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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�� -1 I1MBING EIMKKANICAL EIELEcntICAL MISCELLANEOUS PAOJECTADDAtSS /b M IN J 21,41 / 'gyp 3 7-S! 32 O-ID DWNFR ►J-D(ryyA _ iO�oC�g1glo-I Ciq�j aMAM STRETADD"M DIY D ; A t,237 �b4 FAX OMTTACr NABIE PES &SfAII. STREETADDRESS OIY,STATS,DP FAX 13 OWNFR ❑ owma-sUDDFR ❑OWNERAaDu oY$7IAACrOR ❑WMRARORAcawr ❑ ARCB= O ENGDm ❑ DEVEIDPFR I]MAN" WNTRACCOR NAME OD ANY NAME R"M STREETADDAEti4 OTY,STATE.ffi s C SI ARCRTl'EC ENGINEEIRRo E LICENSENUMER .BMUCa ODMPANYNAMEE-MAIL FAX WREFTADDREW CTIY,STATF,W PRONE USE OFI❑ MULT",&umMY PROIBCrw WEDI.WD OYES PROIECTDr 13 y 3;ZEDGAN ❑yEs e=WM 000aodEROAL utBANIm"=AM aNO FLOODzo:m ONO WOMHOhm C3 No DESCRDM04of WOM s ' n !� b cvz)�e— ct\ TOTAL VALUATION: BY my dpaaae beim,I wtify m anh ofthe following sm the property ownc or antltoriaed mason rhe eppliatim sad the mfmmadon I have °8� Propel'ownds b ZI ha rad this ord'mmw and stare Ims"dating t, is rad the Desaip6on of Wodc evd verity it is aeemam. I agtae m rA applicable foal inyp�on ,Sigozoae ofApplieaoVAgtmt ALINFORMATION!!m 77,F FICE"LSE ONLYE3 ovmTwcoaam RF15NDARDGEIOR 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