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13020107 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10962 SWEET OAK ST CONTRACTOR:BATH FITTER NORTHERN PERMIT NO: 13020107 CALIFORNIA OWNER'S NAME: POON HENRY M AND ALICE 2118 ZANKER RD DATE ISSUED:02/20/2013 OWNER'S PHONE: 9257855706 SAN JOSE,CA 95133 PHONE NO:(408)834.1111 LICENSED CONTRACrOR'S DECLARATION r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB License Cl#wih Lic.N r r F n1 / MECH RESIDENTIAL COMMERCIAL Contractor Date O�-� I hereby am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE WATER MIXING VALVES IN(2) (commencon 7000)of Division3 of the Business&Professions BATHS.REPLACE Code and that my license is in full force and effect. SHOWER PAN&WALL SURROUND IN MASTER BATH.REPLACE BATHTUB&WALL SURROUND IN GUEST BATH 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. 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 permit is issued. Sq.Ft Floor Area: Valuation:$5000 APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is APN Number:32651055.00 Occupancy Type: correct.1 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. dditionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point sou a ions per the C ino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Signature Date Z0/ Issued by: AN ��r Date: d - 4P4.1-3 ❑ O ER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RF.-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,1 agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7M, inspection. Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should 1 use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District 1 will not employ any person in any manner so as to become subject to the Worker's maintain corn fiance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&S ty de,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,1 must forthwith comply with such provisions or this permit shall be deemed revoked. Owne at Date: 16 APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional GENERAL PERMIT APPLICATION M E P COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERT INO,CA 950143255 M ' CUPERTINO (408)77733333 228•FAX(408)777. •buihiina(�cuoertno ora l30dUio2 sc LUNMINa OmEaiAmm 0RECnUCAL 01,0CELkNEOUS PROIBCTDRESS APNN 2Sy NAME - 85- S9 bl.P B.MAB Q 1 N L2 FAX COMrACr NAME PHONE E-MAIL STREEFADDRESS CRY.SCAIE,ffi FAX ❑OWNER ❑0WMt-BURDE3t ❑OWNERAO@O tbN U=lt ❑CONIRACIORA@rr ❑ AR== ❑ENcENEFR ❑ DEVF 4m ❑TENANT CONIRACMRNAMB L SH BDS N tb ANY E-MAIL .L F -7 —lilt SIAEETADDRES4 Qn.57A � ' S C 51 "Wxt ARQ4TECr/FNENEERNAME LICENSE NUMBER .BUSUCN CONPANY NAMESMALL FAX Si=ADDRESS CRY,SrATE.Z PRONE USE OF wDOP= ❑ MULTFFAMR.Y PRO=INWBDLAND ❑ YES PRO crm ❑YES IS;ZM—MAN ❑YES BUILDING: 13CONGER= e1RWINIFRFACEAREA ❑NO A=zoNE ❑No EKHMNOME7 ❑No DESCWnOX OF WORK otp TOTALVALUA ON, RECENED BY: By my sigaat rt below,I ratify m each of following: I am tha property owns or authorized egmt m set on die applieation and the iafmmadon I havepro hRPe � properwa ces behaX I bave tcad mica mdfi mw and stele laws tel On to bail g VwmWw of Work and verily it is awmate. I RE=m comply with all applicable local tadvea ofCepereno m mbw tho abovo-i IDy�cppp Sigomm ofApplimtlAgmt Daft: AL INFORMATION REQUMM OL OFFICE IRiE ONLY w OVERdHE.COINM r . ❑ RXPRFRS V ❑ STANDARD ❑ URGE 6 ❑ MAJOR MEPA&Cdpp 2011.doc revised 06l2lllI CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10962 Sweet Oak St DATE: 02/20/2013 REVIEWED BY: Sean APN: BP#: �3 0 a a VALUATION: $5,000 *PERMIT TYPE: Plumbing Permit PLAN CHECK E: Alteration/Addition/ Repair PRIMARY SFD or Duplex PENTAMATION 1RPFIX USE: PERMIT TYPE: WORKa lace water mixingvalves in 2 baths. Replace shower an and wall surround in master bath. SCOPE Replace bathtub and wall surround in guest bath. APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Fixture or Trap 1BPFIXTURE 2 # $20 TOTALS: $20.00 ha,.,4_k. 1% Vach. Prrot Check Plumb.Plan Check 0.0 hrs $0.00 /sloe.Plan Cher:ic itfech. Ar;nit Fee: Plumb.Permit Fee: IPPERMIT Eiee,Pe,mil1 Oder rtfcrh,Insp. Other Plumb Insp. 1.0 hrs L$45.00 Other Eh e. insp. lfe(;h, Imp, Pee, Plumb.Insp.Fee: IPLMBINSP $133.00 Elec. biap. Fetc 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 Prelimina in ormation available and are only an estimate. Contact the Dept for addn'l into. FEE ITEMS (Fee Resolution 11-053 Efi. 711/12) FEE QTY/FEE MISC ITEMS Plun Check ('eye•: Supp/. 1,C I ee PME Plan Check: $0.00 Pernut Tee: Suppl, hap Fee PME Unit Fee: $20.00 PME Permit Fee: $178.00 ConstruePion Tax: Administrative Fee: IADMIN $42.00 Work Without Permit? O Yes Q No $0.00 �l�drnnc od Plartniug Foos: Travel Documentation Fee: ITRAVDOC $45.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 iBT�OTALS';` $286.50 $0.00 TOTAL FEE: - $286.50 Revised: 01/01/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 C O P E RT I N O Telephone: 408-777-3228 Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# OWNER'S NAME: h 00 1 PHONE #9a75,7f?S— S70r. GENERAL CONTRACTOR: i BUSINESS LICENSE# '� �35� ADDRESS: 'kk/c/ Rd CITY/ZIPCODE: 052 / *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 UBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: ZIA0 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