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12080205 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22116 LINDA VISTA PI, CON pRACI'OR:S B B CONSTRUCTION PERMIT NO: 12080205 OWNER'SNAME: DAVID GOORVffCU 1294 CALDWELL CT DATE ISSUED:08202012 O\YNER'S PHONE: 4082579041 SUNNYVALE,CA 94087 PRONE NO:(408)529-1818 hICFNSFD CONI"RACfOR'SDECLARATION AOR DESCRIPTION: RESIDENTIAL 11 COMMERCIALS] License Class �G/Lie.# J / ✓ S BATHROOM REMODEL 45 SQ FT, REPLACE BATHTUB, Contractor ctg Dane 8) 20/ 12— SHOWER VALVE, VANITY 1 here[, affirm that I am licensed under the provisions of Chapter 9 (nunnhohcing with Section 7000)of Division 3 of the Business S Professions Code and that my license is in full force and effect. 1 hereby affirm under penally of perjury one of the following hyo 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 Sq.Ft Floor Area: Valuation:$8000 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:35608010.00 Occupancy"Type: permit is issued .U'1'hICA N"1'CIiR'I'I FIC.\'PION I certify that I have read this application land state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and stale laws relating WITHIN 1 SO DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purpose's. (We)agree to save ISO DAY FAON.1 LAST CALLED INSPECTION. indemnify and keep harmless the Cily of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 2n RE-ROOFS: Signature Dale A— All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first ob lining an inspection,I agree to remove all new materials for inspection. ❑ O\YNER-11011,lirER DECLARATION Signature of Applicant: Date: 1 hereby affirm that 1 am exempt from the Contractor's license Law for one of the following too reasons: ALI,ROOF COVERINGS'1'O BE CLASS"A"OR BET"1'F,R 1,as ocher 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&Professions Code) I,as owner of the property,ant exclusively contracting with licensed contractors to U.\%ARDOUS MATERIALS DISCLOSURE construct die project(Sec.7044,13usiness fi Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Ilcalth S Safety Code.Sections 25505.25533,and 25534. I will 1 hereby'affirm under penalty of perjury'one of the fallowing three maintain compliance with the Cupertino\lunicipal Code.Chapter 9.12 and the declarations: Ilcalth S Safety Code.Section 25532(a)should 1 store or handle hazardous I have and will Maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by'the Bay Area,\ir Quality Management District performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health S Safe,'Code.Sectims'_5505.2553 , nd 25534. Section 3700 of the Labor Code,for the performance of the work for which this �— permit is issued Owner or authorized agent _ Dale: I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Worker's Compensation lows of California. If,after making this certificate ofexennplion,I CONSTRUCTION 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 this permit is issued(Sec.3097,Civ C.) Lender's Name ,V'I'I,ICAN'I'Cl•:R'I'IFIQef1ON Lender's Address I certify that I have read this application mid state that the above information is correct. I agree to comply with all city and county ordinances and slate 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ,\RCIII'I'IiCT'S DIiCI„\RATION costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Dale CITY OF CUPERTINO U fi O `2 FEE ESTIMATOR — BUILDING DIVISION 35 2 ADDRES 2 Linda Vista PI. DATE: 08/20/2012 REVIEWED BY: jsg APN: 13P#: 'VALUATION: $8,000 *PERMITTYPE: Minor Building Permit PLAN CIIECK TYPE: Remodel, Bath (300 s.f. max) PRIMARYPENTADIATION USE: Residential PERMI'I'TYPE: 1R3SFDRE A WORK Single bathroom remodel replace shower, sink and toilet SCOPE FEE II) FLR AREA 1REMRESBAT 45 Afech. Plan Check Phunh. Plon Check F-lec.Plan Check ,Wech. Permit Fee: Plumb.Permit Fre: Flee Permit Fee: Other Mech. Insp, Other Plumb Insp. Other F,ler•.Insp. L1 I Adech. /hip. Fec: Plumb. hisp.Fee: Clea Insp.Fee: NOTE: This estiautle does not inchtdejees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Server District,School District,etc. . These fees are baser/on the preflyninan information available and are only an estinune. Contact the Dept for addn 7 info. FEE ITEMS (Fee lZesolunion 11-053 F_lL 7111/1) FEE QTY/FEE MISC ITEMS Plan Check Fee: Snppl. PC Fee Phtmb.11fech./Elec Permit Fee: $600.00 Supp/. lisp Fee PIumh.11lech.11,lec Plumb.lddech./Elec Permit Fee.