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12050053 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22014 BAXLEY CT CONTRACTOR:ANTHONY HODDER PERMIT NO: 12050053 CONSTRUCTION OWNER'S NAME: KUSCHILL MARIA T TRUSTEE 7504 BOLLINGER RD DATE ISSUED:05/04/2012 OWNER'S PHONE: 4082570308 CUPERTINO,CA 95014 PI IONE NO:(408)257.4317 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class Lic.M- W6­5-732 - r r MECH RESIDENTIAL r COMMERCIAL Contractor - '=Dote t 1 hereby affirm that am licensed under the provisions of Chapter 9 JOB DESCRIPTION: 106 SQFf MASTER BATHROOM REMODEL (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: 1 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.F1 Floor Area: Valuation:$30000 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of Labor Code,for the performance of the work for which this permit is issued. APN Number:35606033.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and slate that the above information is correct.I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES 1F WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned properly for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expe s which may accme against said City in consequence of the granting oft 's p noir. Additimnally,the applicant understood,and will comply withaull "/;__ ource re ulations pupertino Municipal Code,Section Issued by: !V /(�T�YT Date: � RE-ROOFS: ❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material berg installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for I hereby affirm that 1 am exempt from the Contractor's License Law for one of inspection. the following two reasons: 1,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(Sec.7044, Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penally of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have read the hazardous materials requirements under Chapter 6.95 of the I have and rill maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I 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. Safely Code,Section 25532(s)should I store or handle hazardous material. I have and rill maintain Worker's Compensation Insurance,as provided for by. Additionally,should I use equipment or devices which emit hazardous air Section 3700 of Labor Code,for the performance of the work for which this contamin is as defined by the Bay Area Air Quality Management District I will permit is issued. insults- c pintoce ilh the Cupertino llfunicipal Code,Chapter 9.12 and the Ilealt & fety C Sections 2,.; 5 - 255J3,and 25534. 1 certify that in the performance of the work for which this permit is issued,I shall % nut employ any person in any manner so as to become subject to the Worker's O err Compensation laws of California. If,after making this cerlificale of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must ' forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's APPLICANT CERTIFICATION 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.1 agree to comply with all city and county ordinances and stale laws relating to building construction,and hereby authorize representatives of this city to enter Lender's Address upon the above mentioned property for inspection purposes.(We)agree to save indemnify mid keep harmless the City ofCuperino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply 1 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 CONSTRUCTION,PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DMSION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 13 CUPERTINO (408)777-3228• FAX(408)777-3333 •buildina(acuoertino.cra ❑NEW CONSTRUCTION ❑ ADDITION _ ALTERATION/TI ❑ REVLSION/DEFERRED ORIGINAL=M7# X PRaLEcr+nDaFss ZC, 'c-/ �4�( Le C�4 APN# �P—0/ _ 03::5 OWNER NAR¢ '"Ae, kU SC / I.( L( PHONE;2-,'5-7 _0306 E-Mea /- SCAE=ADDRESSs 2- Lc) , � V/ ( - /e`. crrycv" 4-i,J FA% WNTAGT -pt ( PHONE E-0UE, STAFFFr ADD © � ItiLLQTY.STAZr!