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12070173 CITY OF CUPERTINO BUILDING PERMIT RUILDINGADDRESS: 6790 JOHN DR CONTRACFOR:CAMBRA CONSTRUCTION PERMITNO: 12070173 OWN lilt's NA IN I E: SCOL-1,1711,11111OFF 255 SIIDIMEMILLDR DATE ISSUED:07/23/2012 O1VN'ER'S PRONE: 4087477503 SCOTI'S VALLI11'.CA 95066 PHONENO:008}138-5835 ❑ LICENSED CO\I'RACI'OR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT F- PLUNIB r License Class CS Lie.N AlEct3 r RESIDerv•rL1I,r conlnlERclnL r Contractor CJEgJ"6 !4 @'DwSTRr�77s'7A.13ate �Z 1 hereby affi rin mill I am licensed under the pro%isionv of Chapter 9 •1013 DESCRIPTION: BAT[IROOm REMODEL WITII DRYROT REPAIR AT TUB (commencing with Section 7000)of Division 3 oft lie Bust ness S Professions WALL-, Code and that my license is in full force and effect. 40 SQFT,AND REP]PE INTERIOR WATER,WASTE AND - VENT 1 hereby affirm under penalty of perjury line of the following ben declarations: I have and will maintain a cenificate 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 lot 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 0nc work for which this permit is issued. Sq.Ft Floor Area: Valuation:$25000 A I'I'LICAN"I'CP,IfI'I FIC.\'I'I<)N I certify that I have read this application and state that the above infomnation is APN Number:36923001.00 Occupancy Type: correct.I agree to comply with all city and county ordinances and state Imes relating A to building construction,and hereby authorize representatives of this city to enter 4 upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WOR, yCS NOT STARTED costs,and expenses which may accrue against said City in consequence of the ;�j rd granting ofthis permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PER NFxISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST AL-LEI) INSPECTION. 9.18. ' Signature i Datc�/�.z�I� Issued by: . —�C141/V/ A���k�88YY���' Date: ❑ O\VNI':12-RL111.DF;R 13GCLA R.VI'ION hereby affirm that I am exempt from the Contractor's License Law for one of RL-ROOFS: file following two reasons: All roofs shall he inspecte�pr\tng material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obta ningxdrr ns,peclion,I agree to remove all new materials for will do the work.and the structure is not intended or offered for sale(Sec.7044, inspection. Business R Professions Code) ppt L as owner of the property,am exclusively contracting with licensed contractors to Signature of Applii©n" Date: construct the project(Sec.7044,Business'&' Professions Code). 6./ 1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BE'1"ITR declarations: I have and will maintain a Certificate of Consent to selfinsure for Worker's IIA7.ARD011S\1.\"1'FItIALS DISCLOSURE; Compensation,as provided for by Section 3700 otthe Labor Code,for the - performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Ikallh S Safety Code.Section.,25505,25533,and'5534. 1 will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Jlunicipal Code.Chapter 9.1_and the Health S Safety Code,Section_553_(x)should I shore or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify than in the performance Ofthe work for which this permit is issued,I shall contaminants its defined by the Bary Area Air Qmdity Management District 1 will not employ any person in any manner so as m became subject to the Worker's maintain compliance pith the Cupertino Municipal Code,Chapter 9.12 and the Compensation Imus ofCalifomia. If,ager making this ceniBcate of exemption,1 Health S Safety Code.Sections 25505,25533,and 25534. become subjecrto the Worker's Compensation provisions of the Labor Code,I must u forthwith comply with such provisions or this permit shall be deemed revoked O.r or � Dale. /2 APPLICANT CERTIFICATION CONSI'RUCIION LENDINGAGENCY I certify that I have read this application and state that the above infommtion is correct.I agree to comply with all city and county ordinances and stale laws relating I hereby affimn that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep hamless the City of Cupertino against fiabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address graining of this permit.Additionally,the applicant understands and will comply with all non-point Source regulations per the Cupertino Municipal Code,Section ARB I I'I'ECI"S DECLARATION9.18. I understand any plans shall be used as public records. Signature Dale Licensed Professional ~FI1C'A-DMBRA CONSTRUCTION x o N -TR u c T I 0. PC. 2 3 2012 255 Summerhill Drive Tel: (831) 438-5835 PARTNERS IN ExCELL EV Scotts Valley, CA 95066 Fax: (831) 438-6670 Lic. No. 620564 DATE: 7/z Z PROJECT: T1 L L> rfo J-r4Lc 6w7g SHEET: 1 OF I DRAWN BY: l^n. Cwrh3eW Gca�E - = 1' a" PRJ. # : /2-05- Oo 1- 34 u z z 2c-caY,ED SHww ;100 S«IF' I