11110045 CITY OF CUPERTINO BUILDING PERMIT
BUILDING%DDRESS: 10123 BERKSHIRE CT CONTRACTOR:BAY AREA CUSTOM PERMIT NO: 11110045
BUILDERS INC
OWNER'S NAME: BERNARD&YVONNE MURPHY 1002 S DE ANZA BLVD STE AI DATE ISSUED:11/08/1011
(AMF,R,S PHONE: 4086133922 SAN JOSE,CA 95129 PHONE NO:(408)4461200
❑ LICENSED CONTRACTOR'S DECLARATION r r r
� I t A BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class_ Lic.0 2G6 —1 r �" r.
MECH RESIDENTIAL - COMMERCIAL
Contractor C.'haT/( Q el Date \\ nq
1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:SINGLE FAMILY DWELLING BATHROOM
(commencing with Section 7000)of Division 3 of the Business&Professions REMODEL(150SQFT);NON STRUCTURAL
Code and that my license is in full force and effect.
1 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.
I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$3500
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued.
APN Number:34212104.00 Occupancy Type:
APPLICANT CERTIFICATION
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 PERMIT EXPIRES IF WORK IS NOT STARTED
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION.
granting of this permit. Add *' icant understands and will comply
with all non-point so regulations per Cupertino Municipal Code,Section / c�
9.18. Issued
Signature
OWNER-BUILDER DECLARATION RE-ROOFS:
All roofs shall be inspected prior many roofing material being installed.If a roof is
I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,1 agree to remove all new materials for
the following two reasons: inspection.
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, Signature of Applicant: Date:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's 1 have read the hazardous materials requirements under Chapter 6.95 of the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I stare or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
I certify that in the performance of the work for which this permit is issued,I shall Health&$er eclI as 25505,25533,and 25534.
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 Own{ authorized nt:
become subject to the Worker's Compensation provisions of the Labor Code,I must Dater
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION 1 hereby affirm that there is a construction lending agency for the performance of work's
I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.)
correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
i1 mfy and keep harmless the City of Cupertino against liabilities,judgments,
and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION
ng of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records.
9.18.
Licensed Professional
Signature Dale
• CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34212104 .00
DATE ISSUED. . . . . . . : 11/08/2011
RECEIPT #. . . . . . . . . : SS000015267
REFERENCE ID # . . . : 11110045
SITE ADDRESS . . . . . : 10123 BERKSHIRE CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BERNARD & YVONNE MURPHY
ADDRESS 10123 BERKSHIRE CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5600
RECEIVED FROM . . . . : BAY AREA CUTOM BUIL
CONTRACTOR . . . . . . . : CHARLES BALANOJ LIC # 31905
COMPANY . . . . . . . . . . : BAY AREA CUSTOM BUILDERS INC
ADDRESS . . . . . . . . . . : 1002 S DE ANZA BLVD STE Al
CITY/STATE/ZIP . . . : SAN JOSE, CA 95129
TELEPHONE . . . . . . . . : (408) 446-1200
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 3, 500.00 1. 00 0. 00 1.00 0. 00
1BSEISMICR VALUATION 3, 500.00 0.50 0. 00 0.50 0 . 00
1REMRESBAT SQ FEET 1.00 588 . 00 0. 00 588.00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 589.50 0. 00 589.50 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 589.50 #2833
---------------
TOTAL RECEIPT 589.50
•
CONSTRUCTION PERMITAPPLICATION
EQ COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
•CUPERTINO (408)777-3228•FAX(408)777-3333• buildingecupertino.om
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT q
PROJECT ADDRESS e C AFN N o1)
OWNER NAME PHO E-MAIL
STREET ADDRESS CITY, STATE,ZIP FAX
CONTACT NAME PHONE
STREET ADDRESS CITY,STATE, ZIP FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHnECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTORN LICENSE NUMBER LICENSE TYPE Bus.LIC4
COMPANY NAME / E-MAIL FAX
NV 1q
N
STREET KDDRESS CTT Y,STATB,ZTP PHON6
se
VL1 -6 LOA
ARCHITECTA NGINEER NAME LICENSE NUMBER BUS.LIC q
COMPANY NAME E-MAI. FAX
STREET ADDRESS CITY.STATE,ZIP PHONE
N OF WORK 11 p
e 2 tr v L /P� J e e_tl
o e 7,, ° w �✓
EXISPAIGUSE PROPOSED USE C TYPE aSTUBIES
USE TYPE OCC. SQFT. VALUATION(S)
EXLSr NEW FLOOR DEMO
AREA AREA AREA
BATHROOM KILCHEN OTHER J
RE.JODELALEA REMODELAREA REMODEL AREA
FORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGEAREA: DETACH
A ACH
q DWELLING UNrIS: JBA SECOND UNIT YES SECONDSTORY YES
BEffiGAn0E0T []NO ADDOTOW ❑NO
PRE-APPLICATION ❑YES R YES,PROVIDE COPY OF rS TBE BLDG AN ❑YES RECEIVED BY: TOTAL VALUATION:
PLANNINGAPPLO ❑NO PLANNPIGAPPROVALLETTER EICHLZRHOMHT []NO
By my signature below,I certify to each of the��awiR . am a prop owner or authorized aaent to act on the prpperty owner's behalf I have read this
application and the information I have pryyrrt'ded is cormct lliave m Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws ml Bring to gilding construction. I rue Mpresentadves of Cupertino to cow the above-identified property for inspection purposes.
