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12050172 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7618 HOLLANDERRY PL CONTRACTOR:ANDY HORIUCHI PERMIT NO: 12050172 CONSTRUCTION OWNER'S NANIF.: TSUCHIDA STEVE A AND REIKO 847 LOS ALTOS AVE DATE ISSUED:0522/2012 OWNER'S PHONE: 4089968839 LOS ALTOS,CA 94022 PHONE.NO:(650)948-2028 ❑ LICENSED CONTRA - 7C -TO pR ' 'SS DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class Lic.4 1 8 7 2 0 I r r r MECH RESIDENTIAL COMMERCIAL Contractor Dale 2 L. �-- 1 hereby affirm that I em licensed under the provisions of Chapter 9 JOB DESCRIPTION:SINGLE FAMILY DWELLING TWO(2)BATHROOM (commencing with Section 7000)of Division 3 of the Business&Professions REMODEL (100 SOFT)NON-STRUCTURAL Code and that my license is in full force and effect. I 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. 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.Ft Floor Area: Valualion:$15000 pemti(is issued. APPLICANT CERTIFICATION APN Number:36229004.00 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 slate laws relaling 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 permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18.. .L �,L y _ Dnte:SZZf Signature DaleIssued b ❑ OWNER-BUILDER DECLARATION RE-ROOFS: 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 being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,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 sole(Sec.7044, Business&Professions Code) Signature of Applicant: Dale: I,as owner of the property,am exclusively contracting with licensed contruclors to construe(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 Ibree declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapler 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code.Chapter 9.12 and the Health& Section 7700 of the Labor Codc,for the performance of the work for which This Safety Code,Section 25532(a)should 1 store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District 1 will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance 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&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Own r o aul o�iz d agDale: ent: forthwith comply with such provisions or this permit shall be deemed revoked. `` CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that(here is a construction lending agency for the performance Of work's correct,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 conslruclion,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 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp.: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36229004 .00 DATE' ISSUED. . . . . . . : 05/22/2012 RECEIPT #.. . . . . . . . . : BS000016885 REFERENCR ID # . . . : 12050172 SITE ADDRESS . . . . . : 7618 HOLLANDERRY PL SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : TSUCHIDA STEVE A AND REIKO ADDRESS . . . . . . . . . . : 7618 HOLLANDERRY PL CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5071 RECEIVED FROM . . . . : ANDY HORIUCHI CONTRACTOR . . . . . . . : ANDY HORIUCHI LIC # 26027 COMPANY . . . . . . . . . . : ANDY HORIUCHI CONSTRUCTION ADDRESS . . . . . . . . . . : 847 LOS ALTOS AVE CITY/STATE/ZIP . . . : LOS ALTOS, CA 94022 TELEPHONE (650) 948-2028 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 15, 000 .00 1 .00 0 . 00 1. 00 0 .00 1BSEISMICR VALUATION 15, 000 .00 1 .50 0 . 00 1 .50 0 .00 1REMRESBAT SQ FEET 1 .00 568 .00 0 . 00 588 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 590 . 50 0. 00 590.50 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 590. 50 MC --------------- TOTAL RECEIPT 590. 50 CITY OF CUPERTINO 191 . FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 7618 hollanderry pl. DATE: 05/22/2012 REVIEWED BY: bob s. APN: BP#: 'VALUATION: 1$15,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration I Repair PRIMARY SFD or Duplex PENTAMATION 1R3SFDREM USE: PERMIT TYPE: WORK sfd 2 bathroom remodel non structural. SCOPE il.•clr. I'(nn Chat Plumb. Plan Check /ileo. Plan(,h,:ek med). l'rrnr l Fee: Mand" Permit Fen: lilec. Permit Fro: Orher,llceh. Insp. Ocher Plumb Insp. Li Other Eler. /nap. ,Mach. hr..p. Arc: Plumb hr.rp. Fee: Elco Insp.Fee: NOTE: This estimate does not include fees due to other Departments(ie.