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12090005 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10591 S BLANEY AVE CONTRACTOR:' PERMITNO: 12090005 OWNER'SNAME: RICHARD MAK Gict£rd " Csl4 , DATE ISSUED:09/0411012 OWNER'S PlIONE: 4084647270 , �jTo i�L PHONE NO: ❑ LICENSED CONTRAC`FOpR'S DECLARATION BUILDING PERMIT INFO: BLDG C ELECT r PLUMB C License Class Lic.4 3 Z Scram MECH r RESIDENTIAL r' COMMERCIAL (- Contractor CIA&1/ 60(1r/.t1&---/cep Date 6' 2 1 hereby affirm that I am licensed under the provisions'of hapter 9 JOB DESCRIPTION:REMODEL BATHROOM 40 SQ FT,REVISE SINK IN 2ND (commencing with Section 7000)of Dh ision 3 of the Business S Professions BATHROOM. Code and that my license is in full force and effect. hereby affirm under penalty of perjury one of the following tsvo 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 Section 3700 of the Labor Code,Ibr the performance ofilic work for which this Sq.Ft Floor Area: Valuation:$20000 permit is issued. APPLICANTCERTTFICATTON APN Number:36933004.00 Occupancy Type: 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 property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep hammless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant underuandsand willcomply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per dtrCupertt , mocipal Code,Section 9.18. p ��/ Issued by: Jl��,, / !% 9 j 9.18.Signu " Date / `,v r Date: ❑ ( O\VNFR-BUILDER DI.CLARATION RE-ROOFS: 1 hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner ofthe property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered far sale(Sce.7044, Business&Professions Code) Signature of Applicant: Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BET'T'ER 1 hereby affirm under penally 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 critic Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the perli m mance of the work for which this permit is issued California health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Workers Compensation Insurance,as provided far 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(a)should 1 store or handle hazLrdaus material. Additionally,should 1 use equipment or devices which emit hazardous air permit is issued contaminants as defined by the Bay Area Air Quality Management Distriet I will I certify that in the performance of the work for which this permit is issued I shall maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Ilealth&Safety Code.SectinnsJ5505.25533.and 25534. Compensation laws of Cali forma. If-after making this certificate ofexemplion,1 / become subject to the Worker's Compensation provisions of the Labor Code,1 must Ovine r an riz -a c(nt: forthwith comply with such provisions or this permit shall be deemed revoked. / Date: APPLICANTCERTIFICATION CONSTRUCFION LENDING ACENC1' I certify that I have read this application and state that the above information is I hereby affirm that there is a constmction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and stale laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender'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 aceme against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCI I ITEC`I"S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION :911 ADDRESS: 10591 So. Blaney Ave DATE: 09/04/2012 REVIEWED BY: Sean APN: BP#: 'VALUATION: $20,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY PENTAMATION USE: SFDorDuplex PERMITTYPE: 1R3SFDRE WORK Bathroom remodel 40 sq ft and revise sink plumbing in second bathroom. SCOPE blech. Flan Check Plumb. Plan Check 0.0 hrs $0.00 r/,,.P/rnr Check Mech. Permit Fee: Plumb. Permit Fee: IPPERM/T rree.Permit Fee: . Other,tfech. Insp. Other Plumb Insp. 0.0 hrs $45.00 Other Elce.Insp. Ilech.Imp. Fec: Plumb. Inep. Fee: Elce.Insp, Fac: NOTE: This estimate does not includejees due to other Departments(i.e. Planting, Public Works, Fire,Sanitary Sewer District,School District,etc. . There ees are based on the prelintinan information available and are on/w,an estimate. Contact the De t or addrt'I info. FEE ITEMS (Fee Resolulion /1-053 Elf 71111 U FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 40 s.f. Remodel, Bath (<=300 sQ Suppl. PC Fee: Q) Reg. 0 OT 0.0 hrs $0.00 $600.00 IREt1RESBAT PME Plan Check: $0.00 1 # Plumbing Permit Fee: $0.00 $10.00 18PFIXTURE Fixture or Trap Suppl. Insp. FeeQ Reg. 0 OT F0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 Construction Tax: Administrative Fee: LtD,tnv $42.00 0 Work Without Permit? 