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12080217 CITY OF CUPERTINO BUILDING PERMIT nurr.nwr...nnnreP, nano PlelGPROO{!CT CONTRA CFOR:ANTI ION Y/IODDER PERMITNO: 12080217 CONSTRUCTION OWNER'S NAME: GLEN R LOUISE FISHLER 7504 BOLLINGER 111) DATE, ISSUED:08212012 OWNER'S PHONE: 4085944128 CUPER7INO,CA 95014 PUONENO:(408)257-4317 $ LICENSED CON I'RACI'OR'S DECLARATION - BUILDING PERMIT INFO: 13LUG .- ELECT PLUMB License Class=3 Lic.# '7 q S? 3 r r r / DIIiC14 RESIDENTIAL COMDIERCIAL Conlractorr7MrYL � "Jg,a,— Date 2 2 JOB DESCRI PTION:WATER DAMAGE REPAIRS TO SIIEL•rfROCK,REPLACE I hereby affirm(h:u 1 am licensed under the provisions of Chapter 9 WATER (commencing with Section 7000)of Division 3 of the Business& Professions Cudc and chat my license is in full force and effect. liHEAth\ ,FURNACE AND PARTIAL DUCTING EXHAUST FAN 2 IOILS ETERR I herehy affirm wider penalty of perjury one of Ere 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 perfomtance of the work for 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 the work for which this permit is issued. Sq. Ft Floor Area: Valuation:$20000 .U'PhICAN'1'CI:IfI'I PIC,\PION I certify that I have read this application and stale that the above infomtation is AI;N Number:36604060.00 Occupancy Type: correct, I agree to comply with all city and county ordinances and state Imus relating to building construction,and hereby authorize representatives of this city to enter upon Ilse above mentioned property for inspection purposes. (We)agree to save indemnilyandkeepharmlesslheCityol'Cupertinoagainstliabilities,judgments• PERMIT EXPIRES IFWORK ISNOT STARTED costs,and expenses which may accrue against said City in consequence of the graining of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 D YS FROM CALLED INSPECTION. 9.18. 4 /� t Signatu Dale U �2 Issued by: h,✓ Date: 21 ❑ DvvnrR-Buu.DER DECLnen'noN 1 hereby alfirnl that I am exempt from the Contractor's License Lav for tine of It R.ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,1 agree to remove all new materials for will do the work,lard the structure is not intended or offered for sale(Sec.7044, inspection. Business R Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business C Professions Code). 1 hereby affirm under penally of perjury uric of the following three ALL ROOF COVF,RINGS TO BE CLASS"A"OR BETITR declarations: I hive and will maintain a Certificate of Consent to self-insure for Worker's IL\7,ARDOUS MATERIALS DISCLOSIJREE 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 read the hazardous materials requirements under Chapter 6.95 of tire 1 have and will maintain Worker's Compensation Insurance,as provided for by California Ileallh&Safely Code,Sections 25505,25533,and 25534. 1 will maintain compliance with the Cupe Section 3700 of the Labor Code,for the performance of die work for which this rtino Municipal Code,Chapter 9.12 and the Ilealth S Safely Code,Section.553_(x)should 1 store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the liar Area Air Quality Management District 1 Brill not employ any person in any mmrner so as no become subject to the Worker's maintain eon pliance with the Cupertino Municipal Code.Chapter 9.12 and the Compensation Imes of California. If,atter making this certificate of exemption,I Ileal S Safety Code,Sections 25505.25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I n forthwith comply with such provisions or this permit shall be deemed revoked ";u ized ngen t,) 2 .U'1'LIC,\N'1'CI?Itl'I PICA"PION CONSTRUCTION LENDING,\GENCY 1 certily that I have read this application and state that the above information is correct.1 agree to comply with all city and county ordinances and state laws relating I hereby affirm 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 harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this pemmil.