09050162 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ' NE ` '
PERMIT NO.
BUILDING ADDRESS:
10191 LEBANON DR MAXINE ERLUND & MIKE
OWNER'S NAME: PH I LL I F S PERMIT ISSUE DATE
S A CONTROL NO.
NE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0 0 0
app LICENSED CONTRACTOR'S DECLARATION Job Description
U I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z with Section 70110)of Division 3 of the Business and Professions Code.and my license is BTHRM F MDL F I XTUR S TOUNFISHED; NO RE-RF& NO
a in full force and effect
z License Class Lk• STRUCTR L(4 0 SQ)
-a Date Contractor
ARCHITECTS DECLARATION
C2 U I understand my plans shall be used as public records
s
W y Licensed Professional
O< OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
t$9 which requires a permit to construct,alter,improve,demolish,or repair any structure
in prior rior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
y^
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area
Y F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
$5000
y 5 that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(SM. 34214010 . 00
❑I,as owner of the property,or my employees with wages as their sole 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 we 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
sok.).
5e,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's li-
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.
❑I am exempt under Sea B&P C for this mason
Owner���� Date��_
1���RKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
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 Workers Compensation Insurance carrier and Policy number are:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($I00)
or less.)
1 certify that in the performance of the work for which this permit is issued,l shall not
employ any person in any man r so as to b col:gbjyct to the Workers'Compensation
Laws of California.pato `Yi
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 O forthwith comply with such provisions or this permit shall be deemed revoked.
Z 0-4 CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lenders Name
aZ Lenders Address
U 0 I certify that I have read this application and state that the above information is
LL corccL I agree to comply with all city and county ordinances and state laws relating to
U building construction,and hereby authorize representatives of this city to enter upon the
U above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep hornless rite City of Cupertino against
rA liabilities,judgments,costs and expenses which may in any way accrue against said City n
V Z in consequence of the granting of this permit. Date S lj
�+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b•r:
SOUR REGULATIONS.
—� -5_—Z5,-7_D01 Re-roofs
Signature PPlican� UC°"t+ or Date
HAZARDOUS MATERIALS DISCLOSURE Type of.ZOOf
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(x)? All roof! shall be inspected prior to any roofing material being Installed.
❑Yes o
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
At hazardous air contaminants as defined by the Bay Area Air Quality Management all new 1 naterials for inspection.
Oistricl?
❑Yes
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
does not currently have a tenant,that it is my responsibility to notify the occupant of the
requirements which must he met prior to issuance of a certifhcWf Occupancy. Signatur:of Applicant Date
All roof coverings to be Class'J ``or better
Owner or authorized agent Date
OWNER-BUILDEIR VERIFICATION o (2 l
1. (Check one) I or my immediate family parent,spouse or child) will perform:
A. All the work authorized by this permit
B. A portion of the we rk
C. None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hirec.to do:
A. All of the work
B. A portion of the work(complete section below)
Contractor Address/City. Phone # State License # Type of work to
3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
PersorVTirm Address/City . Phone Number Type of work to be
performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side).
Property Owner's Signature: Date: n
Job Address: C O 21 Le ba r,0A Or Permit# 091' 16 2
Any changes to the information Provided on this form shall be submitted to the City of Cupertino Build
Department.
Ile
Bathroom to
be Finished
MDI Fridg.
1� Wsh
r---1I
0o
oO o
o u
f
LCI
o
�! it I IIII I
avED
1`J I
p G
tA�V �. S 'LT39
,t
to
77
c E ED
m,AY
BY'._
i
�i
R-2
O _�
Description of work:
Remove existing drywall from tub surround area and adjacent walls in unfinished
bathroom area. Remove existing carpet ani pad. Install bathtub connecting to
existingdrain, adding new shower valve. Install Dense shield waterproof drywall per
manufacturer's installation instructions pertaining to tub surround and back splash(see
attached). Install slab granite over dense shield as bathtub surround extending from
bathtub flange to ceiling. Install sliding glass tub/shower door per manufacures
specifications. Install 1/4" Hardi backer ov(!rlain by 3/8 tile flooring. Install low flow
toilet connecting to existing plumbing. Install vanity sink, cabinet, granite countertop
and back splash connecting to existing plumbing. GFCI receptacle existing. Fluorescent
light fixture/ventilation fan existing.
Vt�C�
lk4
By 0017
ti
1
PC
�.. _ -, £ , h x t .. — mac- r. '� -•3,. -
m.GFE
Rt
tJ� RAY I R v't k
-c
t
" a �^;` ' t> `L� a»,..
-x.�. %kr z c3: i-
Yr-.aal-40N':-x S.: ne-.rk_ �..r.?� c'— -
y z y
_. .fir'.'- t
Assessor's Parcel Number:
Name of owner. I_ `uX L!� r , �''t ✓` �� `' �� ` ' 11,� S
Project address. y L- b C4-
q nn t
Contact person. �`��- C h ��� Phone. Lf 2Sy 6
Fax.
Net square footage of lot. 1 Z 1
Existin Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces inside the garage? Y N
�.,privacy protection planting required for the project? Y N
On what floor(s) is work being done?
Brief description of work. (k``'`P Ie+e 6 k�n
Code editions:2008 CBC (:n-N)2008 CFC (6-N)2008 CMC �-N)
2008 CPC -N)2008 NEC CT-N)
Effective 1/1/08 IL NE� j�,j �
MAY
�3Y:
Plan Review Process Work Book Page-B-Revised 1/1/08
➢othrooM to y
Oe finished
CDish LFridg.