��W FAX ' �.✓-�vt.v ❑OwNER ❑ owrm.BUKnm ❑ OWNERAGENT $4,DNTRACrOR ❑CMrrRA RACENT ❑ Aacn= ❑aNcwm ❑ oEVEwPER ❑ rPNANr fICE SE NUMBER uCENSE TYPE BUS.LIC P CO N P/y EMAIL. FAX STREET D c(� QTY,STATE,Z$ ARQDTECIIENGINEERNAME IICENSENrISiHtA 6 7 - l3 BUS.LIC# COMPANY NAM$ E-MAD. FAX STREET ADDRESS CIrY,STATE.ZrP PHONE DESCIOPRON OF WORK ''//,// Tng USE PROPa SE CDNSMTYPfi I #SM73 USE TYPE OCC SQFr. VALUATION(5) V AREAExCrrNEW FLCo0. DF]ta0 TOTAL AREA AREA AREA NET AREA MTHROCM KO'CHEN` OTFm REMODELAREA /O/ R OOELARPA REMDDELARFA PORCHAREA I DEOCAREA TUTALDECIOPORCH AREA GARAGE AREA: a DETACH ATTACH #DWELLING UNWS: 6 A SECOND DNR UYES SRCONI STORY YES RMG ADD®t 1XNO ADDITION ONO PRE-APPL[GTrON ❑YES tF YEa,PROVIDE COPY OF I Ur SLDGAN OYES RECEVMBY; TOTAL VALUATION: PLANNINGAPPL# ONO PLANNING APPROVAL t£RER zl J 30m? ONO J ' By OA" / KJ By my signature below,I certify to of a followiDW I sm the property m anthmized aatmt to art on the MWerty.ovmds behalf. f have read this application and the mfornation I ba pro ded is - I bave read the ' tioo o Work and verify it u acemare. I agree m comply with an applicable local atdmaaces and state laws relating I emhorim ��ertma to enter the above-ideatifled property for inspection purposes. Sigoanae ofApplieandAgent - Date: SUPPLMY=ALINFORMATLONREQ PLANCBZCKTYPE aovmvcsT.e New SFD or Multifamily dwellings: Apply for demolition permit for {OYER-TE'uoumm MMVIvc PLAN REVIEW adstmg bmldmg(s). Demolition permit is required prior to issuance of bolding permit for new building. ❑ XnTms ❑ PLArnsmcPLANRavmw Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD E3POBLIC Wawa form if arty Hazardous Materials are being used as part of this project ❑ oats ❑ aLaKnePr Copy ofPla fm Approval Letter or Meeting with Planning prior to ❑ awoR ❑ samrnaysawEz DLSl'RICI' submittal of Building Pemnit application. ❑ m"mommm4-rAL HEALTH. B1dgApp 2011.doc revised 06/21171 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35606033 . 00 DATE ISSUED. . . . . . . : 05/04/2012 RECEIPT #. . . . . . . . . : BS000016707 REFERENCE ID # . . . : 12050053 SITE ADDRESS . . . . . : 22014 BAXLEY CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : KUSCHILL MARIA T TRUSTEE ADDRESS . . . . . . . . . . : 22014 BAXLEY CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED' FROM . . . . : ANTHONY HODDER CONS CONTRACTOR . . . . . . . : ANTHONY HODDER LIC # 28979 COMPANY . . . . . . . . . . : ANTHONY HODDER CONSTRUCTION ADDRESS 7504 BOLLINGER RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (408) 257-4317 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ----- ---- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 30, 000 .00 2 . 00 0 . 00 2 .00 0 . 00 1BSEISMICR VALUATION 30, 000 .00 3 . 00 0 . 00 3 .00 0 . 00 1REMRESBAT SQ FEET 106 .00 588 .00 0 . 00 588 .00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 593 . 00 0. 00 593 .00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 593 .00 #16002 --------------- TOTAL RECEIPT 593 .00 OUTLET UNDER FOR NEW JACUZZI MOTOR. Rte+ C F'-T�jp, ACCESS THRU RIGHT SINK LOWER CAB. MAY 0 4 2012 tW-r AM= BY:------- TEM� �a e JACUZZI CONTROLS i sllowER FAN-LIGHT swrrcH- POSIRON CENTER CEILING OF SH01 b RADIANT FLOOR HEATER SWITCH. I O f/iF�rl �f FiG//G Y aft �s/✓t GcG L�9r✓i .{ C.OMMUNITY DEVELDPMENT DE EIJT MAIN ROOM SWITCH TO RECESSED BUILDING DNISIDN-CUPERTI COLING LIGHTS W/ DIMMER. APPROVED RECESSED LIGHT ROOM CENTER This set of plans and specifications MUST be kept at the & ABOVE TOILET W/DIMMER. job site during construction. It is unlawful to make any changes or alterations on same,or to deviate therefrom,without approval from the Building Official. The stamping of this Ian and specifications SHALL NOT F �� be held t��t�ti � $ I of the violation of any pr IVf yx Ordmw-' St�tedcsurj i IN C E 0" P Y BY oi9i✓ L/ �9I ilGvVl�l lJY DATE PERMIT NO. /��J� Go 3