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12070019 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 23100 VIA ESPLENDOR UNIT.V46 CONTRACTOR:HANKINS CONSTRUCTION PERMIT NO: 12070019 INC OWNER'SNAME: HEINSEN LAVONE F TRUSTEE 38227 FREMONT BLVD DATE ISSUED:07/03/2012 OWNER'S PHONE: 6509440100 FREMONT,CA 94536 PHONE NO:(510)795-9651 ❑ LICENSED CONTRACTOR'S DECLARATION) BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Clercs 0 i6 5�J1,ic.4 nLh J4�� r r r Fi�(�UC)S )r zlf0atil 3 �" MECH RESIDENTIAL COMMERCIAL Contractor _ r JOB DESCRIPTION: REPLACE EXISTING SHOWER STALL WITH NEW MARBLE 1 hereby affirm that I am licensed under the provisions i es opted SHOWER PAN AND WAILS (commenting 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 which this permit is issued. I have and will maintain Workers Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$3600 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:34255031.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes.-(We)agree to save indemnify,and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations pe the pertino Municipal Code,Section 9.18. Issued by: '���'/� /l/� Date: /73-%�L Signature -- t ❑ OWNER-B ILDFR DECLARATION RF.-ROOFS: All roofs shall be inspected prior to any roofing material berg installed If a roof is hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. 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, Signature of Applicant: Date. Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec7044,Business&Professions Code). .\LI.ROOF COVERINGS TO BE CLASS"A"OR BETTER 1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE, declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Cade.Chapter 9.12 and the health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Section 25505,25533,and 25534. not employ any person irony manner so as to become subject to the Worker's - Compensation laws ofCalifornia. If,after making this certificate of exemption,l Owner or an tic enP 1 become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING Af.F:NCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and stale laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs•and expenses which may acerae against said City in consequence of the ARCIHTF-CT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date COMMUNITY DEVELOPMENT DEPARTMENT.I BUILDING DIVISION-CUPERTINO APPKUV r_: I t R7E� ' g�TEI� Thls set of plans an"d spacificatlons fie kept at the make any ". Job site during construction. ff isPPSlate I :_1 i as JUL 0 3 2012 changes or alte`ratlons on'sangp Qr���av + - therefrom,wRho ut approval:$om the Bulldmg Official. I © _ _..._ i____ m . j 1 The staping of this.PIan-and., -! be held to permit rlto be an pro oevlolatlon_ i r . -Master-Bedroom of any provislonsiof any�CRy' ' a a for 5tato.law.:. 13'0'z 12'0" ?_ 1 - - L. —J. I. . ._ BY —'I DATES l 6'D-;Mr0'o- Passage x54'= —"--0-4'3"-X-5'2"--- PERMIT NO. u l I I I© f I l i -8 : I ets © I I �. ', i _ 2 0'k 1. I -DiI j I - 12.0"x 9W I 'i ' Bath' - - Kitchen 1 j 9'0) x94 =1CIO Lit p -13 x115' © (D __Ll _ I I >:; men_ j I51x7:0; 1 1 i 81 x 2'3'—' © Garage]1.0.x200 f p © I I $' r—I-' in' �BedroaI m- - j122 x 11'6" qj F F 1(`;h E C 0 'S'Emergency Response System. 0 ,Electrical Outlet I 0 Cable Television Outlet 2P Telephone Outlet = 1 foot I - 1 StI andard Villa INTERIOR LIVING SPACE ��u 1 11 1,280 Square Feet TWOI Bedrooms e TWO Baths TOTAL DECK SPACE 1 - 190 Square Feet AT RANCHO SAN ANTONIO Flag: artrc pima pramraua.Acmal mrasare m and laym,may wry.