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12070078CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11103 CANYON VISTA DR CONTRACTOR: Cl IIA I -IU PERMIT NO: 12070078 OWNER'S NAME: Cl IIA till 2409 LOMENT PL DATE ISSUED: 07/112012 OWNER'S Pl IONE: 4088077897 SAN JOSE, CA 95124 PIIONF. NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL License Class Lic.11 REMODEL 2 BATHS NO ELECTRICAL OR LIGHTING, ONLY Contractor Date MECH AND PLUMBING 1 hereby affirm that 1 am licensed under the provisions 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. 1 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 Sq. Fi Floor Area: Valuation: $7500 performance of the work for which this permit is issued. 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: 35628029.00 Occupancy Type: permit is issued APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED coffee(. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to budding 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. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Issued la Date: granting of this permit. Additionally, the applicant understands and will comply 11 a with all non -point source regula(i os per the Cupertino Municipal Code, Section 9,18. RF. -ROOF'S: Signature Date 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-RUILDF.R DECLARATION Signature of Applicmt: Date: I hereby affirm that I em cxrmp from the Contractor's License Lew for one of the fallowing two reasons: AL1- ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole comp_nsalion. will do the work, aid the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner ollhe properly, am exclusively contracting with licensed contractors to IIA7.ARDOUS \IATF.RIA S DISCLOSURE construct the project (Sec.7044, Business & Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Ileallh & Safety Cade, Sections 25505, 25533, and 25534. 1 will 1 hereby affirm under penalty of perjury one of the fallowing three maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and the declarations: Ileallh & Safely Code, Section 25532(x) should 1 store or handle hazardous I have and will maintain a Certilica(e of Consent to self -insure for Workers material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air conlaminams as defined by the Bay Area Air Qualily Management District l performance of (he work for which this permit is issued. will maintain compliance svilh the Cupertino M unicipai Code. Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Ileallh & Safely Code. Sections 255 . 25 3, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date t permit is issued, I certify that in the perfomhance of the work for which this permit is issued, I shall not employ amperson in my manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I CONSIRU(TION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I 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. w'ork's for which (his 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 stale laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned properly for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmlessmathe Cil of Cupertino against liabilities, judgments, costs, and expenses whidi y ac c against said City in consequence of the I understand my plans shall be used as public records, granting of this permit, A4,ifion , the applicant understands and will comply with all non -point sours r s per the Cupertino Municipal C e, cation Licensed Professional 9.18. �� y Signature Date RESIDENTIALPROJECT COVER SHEET Assessor's Parcel Number:- Name umber:Name of owner. Z a 4, La.L- Project address. O 3 /Cl,4� V4 N Contact person. �f�/�. 40 Phone. Y4 - A� 7 _? ?,y 7 Fax. Net square footage of lot. 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. 1Z,--. 1 Is privacy protection planting.required for the project? /Y-�N Build it Green Total Points On what floor(s) is work being done? _ Brief description of work. Code editions: 2007 CBC- „ N)2007 CFC N)2007 CMC (�9) N) 2007 CPC ��PMEpapgEATib G I ION - PE N ' 'APPROVED Effective 1 / 1 /08 This set'of plans and specifications MUST be kept at the Job site during. construction. It is unlawful to make any change"s 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 off-aDy/�City OrdigancAe or State law. BY I L( "7 DATE. PERMIT NO. NO.�— Plan Review Process Work Book. , ;Page;-8-Revised8 At o el -Z4 w�a ,Vo LiGje, gVC.0]�+ TIV D JUL 1 X 2012 BY.— W ti IS z CIIiA I -IL. I I l 013 Ce"yon v S+4 -Dr (✓�t�i Ilh (i � Ioa�L7 1`_t'r'HecQe f Anus{� - Z� /� I Replace &4;,,,4: Ivo -4e.. Toe - TILES, TL . I� let p, ele.E.. N. Lcu.nj 7' t i /%%on�r�/J' 4 wo z JIJ�, X ZO s l fi I r / WAA ' � �lID3 CuhYon VcS-�°i �r CUP -e,4,'- o 0" (2�jucc cub �ei ; Cuo4�TR k _ Todet. r7Lr ��RrP .QrOn� f/l �. T�.