Signature ofApplicant/Agent .s. Date.
SUPPLEMENTAL ORMATION REQUIRED PLANCHECKTYPE 8 ROIITING SISP
New SFD or Multifamily dwellings: Apply for demolition permit for =OUNTER 2--690,na+40 PLAN Rzvnw
existing building(s). Demolition permit is required prior to issuance of building
permit for new building. ❑ EXPRESS ❑ PLANPB NG PLAN RENTEW
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ POBLPCwORHS
form if any Hazardous Materials are being used as partof this project. 11 LARGE ❑ Fmx DEPT
Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER INST'RICT
mittal of Building Permit application.
❑ ENVmONME'NTAL HEALTH.
B(dg4pp_1011.doc revised 06121/11
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
• ADDRESS: 10123 berkshlre ct. DATE: 11/06/2011 REVIEWED BY: bobs.
APN: BP#: "VALUATION: $3,500
"PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM
USE: PERMIT TYPE:
WORK sfd bathroom remodel non structural.
SCOPE
Ife.A, Ph:n Che,* 1,1141+1). Plan C'deok I'lee.Ptnu Check
:Meeh. Perini Pee: Plum/% Pemit Fee: T:Irc. Pernm Fey"
Other Hech.hasp. Obteu Pl:o1h 1ANp. oth«, hhx: hasp. Li
1,fech.leap. Few Plumh. Ins[).Fee: Ishii lnV7.Pee:
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 prelindina In ormation available and are only an estimate. Contact the Dept for addn7 Info.
FEE ITEMS fFee Resohdion 11-053 L' . ZIUI11 FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 150 s.f Remodel,Bath(<=300 sO
Suppl. PC Fee: 0 Reg. 0 OT FO.0 T hrs $0.00 $588.00 iREMRESBAT
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee:O Reg. Q OTQ,Q hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
C onsttweliun 'l'a.r
Administrative bee: O
Work Without Permit? Yes 0 No $0.00 0
Advanced Planning Fee: $0.00 Select a Non-Residential 0
1`ravel Documentation 1-'ees: Building or Structure
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
• Blda Stds Commission Fee: IBCBSC $1.00
" SUBTOTALS: $1.50 $588.001 TOTAL FEE: $589.50
Revised: 10/01/2011
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
DU P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT# 0e) Y S
OWNER'S NAME: PHONE# ZZ
GENERAL CONTRACTOR:E BUSINESS LICENSE# 0(26 6 K
ADDRESS: ppZ CITY/ZIPCODE: -5a h o� e
*Our municipal code requires all businesses working in the city to have a City of Cupertino usiness license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCOOBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
ignature Date
Please check applicable subcontractors and complete the following information:
t/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/Carpeting
Linoleum / Wood
Glass/Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
i
♦, 4
r 0 U ..�..
of `
C N >
s l c
• 0 � d • U d Li s � � � a
ci
Vk
cl
IJJ
0
a
N
O
CD
O
I mT F
zoo
J N
F N mNO � •> 'co
t- 0> m
o a ° v N
O o
f2 U
oa arE r
0 0aa
j mv0
�
2a OZ O " o 0 m
ON = co a w
VE ° m
2 o
�I
,
�z v �� H o� 0o
0 z9 0o -cc
o
� AS o � �
WOOdHiVG 831SVYq (3)
0
LL
1 x
v
pWN�
W
C�.4.
H00£OZ H0090£
JON
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ---'
• I
I
I