11040125 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10311 GREENWOOD CT CONTRACTOR PERMIT NO: 11040125
OWNER'S NAME: CUPERTINO COMMUNITY SERVICES DATE ISSUED:04/19/2011
OWNER'S PHONE: 4088570888 �j�I/tw:'�t %tom PHONE NO:
L LICENSED CONTRACTOR'S DECLARATION F
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class 13 Lic.# 741 7%q S
MECH F RESIDENTIAL F COMMERCIAL�
Contractor 5-a-,•t Ch e 2 S�&Date y-1 9'-1 l
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:APT 1&2(DUPLEX)-RENOVATE TUB/SHOWER,REPLACE
(commencing with Section 7000)of Division 3 of the Business&Professions VANITY&WATER CLOSET,NO ELECTRIC&NO LIGHTING
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 Sq.Ft Floor Area: Valuation:$2008
permit is issued.
APPLICANT CERTIFICATION APN Number:36914025.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Issued by: Date:
Signature/ Date
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by 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(x)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner orauthorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. R 1
0 50 41Cffe Z, Date:41-
APPLICANT
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
and expenses which may accrue against said City in consequence of the
ng of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
wun all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10311 greenwood ct. apt 182 DATE: 04/19/2011 REVIEWED BY: bobs.
F91APN: BP#: "VALUATION: 1$2,008
r PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition/ Repair
PRIMARY SFD or Du lex PENTAMATION 1 RPFIX
USE: p PERMIT TYPE:
WORK renovate tub/shower, replace vanity and water closet no elect no li htin .
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Fixture or Trap 1BPFIXTURE 6 # $48
TOTALS: $48.00
-T-T
Plumb.Plan Check 0.0 hrs $0.00
Plumb.Permit Fee: 1PPERMIT
Other Plumb Insp. 2.0 hrs $42.00 .
Plumb.Insp.Fee: IPLMBINSP $252.00
NOTE: Thesefees are based on the prefindnary in ormation available and are only an estimate. Contact the De t or addn'1 info,
FEE ITEMS (Cee Resolution 09-05I I f. 1.-10 FEE QTY/FEE MISC ITEMS
PME Plan Check: $0.00
PME Unit Fee: $48.00
PME Permit Fee: $294.00
Work Without Permit? 0 Yes No $0.00
Travel Documentation Fee: ITRA VDOC $42.00
Stroh:Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
SUBTOTALS: $385.50 $0.00 TOTAL FEE: F $385.50
Revised: 01/15/2011
PROJECT DATA - RESIDENTIAL
X.
ILE
COMMUNITY DEVELOPMENTDP (VISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINC3 (408)777-3228• FAX(408)777-3333•buildin-wQcupertino.org
PR JECT ADDRESS APN#
OEIL,NAME PHONE E-MAIL
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STREET A DRESS p Y STATE,ZIP
Ja/ 27- a&- Vn
APPLICANT NAME
STF,EE ADDRESS CITY,STATE ZIP AX
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❑OWNER ❑ OWNER-Bua.DER ❑ OWNER AGENT ❑ CONTRAcrOR ❑CONTRAcTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
DESCRIPTION F O
Y
EXISTING USE(S): C PROPOSED USE(S): l n
OCCUPANCY(S): TYPE OF �7 PARCEL
CONSTRUCTION: v(J AREA:
FIRE y N WUI AREA: Y N FLOOD AREA: Y N SIESMIC AREA: Y N
SPRINKLERS:
Existing Proposed
Floor Area: First Floor: s.f. X.
Second Floor: s.f. ` r
Garage S. s !4 3 .1
TOTAL: S. S. $
Are there at least two 10 feet by 20 feet clear spaces inside the garage?
Is privacy protection planting required for the project? z O CL
r o C �- 4\ 'N
Governing Codes: 2010 California Building Code(based on the 2009 International Build' ) 47' c w s acgiU
2010 California Residential Code(based on the 2009 International Re 6�It Ccl,e o v~
2010 California Plumbing Code(based on the 2009 Uniform Plumbin d c m w 'g
2010 California Mechanical Code(based on the 2009 Uniform Mech Code o �' •� , ` \
2010 California Electrical Code(based on the 2009 International Elec _ Code L° o
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2010 California Energy Code a E o a
2010 California Green Building Standards Code $ ®s E v a z
Cupertino Municipal Code 0 L
s $ 'fi c a�.
ProjectData-ResidentiaLdoc revised 03/09/11
Building Department
City Of Cupertino
La 10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: PERMIT# ozzo L-e�( 2,-
OWNER'S NAME: , - Q c/,,tT V St�v PHONE# --0
GENERAL CONTRACTOR: CA ,z S BUSINESS LICENSE#
ADDRESS:jY3gl (f Cr. Sanki Tose c44V27 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 INSPECTION(S) 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 and complete the following information:
V 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
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPER�"INc3 (408)777-3228• FAX(408)777-3333 •building-Scupertino.org MISC
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A041P ISR APN fk
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p PHONE Q SR MAIL
SkAM
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W E-MAIL
SS FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHTPECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
C OR NAME LI S BUS.LIC#
CO ANY ) RW C" FAX
S=S V�v � ^ CTiY Sl'A - s, PHONE
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ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC k
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
ISE OF SFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No
DESCRIPTION OF WO �o
NCO
TOTAL VALUATION:
V
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authori representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL INFORMATION REQUIRED
per G -
.� SY �11lS1FW' � :0
_ 3z
MEPMisc,4pp 101 Ldoc revised 03/16/11