- Construction ee:Construction Tar: Administrative Fee: Work Without Permit? 0 Yes 0 No $0.00 Advanced Planning Fees: Travel Documentation Fees: SII'Onff Motion Fee: IBMSMICB $0.80 Select an Administrative Item 131de Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $601.80 $0.00 TOTAL FEE: $601.80 Revised: 07/01/2012 CONSTRUCTION PERMIT APPLICATION ,�O 5 30 COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIONq�O 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 _ (1 amp CUPERTINO (408) 777-3228 • FAX (408) 777-3333• buildingliftupertino.oro ❑NEW CONSTRUCTION ❑ ADDITION ❑//A�,LTTE7R-A/'TION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT PROJECT ADDRESS �iN.�A �/ /�✓//'7- �j APN4 OWNER NAME' I/'^G_v.,ljq ��V/,�G l� PHON / _;c� [gH E-MAIL STREET ADDRESS T/ CIN. STATE ZIP SJ 1/`J`/j FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX O OWNER O owNER.BUILDER O OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMELICENSE NUMBER p �J- �- LICENSE TYPE / BUS. LIC0 COMPANY NAMEGE-MAIL FAX STREET ADDRESS 51 '�-11y) STATEZIP PHONE 0o_/20/ n'cy— ARCHITECTIENGNEER NAME LICENSENUMBER (/!^/� BUS.LICA i7 O COMPANY NAME EMAIL FAX STREETADDRESS yT CITY,STATE,ZIP PHONE DESCRIPTION OF WORK W 7t//�� ^�///O tIAM TY, 0/'-U., .5-7-1,1r, oUeu —7C� Lf-r- r EXISTING USE/ PROPOSED USE CONSTR_TYPE Y STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMOTOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODELARFA PORCH AREA DECK AREA TOTALDECKIPORCH AREA GARAGEAREA: U DETACH ❑ATTACK N DWELLLNG UNITS: ISASF.COSDUSIT []YES SF.CoxDSTORY OYES BEINGADDF.D' ONO ADDITION! ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPYOF ISl'HEOLDGAN OYES ;RECEIVEDBY: TOT V�Ie�1ATION: PLANNING APPLa ONO PLANNING APPROVAL LETTER EICULER IIOM I:. ONO ., ' - -')[' 00 By my signature below,1 certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf!I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and state laws relating to building conswgti authorizerep senlatives of upeAino to enter the aboveXpy-idem//(SIfied properly for inspection purposes. Signature of Applicant/Agent: v Date: o`--o /Z— SUPPLEMENTAL Z SUPPLEMENTALINFORI�A I UIRED PLANCHECKTYPE - 'ROUilNcsiAP _New SFD or Multifamily dwellings: Apply for demolition permit for p, o�'F;R=rflirlcgun'rr:ai'- ❑ BUILDING PIaN REVIEW - existing building(s). Demolition permit is required prior to issuance of building _ permit for new building. ❑- F-m-BESS - '❑ PLANS•ING PLAN REVIF"W _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD •❑,'s'UnLlc,i+'Deis " form if any Hazardous Materials are being used as pan of this project. - - El ^[,ABGIi ❑ 'FIRE"UF.1'1°.- - _Copy of Planning Approval Letter or Meeting with Planning prior to ❑.aIAJOR 11S,+NITARI'SE+VER DISTRICT submittal of Building Permit application. I - - - - ❑_tNvtaoNMEsru. BldgADD_2011.doc revised 06/31/1/ � I . t,�,�E-� o `��.vcq � .Nol2lnnR �02•vi-re++l . I � I I _ :III I it - - - �I I I I I I cuP�• scieae ; I ' CJ �3� I 0 . � f . I d � 3 I COMMUNITY DEVELOPMENT DEPART BUILDING DIVISION-CUPERTIV9 APPROVED This set of plans and specifications MUST be ke"p,,w.t e 7 lob site during construction. It is unlawful to meKe any changes or alterations on same,or to deviate C therefrom,without approval from the Building Official. O The stamping of this plan and specifications SHALL NOT l be hcid to permit or to be an approval of the violation , of any prolons�o�f� � Zany City Ordinance or State Law. DATE — —��2 t, � l PERMIT NO. �_�2,0 8* Z 1 J j ILII � 11