Wsh
r--� cn
0 on
LQ
n
a
0
o
IIII
U U t I
U F
10
LJL-
2009
$Y:
� O la I I-e�tnpn Q�
RECEIVED
MAY 2 8 2009
BY:--
b(l�2 �� �ou•v�
CITY OF CUPERTINO
ADDITION/REMODEL
CUPERTINO FEE SCHEDULE
APN # ' I O ' 0 ' � Date: n n u y r Z �10
,� , � I
Building Address: to`"i I C1 1
Mailing Address (if different from building address):
Owner's Name: Jv\tuj t, —i i+...t,-4- -S- fA-Alk, Vk'k t,�5 Phone# : `111 g {7 11� I
cf,(u.ncl
HOA: (Exterior work only) Yes ❑ No ❑
If yes, provide letter from HOA
Contractor: Phone#:
�" Fax #:
Contractor License#:
Cupertino Business License#:
Contact: Phone#:
Fax #:
Building Permit Info:
Bldg. ❑ Elect. ❑ Plumb. ❑ Mech. ❑ Hillside ❑
Job Description:
Addition-What is being added?(Be Specific):
v3 (.4,k�P-r c 0 �'�--
What is being remodeled (not including additio:i)?
Remodel Includes Re-Roof. Yes ❑ No Q_ If yes list number of squares
Remodel Includes Structural: Yes ❑ No 12
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 Bath Other
Type of Construction (Usage Class): Occupancy Type:
I-A, 1-B ❑ IUIII/V-A ❑ IUIII B, IV-HT, V-B � V_ r 17,
Valuatio Please check this box if the project is a
7 U second-story addition ❑
Project Size: Express ffJStandard ❑ Large ❑ Major❑
Please complete relevant portion of the Green Building
Checklist& attach it to the application or if applicable, Green Building Points Achieved:
include in plan set& the sheet index.
***For Office Use Only***
Over-the-Counter ElRevised 02/05/09
CITY OF CUPERTINO
ADDITON/REMODEL
FEE S41HEDULE
Quantity Fee ID Fee Description Fee Permit Type
Sq Ft Group
DECKS 1R3SFDADD OR
1R3SFDREM
1 DECKWOOD Deck(l Vood)-Each B
(Each)
1DECKRAIL Deck Railing-Each B
(Each)
GARAGES 1R3SFDADD OR
DETACHED 1R3SFDREM
1 GARDTW<=1 K Wood frame up to B
1,000 SF (each)
1 GARDTM<=1 K Masonry up to 1,000 SF B
(each)
BCONSTAXR Construction Tax Res
(new dE tached garage)
PATIO'S OPEN 1R3SFDADD OR
1R3SFDREM
1 PATIOWOOD Wood Frame up to 300 B
SF
1PATIOMETAL Metal Frame up to 300 B
SF
1 PATIOOTHER Other Frame up to 300 B
SF
PATIO'S CLOSED 1R3SFDADD OR
& SUN ROOMS 1R3SFDREM
1 PATIOENCLW Enclosed Wood up to B
300 SF
1 PATIOENCLM Enclosed Metal up to B
300 SF
1 PATIOENCLO Other E reclosed Patio up B
to 300 c F
1 COVPORCH Porch Covered-Each B
(Each)
REMODELS 1R3SFDREM
1 REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan
300 SF check
1REMRESBAT Bath Remodel up to 300 B 66
SF
1 REMREOTH Other R-,model up to 300 B "
SF
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Permit Type
Sq Ft Group
1 MECPLNCK Stand Alone Mechanical M
Pln Ck ;hourly
1 PLMPLNCK StandAlone Plumbing P
Pln Ck (hourly)
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1 BSEISMICRE Seismic;Residential B
1 TRAVDOC Travel &Documentation B
1 BUSLIC Busine;s License B
Green Building Plan Check
Index of Green Building Points/Categories
A. Category Example of an Index or Table of 3reen Plan Sheet or Page Points
Building Points Categories that must be
shown and referenced on the Project
Plans See below
B. Site 9. Install H.E. Irrigation, (details/s pec)* L-1 2 points
11. Permeable Paving, Note L-1 2 points
C. Foundation 1. Use 15 % Flyash Concrete, (nate) S-1 5 points
D. Structural 3. Uses Wood I-Joist, (See Spec.) S-2 2 points
5. Use Truss with heels, (detail) S-2 2 points
6. B. OSB Sheathing, detail S-2 2 points
E. Ext. Finish 1. Composite Decking, (Note/Spec.) A-3 2 points
4. B. Fiber Cement Siding, NoteiS ec. A-4 2 points
F. Plumbing 1. Insulate all H.W. pipes, (Note/:ipec.) P-1 2 points
5. Tankless W.H., (Note/Spec.) A-2 2 points
11. A 2500 Gal. Tank, (Note/SpecL-1 10 points
G. Electrical 4. E. Ceiling Fans, (Note/Spec.) A-3 4 points
H. Appliances 1. Energy Star Dishwasher, (Notes/Spec.) A-3 1 point
3. Energy Star Refrigerator, (Note:/Spec. A-3 1 point
P. Other 1. List Green Features on Plans 1 point
TOTAL I20INTS 40 points
Plan Review Process Work Book Page-12-Revised 3/25108