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12100175 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10135 IMPERIAL AVE CONTRACTOR: PERMIT NO: 12100175 ON jNER'S NAME: REYES ANTONIO SAND JESSICA S 11� (/��! � 5DATE ISSUED: 10242012 OWNER'S PIIONF.: 4089931900 PBONF NOo ❑ 1.1 .ENSLD CONI'R,}CTOR'S DECLARA'T'ION BUILDING PERMIT INFO: BLDG r ELECT' r PLUMB r License Class Lia N 7 Y/ t NIECH r RESIDENTIAL(_• COMMERCIAL r ContractorI�t$ I"1 Date L� y �� hereby affirm that I am licensed under the provisions of Chapter 9SHOW •106 DESCRIPTION:REPAIR DRYROT DAMAGE IN BATfIROOM(FLOORRND (commencing e'ith Section 7000)of Division 3 of(hWALL) e Business S Professions ER Code and that my license is in full force and effect. ALL);RE=I'll-Ii AND INS:,TAI-I.NEW'I'UB 1 hereby affirm under penally of perjury one of the following two declarations: 1 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,for the performance of the work for which this pennit is issued Sq.Ft Floor Area: Valuation:$4500 APPLICANT CERTIFICATION I certify that I have read this application and state dial the above information is APN Number:35717019.00 Occupancy Type: correct.I agree to Comply with all city and county ordinances laid state Imes 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 indemnify and keep hmndess the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses wh' h may accrue against said City in consequence of the grantingofflus emmi. Additionally,the applicant understandsandwill comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-po' i sy6rce regulatirrs per th C pertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date O Issued by: /Ei ✓ Y/Tl/r/ Date: �G•a�•�a•• MY ❑ OWNER-IRM. F.R DECLARATION hereby affirm that I am exempt from the Contractor's License Law for one of RF:ROOFS: the Following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without fust obtaining an inspection,I agree m remove all new materialsfor will do the work,and the structure is not intended or offered for sale(Sec-7044, inspection. Business&Professions Code) 1,as owner of the property,ant exclusively contracting with licensed contractors to Signature of Applicmt: Date: construct the project(Sec.7044,Business&Professions Code). 1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I hart 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 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 Workers Compensation Insurance,as provided for by, California I Iealth S Safety Code Sections 25505,25533,and 25534. I will maintain Section 3700 of the Labor Code,for the performance of the work for which this eom plin nee with the Cu pe'ti no Municipal Code,Chapter 9.12 and the I Iealth S Safety Code.Section_553_(a)should I 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,forwhich this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District 1 will not employ any person in any manner so as to become subject to the Worker's maintain . plin nee with the Cupertino Municipal Code.Chapter 9.12 and the Compensation Imus of California. If,after making this certificate of exemption,I Ileal h Safety Code. 'ections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. it or nmhoriz• e Date: APPLICANT CERTIFICATION CONS'I'RIICI'ION I-IiNDING ACEN'Cl' I cenify that I have read this application and slate that the above information is correct. I 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 Leader's Address griming of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino.Municipal Code,Section ARCIIITECI"S DECLARATION 9.18. 