13010043 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10683 MINETfE PL CONTRACTOR:BATH FITTER PERMIT NO: 13010043
NORTHERN CALIFORNIA
OWNER'S NAME: LINDA MILLER 2118 ZANKER RD DATE ISSUED:01/082013
OWNER'S PHONE: 4089661943 SAN]OSE,CA 95133 PHONE NO:(408)834-1111
❑ LICENSED C./OQ/ R' DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL
License Class - ;°61C.# INSTALL ACRYLIC SURROUND STALL FOR SHOWER
ENCLOSURE&REPLACE SHOWER FIXTURE
Contractor Date
1 hereby affirm that I am licensed under the provisi os of Chapter 9
(commencing with S,ction 7000)of Division Sof 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:
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. Sq.Ft Floor Area: Valuation:$5000
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:37532040.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that 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 WITMN 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 FRO CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses whichmay accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply Date: , r
with all non-point source regul 'ons per the upertino Municipal Code,Section) TT�
9.18.
RE-ROOFS:
Signature Date 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.
13 OWNER-BUILDER DECLARATION
:
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of ApplicantDate:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,m 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)
1,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. 1 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 2550 ,25533, d 25534.
Section 3700 of the labor Code,for the performance of the work for which this Owner or authorized agent: / Dater
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,I 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 state 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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the 1 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
GENERAL PERMIT APPLICATION M E P
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 O O� M '
CUPERTINO (408)TR-3228-FAX(408)777,3333•buildina(tDcuce lino ora 3��
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MEPMiscApp I011.doc revised 06/11/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 10683 MINETTE PL DATE: 01/08/2013 REVIEWED BY: MELISSA
APN: 375-32-040 BP#: `VALUATION: $5,000
*PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY SFD of Duplex PENTAMATION 1RPFIX
USE: PERMIT TYPE:
woRK INSTALL ACRYLIC SURROUND STALL FOR SHOWER ENCLOSURE & REPLACE SHOWER
SCOPE I FIXTURE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Fixture or Trap 1BPFIXTURE 1 # $10
TOTALS: $10.00 Frj
t t a Jnr,, M tI-
;Meeh. Plan Check Plumb.Plan Check 0.0 Ins $0.00 Flee. Plan Check
Mech. Permit Feta: Plumb.Permit Fee: IPPERMIT I Elec, Permit Fee:
Other Vech. /n.sp. Other Plumb Insp. 0.0 hrs $45.00 Other Elec.Insp. Ej
;Meeh.Insp. Fee.: Phunh hasp. Fee: Elec. Insp.Pee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District etc. . Thesefees are based on the Preamina in ormadon available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS(Fee Resolution 11-053 E$ 7/U121 FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
PME Plan Check: $0.00
Permit Fee:-
Suppl. Insp Fee
PME Unit Fee: $10.00
PME Permit Fee: $45.00
Construction Tax:
Administrative Fee: 1ADM@1 $42.00
Work Without Permit? O Yes Q No $0.00
Advanced Planning Fees:
Travel Documentation Fee: InUVDOC $45.00
Strone Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
L!L321 0.00 ' TOTAL FEE:u $143.50
Revised: 10/01/2012
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: 408-777-3228
C O P E RTI N O Fax: 408-777-3333
CONTRACTOR/SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT#
OWNER'S NAME: PHONE#
GENERAL CONTRACTOR:- BUSINESS LICENSE#
ADDRESS: CITY/ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors nd 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