The URL can be used to link to this page

12040144 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10558 CULBERTSON DR CONTRACTOR:BATH FITTER NORTHERN PERI%IIT NO: 12040144 CALIFORNIA OWNER'S NAME: SCI-IMIDT ENO A AND LILLIAN Y TRUST 2118 ZANKER RD DATE ISSUED:04262012 OWNER'SPHONE: 4082552102 SAN JOSE,CA 95133 PHONE NO:(408)S3441 It ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License J.11h LicMECH rRESIDENTIAL rCOMMERCIAL rCo1 hereby eam licensed under the provisions of CM1epler9 JOB DESCRIPTION:REPLACE WAIL SURROUND AND VALVE IN (commencing with action 700%0)of Division 3 of the Business&Professions BATHROOMpI, CREPLACE SHOWER PAN AND WALL SURROUND IN BATHROOMk2 Code and that my license is in full force and effect. I hereby affirm under penally 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 Section 3700 of the Labor Code,for the performance of the work for which this Sq.FI Floor Area: Valuation:$5000 permit is issued. APPLICANT CERTIFICATION APN Number:37534038.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this per hit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point urcc re ulalions per dhe Cupertino Municipal Code,Section 9.18. Issued by: /� R� Date: y-496_1 Signature DateZ ❑ OWNER-BUILDER DECLARATION RF:ROOFS: 1 hereby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material berg installed.If a roof is the following two reasons: installed without first obtaining an inspection.I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature of Applicant: Date: 1,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 I hereby affirm under penalty of perjury one of the following three declarations: 1 have and will maintain a Ccnificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safely Code,Sections 25505,25533,and 25534. I will maintain 1 have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Ilealth& Section 3700 of tire Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should 1 store or handle hazardous material. Additionally,should 1 use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District l will I certify that in the performance of the work for which This permit is issued.I shall maintain con fiance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&S e,�y C., ,Sections 25505,25533,and 25534. Compensation lases of California. If.after making this certificate of exemption,I (/ become subject to the Worker's Compensation provisions of the Labor Code,I must Owner o t o d forthwith comply with such provisions or this permit shall be deemed revoked. Dete: ��Z APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and stale that the above information is 1 hereby affirm that there is a construction lending agency for the performance of work's cored.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 7 ITEMS OF 7 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37534038 . 00 DATE ISSUED. . . . . . . : 04/26/2012 RECEIPT #. . . . . . . . . : BS000016628 REFERENCE ID # . . . : 12040144 SITE ADDRESS . . . . . : 10558. CULBERTSON DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SCHMIDT ENO A AND LILLIAN Y TR ADDRESS . . . . . . . . . . : 10558 CULBERTSON DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 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 SAL ---------- ------------- ---------- ---------- --------- -ADMIN HOURS 1.00 41. 00 0.00 41 .00 0. 00 1BCBSC VALUATION 5, 000.00 1. 00 0 . 00 1 .00 0. 00 1BPFIXTURE NO OF FIXTURE 1.00 9.00 0 .00 9.00 0. 