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15100086CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22024 CREEKSIDE CT CONTRACTOR: ALI'S CONSTRUCTION & PERMIT NO: 15100086 REMODELING OWNER'S NAME: ROSE ROBERT A TRUSTEE 1011 S DE ANZA BLVD DATE ISSUED: 10/12/2015 OWNER'S PHONE: 4082424581 SAN JOSE, CA 95129 PHONE NO: (408) 898-6474 Ja LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ .6 (� 13� REMODEL ALL 3 (E) BATHROOMS (250 S.F.) & (E) KITCHEN (150 S.F.) License Class Lic. # 9 i a l i cAtldcu Date I'D — t Contractor S 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. Sq. Ft Floor Area: Valuation: $50000 I hereby affirm under penalty of perjury one of the following two declarations: 1. I have and will maintain a certificate of consent to self -insure for Worker's APN Number: 32639061.00 Occupancy Type: Compensation, as provided for by Section 3700 of the Labor Code, for the 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 permit is issued. PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 PERMIT ISSUANCE OR APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is ALLED INSPECTION. correct. I agree to comply with all city and county ordinances and state laws relator to building construction, and hereby authorize representatives of this city to e 2 upon the above mentioned property for inspection purposes. (We) agree to save Issu e: t l indemnify and keep harmless the Ci of Cupertino against liabilities, judgments, costs, and expenses which may ac agains said City in consequence of the granting of this ermit d the ap icaunderstands and will comply with RE -ROOFS: all non -point s ce r g lat r e Cup Municipal Code, Section 9.18. ' All roofs shall be inspected prior to any roofing material being installed. If a roof is Signature Date d 2 installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER E LARATION Signature of Applicant: Date: I hereby affirm that I am exempt fro the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER the following two reasons: 1. 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 HAZARDOUS MATERIALS DISCLOSURE sale (Sec.7044, Business & Professions Code) I have read the hazardous materials requirements under Chapter 6.95 of the 2. I, as owner of the property, am exclusively contracting with licensed contractors to California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain construct the project (Sec.7044, Business & Professions Code). compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. I hereby affirm under penalty of perjury one of the following three declarations: Additionally, should I use equipment or devices which emit hazardous air 1. I have and will maintain a Certificate of Consent to self -insure for Worker's contaminants as defined by the Bay Area Air Quality Management District I will Compensation, as provided for by Section 3700 of the Labor Code, for the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Cod-efiectio 5505, 25533, and 25534. performance of the work for which this permit is issued. 2. 1 have and will maintain Worker's Compensation Insurance, as provided for by Or4tg5lror a h a nt: j ' 127 _d45 Section 3700 of the Labor Code, for the performance of the work for which this Date: 1 D permit is issued. s. I certify that in the performance of the work for which this permit is issued, I shall C N RUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's become subject to the Worker's Compensation provisions of the Labor Code, I for which this permit is issued (Sec. 3097, Civ C.) Lender's Name must forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Address APPLICANT CERTIFICATION ARCHITECT'S DECLARATION I certify that I have read this application and state that the above information is I understand my plans shall be used as public records. 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 Licensed Professional upon the above mentioned property for inspection purposes. (We) agree to save 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 with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date CUPERTINO F-1 NEW CnNSTRUCTION CONSTRUCTION PERMIT APPLICATION J5J()C0fb' COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - buildinq(a7cu)ertino.crg F-1 ADDITION n ALTERATION / TI n REVISION / DEFERRED ORIGINAL PERMIT # PROTECf ADDRESS .2���iq C� k s-l� APN R 3 p D OWNER NAME yZ `_ / �✓.Jga.