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12040060 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 906 SAGE CT CONTRiC7'OR''I'BD-'rOIVPDPTPRMIN17.1) PF-RNII'I-NO: 12040060 OWNER'S NAME: FISH DOUGLAS D AND MARION A E � h DATE ISSUED:04/11/2012 OWNER'S PHONE: 4083068334 PHONE NO: yLICENSED CONTRACT�O'/R'SS DECLARATION' BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class Lic,_q. =-II`-7-��L- - �p�, z �r/e MECIi r RESIDENTIAL r COMMERCIAL r Contractor Iwl7f}'/I� u�/wiC-Date17� [hereby affirm that I am licensed under.the provisions of Chapter 9 JOB DESCRIPTION: 11AI.1-WAV IIA'I"II RIiMODC1.SONS"1'RUC'I'URAI-50 SQI_ I (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 perjuryone 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:S16500 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. APN Number:35906013.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and stale that the above information is correct. I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep hnrmlesS the City ol'Cupertino against liabilities.judgments, 180 DAYS FROM LAST CALLED INSPECTION. 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 Issued by: �- 9.18. Signalurc Date 2 RF:ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.11'a roof is installed without first obtaining an inspection.I agree to remove all new materials for hereby affirm that I am exempt from the Contractor's License Law for one of inspection the following two reasons: I,as owner of the property,or my employees with wages as their sole compensation. Signature of Applicant_ Date: will do the work,and the structure is not intended or offered for sale(Sce.7044. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BEriTER construct the project(Sec.7044,Business&Professions Code). 1 hereby affirm under penally of perjury one of the following three IIAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain a Certificate of Consent to self-insure for Worker's California Ilealth&Safely Code.Sections 25505,25533,and 25534. 1 will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& performance of the work for which this permit is issued. Safety Code.Section 25532(x)should I store or handle hazardous material. I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Ma nagemcnt District 1 will omit is issued.. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the P' Iludth&Safety Code,Sections 25505,25533,and 25534. 1 certify that in the perfomtance of the work for which this permit is issued.I shall not employ any person in any manner so as to becomesubject to the Worker's Owner or an r''. Compensation laws of California. If,after making this certificate of exemption,1 Date:` become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shallibe deemed revoked. CONS'IRUCHON LENDING AGF.NCI' 1 hereby alLmt that there is a construction lending agency for the performance of work's APPLICANTCERTIFICATION for which this permit is issued(Sec,3097,Civ C.) I certify that I have read this application and state that the above information is Lender's Name correct- I agree to comply with all city and county ordinances and slate laws relating to building construction,and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned properly for inspection purposes-(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCI11-I-E -PS DF.CLARA"1 ION costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records, with all non-point source regulations per the Cupertino Municipal Code,Section 9.18, Licensed Professional Signature Date Building Department City Of Cupertino 10300 Torre Avenue Gq,crtinu, CA 95014-3255 C O P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: qOGs _lZ C% 6&,P--1ZT1"e4 IPERMITfl D O D OWNER'S NAME: / OV(, Fly PHONE# d —V� GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: . fI-X eeT eotc44 "5-/ CITY/ZIPCODE: *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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 am not using any subcontractors: Sign Date Please check applicable subcontractors and complete the following information: V 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 Shect Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . .,. . . . . : 35906013 . 