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13020036 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21078 MANITA CT CONTRACTOR:RDH CONSTRUCTION PERMIT NO: 13020036 OWNER'S NAME: ENGLISH WILLIAM L AND GLORIA M 1695 GRIZILO DR DATE ISSUED:02/072013 OWNER'S PHONE: 4082536423 SAN JOSE,CA 95124 PHONE NO:(408)476-7568 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class Lia q 5 1 ( O z BATHROOM REMODEL 78 SQ FT Contractor('} C.�N.Sd'�'t,y,�7�cJ Date J 7) Z-oJ 3 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 (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 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. Sq.Ft Floor Area: Valuation:$10000 1 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:36223048.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.1 agree to comply with all city and county ordinances and state laws relating WITH 80 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 DA FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, ?/3� costs,and expenses which may accrue against said City in consequence of the l Date. granting of this permit. Additionally,the applicant understands and will comply Issued by: with all non-point source regulations per the Cupertino Municipal Code,Section RE-ROOFS: Signaturp/-/ Date 4 3 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. ❑ OWNER-BUILDER 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 1,as owner of the property,or 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). 1 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 fallowing 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 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 25534. Section 3700 of the Labor Code,for the performance of the work for which this f , Owner or authorized agent _��` Date: permit is issued. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,1 CONSTRUCTION LENDING AGENCY 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 county ordinances and slate 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION costs,and expenses which may 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 Date VA In" A—v 33 PLJAMZ I N to L? Vati" Li 4 0-7> G _xlv)cb'w ' -7 uo LJ-) c c; LJ OWN*Sr- r4 r�� -T ue, rl. OFFICE COP-, qA 41 Z; D i 1 LVIn��N I Y Tum ff , CSG u, ,J CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION IF AIR ADDRESS: 21078 manita ct DATE: 02/07/2013 REVIEWED BY: Mendez APN: ;'(/J BP#; *VALUATION: $10,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARYPENTAMATION 1R3SFDREM USE: SFD or Duplex PERMIT TYPE: WORK remodel bathroom 78 sq ft SCOPE .ltc,/t. Plan Check P/mrth. lYun C Lr<-(, 11cr. PLm CPo<rk Ife, Permit I'er. Plmnh. Perm a l' I 1-1"� Po nw Ira OJier Alec h. Irrvp. Oth,a P6unL Irta/, Udrrr 0", Imp. .41ach brep. her. Phmrh. hz.p.he.r Occ. ED Inv,. NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc). These fees are based on the prelimina information available and are only an estimate. Contact the Dept for addh7 into. FEE ITEMS(Fee Resolution I1-053 Eft 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 78 s.f. Remodel,Bath(<=300 sf) Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $600.00 1REMBESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feee. Reg. © OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cmisauction To dchninistrath•e 1'ee_ Work Without Permit? O Yes Q No $0.00 O Advanced Planning Fee: $0.00 Select Non-Residential 0 Building or Structure 0 1 ralwl IJouonentalinn Vice' - Strong Motion Fee: 1BSE1SM1Cn $1.00 Select an Administrative Item Bldg Stds Commission Fee: /BCBSC $1.00 SUBTOTALS: $2.00 $600.00 TOTAL FEE: 1 $602.00 Revised: 01/01/2013 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION n, 10300 TORRE AVENUE•CUPERTINO, CA 95014-32551' GUPERTtNO (408)777-3228• FAX(408)777-3333•building cDcuoertino.org 0, ❑NEW CONSTRUCTION —1 ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS L( C) -� A� i-I— C i APN# OWNERNAME I" I P M d- L4 S P ONEE-MAIL STREET ADDRESS 2-1, v -] 3 UT CITY, STATE, �Q FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX 13 OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT 13 CONTRACTOR 11CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME TJDf.�T „_��S£� LICENSE NUMBER LICENSE TIDE BUS.LIC# COMPANY NAME PZ c' o E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTIONOF WORK L;_'aV'"—0 L✓` EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(8) EXISTG NEWFLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODELAREA '� c� REMODELAREA REMODELAREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH []ATTACH #DWELLING UNHS: IS A SECOND UNIT OYES SECOND STORY YES BEINGADDED? E]NO ADDITION? 11NO PRE-APPLICATION AYES IF YES,PROVIDE COPY OF ISTHEBLDGAN ❑1'ES RECfF E TOTAL VALUATTON: PLANNING APPL# E]NO PLANNING APPROVAL LETTER EICHLERHOME? []NO 1 IO Q J / By my signature below,I certify to each of the following: I am the property owner or authofize gent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work d verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building constmcti . I at H e represen Yves of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: I\? 1 ZJ13 SUPPLEMENTAL INFORMATION REQUIRED 'PLAN CUJECK TYPE ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for IERR-THE-Cl Tart n.DINc rLAN REVIEW existing building(s). Demolition permit is required prior to issuance of buildi e permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ElsTANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ EPEE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH BldgApp_201 Ldoc revised 06127111 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: Z-k c>-13 mo :no cT PERMIT# OWNER'S NAME: '� N] cof-,l5 C PHONE# ODS- �4 1 (R 1 S &V GENERAL CONTRACTOR: BUSINESS LICENSE# 33e ') ADDRESS: Ibz�S Q& Zj w pri , Sp:q qS)Z`I CITY/ZIPCODE:50i-4 3-O' ' 9 2-- *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 OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. //���✓, I am not using any subcontractors: l Signature Date Please check applicable subcontractors and complete 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