1 understand my plans shall be used as public records. Signature Date Licensed Professional Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228' CUPERTINO Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: ZD 3 X; t,C PERMIT# O J .OWNER'S NAME: -PHONE # elof- a,7,1 y GENERAL CONTRACTOR: BUSINESS LICENSE # ADDRESS: v /GG :G CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINrkL OCC PANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL ICONTRAqTOPjS HAVE OBTAINED A CITY OF CUPE 2TINO BUSINESS LICENSE. I am not using any sobcofitractors: X Signet Dat Please check applicable subcontractors and complete Me following information: SUBCONTRACTOR BUSINESS.NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum / Wood Glass/Glazing Heating Insulation Landscaping,' - Lathing Masonry Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX (408)777-3333•building(a)cuoertino.org ❑NEW CONSTRUCTION ❑ ADDITION ALTERATION/-1.1 ❑ REVISION/DEFERRED ORIGINALPERMITk PROJECT ADDRESS APN Hrl OWNERNAME PHONE n fy „v/��/ -MAIL T' S70.EET apD0.PSS _ CRY, STATE,ZIP FAX SLS FE�/ i Z / O C4 SO/L/ CO N ME PHONE U - —% ./ E-MAIL 1 k7 1 STREET ADDRESS �.// CITY,STATE,ZIP FAX OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT E-I c-, 1ZCTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CO CI'OR NAME LICENSE NUMBER / LICFNS ]'1'PH BUS.LIC K COMPAyCN�A/ME / �c— E-MAIL J � F@ 33 _��-7 STREETADDRESS J Cr1Y,STAT ZIP w ��CLT�rTM1.T• (J c z �/ r ARMIITECTAINGINEER NAME LICENSE NUMBER BUS.LIC a COMPANY NAME I=MAIL PAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK -% C —V& A`2 E%LSTIN USE PROPOS �USE CONSTA PE tlSTO IES rC/ 1 / USE TYPE OCC. SQ.FI'. VALUATION(S) E.VSTG NEW FLOOR DEMO V TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA >�Ir REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTALDECKJPORCBAREA GARAGEAREA: DETACH ATTACH tl DWELLING UNITS: ISASECONDUNIT OYES SECONDSTORY ❑YES BEING ADDED! 0 N ADDITION! 0 N PRE-APPUCATION OYES IFYES.PROVIDECOPYOP I IS TILE BLDG AN ❑YES RECEIVED BY: TOTAt,VALUATION: PLANNING APPL0 0 N PLANNINGAPPROVALLETTER EICHLERHOME! ONO By my signature below,1 certify to each of 06 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 I have pr v' ed is correct. ve read the Description of Work and verify it is accurate. 1 agree to comply with all applicable local ordinances and sate laws relating to bd g con;.wctio th Cupertino to enter the above-idcn'ficd pro rty for inspection purposes. Signature of Applicant/Agew. / Dale:—Z—1Z SUPPLEMENTA INFORMATION .Q IRHU PLAN CIIF.CK TYPE' ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for OVER-TII6COlIhTER BUILDING PLAN REVIEW building(s). Demolition permit is required prior to issuance ofbuilding permit for new building. F_xPRFSS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed hazardous Materials Disclosure El STANDARD ElPUBI.ICN'ORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE.DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITAR\'SEW ER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL BEALTH Bidgdpp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10135 IMPERIAL AVE DATE: 10/24/2012 REVIEWED BY: SEAN APN: BP#: *VALUATION: $4,500 *PERMIT TYPE: Building Permit PLAN CIIECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1RPFIX USE: PERMIT TYPE: (YORK REPAIR DRYROT DAMAGE IN BATHROOM FLOOR AND SHOWER WALL); RE-TILE AND SCOPE INSTALL NEW TUB. ,Keele.Plan Check Plumb. Plan Check 0.0 hrs $0.00 F.lec.Plan Check Mech. Permit Fee: Plumb. Permit Fee: 1PPPR,bIIT rice.Permit Fee: Other,llech.Imp. Other Plumb Insp. 0.0 hrs $45.00 Other Elce.Insp. ,Neck.Inap. Fee: Plumb. help. Fee: Elce. Insp. Fere: NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Public Works, Fire,Sanitary Server District,School District,etc. . These fees are based on the prelirninan information available and are onb,an estimate. Contact the Dept for addn 7 info. FEE ITEMS (Fee Resolution I1-053 EfX 711111) FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 F-1-1 # Plumbing Suppl. PC Fee: Q) Reg. Q OT 0.0 hrs $0.00 $10.00 1B1`Frt7URE Fixture or Trap PME Plan Check: $0.00 Permit Fee: Hourly Only? C Yes G No $0.00 Suppl. Insp. Fee0 Reg. Q OT 1 0,0hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 Construction Tax: Administrative Fee: IADAHN $42.00 Work Without Permit? O Yes (j) No $0.00 Advanced Planning Fee: $0.00 0 hours Inspections t7 Travel Documentation Fee: ITRAI DOC $45.00 $266.00 /STINSP Inspection, Hourly 0 Strong, Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: 1 $133.50 $276.001 TOTAL FEE: $409.50 Revised: 10/01/2012 � 19 5 8 ' 7