13020053 CITY OF CUPERTINO BUILDING PnnE//RRaM''IT
BUILDING ADDRESS: 879BETTE AVE _ CONTRACTOR: PERMIT NO:13020053
V
OWNER'S NAME: NORGA LOUIS H AND JEANNINE L T DATE ISSUED:02/122013
OWNER'S PHONE: 4082570364 PHONE NO:
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class G 3 3' Lie.# V G 1 y�'Z REPLACE(E)BATHTUB WITH WALK-IN HYDRO
THERAPY
Contractor G 'I-� ?>ate 2 1240 TUB,SAME LOCATION St DEMESIONS.ADD NEW GFCI
I hereby affirm that.I am licensed under the provisions of Chapter 9 RECEPTACLE
(commencing with Section 7000)of Division'3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain acertificate 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:$5000
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 APN Number:36927050.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and 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 state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We).agree to save 180 DAYS ' ST CALLED INSPECTION./
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the Iss Date: Z
granting of this permit. Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Munici al Code,Section
9.18.
RE-ROOFS:
Signature Date 2 j 2_ i3 All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ R-B ILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,dor 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,am.exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: - Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I 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 Air Quality Management District I
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&Safety Code,Sections 25505,25533,and 25
Section 3700 of the Labor Code,for the,performance of the work for which this Owner or authorized agent: Date.2�iz/13
permit is issued. _
I certify that in the performance of the work for which this permit is issued,Ishall
not employ any person in any manner so as to become subject to the Worker's C CfION LENDING AGENCY
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 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. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
-APPLICANT CERTIFICATION Lender's Address
I certify that I have read this application and state that the above information is - -
correct.I agree to comply with all city and copnty.ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the.abovementioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses whichmay 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 - Data
GENERAL PERMIT APPLICATION O� M E P
:01 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 \�ID M I
CUPERTINO (408)777-3228•FAX(408)777-3333•buildina(fDcuoertino.ora
O
PLUMBING MECHANICAL LECTRICALsc
MISCELLANEOUS
PROJECTADDRESS C I TE C APN# 3 q _ Z� - p S O
OWNER NAME :E/I A A)^, I ro (• PHONPHONEZS/ 034 'MAIL
STREET ADDRESS t CFfY,STATE,ZIPFAX
7- E (::-o Pol TIAI D C SD
CONTACT NAME PHONE E-MAIL
STREET ADDRESS CITY,STATE,ZIP FAX
11 OWNER ❑ OWNER-BUILDER ❑ OWNERAGENTCONTRACTOR 000NTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAMED LICENSE NUMBER WCENN TYPE BUS,LIC#
G
COMPANYNAME6zu v. 1 EMAIL FpZ . C-. / , � O
S�TLREET AaDnDRESS G G O CI ,STATE,ZIP tl eA . 94 5 g3 4zo E -z 7_F�'45 5O
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME EMAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF OSM DUPLE`( ❑ MUL .FAMILY PROJECrMWILDIAND ❑ YES PROJECT IN [3 YES IS THE BLDG AN [3 YES
BUILDING: []COMMERCIAL URBANMTERFACEAREA 00 NO FLOODZONE I]No EICHLERHOME1 ❑ NO
DESCRIPTION OF WORK '• '.' 2 1
L 1 5'7I A/ TJJ5 W IY I - W — 1 .
tt IGh7L- G �G GIZcuIT.
TOTAL VALUATION:
By my signature below,I certify to each of the following: I am the property owner or autho' agent to act o p f. I have read this
application and the information Ihave provided incorrect. I have read the Description of Work and verify itis accurate. I agree to comply withal]applicable local
ordinances and state laws relating to building construction. I authorize reptes o to enter the above-identifiedproperty for inspection purposes.
Signature of Applicant/Agent: Date: Z/IZ
SUPPLE L ATION REQUIRED
,(JIFFICE USE ONLY
'„v0_VER-THE-COUNTER
iYCPRFSS
:..R(iDARD
YJOR
MEPMiscApp_2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 879 BETTE AVE DATE: 02/12/2013 REVIEWED BY: MELISSA
APN: 369 27 050 BP#: 'VALUATION: $5,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY SFDorDuplex PENTAMATION 1R3SFDREM
USE: PERMIT TYPE:
WORK REPLACE E BATHTUB WITH WALK-IN HYDRO THERAPY TUB SAME LOCATION &
SCOPE DEMESIONS.ADD NEW GFCI RECEPTACLE
, icx ; � Is•-
.. .
iLfech Wan Check Phunb.Plan Cheek Elec.Plan Check 0.0 hrs $0.00.
bfech. Permit Fee� Elec.Permit Fee: IEPERMIT
Other Mech.Insp. Other Plumb Insp. Other Elec.Insp. 0.0 hrs $45.00
Mech. Insp.fee: Plumb. his)).Fre: Elec.Insp.T ee:
NOTE:This estimate does not include fees due to other Departments(le.Planning,Public Works,Fire,Sanitary Sewer District,School
District eta). These ees are based on the relimina in ormadon available and are only an estimate. Contact the De t for addn'1 into.
