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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