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12050077 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19811 PRICE AVE CONTRACTOR-+HR­-+E0-BE PERMIT NO: 12050077 Z6TC4khffNE4y OWNER'S NAME.: ADAM 101:1,F AND SHARON M TRUSTEE S (2 PA-P DATE ISSUED:05/072012 OWNER'S PHONE: 4084720451 J PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION 30BDESCRIPTION: RESIDENTIAL COM%IF,RCIAL License Class Lic.q to 5,q oZj (! REMODEL 2 BATHROOMS 90 SQ FT Contractor ate S 7 —Ia- 1 hereby affirm that I am licensed nder the revisions 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. 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 whichthis permit is issued. Sq.Ft Floor Area: Valuation:$24000 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 APN Number:36905017.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that 1 have read this application and stale 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 DAYS FROM LAST CALLED INSPECTION. indcmnify and keep harmless the City of Cupertino against liabilities,judgments, -/ 7 costs,and expenses whidh may accrue against said City in consequence of the issued b ��.�/V 19T1/� Date: / granting of this permit. Additionally,the applicant understands and will comply y L 7-,1,7- with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 7-1 ^L RE:ROOFS: Signature Date O 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. ❑ OWNER-BUILDER DECLARATION Signature of Applicatn: Date: I hereby affirm that I am exemptfrom the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE:CLASS"A"OR BETTER I,as owner of the property,or nn) employees with wages as their sole compensation, 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 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. I will 1 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(x)should I store or handle hazardous 1 have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 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 Bay Area Air Quality Management District 1 performance of the work for whichthis permit is issued. will maintain compliance with the Cupertino hl unicipai Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Ileallh&Safety Code.Sections5505,25.S33 and 25534. Section 3700 of the Labor Code,for the performance of the work for which this agent: or authorized agen permit is issued. Del I cenify that in the performance of the work for which this permit is issued,1 shall not employ any person many manner so as to become subject to the Worker's Conhpensation laws of Calif'onhia. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must 1 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 CJ 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 ARCIIITF.(T'S DECLARATION and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses whidh 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 Processional 9.18. Signature Dale CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36905017. 00 DATE ISSUED. . . . . . . : 05/07/2012 RECEIPT #. . . . . . . . . : BS000016738 REFERENCE ID # . . . : 12050077 SITE ADDRESS . . . . . : 19811 PRICE AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : ADAM JOEL F AND SHARON M TRUST ADDRESS . . . . ... . . . . : 19811 PRICE AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : S. P CASPARY 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 24, 000 .00 1 . 00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 24, 000 .00 2 .40 0. 00 2 .40 0. 00 1BUSLIC FLAT RATE .1.00 119. 00 0. 00 119 .00 0.00 1REMRESBAT SQ FEET 90.00 588. 00 0.00 588 .00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 710.40 0. 00 710.40 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER -------- --------- --------------- -------------------- CHECK 710.40 1874 --------------- TOTAL RECEIPT 710 .40 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 19811 Price Ave DATE: 05/07/2012 REVIEWED BY: Sean APN: BPI/: `VALUATION: $24,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1R3SFDREM USE: PERMIT TYPE: WORK Remodel 2 bathrooms 90 sq ft SCOPE I,1lech. Ilan Check Plunk. Plmr Cheek Elee, Plan Check bh":h_ A"1111.1 FCa: Plumb. Peouil Far.: r1ec. P""I'a Fee: Oiher,1/arh. Insp. Oiher Plumb Insp. Li I Ocher Etc". In 31,adr. bt,p. Fac: Plumb. /nqp. Fee: Elec. In.sp. Fre: NOTE: This estimate does not include fees due to other Departments(i a Planning, Public Works,Fire,Sanitary Sewer District,School District,etc). Thesefees are based on the prelimina information available and are only an estimate Contact the De r or addn7 info, FEE ITEMS(Fcc Resolution //-053 L(d' 7/1/11) FEE QTY/FEE IMISC ITEMS Plan Check Fee: $0.00 90 s.f. Remodel, Bath(<=300 