FEE ITEMS (Fee Resolution 1.1-053 E . 7/1/12) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 F 10 s.£ Remodel,Other
Suppl. PC Fee: O Reg. 00 0.0 hrs $0.00 $400.00 IREMRESOTH
PME Plan Check: $0.00 Electrical
Permit Fee: $0.00 $0.00 1 iBRSMRECEP Recep/Switch/Outlets
Suppl. Insp.FeelD Reg. Q OT Q,0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $45.00
Construction Tac:
Administrative Fee: IADMIN $42.00 O
Work Without Permit? O Yes (j) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential
Travel Documentation Feer 1TRAVDOC $45.00 Building or Structure O
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
1 $133.50 $400.001.1.., ^TQTALKi+EE ti $533.50
-
Revised: 01/01/2013
Jan 31 13 01:55a %X% 51D-778-9154 P. 10
.4nv Precenceofmadew! ygs DP1f0'FUS: Yes Eletrlca[!pees&Photo Requirements:
Suudc:_i::i2nt of Ex Wit;Tub-Four.[is luca:rd un: Electrical Panc' Lrtx:iont
tet�// R:y5t_ Fr{.nl d.•.•r�nvl.r iroutraao-a'p'+,ici rci'nn'.�•'d
Please P-v%I'd,:Photos of the fullowin> Circle the earn:or-Elect-Panel.NI FR: Brant,Cha llcn;cr.
P+nitio.t ttalle? YEt 1014•,4; 1�'+Ib sryan:ma NMfMw+er ne: Ceder Hammer,Federal Paci5c Elect.General Elrnric.plura•:•
Screw Fuse,Siemens.Scuarc-D.Sylvania,lteatinghom' Ziasco
Parti:i.a stall I:Width f%AK Height_'{,)& Depth:_(
Other.
Pa-Ill; .tall.:R•id:h Height, Death:
(L.W r:.L.�Li:se;+1,�.:rw ro,un,:nri lair r vRa w tm•.JA.n�nw.i...u.e,
f'ariiiotr .\'all S:R'idtt Heigb[ Depth; +""11q""�+t w+•'r
l0\I,llf\'F$(Ilo:neo�•n�curKan4 remark.areuerliaml:Lm( �Cl�.�Vw].}� l�• .,1 .aye-) d�
"� y c tr �i �'onk7 1E1k1d`T �F 4�. 8 L� y 1�cv- [sift
Ruth R m [ Cr 141" WTvw
0-t-- fn!02
2�f9rooan I
Ltisf �t'�' '91N1r3r1 1'i1rJl(� �L� �� f tJ� L•� N t�
Kwa ausY I � G 1= } G r 12 e—u -T i—(n�rZ
111V1 IeG
D!.'i—LN`CUPERTIIN01ENT
:rnd spscificallons MUST be kept at the
cr;nstra^,tion. It is unlawful to make any
- aRzra'Jons on same, or to deviate
Without approval from the Building Official.
c
If this plan and specifications SHALL NOT
n.agca->=:Ta`•c=:` I.,,,.Glii or to be an approval of the violation
ptST �,' -rc'.inions of any City Ordinance or State Law.
i' T �12�13
PF"Ividf No. _ 1302005
BuGi`id g Dp armee t
FEB 12 2013
F"`�iBINEJ FCR CODE COMPLIANCE
Reviewed By.
cz�gV
8y FEB 12 Z0r J21i
0FF;;10EX0PY
Building Department
City Of Cupertino
10300 Torre Avenue
Clllle1�111� C�OSS»��55
CUPERTINO YBJC. 4V2f-%YY-S 53S
CONTRACTOR 7 SUBCONTRACTOR LIST
JOB ADDRESS: 'E?7 PERMIT# / O L-",53
OWNER'S NAME: Tg;4 „/tnl!< oR PHONE# tfog •2-5-7 • 03 6
GENERAL CONTRACTOR: G,(R �1 JS BUSINESS LICENSE#
ADDRESS:2-500 a D GiDiz R.,MVA1 `1�{
*Our municipal code requires all-businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINEP A CITY OF CUPERTINO
BUSINESS LICENSE.
2-11
I am not using any subcontractors: D -z-/ )3
ure Date
Please check applicabl"ubcojttractor2s �plete the 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