41
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION-CUPERTINO
APPROVED
This set of plans and specifications MUST be kept at the
Job site during construction. It is unlawful to make any
changes or alterations on same,or to deviate lrao
therefrom,without approval from the Building Official.
The s',-irnring of this plan and specifications SHALL NOT
be hcid perrmt n _,'royal of the vloi�tion 06,
of Zvi icns ce or State Law.
DATE
PERMIT NO.
to2 fwAodeCed 6� 1
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flEFR. PANTRY i
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113 Ix ; I i- I I .
RANi�E o� o w
_ I I • ( ISINXI
I j Bl..DVI N:
L_ i (!
LIVING ROOM DININ OOM'
25'-4' X 13'-8'
1JUR ,
FAMILY• 0I
24's 7� 18'-4'
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E 7 t BAR fume WIN FIREPLACE
E fi l:.I o
A I FUR
TUB
"1T( li �� 1! 111 LIN y 1 ; I SHOWER T L O
OFFICE/B DROO AEI !I G 'BIS 3
10,-11,
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SHOP AREA
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