�per y1�1 -rub ewa��f Aoamy Meekr l ins,//uCe 4- o,A;,lee An.(ee (ki %T rl WWI-, col RRCJE� yl�,n JUL 1 X [017 BYL CITY OF CUPERTINO I/lll FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not includejees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Divriet. ere k These lees are haled an the nreliminary information available and are only an estimate. Contact the Dent for adtln'l info. FEE ITEMS (Fcc Resolution 11-053 Ell' 711111) ADDRESS: 11103 canyon vista dr. DATE: 07/11/2012 APN: BP#: REVIEWED BY: bob.s 'VALUATION: $7,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: !il✓c. l', u,nir l4„ ENTAMATION 1R3SFDREM PPERMIT TYPE: WORK sfd 2 bath remodel no electrical or lighting, only mech and plumbing. SCOPE Plump_ /)I'/). 1-c- NOTE: This estimate does not includejees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Divriet. ere k These lees are haled an the nreliminary information available and are only an estimate. Contact the Dent for adtln'l info. FEE ITEMS (Fcc Resolution 11-053 Ell' 711111) t lr, ir, l'Lni r'h: r k I'bunb. Plow Ch, I lce:_ Non iarrak 1lrch. !t•nrrir Fr..' /'hmrh. 1'c, -mit Fns: !il✓c. l', u,nir l4„ llrlrr,'Vr, l,. lru7, Otlrr, Numb /n9p. Urhr,'P:hv. Iny. Plump_ /)I'/). 1-c- beep. NOTE: This estimate does not includejees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Divriet. ere k These lees are haled an the nreliminary information available and are only an estimate. Contact the Dent for adtln'l info. FEE ITEMS (Fcc Resolution 11-053 Ell' 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 125 s.f. $600.00 Remodel, Bath (<=300 sf) IREAIRF.SBAT Suppl. PC Fee: Q Reg. Q OT 0.0hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee -.0 Reg. Q OT FooThrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 i.', wtrn rrrli7n 7,o l,Imini_'lr 7 rlk", /'"". 1 1 C) E) Work Without Permit? 0 Yes (E) No $0.00 Advanced Plannine Fcc: $0.00 Select Non -Residential Building or Structure G 0 i 76,me1 /)„c run"wellirwl I ces. StronC Motion Fcc: IBSEISMICR $0.75 Select an Administrative Item Bldg Sids Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.75 $600.001 TOTAL FEE: $601.75 Revised: 0710112012 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 t I I (408) 777-3228 • FAX (408 -3333 • buildinO D(D.cuoertino.OrG CUPERTINO ,L-oJ(% ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION/7 ❑ REVISION / DEFER -IED ORIGINAL. FT RYQ? Y PROPECTADORESS V/y t A -Dr o �C, VI .. O� O ��{jc�li,1i'1� OWNER NAME [ Qx I�` PHONE LOO- f7_7& 5 EMAILyR2J �QI PLQevf VG1� O (tQusl O J 1• STAE7' ADDRESS O 40M [ /t -�- D / CITY. STATE ZIP �/ FAX �S40M�77! V N'Z �jM 1 Son ✓o CONTACT NAME OHI A Ck S PH�OANE�I - [vG 7_ 7 �/n/ I y� /�"'n JA— 2 1 31'6 SRL( L.//RA L. A' S7 .H S7=ADDRESS� LONA P� fi l CTTY gA p �J I2 FAX �0 nZl?, - 0 OWNER ❑ OWNER -BUDDER ❑ OWNERAGPNT ❑ CONTRACTOR ❑CCCNTRAC RAGE`f-, ❑ ARCHITECT ❑' CINES. ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER L'CFNSE TYPE Bus, LIC A COWANYNAME E-MAIL FAX STREET ADDRESS CITY, STATE, IIP PHONE ARCHTTECT/ENGLN¢ER NAME LICENSE NUMBER BUS. UC 4 COMPANY NAME E -MAD. FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF ORK II e�.�..- r lC.��M W`QeJv�l�2�1 O✓l� EXISWO USE PROPOSED USE CONSTR. TYPE p51'OaZES USE 7TPE OCC. SQ.FT. VALUATION(3) eXSTG AREA NEWPLCOR AREA DEMO AREA TOTAL NET .IAEA S l ` J v BATHACOM KNTCHEN REMODELAREAI ^� ')CI REMODEL AREA R OOELARE\ PORIX nRFA DECK AREA TOTALDECIOPORIX AREA GARAGE AAEI DETACH AT .AIX 4 DWELL -NG UNITS: 0A SECOND UNrr El YES SICONMMR'Y YES BEING ADD®' ❑NO ADDMOP. - ONO PRE-APPLICAtION []YES I YES, PROVIDE COPY OF IS THE BLDG AN ❑YES RECIIVED BY: TOTAL VALUATI-ON: PLANNINGAPPLI ❑NO PLANNING APPROVAL LETTER ®CELERHOME' []NO By my signature below, I Cady to each of the fallowing: I am the property owner or authorized agent m act an the prypnty owner's behalf. f have read this application and the information I have provided is corecV I have read the Descripcion of Work and verify it is acenare. I agree ro comply with all applicable local ordinances and state laws dating to buildin I authorize representatives of Cupertino m enter the above --id " ed prop for inspection ptsposes. Signanne of Applicant/Agent: Daze: / 2, SUPPL.EvENTAL E-4FORNrATION REQUIRED PLAN CEIECK TYPE ROUTING SLIP ❑ OVER-THE-COUNTER CIBDIDme Pr r.Y RRvrEw New SFD or Multifa>mly dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANrwG PLAN REvtEw Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project ❑ LARGE ❑ FrnH oEPr Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ sA.NrrARY SEWER DISTRICT submittal of Building Permit application. ❑ ENNVItON4UE.NTAL HEALTH BldgApp_2011. doc rr fsed 06/21/11