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15070011 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10387 MARY AVE CONTRACTOR:HOLLISTER LOUISE P PERMIT NO: 1�07001 I TRUSTEE 0�1'NER'S NAME: HOI,LISTER LOUISE P TRUSTEE DATE ISSI�ED:07/Ol/2015 O�VNER'S PIiONE: 6504657972 CUPERTINO CA, 95014-1343 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION �OB DESCRIPTION:RESIDENTIAL � COMMERCIAL � REPLACE SHOWER VALVE AND TUB SURROUND; License Class Lic.# REPLACE EXHAUST FAN; INSTALL(2) LED LIGHTS. Contractor Date I hereby affirm that 1 am licensed ander 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. 1 hereby affirm under penalty of perjury one of the following hvo 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:$2500 I have and will maintain Worker's Compensation lnsurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:32652036.00 Occupancy Type: permi[is issued. APPLICANT CERTIFICATION 1 certify tha[t have read this application and state that the above information is pERMIT EXPIRES IF WORK IS NOT STARTED correct. 1 agree to comply with all city and county ordinances and state laws relating wITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construc[ion,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST 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 �ssued b ��V �� !L � �� l l granting of this permit. Additionally,the applicant understands and will comply Y� -�� f U Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOF'S: Signature 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. ❑ OWNF,R-BI�ILDER DECLARATION Signature of Applicant Date: 1 hereby aftirm 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 l,as owner of the property,or my em 1�yees�kith wages as their sole compensation, will do the work,and[he structure is not intended or offered for sale(Sec.7044, Business&Professions Code) l,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will 1 hereby affrm under penalty of perjury one of the following three maintain compliance with the Cupertino Alunicipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous l have and will maintain a Certiticate 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 1 performance of the work tbr which this permit is issued. will maintain compliance with the Cupertino Monicipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505 5 , nd 25534. Section 3700 of the Labor Code,for the performance of the work for which this ,y permit is issued. Owner or authorized agent:�, Date: � I certify that in the performance of the work for which this permit is issued,1 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,1 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,l must 1 hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this pern�it shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFIC:�TION Lender's Address l certify that I have read this application and state that the above information is correct. t 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,judgmen[s, ARCHITECT'S DECLARATION 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 �t� Date � 1 �� CONSTRUCTION PERMfT APPLICATION � , � COM��UNITY DEVELOPPJIENT DEPARTMENT • BUILDING DIVISION � 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 �� (408)�77-3228 • FP,X (408)7�7-3333• buildina a(�cuuer�ino.ora 1�� CUPERTINO ❑iv�W CO:�STP�UCTION ❑ ADDITiON P.LTERATION/TI ❑ REVISION/DEFERRED ORIGIIvAL PERMIT� PRo�cr F.nD�ss , I .�h� 2�K� , � �� u 3��7 ►��/'�R� ;��.n...� .i O'J+'?�ERN:.1�c P?-IONE c-MAIL rJr��+.t� i�-��.�. � C-`��- �5 =7ci'7� c5 L L S� � �'Ahcc�.c� ST�ET=.DDRESS CITY, STP.TE,ZIP FAX 3�0 OCI, M�to �Aa.� �a�,�r�,�� .�tc�rJ �4�-�o-q cJl � CONT?.CT NAME PHOt�� E-1�4?.IL �t� i�CL.LI S �c'�b"'_ STREtThDDRESS �. CIiY,ST.ATc, ZIP FAX �� ❑ 0�1'?vcR �l'NER-BUII.DER ❑ OV1?�cR AGENT � CO?.'TRACIOR ❑COhTRhCTOR AGE1�T ❑ .SRCHICECT ❑ENGII�'EER ❑ Dc�cL0°ER ❑ IcN.qA�7' CO:JTR.SCTOR NAME LICET.SE NLR�29ER I LICENSE T1'PE I BUS.LIC k w a�� — 6:J►�� CO1�fPA?�IY NA?�'�E E•hih1L FAX S7'R.EET ADDRESS CITY,STATE,ZIP PHGN� �� .ARCHITECT/ENGLN�ER N?JvIF �� LICE\SE I��T:BER BUS LiC� /.aau� COMPAI�I"NA��fE E-1�4AIL FAX STREcT P.DDRESS CITY,STP.Tc,ZIP I PHOh.B DESCP.IPTION OF WORK ZH2c�M ' i1P�VCT� � Ea1�TRJG USE PP,OPOSED USc CO\STi2 TYP� �'STORLS liSE IYP� OCC. SQFT. V.4LL;ATIOti(5j ��C�(�IJC�M . C Fa"iSTG r`tl1'r�I.00R DEI�40 TOT;,L I — AFEA AREA AREA 1�tT hF�c..4 .. B ATI-�00'�t Y.Sf CHEN OT'r.t R REMODELP.FE.4 P.E?