12020064CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 5938 SUTTON PARK PL
CONTRACTOR: BATH FITTER
PERMIT NO: 12020064
NORTHERN CALIFORNIA
OWNER'S NAME: ROBERTS JAMES A AND JANET
2118 ZANKER RD
DATE ISSUED: 02/14/2012
OWNER'S PHONE: 4082579980
SAN JOSE, CA 95133
PHONE NO: (408) 834-1111
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INTO: BLDG r� ELECT (� PLUMB r
License Class Lic.4 qQ 3 5 /c 3
I F
1.MECH
Contractor P24 Date Z Z
RESIDENTIAL COMMERCIAL
JOB DESCRIPTION: REPLACE SHOWER PAN &VALVE
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.
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.
Sq. Ft Floor Area:
Valuation: $2000
1 have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 37535031.00
Occupancy Type:
Section 3700 of the Labor Code, for the performance of the work f this
permit is issued.
APPLICANT CERTIFICATION
1 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 DAY OM LAST CALLED INSPE TIO
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
said City in consequence of the
¢
g'2(%� Z
costs, and expenses which may accrue against
Issued by: Date:
granting of this pe it. ditionally, the applicant understands and will comply
with all non-poin o gulations per the Cupertino Municipal Code, Section
9.18.
RE -ROOFS:
Signature Date Z
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.
It
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that 1 am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
1, 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)
1, 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 B Area Air Quality Management District
performance of the work for which this permit is issued.
will maintain compliance with the u e tin Municipal Code, Chapter 9.12 and
1 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
the health &Safety Code, Sectio 2 5533, and 25534.
Date:
4k��
Owner or authorized agent:
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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, 1 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
1 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
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS: '-j& S k PL
PERMIT #
OWNER'S NAME:,U'ivn �,,i
PHONE # 1 --9: —/l
GENERAL CONTRACTOR: P---c,l'
BUSINESS LICENSE #
ADDRESS: ; 1"" 1&
CITY/ZIPCODE: S" lip -w- 5� /
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL S BCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
Owner / Contractor Signature
Date
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
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 5938 sufton pl.
FEE ID
DATE: 02114/2012
REVIEWED BY: bobs.
APN:
BP#:
VALUATION: 1$2,000
PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
USE: �L
#
PENTAMATION 1 RPFIX
� PERMIT TYPE:
WORK
replace shower an and valve.
SCOPE
LLJ
APPLIANCE / EQUIP TYPE
FEE ID
Plumb. Plan Check 1 0.0 1 hrs $0.00
Plumb. Permit Fee: IPPERMIT
Other Plumb Insp. OA hrs $44.00
QTY
UNITS
BP FEES
Fixture or Trap
1 BPFIXTURE
1
#
$9
LLJ
PME Unit Fee:
$9.00
PME Permit Fee:
$44.00
Administrative Fee: IADAfIjV
$41.00
Work Without Permit? Yes ( No
$0.00
TOTALS:
Travel Documentation Fee: I TP -4 VDOC
1 $9.001
Slrow,��vlotion FCC: IBSEISMICR
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the Prelininarp information available and are only an estintate. Contact the Dept for addn 7 info.
FEE ITEMSRq,);Vfion il'-053Z 71,11)
FEE
Plumb. Plan Check 1 0.0 1 hrs $0.00
Plumb. Permit Fee: IPPERMIT
Other Plumb Insp. OA hrs $44.00
MISC ITEMS
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc.). These fees are based on the Prelininarp information available and are only an estintate. Contact the Dept for addn 7 info.