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc.). Thesefees are based on the prefimina information available and are only an estimate Contact Ute De t or addn 7 info. FEE ITEMS (Fee Resolulion 11-053 Eff 711111), FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 EKI s.f. Remodel,Bath (<=300 sf) Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $588.00 IREMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.0 Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Conslrn(liun Telt' A(.hniW vt r ti l e Fire: O Work Without Permit? O Yes Q No $0.00 0 Advanced Planning Fee-.. -Residential$0.00 Select aNon Travel Uncuntenlalinn Fees: Building or Structure O Strong Motion Fee: IBSEISMICR $1.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $2.50 $588.00 TOTAL FEE, $590.50 Revised: 04/01/2012 L ICD oI � Z CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•buildincl(O.cupertino.orO ❑NEW CONSTRUCTION EI ADDITION ❑ ALTERATTIION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT PROJECT ADDRESS _76 \ 2 - `-u1 A1Up rY` APN n �P / —Z I Q u q OWNER NAME ST''Uf- p 6 3 11 E-MAIL STREET ADDRESS CITY. STATEZIP FAX 21 1 CONTACT NAMEn `uC QN \ �6[`r 11 Q� E-MAIL STREET ADDRESS V / o� J1, u Cljl'�(T�r ) o omT ` A FAY 13 OWNER ❑ OWNER-BUILDER 11OWNERAGENT CONTRACTOR(-_❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONT OR NAME t r�C EF G LICENSE NUMBER 7 n r�� 1 LICENSE TYPE BUS.LIC n.Z 6 U? COMPA NAME �� E-MAIL / V vca FAX , STREET ADDRESS CITY.STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC p COMPANY NAME E-MAIL FAX STREET ADDRESS CITY.STATE.ZIP PHONE DESCRIPTION OF WORK ' ` vX kg I I•&)L 3 AC-4 c kL AT01 W LA EXISTNG USE PROPOSED USE CONSTR.TYPE I ASTORIES USE TYPE OCC. SOFT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA REMODELAREA REMODELAREA PORCH AREA I DECKAREA TOTALDECKIPORCHAREt GARAGE AREA 115EFACH ATTACH N DWELLING UNITS: ISASECONDUNTT ❑YES SECOND STORY OYES BEING ADDED' ❑NO' ADDITION' ❑NO. PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN 1[]YES RECEIVED BY: TALVA�^LUATION ❑ IN : PLANNNGAPPL4 NO PLANNING APPROVAL LETTER EICHLER HOME` ❑NO W �/ O ct By my signature below,I certify to each of the following: 1 am the property owner or authorized seem to act on the property owner's behalf. I have read this application and the information I have provided is correct..I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatingtldin cons etio 1 authorize representatives of Cupertino to enter the above-identified pmperty for inspection purposes. Signature of Applicant/Agent: Date: '�" 2--L-(7-- SUPPLEMENTAL INFORMATION.REQUIRED PUN CHECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit PoroLT vex-TxecouNTER B� mLnwc PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLANREVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure E] STANDARD ❑ PUBLIC WORNS form if any Hazardous Materials are being used as pan of this project. ❑ LARGE ❑ FIRE DEPT —Copy of Planning Approval Letter or Meeting with Planning prior to ❑ m OR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_2011-doc re,ised 06121111 Proposed Bathroom Remodel �t t ,`J` Mr. & Mrs. Tsuchida , 7618 Hollandery Place Cupertino, CA 95014 ' I •� I v tl 7 L f sli 51, hb IJ 4 1. i�»A ,�` .k 11..�� �I Y � ��! I 1'� ,•M•—...•gym.+ _i`' (.. '�a:7.`�✓'S�.c..Si> f�_ 1 f S'I E' !. -la�"�la �YA t _ Existing bathr000ms to Be remodeled. I No Changes in floorplan71 � rAt . 4 QPMEN rlAE�` �/�•O��r'C S �U-•LX "'—BUft'D 7'�KVI�ION;CU 6lr ' APPROVED% 4y,, Th=srt of plans and peclllcatlons MUST'tie kept,ml4 rI IUc.rnS gJconStn'lOhon' It is unlavlul t. � n „G I +f r,� •r X 11. 1,t OI r alterjIJnson same,or L ! tld �1 ', + 1 rp ! applovalfrom the Bullding40fflctaf. n r t u ,....:..' r 3�_,•',, ' Thr. ?'"r•ino cf this plan and specdlc,ations�SIiALL YOT-. 1 ti ,rl w x I r, r > .yy tom: :r IIEI(. .r. p=';nit or to be an:aPl�reval'oflthe,wolaUori of.nyprovisions of anyUty;Ordlnan^ceor, StfeLdN: � 'll Pcl i }Inli no DeP GR4_ -ILn ; t i �,,�cL�w-� �, lrc�Q-�ar,�,. , ' �Ay�27Z�2012? `;���, � •s�-, d./ c��z c�to terry MEWED FOR COD I"6 �N^ ` 4 { f � Andy Horiuchi Construction o n ;', .. 847 Los Altos Ave. Los Altos, CA 94022 t, k ,°'> a" °,CUPERTINO l..'rS y )� LS): 'j it G4n Cal Lic. 783881 (loSa> FS 8 ���5 1--" i A '� �.s^ auuding'Department MAY;' r'fl'> REVIEWED FO COMPLIE; , y dt �, .. '' . ` C�}✓