00 DATE ISSUED. . . . . . . : 04/11/2012 RECEIPT #. . . . . . . . . : BS000016514 REFERENCE ID # . : 12040060 SITE ADDRESS . . . . . : 906 SAGE CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER -. . . . . . . . . . . . : FISH DOUGLAS D AND MARION A ADDRESS' . . . . . . . . . . : 906 SAGE CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4217 RECEIVED FROM . . . . : RE BATH BY SCHICKER CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC. # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 16, 500. 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 16, 500 .00 1 . 65 0 . 00 1 . 65 0 . 00 1BUSLIC FLAT RATE 1 . 00 119 . 00 0 . 00 119 . 00 0 . 00 1REMRESBAT SQ FEET 1 .00 588 . 00 0 . 00 588 . 00 0 . 00 ---------- ---------- ---------- --------- - TOTAL PERMIT 709 . 65 0 . 00 709 . 65 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ------------- ---- - --- ----------- ----- -- ------------- CHECK 709 . 65 15727 925-676-8422 --------------- TOTAL RECEIPT 709 .65 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 906 sage ct. DATE: 04/11/2012 REVIEWED BY: bobs. APN: & C21 BP#: do D&6 'VALUATION: $16,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/Repair PRIMARY SFD or Duplex PENTAMATION 1R3SFDREM USE: PERMIT TYPE: WORK sfd hallway bath remodel non structural. SCOPE ,Etre/. Plan('heck Plumb. Pleur Chuck Elcr.. Plan Check ,Llrcb. Perm/Fee, Phonh. Permit Fee: fhrr. Permit Fre: Oarr, Vc A Insp. Odrer Plumb Insp. Oihv, E/ce. hirp. Li I ,bl,rh. bi.p. Fcc: Plumb. leap. Fee: Eler.hup. Fee: NOTE:This estimate does not include fees due to other Departments(ie. Planning,Public Works, Fire,Sanitary Sewer District,School District,etc. . These fees are based on the Prefitirdna information available and are only an estimate. Contact the De t or addn7 info. FEE ITEMS (Fie Resolution 1I-053 Elf 7/1/11) FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel, Bath(<=300 sf) Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 $588.00 IREMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Couto r•tion Tax. ridininistrnllre Pic: 0 Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning! Pee: $0.00 Select a Non-Residential 0 Building or Structure 0 Travel Documenlalion Feces: A Strong Motion Fee: IBSEISMICR $1.65 Select an Administrative Item l3ldt+Sids Commission Fee: 1BCBSC $1.00 SUBTOTALS: $2.65 $588.00 TOTAL FEE: $590.65 Revised: 04/01/2012 RESIDENTIAL PROJECT COVER SHEET Assessor's Parcel Number: Name of owner. s DaL, Project address. C 17. Cv12-it7l`0 1 Contact person. Lfzl Phone. Fax. Net square footage of lot. Existing Proposed Square footage: First floor: Second floor: Garage: TOTAL: Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y�1� Is privacy protection planting required for the project? 7frN' Build it Green Total Points ��— ` d On what floor(s) is work being done? (/rlInr27 Brief description of wbork. IZaW1Ztr0-I /L/W/J<-e S S All?� Code editions: 2010 CBC . �- N)2010 CFC C- N)2010 CMC (f4>N) $j. APR 2010 CPC - 2010 NEC �-N) California Greenen Building StangW#yp\A3dde 2010 �tl0 1� Effective l-bl s\noid AO W BousuxP 0'-'�F 0 4 o u�d ul P1 Ins a� Me 4 ate1S 1O °\en0idde ue�e ug\d sPN 4°6u!d� 1e4� o na414 OadsP N`'w ° uo!le1o. suo�le0\N �ddel^ol eue4 1�N�'\tlH6u.P1!^90 uew s u\o SU o11s^"sum S e1d o las alks sow' \e\01 0 01 s\l\ s p e\e!`nu \u^suopes!419ad Rue a)dad eq 1S^W AAO�a� ayll NooN\a`ON\oWIVAr'400 1N3W1dd 3, i �wd0_13 Plan Review Process Work Book Page-8- Revised 12/21/10 Table of Contents Page 1. Building Permit application Page 2. Business License application Page 3. Scope of Work Page 4. Insurance Page 5. Contractor's License Page 6. (5) Sets of Plans Page 7. Authorization letter R9 4,0 /T Scope of Work Work to be done for: Marion& Doug Fish Address: 906 Sage Ct. City: Cupertino, Ca. 95014 Home Phone: 408-306-8334 Cell Phone: Scope: Hallway Bathroom Remove existing cast iron tub and replace with Safety Tub. Replace plumbing fixtures. Install 4-GFCI outlets, exhaust fan, and motio9'sensor switch. TAY S.n oic c ON' �u2 /G9+V3vn/ A, erV e r_., 9 f -0 60616 s h� f � A C ' 1. 