�10DEL.4REA REt.10DEL.SREA PORCH AREA DECK A�A TOTP1 DECiUPO?CH hR%A GAR.4.GE AP.FA: DETAC?-I I I �AileCH �D'�l�LLi'�'G L�i i 5: IS A SE��OND IINfC �1'ES SECOND STORI' �'i e.S I I�EINGADDED" �:�0 .4DDITION7 �NO I FP.E-F°?L'C?.TIO.'d ❑tcS ':r 1'ES,PRO\'IDE COP�'GF ISTHE BLDG F.N ❑1'rS 3Zt,CE1\%- B1' � OTAL V�1.U.4TI0?J: PL."\;:f'EG?3PL� [J?�0 PLAhT�Z'dGAPFROVP.LLETTER EICHLERHOM1IET �NO _ - _'_� � ��.. - By my signature belo��,I certiy to each of the fcflo•��ir.g: I a-1 t~�e propere}�o�;ner or zuthorized zeer.t to zct cn tne property o�.i��r's b:; li". I ha ead this zpplica?ion and the inforroation I have provided is correct. I ha�-e read the Description of��ork and verify it is accurate. I agree to comply��ith 211 appliczb!e local ordinznces znd stzte la«�s relating t building o.st c`o, . I a��-ho;iz�representatives of Cup:Rino to enter the above-identified property for inspection p�::roses. Signatt!re ofApplicant/A�ent: � . � D"-';'.-- � � �—_---__- _ SUPPLEMENTAL IIv'FORl'�ZATION REQUIRED ri�v cii�cx-r��r�f� ;I_ rot�L�c si:ii> ?vew SFD or�'Iultifamily d��ellines: Apply for demolition permit ior ' = ' �O�i:3 THI'COL:�TEK_ �vL'ILDI\G I'L�Iv FtL�1F�V existin�buildinQ(s). Demolition permit is requir�d prior to is_uance of buildin� ��rmit for new buildin�. ❑ pkF'FF,SS _ ❑ pT:1\?�I\G PLAN P,E�'It�V " - Commercial Bldgs: Provide a completed Hazardow?�4aterizls Disclosure ❑ sr��n�r.v : , - ❑ etiBt.tc�iot�.s ` _ form if any Haza:dous i��faterials are b:ing used as part of this project. � ❑ LARGI. � FII�,DEPI . Copy of Plannin�Approval Le�,er or�leeting��ith Planning prior to - - submittalofI3uildin�Permitapplic�tion. � �� ri��oF ` n �,��tT�F��`��j��isTtzicr . __ - � ❑-E�'FIRC)V>Si�.�i4L13�}:1L7H'� - BldgApp_2011.doc rel�ised 06i11i1] CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10387 Mary Ave DATE: 07/01/2015 REVIEWED BY: Sean � :�PN: BP#: 'VALUATION: $2,500 P1�.R111'1'TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY PENTAMATION USE: SFD or Duplex PERMIT TYPE: 1 RPFI� WORK Re lace shower valve and tub surround� re lace exhaust fan� install 2 LED li hts. SCOPE Mech. Plan Check 0.0 hrs $0.00 Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check 0.0 hrs $0.00 Mech.Permit Fee: IMPERA�IIT Plumb. Permit Fee: IPPERMIT Elec. Permit Fee: IEPERM/T Other Mech. Insp. 0.0 hrs $48.00 Other Plumb Insp. 0.0 hrs $48.00 Other Elec. Insp. 0.0 hrs $48.00 NOTE: This estimate does not include fees due to other Departments(i.e.Planning, Public Works, Fire,Sanitary Sewer District,School District,etc. . These ees are basetl on the relimina in ormation available and are onl�an estimale. Contact the De 1 or nd�ln'1 rn o. FEE ITEMS (Fee Resolarjion 11-0�3 Et1.� %7��13i FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1� # Plumbing Suppl. PC Fee: 0 Reg. Q OT p.p hrs $0.00 $10.00 �BPFIx7'U1tE Fixture or Trap PME Plan Check: $0.00 1 # Mechanical Permit Fee: $0.00 $25.00 1BxE��vENF Ventilation Fan Suppl. Insp. Fee:Q Reg. Q OT p.Q hrs $0.00 2� Electrical PME Unit Fee: $0.00 $72.00 IBREMFIX7' Fixtures, Lighting PME Permit Fee: $144.00 Administrative Fee: �,9oMtN �✓ $45.00 � Work Without Permit? � Yes � No $0.00 � Advanced Plannit�� f�ee: $0.00 Select a Non-Residential � Travel Documentation Fee: 17'R.t vDOC ✓$48.00 Building or Structure � i Stron�Motion Fee: IBSE�SMICR ✓ $0.50 Select an Administrative Item C31d<�Stds Commission Fce: IBCBSC �$1.00 SUB'roTALs: $238.50 $107.00 TOTAL FEE: $345.50 Revised: 05/07/2015 l 0�87 tvt�� lav� � __ __ �.�,:`�.I.ED JUL O 1 2015 6�ro�! �� aw ,��_� �� ,�!,�� ;,. ,' ' ~` 1°�JEcT' � �. � /- ,�r �/ A2E�c t J � � • s-o ; S, • --___� , �. - , , , . . . . . . COMMUNITYDEV��' '��'^-°��T �A T �� BUILDING DI`. 3,.a" � �=F� O AP � This set of plans ar� " ' ? hP ke ` ' job site during cor ' � �' ��'' 'r�' .2!...-q ►r changes or al;� t , therefrom,withou" The Stamping of!r be held to per��t cr �o be �� ;:+;,: " of any provi �ons of any ��tr C>r.:;� � � �Vtt'J t-IoLL tSi�`Q BY � .�✓ _/_� �� - DATE ------�'--� �-�,j � Ow�E'R/QUt�OC1� . p�R�„T _ _--�L-D . ��' �� IPY �� c��/ .