00 1BSEISMICR VALUATION 5, 000.00 0.50 0 .00 0 .50 0. 00 1PLMBINSP HOURS 1 .00 130.00 0.00 130 .00 0.00 1PPERMITFE FLAT RATE 1 .00 44 .00 0 .00 44 .00 0 .00 1TRAVDOC FLAT RATE 1 .00 44.00 0 .00 44 .00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 269.50 0 .00 269.50 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT -----------`----- CREDIT CARD 269.50 VISA --------------- TOTAL RECEIPT 269. 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING 512 FINAL HANDI-CAP CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10558 Culbertson Drive DATE: 04/2612012 REVIEWED BY: Sean APN: BP#: 'VALUATION: $5,000 *PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1RPFIX USE: PERMIT TYPE: WORK I Replace wall surround and valve in bathroom#1 replace shower pan and wall surround in bathroom SCOPE #2. APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Fixture set on One Trap 1 BPFIXTURE 1 # $9 TOTALS: $9.00 Plumb. Plan Check 0.0 hrs $0.00 151m. Phm('lined ;lle;:G. 14•rnin Feer Plumb. Permit Fee: IPPERMIT E4'r:. Pwnrir 1•'n- orhz;:b/tar. hrsr. Other Plumb Insp. 1.0 hrs $44.00 i 1her El,c Irsl;. Al ch. 111sp. 1•'.e Plumb.Insp. Fee: IPLAIBINSP $130.00 Ele.c. In j+ /'r e: NOTE: This estimate does not include fees due to other Departments(i.e. Planning,Public{Yorks,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 addh 7 info. FEE ITEMS(Fee Resolulion 11-853Iff Til/I 11 FEE QTY/FEE MISC ITEMS Plan Check Pee S'uppl. P(:: Fed PME Plan Check: $0.00 Permil k2:cr: S'uppl. lh'l, Fed PME Unit Fee: $9.00 PME Permit Fee: $174.00 Administrative Fee: (ADMIN $41.00 Work Without Permit? Yes (F) No $0.00 Aelvunvvet Planning Fres: Travel Documentation Fee: ITRAVDOC $44.00 A Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $269.50 $0.00 TOTAUFEE: $269.50 Revised: 04/0112012 GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 M I SC CUPERTINO (408)777-3228•FAX(408)777-3333•buildingecuoertino.orO •PLUMBING MECHANICAL ELECTRICAL MISCELLANEOUS PROJECT ADDRESS 07-47 OS✓ [�t�n /V Die I V p �� — 1 OWNERNAME�Nn ClLL/IpV Sc#mjf)7 PHONE G-; STs IUr�._ E-MAIL STREET ADDRESS/ X541 C DN r . YTA - `O A 1/5V / FA% CONTACT NAME ((`// C 1 1 PHONE �I E-MAEL STREET ADDRESS J ` Cr1Y.STATE. ZIP FAX ❑OWNER ❑ OWNER-BUDDER ❑ OWNEAAc7ENT CO r AcmR. ❑comrRACTORAGFNT ❑ ARGVTFIT ❑ENGPIEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME TLS �n�,(�T 7/JZ LICENS ER +yin C.LICENSE 2LI( COMPANYN �/U /'VI 1 �/C_ E:a OSP LTA F og-ff3tl—///2 STREET ADDRE S ORf) CIN.STA Z2semi ^ - �57� PHONE�/UJ— -J LI III/ ARCHTTECTIENGINEER NAME UCENSE NUMBER -J l BUS.LIC p CONOANYNAME' - E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF IRkm m DUPLIX ❑'MuUrT-FAMILY r PROJECT IN WBDLWD ❑ YES PROJECT PI ❑YES IS TIB:BLDG AN ❑ YFS BUILDING: COMMERC URBAN PITERFACE AREA ❑ NO FLOODZONE ❑NO EICHI-EII HOME? ❑NO DESCRIPTION OF WORK r lie - WA L L S v D N \- 42 c�p— l h ztj R epL e WALL 1;kkk(WU '� TOTAL VALUATION: 14l U U RECEIVED BY: By my signature below,I certiyhavap e olloyl' g: I am the property owner or authorized agent to act on the property owner's behalf. 1 have read this application and the information 1 E cL; have read the Desorption of Work and verify it is accurate. I agree to comply with all applicable local ordinances and stain Taws¢laco c u riu entatives of Cupertino to rnter rhe above-identi ed pmp Cor inspection pu(poses. SignaNre ofApplirantlAgenc Date: SLIPI, AL INFORMATION REQUIRED OFFICE USE ONLY m OVER-THE-COUNTER Y ❑ EXPRESS W ❑ STANDARD u 3 ❑ LARGE ❑ MAJOR AffPMscApp_2011.doc revised 06121/11