925-676-8422, License #: 915392 and OwnL� A, 1059 Detroit Ave. Concord, California 94518, te _3 J%.4_,)_Work Order <:I�I�n D�ne_,, 7 Purchaser Y_41� Ice'; L�;;t installed on _75 Media Address -V C/A installed by J,,/ J! 66 Lip Sales Rep./ Cell L r:w-CC L 07 r TViii- 1- 17 0 7 -1------------ Ci a� C=� � 1?0. ReBath by Schicker Home Improvement Agreement Th'RelhGOnim(e""- rd J This agreement, between ReBath by Schicker, •�` ...1059 Detroit Ave. Concord, California 94518, tel. 925-676-8422, License #: 915382 and Owner: 21 1 / LWork Order NGS i Purchaser D e r: zc N Address Media Installed on ::l % -/-J -� �� C i ; /.rt �i r City Zip Sales Rep./ _. Installed by Home Cell t z, r` C _ .k" is l . i l-t: '— C_L;(t1i•'-4; �� • v`'�z.('I err, r �ut,r� ��-.L�_ ;lJ-C_:3�� 'Xe-��,�-i� Email �� ; Description of the Project and Descriptio of Significant Materials to be Used and Equipment to be Installed. Contractor will furnish all labor and materials to construct and complete the work to be performed in a good, workmanlike, and substantial manner. A description of the project and a description of the significant materials to be used and equipment to be installed is set forth below: QTY. AMOUNT w4 11!YL ;-<_.=J�..�._•�G=L�'Z- .�T. I_ I ., L._._..- \.L___._I ._ ..._._._I - I _.._ __ I I I - - I I t —J I �� i-.X✓(� Imo% .)i'L�/ll _. I -ti`s.'- _ I i �:+ w "icy �l- I �L:C•C� Et.� i�l�i_ � Y��i 7•'±s� _!�•'1� _:.L/2/,�.L-_ _a I_,�-��C �2�1��')_I�� lLL?� -��-'r..� ' ---I---- ` I l _ _C_''x-/_cG�-L..aE�� ,'�iJ'ie �_ i/1i:.et i_L% �_ �.?.�[;L_.n� ^:.C�i�l,Cr��i7'_l•`- I I--- - I --'---- - -- � �� --.I----- I I � I - ----' -- -- — I I— �— f2-7 r7 I — -- ---i --Iv I - --- ---- I --- --- - ' i I i-- ' I I I I I I I I IMPORTANT: —$135/hr:-+-material-for-dry rot,plumbing;repair-and/or-any additional work initial Custom.shower-door_installation-wi11 be-10-14--days after bathroom completion. initial cli......�frr�nt.nno+ino-nn-thA-fish-mr-thn_c6n�n.cr..na n-_VF-C-_I=1._-NL.1_I-1 ..-- Initial CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•buildinaCdcuoertino.ora �$[��v��)// CUPERTINO /J r�v/ U� o ❑NEW CONSTRUCTION ❑ ADDITION. f ALTERATION/TI [:1REVISION/DEFERRED ORIGINAL PERMIT N rrr�� PROJECTADDRESS APN# C Q/3 OWNER NAME M OM T VW-1 S 1— PHOE`O rr _�1-_(r'�(JJ� E-MAIL STREET ADDRESSY , CITY. STATE.ZIPb W D), FAX U r CONTACT NAME / aN`I PHO, NAIL 7L G Z�- �70 �K STREET ADDRESS CTTY,STATE, ZIP FAX 13 OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHRECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAM 1 LICENS UMBER LICENSE TYPE B/��U�ySf,LICK- ( n COMPANYNAME - \A \r E-MAIL \ F-It-S' �t7U�v STREET ADDRESS X17 V cri-OTATE,ZIP PHOS to '1 5 ITS lob b-8.4 T'1- ARCHTTECr/ENGMEERNA.ME ) �� LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE #STORIES USE TYPE OCC. SQ FT. VALUATION(5) EXISTG NEW FLOOR DEMO TOTAL / II AREA AREA AREA NETAMA S(rf\ . A7 CII �O 6 rOG BATHROOM KITCHEN OTHER vIJ IN J M,10DEL.kMA 50 REMODEL AREA RENODELAREA PORCH AREA DECK AREA TOTAL DECK TECH AREA GARAGE AREA' DETACH ATTACH #DWELLING UNITS ISASECONDUNIT ❑YEs SECONDSTORY [ YES BEING ADDED! []NO ADDITION! []NO PRE-APPLICATION DYES IF YES,PROVIDE COPY OF IS TILE BLDG AN ❑YES RECEIVED BY: TOTAL VALUATION: PLANNING APPL9 []NO PLANNINGAPPROVALLEITER EICHLER IIDME! []NO ( �� r rN By my Signature below,1 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 provided is correct. 1 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 buildingco ions representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: z Date: SUPPLEMENTAL INFORMATION44EQUIRED _ PLANCHECKTYPE _ `ROUTI\GSLIP.._- 1 _New SFD or Multifamily dwellings: Apply for demolition permit for 91- UONTaER' ryrotlMrNvG P`LAN REVIIV' existing building(s). Demolition permit is required prior to issuance ofbuilding permit for new building. ❑t exrREss El—,PLAnrvwc PLAN REVILw _Commercial Bldgs: Provide completed Hazardous Materials Disclosure '❑ STANDARD 'O-PUBLIC WORKS Tom if any Hazardous Materials are being used as part of this project. -. aE' O,�FIM DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to O,awioa - ❑�SANITARY SEWER DISTRICT submittal of Building Permit application. _ ' .❑ ENVIROMIENTAL HEALTH Bldgdpp_101 Ldoc revised 06121111