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12080003CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10400 E ESTATES DR CONTRACI'OR: WM 11 FRY PERMIT NO: 12080003 CONSTRUCTION COMPANY OWNER'S NAME: FRY WILLIAM Ii TIt USTIi1? X 11' Al, 10351 SAN FERNANDO AVE DATE ISSUIiD: 08 /012012 OWNER'S PI IONS: 4086058200 CUPERTINO, CA 95014 PHONE NO: (408) 605-X210 ®� LICENSED COQ 1'K,ACI'OR'S UICCI,.UtA'1'ION r r r BUILDING PERMIT INFO: RLDC ELECT PIIUN113 License Class Lic. q 926 % p 5 r r r D1ECH RESIDENTIAL COMMERCIAL Contractor (s///7 ff FkY CevV 57, Co Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: SINGLE FAMILY DWELLING BATI VTUB SHOWER (commencing e'ith Section 7000) of Division 3 of the Business S 1'rofessiuns REPLACEMENT(20 SOFT). RELOCATE LIGHT FIXTURE. Code and that my license is in full force and effect. REPLACE DATA WINDOW I hereby affirm under penalty 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 Worker's Compensation Insurance, as provided for by Sq. Ft Floor Areu: Valuation: $8000 Section 3700 of the Labor Code, for the performance of die work for Which this permit is issued. AI'N Nutritive: 36925038.00 Occupancy'T'ype: AI'I'IJCA \I'CF :R'1'I PIG. \'I'1(LN I certify that I have read this application and stale that the above information is correct. I agree to comply with all city and county ordinances mid state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgmcnts, costs, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting ol'this permit. Additionally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature �6Li �rZ �- I — /-Z Done Issued by fo ", Date: ❑ OWNER - BUILDER DIiCLARATION RE-ROOFS, I hereby affirm that I am exempt from the Contractor's License Law For one or All roofs shall be inspected prior to any roofing material beilg installed. If a roof is the following teo reasons: installed without first obtaining an inspection, I agree to remove all new materials for 1, as owncr of the property, or Illy employees with wages as Ihelr sole colnpellS.11loa, Inspection. will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: Date: 1, as owner of the property, am exclusively contracting with licensed contraclors to construct the project (Sec.7044, 13usincss & Protessions Code). ALL ROOF COVERINGS TO 13E CLASS ".P' OR I3GI "I'IiR 1 hereby affirm under penalty of perjury' one of the following three declarations: I have and will maintain a Certificate of Consent to self insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation, as provided for by Section 3700 of the Labor Code, for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health & Safety Code. Sections 25505, 25533, and 25534. I will maintain I have and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Code. Chapter 9.12 and the Health & Section 3700 of the Labor Code, for the performance of the work for which this Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air permit is issued, contaminants as defined by the Bay Arca Air Quality Management District I will 1 certify that in the performance of the work for which this permit is issued. I shall maintain compliance with the Cupertino Dl unieipal Code, Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health & Safety Code, Sections 25505. 25533, and 25534. Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must Own r or author /iLyed—a�e�nC Date: forthwith comply with such provisions or this permit shall be deemed revoked. " APPLICANT CERTIFICATION CONSTRUCITON LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state Imes relating for which this permit is issued (Sec. 3097, Civ C.) to building construction, and hereby authorize representatives of this city to enter Lcnder's Name upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities ,judgments, Lender's Address costs, and expenses which may accrue against said City in consequence of the granting ofthis permit. Additionally, the applicant understands and will comply AItCI I ITECI" S DECLARATION with all non -point source regulations per the Cupertino Municipal Code, Sectial 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional SCOPr of V,I Z, rJ logoo CArr t7s,-A r8S Del / t- - OL- molarlcw A,� Qz-p ncCi»_;P v,� /JYISrvL /SA- 1•�2oom 5.+�,�E�C - RtPLACC- ter /rnrL /l7.grrtt w� iv N&' /{,v0 i.:6..IT /NG - NEl✓ SHcwAL r'J� ✓n,Giwti r r'7La?ES ._ 05E' w4TZ7L REF/srv-7 — PK-f/ .kLL p- SNel � �cc,f •6. FAA If e-,cc ISG APpx4 -o T, FiK D,tn1j1 COU -T /�U 5`- -� o z°zz W w 5,4 T- GLLNL'7L = wm + /2l+on.a Fay 4'u fi' Goy' Y�Zco GpNT12�.TOQ } 6 Ill m v a y' tc- �4` c I FT 5c.oPE aF 1--Ri-c- WS �SKrau37L I2CPc,tCUnEt--T- Wm H. r2, CON STP ✓cT /.:.✓ cr nl 7..a� 1655 QcCFQi AV6- 54" TTc gS71L YOB PC--4 � Cnz-E- CJGS4T Fr'TVRC- Zolo m T ~O c 3 GPG ° cJl7 C 2c91© CEG amsc YE>c n z N« C O Z O C O O m Da. m E n0 U p - w ` O. ma 0 N W a00 ° 'm 0. cc ul> It .V O mU Fn >n. C O m °tea 9 T mom o OL CL a m a « }} ym� moo CO t° om ° 'z O O ZJ C Ol° m :3:3 m c m 3 Cl O- '-'o 2 a9c E .ag n F:9 >` 00 i � p L O GLLNL'7L = wm + /2l+on.a Fay 4'u fi' Goy' Y�Zco GpNT12�.TOQ } 6 Ill m v a y' tc- �4` c I FT 5c.oPE aF 1--Ri-c- WS �SKrau37L I2CPc,tCUnEt--T- Wm H. r2, CON STP ✓cT /.:.✓ cr nl 7..a� 1655 QcCFQi AV6- 54" TTc gS71L YOB PC--4 � Cnz-E- CJGS4T Fr'TVRC- Zolo 43C ?_ClO GPG �7. -t'1 U cJl7 C 2c91© CEG "` x SOY CUPERTINO Building DepeFtment AUG 01 2012 REVIEWED FOR CODE COMPLIANCE Reviewed By: q)Alf CUPERTINO 1 n NEW CONSTRUCTION CA JPe -'V+ (�-z f Z °g cx 3 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 ts (408 4 ) 777 -3228 • FAX ((40088) )7777 -3333 • buildino(8cupertino.oro F1 1 ADDITION 1"I ALTERATION /Ti F) REVISION /DEFERRFD ORIGNAI_ PFRMtT9 PROJECT ADDRESS APN '�j (09, 5 — 0 �J /o vao ,545,545,T- EsriTas oe,rc p2 OWNERNAME r (jai /e czt n y lz-( P NE S- -aeco E -MAIL glC�re (3 (CC /CY C::.K'Si/C tL'7 /aN. CgpV STREETADDRESS /0 3 S/ SA.v 'i+ERN.{N!b ALG CITY, STATE, ZIP p FAQ 1= . PER71A^ o Ci+ ` SUl rf" CONTACT NAME PHONE 82a� E -MAIL 7J STREET ADDRESS CITY, STATE, ZIP FAX OWNER CI OWNER-BUILDER El OWNER AGENT ,�/ �1 CONTIUCiOR ❑ CONTRACTOR AGENT ❑ ARCHITMCr ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LIC NUMBER LICEN O' E BUS. LIC d ' L�i H Fr--( CO COMPANY NAME (,M- FRY E -MAIL ( lI & CSte.r -JtR Cewsrn..eria- . cow FAX STREgS pRESS�-49CERS AI-115-- CITY, S�T M C? PHONE ARCCHITECTTIEIGMEER NAME N LICENSE NUMBER BUS. LIC 9 COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 912)1a764 — - 0P4KF u6 .ri -774C- F44trz a- r 57�ir -G rH2O /.rte - E?r/STiA. — 4W1A — XE70LnCG FiW `t- 416 HT . -USE PL LaO//T /i ( -- /.k--Mr < EXISTING USE PROPOSED USE CONSTILTYPE OSTORIFS I USE TYPE OCC. sQ.FT. VALUATION (S) EXISTG {AEA NEW FLOOR AREA DEMO AREA TOTAL NEr AAE\ S'�� BATHROOM KITCHEN OTFmt RENODELAREA REMODEL AREA RENODFL AREA PORCH AREA DECK AREA TOTALDECKMORCH AAFA GARAGE AREA: CIDETACH ❑ATTACH d DWELLING UNITS: IS A SECOND UNIT Li YES SECOND STORY ❑YES DEINGADDED' [:],No ADDITION' ❑NO PRE - APPLICATION El YES IF YES. PROVIDE COPY OF PLANNIN0APPL4 ❑NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑YES EICHLER HONE' El NO IRECEIVEDBY:j- f "� $'�%1 TOTAL VALUATION: By my signature below, I certify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information have provided is correct. I have read the Description of Work and verify it is accurate. I agree m comply with all applicable local ordinances and state laws relating)oo bbudding construction. I authorize representatives of Cupertino to enter the above - identified property for inspection purposes. Signature of Applicant/Agent //"� Date: -�—�Z SUPPLEMENTAL [NFORIvIATION REQUIRED r'.. eii cxecl'`TYee .L z -I `. = " "� }ao�uiT -, csu New SFD or Multifamily dwellings: Apply for demolition permit for -'{ A- \'ER COUNTER .� £ , €_2 �` E31 t5 existing building(s). Demolition permit is required prior to issuance of building -TFIF e "� �. ILDINC Pf:A.� RE\TEw �c 4 C-., permit for new building. n "eXPBESSf '',�, �F ❑" tPL\N1YINC et.A.0 R'nEVlew _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure y ❑!iSTAVDARD .fin I - ' '� qY 1p PUBLIC{ \VOR13 � : �+rf form if any Hazardous Materials are being used as part of this project. "—,0, ­j " } ', S ,rF ,`- 1 17�WRCE� "$. �,L�`-yI j❑ ",FIRE DEPT " .. 'si � L Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR` P' ^° '- �❑ submittal of Building Permit application. i $AVTAB] SEWER DISTRICT =i�:T •ti Y. f°,." D.. iy❑ F!E,N \'IRONNEhTA41IE. \LTH� --��I Bldglpp_2011.doc revised 06/31/11 - 0 W90 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION a ADDRESS: 10400 east estates dr. DATE: 08/01/2012 RIiYIEIVEU 131': bobs. \ APN: 13P #: 'VALUATION: 1$8,000 *PERMI"1 TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRItMARY USE: SFD or Duplex Flee. Insp. Fee: PENTAMATION PERMITTI'PE: ""- i WORK sfd bath tub /shower replacement, relocate light fixture replace bath window. SCOPE NOTE: This estimate does not inclut/ejees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Seaver District, School District, etc.). These ees are based on the prelindnon information available and are only an evintate Contact the De t or adt/n 7 info. FEE ITEMS (Fee Resolulion 11 -053 Elf 711111) Xleeh. Mon Check Plumb. Plan Check Elec. Plan Check Mach. Permit Fce: PL,mb. Permit Fee: Elec, Pennir Fee: OJrer Much. Imp, Other Plumb Insp. Other E "lcr. Insp. 1190.ch. In.,p. Fee: Phmtb. h,aP. Fee: Flee. Insp. Fee: NOTE: This estimate does not inclut/ejees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Seaver District, School District, etc.). These ees are based on the prelindnon information available and are only an evintate Contact the De t or adt/n 7 info. FEE ITEMS (Fee Resolulion 11 -053 Elf 711111) FEE QTY /FEE MISC ITEMS Plan Check Fee: $0.00 Select a Misc Bldg/Structure or Element of a Building Suppl. PC Fee: Q Reg. Q OT 0.0 T hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Onlc? O Yes Q No $0.00 Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consimction Tur: Adlntnisti -afive Fee: O Work Without Permit? O Yes Q No $0.00 Advanced Planning Fee: $0.00 0 hours Inspections $399.00 1STINSP Inspection, Hourly 0 0 Travel Documentation Fees: Strome Motion Fee: IBSEISMICR $0.80 Select an Administrative Item Blda Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.80 $399.00 TOTAL FEE: $400.80 Revised: 07/01/2012 t IIYT�rZIo1z Gym,/ - lgD�z)GG 3