o M 24" 13102 LIGAT' N 14 REC8-55C-5 LC 7> C�hl UGr7'r'S CUPE AINA:reww,IcL TILS M Building 4NRO4E (3r4ckC r, Culi 1')L 2 212 \ D PLIA CE REjI I ED OR To,, --r 1.2 G.PF. RevieN+ By' I D� FAN/Ctr;NT Cowl�o Sorr Date: July 16, 2012 Project No.: 12-05-001 Prepared For: Mr. Mark Cambra Cambra Construction Re: Permission to Obtain Building Permits 6790 John Drive Cupertino, California Dear Mark: This letter confirms to I am the owner at 6790 John Drive and Cambra construction has my permission to obtain building permits related to remodeling and re-piping of my house. If you have any questions or need any additional information, please call me. Sincere ly,, Scott E. Fitinghoff Copies: Addressee (1 via email) CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 6790 John Drive DATE: 07/2312012 REVIEWED BY: Sean APN: BP#: VALUA'T'ION: $25,000 *PERMITTYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1R3SFDRE USE: pPERMIT TYPE: WORK Bathroom remodel with dryrot repair at tub wall 40 sq ftand re i e interior water, waste and vent. SCOPE Ahch.Plan Check Plumb. Plan Check 0.0 hrs $0.00 Elec.Plan Check Afech. Permit Fee: Plumb. Permit Fee: IPPERifIT riec.Permit Fee: orber Afech.Insp. Other Plumb Insp. 0.0 hrs $45.00 Other Elce.Insp. Alech.Insp. Fee: Plumb. Insp. Fee: Flee.Insp.Fee: NOTE: This evtinuue does not include jeer due to other Departments(i.e. Planning, Puhlic Works, Fire,Sanitary Sewer District,School District, etc.). These env are baser/on the prelintinan information available and are onh•an evtinuae. Contact the De t or arldn7 in o. FEE ITEMS (Fee Resolution 11-053 F_ff 7/1/1/) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 40 s.f. Remodel, Bath (<=300 so SuppI. PC Fee: Q Reg. 0 OT 0.Q hrs $0.00 $600.00 IREAMESBAT PME Plan Check: $0.00 1 # Plumbing Permit Fee: $0.00 $13.00 IPRREPIPE Re-Pipe Interior Supp]. Insp. Feer Reg. 0 OT ().Q 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 Conswuction Tac: Administrative Fee: /ADMIN $42.00 0 Work Without Permit? 0 Yes (D No $0.00 E) Advanced Planning, Fee: $0.00 Select a Non-Residential 0 Travel Documentation Fee: ITRAVDOC $45.00 Building or Structure 0 Strong,Motion Fee: IBSFISAIICR $2.50 Select an Administrative Item Bldg, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $135.501 $613.001 TOTAL FEE: $748.50 Revised: 07/0112012 f zo7 o 1 -13 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 • FAX (408) 777-3333 • buildincl(okupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION/T1 ❑ REVISION/DEFERRED ORIGINAL PERMIT PROTECT ADDRESS j� Gam_ APNf Z - /1 _ 2-3 -` OWNERNAME PHONE 4 EMAIL �c a� Yi Tnt>i�o�r CUL 7 — 9S STREET ADDRESS �.vn� y�yCITY, STATE ZIP FAX CONTACT NAME PHONE EMAIL ltiisv C / 2G6 403 4rs�—SS^ cwiaeessuB,uo Pse St�LC AJ >y— STREETAODRESS CITY,SCoTATE. ZIP FAX ULACLG-- �� 7 0 OWNER ❑ OWNER-BUILDER Cl OWNERAGENT I:CONTRACTOR ❑CONTRACrORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSETYPE BUS.LIC d �aiJ1G c4.•r� G"'� � COMPANY NAME E-MAIL FAX STREET ADDRESS CITY.STATE.ZIP p PHONE `•�1 _S' !•w �lL /'l� ,SC Oi,7'S ✓GOlG GQ. (S��CI "�� 1.3�+`$T3r� ARCHITECTIENGINEER NAME / �¢ LICENSE NUMBER BUS.LIC 4 COMPANY NAME 'v EMAIL FAX STREETADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK /yQ j 1T l✓saGG. �ZOI'/�,/2c�'/'1 /7GC/'r'I'bl�Gt;` /7CG�rnn�lJ..�' 2Li� �//'� EXISTING SE PROPOS Eq USE CONSTR E M STORES 7 1/! USE TYPE OCC. SQ.FT. VALUATIONS) ExiSTG NEW FLOOR DEMO TOTAL AAEA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA ��O REMODEL AREA REMODEL AREA PORCHARE\ I DECK AREA TOTALDECK/PORCHAREA GARAGE AREA: DETACH ❑ATTACH 0 DWELLING UNITS: IS A SECOND UNIT 11 YES SECONDSTORY ❑YES BEINCADDED? ElNO ADDITION! C]NO PRE-APPLICATION []YES IF YES,PROVIDE COPY OF ISTHEBLDCAN ❑YES RECEIVED BY: _ TOTAL VALUATION: PLANNTNGAPPLM []NO PLANNING APPROVAL LETTER EICHLERHOME? ANO 9 „a By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. IIhhave 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 relating to builildjingconstruct' rC/I a}u/��Ize r s lives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: �/y /<. C Date: 2� SUPPLEMENTALINFORIMATIONREQUIRED PLAN CIIF.CKTYPE _ ' ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for 0411-'ME-COUN TER tp�auiLDLyc PLAN dcv1E\Y existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑. EXPRESS ❑ PG\NN`INC PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure El STANDARD - El,PUBLIC.wORKS form if any Hazardous Materials are being used as part of this project. ❑' L�NGF•I _ ❑ _FINS DEPT _ _Copy of Planning Approval Letter or Ivfeeting with Planning prior to I � ' ❑ MAJOR - ❑ SANITARY SEWER'DISTRICT submittal of Building Permit application. _ ❑: E3l'IROMIEN'1)\C HEALTH B/dgApp_20/1.doc revised 06121/11