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09030081 CITY OLD CUPERTINO BU77 ILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: ngninopi 10533 ESQUIRE PL COLDSTRE�Q PERMIT ISSUE DATE OWNER'S NAME: PQ BOX— SA CONTROL NO. .nON : BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH REMODEL BATH NON—STRCUTRUAL o c cLICENSED CONTRACTOR'S DECLARATION INCLUDE (M,E, P) Job Description UI ltcreby affirm that I am licensed under provisions of Chapter 9(commencing Z with Swtion 70(10)of Division 3 of the Business and dcya"d my license is H in full force and effecK !/� Lic R�r6/ S v�Z License ConlradO K M Dale ARCHiTEC'CS DECLARATION I understand my plans shall be used as public records 5 6 4 O y Licensed Professional DWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the Co following reason.(Section 7031.5,Business and Professions Code:Any city or county K$ which requires a permit to construct.alter,improve,demolish,or repair any structure prior to its issuance,also requires dw applicant for such permit to rile a signed statement `; •Ft.Floor Area Valuation z< that he is liccrtscd pursuant to the provisions of the Contractor's License Law(Chapter 9 (1 Y F (Co. with Section 7000)of Division 3 of the Business and Professions Code)or y R E that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of PN Number p y yp not more than five hundred dollars($500). 0 1,as owner of the property,or my employees with wages as their sok compensation, will do the work and the structure is not intended or offered for sale(Sec.7044.Business Required Inspections and professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). I,as owner of the property.am exclusively contacting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's U. cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. B&P C for this reason ❑I am exempt under Sec Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury One of the following declarations: I hsas andtw d for b t Section 3700 of the tabor Code,for the performance Of etltc sation,as pro' Y work for which this permit is issued. 1 have and will maintain Worker's Compensation insurance,as required by Section 3700 of the Labor Code.for the performance of the work for which this permit is issued. My Wor r Cpmpe- �, carricr and Polity number O- j 0 Cartier ~�L t` Polity No.:� 3 l CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less) i certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J z forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY E~•r rN. I hereby affirm that there is a construction lending agency for the performance Of Q! the work for which this permit is issued(Sec.3097,Civ,C.) W A Lender's Name Po Lender's Address I certify that 1 have read this application and state that the above information is LUL 0 correct 1 agree to comply with all city and county ordinances and state laws relating to O V building construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes.(We)agree to save,indemnify and keep harmless the City of Cupertino against Ma l� liabilities,judgments,costs and expenses which may in any way ac croc against said City U Z in consequence of the granting of this permiL Date APPLICA DERSTANDS AND WILL L WiTH AL NON DINT Issued b.r: SOUR GULATiONS. Zd b v Re-roof: Signature of Applicant/Contesctor Da T of hoof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roof:;shall be inspected prior to any roofing material being installed. 0Yes If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new naterials for inspection. District? ❑Yes o 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 25 A understand that if the building does not ntly have a tenant,that' is my po bi'ty to notify oats t of the Date mqu' mens which must be met ; issu of C rtific f Sppan •t Signatui a of Applicant o All roof coverings to be Class"r ``or better Owner or authorized agent are Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 .;UPEkTINO Buildin De artment JOB ADDRESS: `A� PERMIT # d 5 3 OWNER,S NAME:�S sties A S PHONE q6f 17--4` L � � GENERAL CONTRACTOR:C--- FAX # YW 7 L S`-2 t Z S_ I am not using any subcontractors: Signature Date Please check applicable subcontractors and com Clete the followinginformation: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork 1 c Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date A 73 3/4" NOTES: -Ceiling ht=95 1/4" -Existing 6"soffit at tub to be removed -tub replaced with new shower 6 3014 75" New maple vanity * with granite CT CU o -qj Z �A Tiled Shower-floor, -T11gd tYo-or d �7 walls, ceiling 0 4- AW,- �Z A, 63" 34- Al C-C-t,-CIAN I 32" .5-1 IV 11 j Lu'IL 1z C- L- co---.39 1/2"----- 30 1/2" L AU (1, 4m, "u 4 6,1f) Sm0ILC i �-744 �"'� FJ , ASsESSOI? — - 73 3!4"-- NOTES; . .. . -Ceiling ht=95 1/4" Existing 6"soffit at tub to be removed tub replaced with new shower 301/2" New maple vanity (i)x\,er with granite CT '+' LON ^D : Tiled Shower-floor, I Tiled floor walls, ceiling I 63 a Q --- 34" - M �R C►G.V- 1`Lj� � j 5 co 30 1/2" +►I I "" t.� '�fevtrl r AU � � CITY OF CUPERTINO ADDITION(REMODEL CUPEI,TINO FEE SCHEDULE a�n bA APN# Date: 2 0-,�2 cj Building Address: 16 33 w44-- ?1k_eAe Mailing Address(if diffe ent from building address): Owner's Name: i �I��n� I �� Phone#��Za 03� +•1 Lf -7 -� HOA: (Exterior work only) Yes ❑ No ❑ If yes, provide letter from HOA Contractor: / Phone#: Fax#: Contractor License#: 3 S Cupertino Business License#: Phone#: Contact: [�dy T-�}�2 - �� < f! Fax#: Building Permit Info: Bld (❑/ Ele [� Plumb. [t� Mech. Hillside ❑ Ct. lob Description: Addition-What is being added?(Be Specific): What is being remodeled(not including ad ' ion) ' r Remodel Includes Re-Roof: Yes ❑ No [j If yes list number of squares Remodel Includes Structural: Yes ❑ No Do you have the pre-application planning approval? Yes ❑ No ❑ If yes,please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen Bathe_ ether Type of Construction(Usage Class): Occupancy Type: 1-A 1-B El I11111 V-A ❑ I011 B,IV-HT, V-B 0-- -7 ' -7 Valuation: ZS uv� Please check this box if the project is a J second-story addition ❑ Project Size: Expressy[rStandard ❑ Large ❑ Nla'or Please complete relevant portion of the Green Building Checklist & attach it to the application or if appli,-.able, Green Building Points Achieved: include in plan set& the sheet index. ***For Office Use Only** Cu- *16^ rte,....,+,... 71D o...moa Al me mn