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13030075CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1297 ASTER LN OWNER'S NAME: DRINKWATER JOSEPH L AND BARBAR OWNER'S PHONE: 4085646373 ❑ LICENSED CONTRACTOR'S DECLARATION License 4ng Lic. # Contra Date I herebat I am licensed under the provisions of Chapter 9 (comm 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. 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. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non-point sgurce r gulations per the Cupertino Municipal Code, Section 9.18. CONTRACTOR: BATH FITTER NORTHERN CALIFORNIA 2118 ZANKER RD SAN JOSE, CA 95133 JOB DESCRIPTION: RESIDENTIAL PERMIT NO: 13030075 DATE ISSUED: 03 /14/2013 PHONE NO: (408) 834 -1111 REPLACE WATER MIXING VALVES IN (2) BATHS.REPLACE SHOWER PAN & WALL SURROUND IN MASTER BATH Sq. Ft Floor Area: I Valuation: $3500 APN Number: 36611088.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS$ FROM LAST CALLED INSPECTION. Issued by: Date• Jam. ,/ /,/ 3 RE- ROOFS: Signature Date - 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 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the B r Air Quality Management District I will maintain compliance with the i Municipal Code, Chapter 9.12 and the Health & Safety Code, Sectio 5534. Owner or authorized agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTiNO GENERAL PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014 -3255 (408) 777 -3228 - FAX (408) 777-3333 - buildingelcupertino.ora APLUMMING f-lmT:.r_9AmTrAr. f71 :T1:rrQ1rAT l�v MILICrC, -CTT AX=nT, MEP misc PROJECT ADD S . ' APN # OWNER NAME V -Ii le 1 PHO�D� �� —t037� EAU STREET AD RRESS N CITY STA ZtP (/ CONTACT NAME PHONE E-MAILJ STREETADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER- BUADER ❑ OWNER AGENT CONTRACTOR ❑CONTPACMRAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE ER LICENSE t'�E BUS. # CO ANY NAME E -MAIL STREET ADDRESS CITY, STATE. ZIPS C n 5 1 �'1 LVV O, Dq --1 l � ` ARCHITEGT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME ' E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF or DUPLEX ❑ MULTI -M&MY BUILDING. ❑ COm1mCL4L PROIECTIN WIIDLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN FLOOD ZONE ❑ YES ❑ NO LS THE BLDG AN ❑ YES EICHLFR HOME? ❑ NO DESCRIPTION OF WORK valve Lz- , Psplary I l , TOTAL VALUATION. �7� V RECEIVED BY By my signature below, I rectify to each application and the information I have p ordinances and state laws relating to b Signature ofApplicant(Agent thCfo. I am the property owner or authorized agent to act on owner's behalf. I have read this .t have read the Description of Work and verify it is . I agree to comply with all applicable local . I authorize representatives of Cupertino to enter the above-identiff property for inspection puR ores. Daze: 3 I:EMENTAL INFORMATION REQUIRED OFFICE USE ONLY e. Y❑ U V n. OVER- THE - COUNTER EXPRESS ❑ STANDARD ❑ LARGE ❑ MAJOR MEPMucA, 1011.doc revised 06121111 CITY OF CUPERTINO UUU 7', crrllk4 A TrnlD — ]IT TIT J1INV DlVT4i()N Mech. Plan Check Plumb. Plan Check 10.0 1 hrs $0.00 DATE: 03/14/2013 REVIEWED BY: mendez IQADDRESS: APN: BP #: *VALUATION: 1$3,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex hrs $ PENTAMATION 1 RPFIX PERMIT TYPE: USE: PME Plan Check: $ $0.00 0 WORK REPLACE WATER MIXING VALVES IN 2 BATHS.REPLACE SHOWER PAN & WALL SURROUND SCOPE IN MASTER BATH Mech. Plan Check Plumb. Plan Check 10.0 1 hrs $0.00 Elec. Plan (.,heck L1ec,h. Perini[ Fee: Plumb. Permit Fee: IPPER1l1IT Elec. Permit Fee: Othei-Alech. Insp, Other Plumb Insp. 0.0 hrs $45.00 (Tiber Elec. Insp. ED-L- Ar£ech. Insp. fete: Plumb. Fist. Fee: Elec, Imp, Fce: hrs $ $0.00 $ PME Plan Check: $ $0.00 0 0 1 # Plumbing Permit Fee: Hourly Only? ® Yes Q No $ $0.00 $ Suppl. Insp. Fee-0 Reg. ® OT O O,Q h hrs $ $0.00 PME Unit Fee: $ $0.00 PME Permit Fee: $ $45.00 L Construction :7iax: F F-1 L Administrative Fee: IADMIN $ Ai "Mint Ors 0 six Mech. Plan Check Plumb. Plan Check 10.0 1 hrs $0.00 Elec. Plan (.,heck L1ec,h. Perini[ Fee: Plumb. Permit Fee: IPPER1l1IT Elec. Permit Fee: Othei-Alech. Insp, Other Plumb Insp. 0.0 hrs $45.00 (Tiber Elec. Insp. ED-L- Ar£ech. Insp. fete: Plumb. Fist. Fee: Elec, Imp, Fce: NOTE: This estimate does not include fees due to other ueparrments (Le. rcammng, ruauc . .n�, l , c, .,u..�•y ��. -�• --•�.• •�•, ��• -��- District, ela ). These fees are based on the prelimina information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11 -053 E . 7if 11112) F FEE Q QTY/FEE M MISC ITEMS Plan Check Fee: $ $0.00 = = # Plumbing Suppl. PC Fee: (j) Reg. ® OT F F6 .0 h hrs $ $0.00 $ PME Plan Check: $ $0.00 0 0 1 # Plumbing Permit Fee: Hourly Only? ® Yes Q No $ $0.00 $ Suppl. Insp. Fee-0 Reg. ® OT O O,Q h hrs $ $0.00 PME Unit Fee: $ $0.00 PME Permit Fee: $ $45.00 L Construction :7iax: F F-1 L Administrative Fee: IADMIN $ $42.00 0 Work Without Permit? 0 Yes (j) No $ $0.00 0 Advanced Planning Fee: $ $0.00 1 1 1 1 hours Inspections Travel Documentation Fee: ITRAVDOC $ $45.00 $ Strong Motion ee. 113SEISMIC Bldg Stds Commission Fee: IBCBSC $1.00 , , A y � $133.50 $153.00 86.50 Revised: 01/01/2013 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: I7 �-7z- I-A-I/er PERMIT # -. 756 r BUSINESS LICENSE # OWNER'S NAME: pl '4-�-ln tt j4 C PHONE # GENERAL CONTRACTO : BUSINESS LICENSE Cement Finishing ADDRESS: Z11 4S A-N)e -C , 12D CITY /ZIPCODE: °!S'! *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 BF:'. SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL S TRACTOR HAVE OBTAINED A CITY OF CUPERTINO _ _ ___ BUSINESS LICENSE. / 13 I am not using any subcontractors: I- . 1. V Signature Date Please check applicable subcontract6r4 and complete the following information: t/ 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 i.