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHI'1'F.CI"S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION 1-214 A1)DRF.SS: 11807 pinebrook U,VI'E: 08/21/2012 REVIEWED 13\': larrys APN: RP#: 'VALUATION: 1$20,000 *PERMITTYPE: Building Permit PLAN CII ECK TYPE: Alteration / Repair PRIMARY 2nd Unit? Yes No 1'ENTApL\'PION USE: SFD or Duplex OTC? 0 Yes 1 R3SFDRE M QNo PERditTT\'PE: \VORKwater damage repairs to sheetrock. replace water heater, furnace and partial ductin exhaust fan 2 SCOPE toilets. OCCUPANCY TYPE: TYPE OF FLR AREA CONSTR. (s.f.) PC FEES PC FEE ID BP FEES 6P FEE ID R-3 (Custom) II-B,III-B,IV,V-e $0.00 $0.00 TOTALS: 0 $0.00 $0.00 MECH, HOURLY 0 Yes (j) No PLUMB, HOURLY 0 Yes Q No ELEC, HOURLY 0 Yes Q No Mech. Plan Check 0.0 hrs $0.00 Plumb. Plan Check 0.0 hrs $0.00 Elec. Plan Check 0.0 hrs $0.00 Mech. Permit Fee: IMPFRMIT Plumb. Permit Fee: IPPERA-1/T Elec. Permit Fee: 1£PERMIT Other Mech. Insp. 1 0.0 Ins L $45.00 Other Plumb Insp. 0.0 hrs $45.00 Other Elec. Insp. 0.0 hrs t $45.00 .14ech.Bup. Fee: Plumb. Insp. Fee: Flew.hap.Fee: NOTE: This awintate doev not includejees due to other Departments(i.e. Planning, Public Warks, Fire,Sanitary Sewer District,School District,etc.). These feav are based on the prefintinan information available and are onh,amt estimate. Contact the De t or adtln7 info. FEE ITEMS (1--cc Resohuion 11-053 F_B: 7/1/11) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel, Other Supp]. PC Fee: Q Reg. 0 OT Q.Q hrs $0.00 $534.00 IREHRESOT/1 PIvIE Plan Check: $0.00 = # Plumbing Permit Fee: $0.00 $27.00 IPRTJfHEATR I Water heater Suppl. Insp. Fee:(D Reg. 0 O"I' Q.Q hrs $0.00 0 # Mechanical PME Unit Fee: $0.00 $133.00 FIVFR=1100 Furnace, Forced-Air PME Permit Fee: $135.00 © # Electrical C011SMICIion Tax: $45.00 IBREMIZECEP Recep/Switch/Outlets Administrative Fee: 0 Work Without Permit? 0 Yes 0 No $0.00 0 Advanced Planning Fee: $0.00 Select Non-Residential E) Travel Documentation Fee: ITR.u'DOC $45.00 Building or Structure 0 Strong Motion Fee: 111SEIDUCR $2.00 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $183.00 $739.001TOTAL FEE: F$922.00 Revised: 07/01/2012 CONSTRUCTION PERMIT APPLICATION -2,0 F O 2- COMMUNITY COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 I CUPERTINO (408) 777-3228• FAX (408) 777-3333 • buildinG(8cupertino.oro Y PRO❑l NEW CONSTRUcI'IONN 0 ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERiXI1Tq Il C) OWNA IE P7 1W.,�e SAIL PHONE /] I IG-MAIL STREET ADDRESS / 907 F i 'n Q S CITV, SJATE,ZIP a �J6 FAX CONTACT NAME 6`/ / ,(/ PHONE ��I E-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHI ECr ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSENUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMP YNA IE E-MAIL FAX Qv SEET DRESS _ C Y,STATZIP L PHONE e>cru DESCRIPTION OF WORK 7.. ILII tdo_-(e_v EXISTING USE PROPOSED USE CONSTR.TYPE I #STORIES ,- USE TYPE OCC. SQ.FT. VALUATION(f) �/ EXISTG NEW FLOOR DEMO TOTAL T AAEA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELARFA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH ATTACH #DWELLING UNITS: IS A SECOND UNIT OYES SECONDSr0RY ❑YES BEIN'GADDED7 ONO ADDITION' 0N PRE-APPLICATION OYES IF YES,PROVIDE COPY OF ISTIIEBLDGAN AYES RECEIVEDBY: TOTAL VALUATION: t PLANNINGAPPL# ONO PLANNING APPROVAL LETTER EICHLERHOME7 ONO X 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. 1 have read this application and the information I have provided is correct. 1 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 construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicam/Agem: Date: SUPPLEMENTAL INFORbIATION REQUIRED PLAN CIIECKTYPE, 'ROU'TIN'G SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER-THE-COUNTER ❑ BUILDING YL.AFRE\'NEN' existing building(s). Demolition permit is required prior to issuance of building - permit for new building. ❑ EXPRESS - ❑ PLANNING PLAX REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ -STAxDAau ,' ❑ PUBLIC,WORKS. form if any Hazardous Materials are being used as pan of this project. ❑ .LARGE ❑ _FIRE DEPT - _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MA.IOR. ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH. BldgApp_2011.doc revised 06/21/11