sf) Suppl. PC Fee: Q Reg. Q OT FO.0 •T hrs $0.00 $588.00 IREMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.e Reg. Q OT F0,0Thrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Comm 11rlion 7"n. Administrative Fec: 0 Work Without Permit? O Yes 0 No $0.00 E) Advanced Planning, Fec: $0.00 Select Non-Residential G Building or Structure O Trwwl Dacmnentalinn Fees: A Strong, Motion ['cc: IBSEISMICR $2.40 Select an Ad" strative Item Bldg,Stds Commission Fee: IBCBSC $1.00 X1/0 r SUBTOTALS: $3.40 $588.00 TOTAL FEE: 1 $591.40 Revised: 04/01/2012 CONSTRUCTION-PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DMSION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)7773228•FAX(408)777-3333•buildina(Mcupertino orn by-06q ❑NEW CONSTRUCTION ❑ ADDIITON ALTERATION/TI ❑ REVISION/DEFERRID ORIGINAL FM Tr p PROTECT ADDEEss I r ia. J�/ "No -3(o CY O� O I OWNER NAME �Ja/J d A�� v ma! q/ _O, I 5 I p-wAm f STREET ADDRESS ^Cr I LC/i v. cm. STATE I' `y , c156 I`I FAX CONTACT NAME �.F n. IGl PEONE 2 —/ E-gAm . O^„ STREETADDRESS b s - �. / 1 FAX -717q-33/6 ❑OWNER ❑ OWNER-BIm.DER ❑ OWNERAGFNr ❑ CONTRACTOR ❑CONTRACTOR A�GEI,7 ❑ AR�rECT ❑ENcI ❑ DEVELOPER ❑ TLNAM CONTRACTORNAME� CETl58 MIME y ^I IW LICENSE BUS.LIC p COMPANYNAM E-MAR���, p/�7y d- FAX STREET ADDRESS 0 V e/ CiSYp}}V ( w PHGNE -7 1 39 10 ARCE(IPECT/ENGINEER NAEOE `J LICENSENUNMEER Q BUS.LIC a COMPANY NAME E-MAIL FAX STREET ADDRESS CRY,STATE M FROM DESCRIPTION OF WORK i USE PROPO SE CON;) SMRIFS USE TYPE OCC SQFr. VALUATION(5) EXITTO NEW FLOOR - DEMO TOTAL AREA AREA AREA NET AREA iL v L2 R BATHROOM RIITNEN OTHER R�MODELAREA REMODELARFA REMOOELAaEA PORCHAREA DECKAREI TOTALDECTVPORCHArlFA I GARAGE AREA E DETACH ATTACH 6 DWELLING UNITS: IS A SECOND UNIT OYES SRCOAM STORY YEE BEING ADD®? ONO AODMOM ❑NO PRCAPPLICATION ❑YES 7YES,PROVI)ECOPYOF Is THE BLDG AN ❑YES RECEIVPeY: TOTAL VALUATION: PLANNDIGAPPLA []NO PLANNING APPROVAL LEITER Jac?ff.R xOatRt E]No D B9 my signature:helaw,I mtify to earhh of the following. i am the property owns ar amhotized aeene to act on the prriQerty,oWRds b-half,lhave read tbs application Bud the mfD®atioo I have vided is cortccr. I have read the Description of Work and verify it is accurate. I agree to comply with an applicable local ordinances and state laaw relating to 1 g [ Orin " es of Cupertino to enter the above-ideen7tified property for inspection pouposes. Signage of Applicant(Agent Date: Oc-- SUPPLEM=AL INFORMATIONREQUUUD I PLANCEXcKTYrx xavinNcsL.rP New SFD m MultifMnly dwellings: Apply for demolition permit far 'A'.(OYER-TBZ.COUN t yrs atin.aitG PLAN REVIEW emstmg building(s). Demolition permit is required prior to issuance of building J� G permit for new bmldmg. Cl HSPRESS ❑ PLAN974G PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11SLUMARD ❑ PUBLIC WORD form if any Hazardous Materials are being used as part of this proje L ❑ LARGE ❑ I=hxFT Copy of Plamiing Approval Letter or Meeting with Planning prior to ❑ Ma1ox ❑ sArlT,v¢Y sEa2R vrsrRla submittal of Building Permit application. ❑ ENYmOMdENTALI ALTE- BldgApp 201 Ldoc revised 06171/11 ;I�e wl�lddl� 4oin bit) �4' //cj/-/ Il AY Iv]E� %/�G " C� G ✓ G/��G LL� T7/-1--e7-,-) 7a " MAY 0 2012 re' 79 BY. a /i✓�j AaG ��G�E a' ���i3ai✓ �G/✓GX/FG /,JG1�GT0/Z� /� \ � �G��,JE/✓GC �►��-/-��, fro IT, -edJ COMMU DIDEVELOPMENTDEPARTMENT /� /►/�( T(X/Y " .-_ BUILDING DIVISION-CUPERTINO ------------- YUI � APPROVED i This set of plans and specifications MUST be kept at the 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 plan and specifications SHALL NOT be held to permit or to be an approval of the violation of any provisions of any City Ordinance or State Law. � - Iffy ,. , DATE. S EAMR NO,F • -- - r 't / d -U 'COP Y -C' -F1 �• _� ' � O _c O c� �Q/�-�1 Y10 �Dov ON Building DVarftnertt MAY 0 7 2012 /n 1 ss REVIEWED For C LIANCE Reviewed By: i W`� Ok��--- —r- - --------� L&) n — I i I i I --- v 1rl M C dur►�- 'Ae51 dma gi P ' V Aye d� CU+A-�na , � f� - Bulldi MAY 0 7 2012 i REVIEWED FOR MPLIANC --- — -- — — ---- -- -- — Reviewed By: SKETCH ADDENDUM File No. 992476 Borrower. Adam Property Address 19811 Price Avenue city Cupertino County Santa Clara state CA zip code 95014 Lender/Client Premier Financial Address 14583 Big Basin Wav #2B. Saratoga. CA 95070 18.0' Bed Bath 31.0' 0 co Kitchen Bath, Bed Dining 1 Bed ' Dining 3.0' Living 0 T N Entty p. sketch by Apex rvwndows-,; .. . .. Comments l� .. AREA CALCULATIONS. SUMMARY LIVING AREA BREAKDOWN Code; Description► ' ' Size :` Totals Breakdown Subtotals . GLAl Firat: Floor 1726.50 1726.50 First Floor GAR Garage 471.00 471.00 18.0 x 35.0 630.00 2.0 x 9.0 18.00 30.0 x 31.0 930.00 5.5 x 27.0 148.50 a m a7d4d1 a m m 3 N 03 O C z . 0 ,