0 Yes (F) No $0.00 (F) Advanced Planning Fee: $0.00 Select a Non-Residential E) Travel Documentation Fee: ITRAVDOC $45.007_71 Building or Structure 0 i Strong Motion Fee: IBSEISX11CR $2.00 Select an Administrative Ite�tt Bldg Sids Commission Fee: IBCBSC $1.00 SUBTOTALS: $135.00 $610.001 TOTAL FEE: 1 $745.00 Revised: 07/01/2012 CONSTRUCTION PERMIT APPLICATION O" COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 00,O CUPERTINO (408) 777-3228• FAX (408) 777-3333• building0cupertino.orcl \� ❑ NEW CONSTRUCTION El ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ` ORIGINAL PERMIT# A PROJECT ADDRESS/OJ,/ _31AIU 41- /\'` OWN ftNAME - PHONE �z 7O E-MAIL /h' 1 M� �IoB- ( STREET ADDRESS CITY, STATE,ZIP I FAX CONTACT NAME (ASO. 1 yG/ W�`NG PHON�30 ' ! 0 _vyze E-MAIL STREEt�D�s C<`f/`/ '(/�� 5 CITY,S A ZIP (•'�j(J C� FAX JJ N7�c� C� S � 11 OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTORAGFNT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER 11 TENANT CONTRACTOR p�`A�++E LICENSE NUMBER LIC TYPE BUS.LIC 9 C Ecw Mw iw,E:eP Tow t g s 7 Z z COMPANY NAME E-MAIL FAX STREsET ADDRESS CITY,STATE, P PHONE . �tirvee�/G sr- rEe� ca 9f3 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC N COMPANYN ME E-MAIL FAX H/c�ral/ECX STREET ADDRESS CITY, AT ,ZIP PHONE s W, /v TCL C:P /Si3 z�i z Y9 DESCRIPTION OF WORK �?�9rA/ L?eMa9eZ : 6X-C 0ac G kC- 10 L/73 1442c61!t7 . si ve T010E7 4V/,V90IAJ C0VW1CeXi' GiUufs/,::9 Ex6TIN USE PROPOSEDUSE CONSTRT E CSTORffs A� �� USE TYPE OCC. SQ.FI. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA ✓8 3 0 BATHROOM I KITCHEN OTHER REMODEL AREA 7(/ REMODEL AREA REMODEL AREA PORCH AAEA DECK AREA AREA TOTAL DECKNORCH AREA GARAGE AREA: DETACH ❑ATTACH M DWELLING UNITS: 7 ISASECONDUNIT ❑YES SECONDSTORY ❑YES UGINGADDFDr Ergo ADDITIONr ,050 PRE-APPLICATION ❑ IF YES.PROVIDE COPY OF IS TILE BLDG AN ❑YES 1tECEIVED:BY t�.<-T'� �>p-�"v P•F£.(: T AL VALUATION: PLA.NNINGAPPLY � PLANNING APPROVAL LETTER EICHLERHOME• �TNO IysS - 's'S ,,. _ .I�1�.°� 7� �•.•� y 000 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. 1 have read this application and the information I have providedis c ect. 1 ha• he Desc X tion of Work,and verify it is accurate. 1 aeree to wmply with all applicable local ordinances and state laws relating to building c recti r✓ authort repre rooves of Cupertino to enter the above-ide 'fledpro /ny for inspection purposes. Signature of Applicant/Agent- �� — Date: / Z SUPPLEMENTp1•L FNFOR1`IATION REQUIRED (,Y� rlan cW;T ME 20' 1—`a;•2-x 3'J d"b .c-isl1I,—,, _New SFD or Multifamily dwellings: Apply for demolition permit for ! pp`..o�LR rnl.cou\rt Rl'4�I� � ;5ILULYG IL41 RkP•\�`H • existing building(s). Demolition permit is required prior to issuance of building ` 1,a. t S T+r•e A+.`n y� permit for new building. �❑c 1 AI RPsSrS 1 -aEJ, O 1 NNNINC PIAN Rr\le� a s M1k..$ 7 Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ©ISTA fo-m if any Hazardous Materials are being used as part of this project. r �i al J t " �s Y ; rs s�a,i`"5 r`r (�E •# t •; Ey1 \kClil � �r ,©�FIRF UEI TI'pN mak' 1Y _ Copy of Planning Approval Letter or Meeting With Planning Prior to `r❑,-f ` G,$'�EN fRDI$IR IC1tK IANITARI submittal of Building Permit application. - 5' :- �„��b y�at"TL ' �©SLN\IRO\�\'TA I:JiEAL7Hl•A�..�L B1dgApp_2011.doc revised 06/11/11 Customer: Richard Mak Green Stone Construction Street 10591 S Blaney Ave 551 Carnegie Street \ city Cupertino, CA 95014 Manteca Ca. 95337V Email acECEIED is Home Phone (408) 464-7270 AUG 0 4 Cell Phone (408) 973-9903 2012 Project #: richmak@vahoo.com BY. Date: 6/16/2012 Store: John Lead # Page 1 of 2 Scope Of Work Worksheet Ft In I In I In Code Description ILin.Ft.1 L I W I D I Ea. I Sq.Ft. Drawing Existing Bath Demo v� ti � w i z Tub and tile walls o (.J Tile Floor Vanity top Vanity cabinet I Pocket door 24x12 window in tub area Wall sconces r New design _ New vanity cabinet Z New top Uba Tuba Lam Doub Rad szs \ Undermount bowl New tub Fan New cabinet over toilet New tile walls to clg New tile wainscoating 't New tile floors Sheetrock and texture baseboards Paint COMMUNITY nmSi211 nk Iight,�RMENT BUILDING U.,,,,:,i. � INO APPROVED This set of plans and specifications MUST be kept at the job site during construction. It Is unlawful to make any changes or alterations on same,or to deviate -,//r��, //"' -111 therefrom,without approval from the Building Official. y y y The stamping this plan and specifications SHALL NOT Ht1 jf) be held to permit or to be an approval of the violation + of any provisions of any City Ordinance or State Law. o r ��• DATE PERMIT NO.