13030076CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 22071 LINDY LN
CONTRACTOR: BATH FITTER
PERMIT NO: 13030076
NORTHERN CALIFORNIA
OWNER'S NAME: WAGUIH ISHAK
2118 ZANKER RD
DATE ISSUED: 03/14/2013
OWNER'S PHONE: 4088572097
SAN JOSE, CA 95133
PHONE NO: (408) 834-1111
JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALII
L ENSEDCONTRACTOR'S DECLARATION
License Clas ic, # �}
REPLACE WATER MIXING VALVES IN (2) BATHS
j
Contractor Date
I hereby aff m t t am licensed under the provisions of Chapter 9
(commend g wi 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
Sq. Ft Floor Area:
Valuation: $1500
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
APN Number: 35627014.00
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 DA F M LAST 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
2
granting of this pe .. Add' . nally, the applicant understands and will comply
Issued by: Date: J
with all no point ur ations per the C pertino Municipal Code, Section
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.
❑ 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).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. T 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(x) 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 quipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by th a Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with t mcipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sect' 5, 25 3 , and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: 3
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
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
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION r,
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 U�
CUPERTINO () 777"3228 •FAX (408) 777-3333 • buildina(aDcuoertino.ora (P misc
CLIMBING ❑MECHANICAL I IFLE=irAT_ I knCf`=T AXT�^T?e
PROJECT ADDRESS ^ `�
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APN # � C � 2�)
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OWNER NAME
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❑ OWNER ❑ OWNERBUILDER
13OWNERAGENT cm; ACDDR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENmem ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
LICENSE LICENSE
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BUS #
CO ANY
E•MAII.
srREt:rADDRESS
ARCHi=/3NaXM NAME
LICEI�ISE NUMBER BUS. LIC #
COMPANY NAME '
E•MAII.
FAX
STREET ADDRESS
CITY, STATE, W
PHONE
USE OF or DUPLEX ❑
BUBAAIG: ❑ CDMAEERCIAL
MULTI-FM�;Y
PROIECTW WWLAND ❑ ya
URBAN DOWACE AREA NO
PRWFITIN ❑ YES
FLOOD ZONE
IS THE BLDG AN
❑ YES
❑
❑ No
EICHiR HOME?
❑ NO
DESCRnMON OF WORK
TOTAL VALUATION: 4 t I S-00 • O(1
By my signature below, I certify tZj,
he followin* I am the
application and the information I bded ' have
ordinances and state In relating I
Sign== of Applicant/Agent--.—_—
W
or authorized agent to act on the propeW owner's behalf I have read this
oa of W, verify it is actuate. I ague to comply with all applicable local
o to enter the abovy22ideadfi/ eed � � far inspection poses.
bate• J • / `1, /!
P ❑ EaRESS
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❑ STANDARD
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❑ LARGz
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❑ MAJOR
MEPJ&a(pp 2011.doc revised 06121111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
.,tech. Plan Check I I Plumb. Plan Check 10.0 1 hrs $0.00 Dec. Plan Check I I
.-VI, ch. Perafil Fee: -. P� Fee:
[Plumb. Permit Fee: IPPERMT Frle� Permit F -C
Oilio-AY(xh. Insp. Li Other Plumb Insp. L Lo i Ins $45.00 01her Dec. Insp.
1,11fech. Insp. Fee: PW0. hap. Fee., Dec. 1nsp,Fue.-
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District School
D;.vfrirt_ etc )- These fops are havoil an the nrefiminary information available and are only an estimate. Contact the Dent for addnl info.
FEE ITEMS (Fee Resolution 11-053 fff. 711112)
FEE
DATE: 03/14/2013
REVIEWED BY: mendez
JimADDRESS:
APN: 5�
BP#:
*VALUATION:
1$1,500
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
SFD or Duplex
USE:
I
PENTAMATION
PERMIT TYPE: 1 RPFIX
I A
.WORK
REPLACE WATER MIXING VALVES IN (2) BATHS.REPLACE SHOWER PAN & WALL SURROUND
SCOPE
IN MASTER BATH
.,tech. Plan Check I I Plumb. Plan Check 10.0 1 hrs $0.00 Dec. Plan Check I I
.-VI, ch. Perafil Fee: -. P� Fee:
[Plumb. Permit Fee: IPPERMT Frle� Permit F -C
Oilio-AY(xh. Insp. Li Other Plumb Insp. L Lo i Ins $45.00 01her Dec. Insp.
1,11fech. Insp. Fee: PW0. hap. Fee., Dec. 1nsp,Fue.-
NOTE. This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District School
D;.vfrirt_ etc )- These fops are havoil an the nrefiminary information available and are only an estimate. Contact the Dent for addnl info.
FEE ITEMS (Fee Resolution 11-053 fff. 711112)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
#
$20.001
Plumbing
IBPFI=RE ] Fixture or Trap
Suppl. PC Fee: (E) Reg. 00TW
hrs
$0.00
PME Plan Check:
$0.00
= #
$0.00
Plumbing
IPRSEWER Sewer, Sanitary
Permit Fee:
$0.00
Suppl. Insp. Fee -.0 Reg. 0 OT0
,0
hrs
$0.00
PME Unit Fee:..
$0.00
PME Permit Fee:
$45.00
Construction Tax. -
Administrative Fee: IADMN
$42.00
0
E)
Work Without Permit? 0 Yes 0 No
$0.00
Advanced Planning Fee.
$0.00
Select a Non -Residential
Building or Structure.
0
Travel Documentation Fee: ITRAVDOC
$45.00
Strong Motion Fee: IBSEISAffCR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
$133.501
$20.00 A M VR9=0-'Aw
M M a
$153.50
Revised: 01/01/2013
CUPERTINO
CONTRACTOR / SUBCONTRACTOKLIST
JOB ADDRESS: 07/ L. \Il alL PERMIT # �j � -Z(41
OWNER'S NAME: J/ PHONE #G�':7
GENERAL CONTRACT /ci s/ BUSINESS LICENSE'#' . 5'
ADDRESS: ,�. Zeujl� ,2 C/ CITY/ZIPCODE:, Yes e.
*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 BCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
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