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15060125 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22235 VIA CAMINO CT CONTRACTOR:BLUE HAVEN BUILDERS PERMIT NO: 15060125 OWNER'S NAME: ZAROSI LOUIS M AND VIVIAN B 1241 ARROYO SECO DR DATE ISSUED:06/18/2015 OWNER'S PHONE: 4087323683 CAMPBELL,CA 95008 PHONE NO:(408)205-5806 14 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL �?? p L� G BATHROOM REMODEL(50 S.F.)-REPLACE SHOWER License Class U Lic.# ! J 6 ( VALVE, Contractor Y N�`� r7��ti s Date 6 /� SHOWER PAN,SHOWER WALLS AND BATHROOM FLOOR ONLY 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:52500 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,fype: 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 S FROM 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 /,, granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: �l/ 01110 with all non-point sourc gulati ns r the Cupertino Municipal Code,Section 9.18. l RE-ROOFS: Signa 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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 the Cuper' o Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25 553J, d 25534. / Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent 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 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)777-3228 • FAX(408)777-3333• building(a)cupertino.org CUPERTIiNO ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT PROJECf ADDRESS r I3;Vo A ,v P� , l /U m % C - OWNER NAME /I 7 PHONE E-MAIL tati+ 4d/j ©x STREET ADDRESSCITY, STATE,ZIP FAX CONTACT NAME / / PHOIN-E 06 E-MAIL L /�/.t1 l L�I(/5 STREET ADDRES �O CITY,STATE, ZC'4Z 1=012 FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT &CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR N MA C�s LICEN INU�IB�R� LICENSE TYPE BUS.LIC 9' 4gA At N /� MAIL / FAX CO ee ea/ tY i cn l a `v e 6 c v ' v LW a e+01%- STREET STREET ADD S I CITY,STATErr Z �A �'rOog HO - ARCHITECT/ENG-NEER.NAME LICENSE NUIviBER BUS.LIC COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK a�lG� l�a� aA-a� .s'�e'U� 4 E>3STING USE PROPOSED USE I CONSTP.TYPE I STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EMSTG ,$9 NEW FLOOR, DEMOTOTAL AREA `` 0/ AREA AREA NET AREA CO BATHROOM KITCHEN. OTHER •1 REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREADECK AREA TOTAL DECKJPORCH AREA GARAGE AREA: DETACH ❑ATTACH DWELLINGUNTrS: IS A SECOND UNrr ❑YES SECOND STORY ❑YES BEING ADDED? NO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES I D BY = TOTAL VALUATION: PLANNING APPL: NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO 0 By my signature below,I certify to each of the following: I am the property owner or authoriz d aeent to act on the property owner's behalf. I have read this application and the information I have provide correct. I h le re the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relat' g to buiidi nstruction. I utho e representatives of Cupertino to enter the abo/ve-i entpifie roperty for inspection purposes. Signature of Applicant/Aeent• --+- Date: r0 O SUPPLEMENTAL D\TF 4ATION REQUIRED RE - `- f Q _ FG��CHECKTI�E€�ti.s �_ tI3ITl,GSL.._ N: New SFD or Multifamily d«'ellings: Apply for demolition permit for # existin gDemolition O�ER TH�GOUI�TR ' BUII DING P1rLrI REVIEW" �s building(s). Demoli-It.on permit is required prior to issuance of building permit for new building. P _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure Q STAR 4 vsL� -ys.p F form if any Hazardous Materials are being used as part of this project. _Copy of Planning Approval Letter or Meeting with Planning prior to i SA1\TrFZYS' SRI submittal of Building Permit application. - _ _ __ - ��.F•A'VIRO7�'MENTAL�HEALTH ".�,�x BIdg-App_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 22235 Via Camino Ct DATE: 06/18/2015 REVIEWED BY: Paul APN: 326 46 018 BP#: 'S D 135. "VALUATION: 1$2,500 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: I I PERMIT TYPE: WORK Bathroom remodel 50 S.f. - Replace shower valve shower pan, shower walls and bathroom floor only SCOPE 7__T Plumb. Plan Cheek Elec.Plan Check vfec;l;. 1'errirri tc.e: Plumb. P,;rxi�1�' <- !(<� Pz:rmit Ff . Other Heck Insp. Other Plumb Insp. 0 Other Elec.Imp. Idech. Insp. Fee: Phtrub. 111ap. Fc !Jec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-053 E,ff 7111132 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 50 s.f. Remodel, Bath(<=300 sf) Suppl. PC Fee: O Reg. Q OT 0.0 hrs $0.00 $645.00 1REMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee. Work Without Permit? ® Yes No $0.00 Advanced Plannin_Fee: $0.00 Select a Non-Residential Building or Structure mel Uocumenialicm Fees: i Strong Motion Fee: IBSEISMICR $0.50 f Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $645.00 TOTAL FEE: $646.50 Revised: 05/07/2015 a3 S_ A'410 (f / S l�dwoxr �106/z 0 60 Al e-fl OFF- 'I C Em Ce '00 11 )vs COMNIU JJTY CE'':`ELOP�.IENT CFP,\R I NIENT BUI DING DIVISION - CUPERTINO APPROVED This set of Dlans 3rd specifications %1' ST be /49, a/_2 I job site du ing corstruction. It is un1J',%tul to make any? I changes or alterations on same, or to deviat6 e J41045`11-t therefrom, without approval from the Building Official. The Stamp g of this plan and speaficat!ons SHALL NOT be held to ermit or to be an approval of the violation of any p sons of ny Cit Ordi ance or State Law. BY DATE PERMIT # ( `j 8 0/t CUPERTINO Building Department JUN 17 1015 REVIEWED FOR CODE COMPLIANCE Reviewed By; I�Muaw L{8 It