�� ,e'f v S f-- PHONE fag Z 2 y 5 E NLAIL STREET ADDRESS -3 CITY, S E, p„ C I I FAX CONTACT NAME I ARCHITECT/ENGINEER NAJvIE PHONE �d �� O />1 0 O -I 7Lf E-MAIL C l,� l2 (i's Cori, f r� fi`nm� j l Ca STREET ADDRESS CITY, STATE, z" cp, q FAX ❑ OWNER ❑. OWNER -BUILDER ❑ OUTLR AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC COMPANY NAME �} Cv!pl S 41vo410 'WE-NLAIL$ � �'YGLC�'C�7 FAX STREET ADDRESS to /l S. Oe / _2d' (3t V;9 CITY, STATE, ZIPS n �Ose �jl 2 �*l► PHONE J 0164 ARCHITECT/ENGINEER NAJvIE I LICENSE N JWABER BUS. LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 3 !�f K--'60TV J PMCA! v A'e-t'-J -re-, le:]-, .'reu V -" (tie S � 0"1/eL) rJU'- 2l'►1 K< ehe7i l roc e a weQ c6tbrro-•b, Are. 140-jc4, nrec✓ 0041-eee 5- t I m S&we- P L'k ce EXISTING USE PROPOSED USE CONSTR TYPE I STORIES I USE TYPE I OCC. I SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA 13ET AREA BATHROOM KITCHEN OTHER REMODEL AREAI REMODEL .AREA 0 {�t"1 REMODEL AREA PORCH AREACED K AREA TOTAL DECL/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH ". DIAIELLING UN`1TS: IS A SECOND UNIT []',-ES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? []NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN E] YES IiD BY - OTAL VALUATION: PLAAWINIG APPL R []NO PLANK 2\'G APPROVAL LETTER EICHLER HOME? ❑ NO = 60C/ By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have proNt ded is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to 1 �� const tion. I authorize representatives of Cupertino to enter the above- identified property for inspection purposes. Signature ofApplicant/Agent: Date: SUPPLEMENTAL II\TFORMATION REQUIRED _-a:- New SFD or Multifamily dwellings: Apply for demolition permit for O�ERTH�COUhTER ❑' BUILDL't'GPLAPIREVIL existing building(s). Demolition permit is required prior to issuance of building = _ x s �: permit for new building ❑ �� �' r EXPRESS r ❑ PLAI�'I�LNGPLATI'RE�'IEWy .. '�,� ""'-cam- c �. Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sTAI�DA _�£ PusLTeoRres form if any Hazardous Materials are being used as Hart of this project. _' Copy of Planning Approval Letter or Meeting with Planning prior to MAJOR z t2 31 ❑0R'IT11RY SE�i ER_DISTItICT submittal of Building Permit application. Bldg, 4pp_201 1. do c revised 06/21/11 N CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION imADDRESS: 22024 CREEKSIDE CT DATE: 10/12/2015 REVIEWED BY: MELISSA Tech. Permit Fee: APN: 326 39 061 FBP#- *VALUATION: 1$50,000 *'PERMIT TYPE: Building Permit [PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex yu'ql PENTAMATION PERMIT TYPE: 1 R3SFDRE i WORK REMODEL ALL E BATHROOMS S.F. & E KITCHEN 150 S.F. SCOPE 150 s.f. $645.00 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt_ otr- )_ Thov,, fops arp havod on the nreliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff.' 7/1/13) FEE Plumb. Plan Check I:/Cc% Man (J leck Tech. Permit Fee: Plumb. Permit kee: h7ezc. Permit lee: Other AIEch.lnssp. Other Plumb Insp. Other Islec. Insp. rt tC yu'ql hrs NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt_ otr- )_ Thov,, fops arp havod on the nreliminary information available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff.' 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =s.f. $645.00 Remodel, Bath (<=300 sf) IREMRESBAT Suppl. PC Fee: (j) Reg. O OT 0.0 I hrs $0.00 PME Plan Check: $0.00 150 s.f. $645.00 Remodel, Kitchen (<=300 st) 1REMRESKIT Permit Fee: $0.00 Suppl. Insp. Fee.S Reg. O OT O.Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C 'On truction Tax: Work Without Permit? O Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 i Travel 1. oettirenialion T'( e5 : Strong Motion Fee: IBSEISMICR $6.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $8.50.$1,290.00 TOTAL FEE: $1,298.501 Revised: 10/01/2015 RECEIVED OFFICE\COPY OCT 12 20f c N � N M 2130 1 '-4" f 1 '-4'• 77 2468 11 TINO Building Department OCT 12 2015 REVIEWED FOR CODE COMPLIANCE --'A.wVVN /- 2,_0„ COMMUNITY DEVELOPMENT DEPARTMENT 1 BUILDING DIVISION - CUPERTINO Ay s� . �,PROV EM / This set of plans and specifications MUST be kept at the r3� fh-fbo ' 5 fdQ-T .pool a /�%�,�,,; �� �� /�fe?�„� J'a�r� j+I+�S job site during construction. It is unlawful to make any 1 __ p ch',�,gss or alterations on same, or to deviate M� burn ��'' ` ''� ' �` therefrom, without approval from the Building Official. �f %y) Ce Thr, stamping of this plan and specifications SHALL NOT be an approval of the violation Cit finance or State Law. Ares )b(749 i L C Ie4f c�AuleS PERMIT < V dda Afe t-1 04 10a 4 W y OW im 30 0' ce A- X B CA SQU - & .ami O �tL , R�(n 8 i� � ffleo-iPN i�� ('�&S P'-PPLV.