� Page 1 of 1 Bathroom renovation Date: 7/1/15 Address: 10387 Mary Ave. Owner/Builder: David Hollister Description of Project • The upstairs bathroom of a two bedroom condominium. It is a "Jack and Jill" style bathroom with one toilet/bathtub area with two separate vanity areas on each side of tub/toilet area. The vanity areas will not be changed or worked on. Only the tub/toilet area will have work done. Proiect Details • Bathtub: Existing 60nx32Hx16" steel tub and waste overflow to remain. • Shower/tub valve: Remove existing shower valve. Install Moen Adler single handle shower and tub faucet with PosiTemp pressure-balancing valve. • Bathtub tile: Remove existing bathtub tile surround. Replace with 12 x 12 tile installed over WonderBoard Lite/over 4mil polyethylene attached to existing wall 2x4 studs. • Floor tile: Existing floor tile to remain. • Fan: Remove existing fan. Replace with Nutone Premier110CFM fan connected to existing 4" sheetmetal duct. • Lights: Replace existing overhead light with two Halo Led RL560WH-R recessed lights. • Switches: Replace single light/fan switch with Lutron Maestro MA-T51 H countdown timer switch for fan and Lutron Maestro MS-VPS2H Vacancy Sensor switch for lights. . . , . • Smoke Alarms: Existing battery operated alarms in bedrooms, upstairs hallway, living room and dining room area. • Carbon Monoxide Detectors: Existing detectors located in upstairs hallway and living room and dining room area. 2015 Pertnit fa bethroom 4�� . OWNER-BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408) 777-3228• FAX(408)777-3333•buildinq a(�.cupertino.orq - CUPERTINO Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS APN BP# / J c��.7 � i,ir. OWNER NAME OWNER ADDRESS �n,� ��L �q�; �� +� v`,_,, j �''. �Y�- S �.0 v'f/ DESCRIPTION OF WORK: i t �?�+U`ZC' CF'V�'�'�'r7" �=- �-f� We are providing you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERiFICATION OF INFORMATION (DIRECTIONS:Please read and inifial each statement below to signify you understand or verify this information.) �� 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liabte and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. (�ri 2. I understand building permits are not required to be signed by property owners unless they are responsib/e for the construction and are not hiring a licensed Contractor to assume this responsibility. fJ�3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. t�:a-( 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. r�1�5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. Q�-ri 6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. (�+-17. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 1�(-r+8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04/14/10 t ' �' Lr�i 9. I understand I may obtain more information regarding my obligations as an "employer"from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. �r� 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. �11. I agree that, as the party legally and financially responsible for this proposed construction activity, I wiil abide by all applicable laws and requirements that govern Owner-Builders as well as employers. �F _12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a resuit of a complaint.Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be heid liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS:Please complete the following construction lendrng agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note:A copy of the property owner's driver's license, form notarization, or other verification acceptab/e to the city may be required to be presented when the permit rs issued to verif the ro ert owne�'s si n ure. Property Owner's Signature: �..v`k Date: f 5 ---------------------------------------------------------------------------------------------------------------------------------- (NOTE: The following Authonzation Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project(or Description of Work): Project Location or Address: Name of Authorized Agent: Tel No Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note:A copy of the property owne�'s driver's license, form notarizafion, or other verificatron acceptable to the city may be required to be presented when the permit is rssued to verify the property owners signafure. Property Owner's Signature: Date: OwnerBuilderForm 2010.doc revised 04/14/10