FEE ITEMSRq,);Vfion il'-053Z 71,11)
FEE
QTY/FEE
MISC ITEMS
PME Plan Check:
$0.00
LLJ
PME Unit Fee:
$9.00
PME Permit Fee:
$44.00
Administrative Fee: IADAfIjV
$41.00
Work Without Permit? Yes ( No
$0.00
Travel Documentation Fee: I TP -4 VDOC
$44.00
Slrow,��vlotion FCC: IBSEISMICR
$0.50
Select an Administrative ftdn-�
1
B11"j-_S'LdsFee� IBCBSC
- $1.00-
ESUBTOTALS:
1 $139.501
$0.001 TOTAL FEE:
I ( $139.50
Revised: 1/ 012
6 ITEMS OF 6
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 37535031.00
DATE ISSUED.......: 02/14/2012
RECEIPT #......... BS000016010
REFERENCE ID # 12020064
SITE ADDRESS 5938 SUTTON PARK PL
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OPERATOR: SylviaM
COPY # : 1
OWNER ............: ROBERTS JAMES A AND JANET
ADDRESS . 5938 SUTTON PL
CITY/STATE/ZIP CUPERTINO, CA 95014-3531
RECEIVED FROM JOE NANNETTI
CONTRACTOR BATH FITTER NORTHERN CALIFORNI LIC # 31358
COMPANY BATH FITTER NORTHERN CALIFORNI
ADDRESS 2118 ZANKER RD
CITY/STATE/ZIP ...: SAN JOSE, CA 95133
TELEPHONE ........: (408) 834-1111
FEE ID
UNIT
QUANTITY
AMOUNT
PD -TO -DT
-------
THIS REC
NEW BAL
---------_
lADMIN
-------------
HOURS
----------
1.00
----------
41.00
0.00
41.00
0.00
1BCBSC
VALUATION
21000.00
1.00
0.00
1.00
0.00
0.00
1BPFIXTURE
NO OF FIXTURE
1.00
9.00
0.00
9.00
0.50
0.00
1BSEISMICR
VALUATION
2,000.00
0.50
0.00
44.00
0.00
1PPERMITFE
FLAT RATE
1.00
44.00
0.00
0.00
1TRAVDOC
FLAT RATE
1.00
44.00
----------
-----44_00
- - --0_00
----------
TOTAL PERMIT
139.50
0.00
139.50
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
139.50
---------------
139.50
VOICE ID DESCRIPTION
-------- ----------------------------
106 SEWER & WATER
REFERENCE NUMBER
--------------------
visa
VOICE ID DESCRIPTION
-------- ----------------------------
202 UNDERFLOOR PLUMBING
301
ROUGH
PLUMBING
302
TUB & OR SHOWER
502
FINAL
PLUMBING ENERGY
506
GAS TEST
507
FINAL
PLUMBING
512
FINAL HANDI-CAP
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
� 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 misc
(408) 777-3228 - FAX (408) 777-3333 - building(c.cupertino.org
CUPERTiNO 120 2 OOLO`/
V1/11T I TKA- TNr I— m-F(HANicAL FELECTRICAL F— I USCELLANEOUS
PROJECT ADDRESS
` i
•�(
APN # %Z� 35r,
01
OWNER N 1
PHONE ijr, _ y
E-MAIL
STREET ADDRESS r,
13 5 Sti'► w✓
L
ti' STyT C'� �isaq
FAX
CONTACT NA r, /%
PH2rZ.j O / 1
E tut yJ a 7`'/ &6i A 44e .C61+
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT
IjkfONTRACCOR ❑ CONTRACTORAGFNT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE NUMBEFq V ICENSE
( J
E i Z
✓
BUS. LIC # i .
COMPANY NAME
��l'.1✓
E-MAIL
FAX( /'{,,
STREET ADDRES 1 ��71
C S T E OJ - ` N ZIP.z
/ J
PHO 6' -'9 �
ARCHITECT/ENGINEER NAME / ^
i
LICENSE NUMBER
BUS. LIC #
COMPANY NAME'
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF SFD nr DUPLEX ❑ MULTI -FAMILY
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN ❑ YES
FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
TOTAL VALUATION:)
RECEIVED BY: , p
By my signature below, I certify to each of 1 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 pro d is 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 buil co ti I tho ' e r res tatives of Cupertino to enter the above -id tified perty for inspection pu{poses.
Signature of Applicant/Agent: Date: / Z_
SLE NTAL INFORMATION REQU=D
OFFICE USE ONLY
c
Y
U
w
U
a
OVER-THE-COUNTER
❑ EXPRESS
❑ STANDARD
❑ LARGE
❑ MAJOR
MEPMuc,4pp_2011.doe revised 06/21111