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11040126 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10321 GREENWOOD CT CONTRACTOR 1 PERMIT NO: 11040126 OWNER'S NAME: CUPERTINO COMMUNITY SERVICES ` �_ &R)fJL_S DATE ISSUED:04/19/2011 (""NER'S PHONE: 4088570888 I�S �� ( u f PHONE NO: LJ LICENSED CONTRACTOR'S DECLARATION F BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class R Lic.#7 L!7 8-q g MECH RESIDENTIAL� COMMERCIAL � Contractor S-a-7 C`t e Z c'-tcl $au Date L 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:36914025.10321 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. Si gn ature r7IIA411�4.�� Date 11_1q_1/ Issued by: Date: a 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: I,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. 1 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(a)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 or authorized agent: forthwith comply with such provisions or this permit shall be deemed revoked. M AA'10 S 4 AlCae Z Date: / 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 wan 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 6 ITEMS OF 13 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36914025.10321 DATE ISSUED. . . . . . . : 04/19/2011 RECEIPT #. . . . . . . . . : BS000013220 REFERENCE ID # . . . : 11040126 SITE ADDRESS . . . . . : 10321 GREENWOOD CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : CUPERTINO COMMUNITY SERVICES ADDRESS . . . . . . . . . . : 10114 VISTA DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : SANCHEZ & SONS CONS CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 2, 008.00 1. 00 0. 00 1.00 0.00 1BPFIXTURE NO OF FIXTURE 6 . 00 48. 00 0.00 48.00 0. 00 1BSEISMICR VALUATION 2, 008 .00 0.50 0. 00 0.50 0. 00 1PLMBINSP HOURS 2 .00 252 .00 0. 00 252 .00 0. 00 1PPERMITFE FLAT RATE 1.00 42. 00 0. 00 42 .00 0.00 1TRAVDOC FLAT RATE 1.00 42. 00 0 . 00 42 .00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 385.50 0. 00 385.50 0. 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING 512 FINAL HANDI-CAP CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10321 greenwood ct. apt 182 DATE: 04/19/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$2,008 y 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 lighting. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Fixture or Trap 1BPFIXTURE 6 # $48 TOTALS: $48.00 Plumb.Plan Check 0.0 1 hrs $0.00 Plumb.Permit Fee: 1PPERMIT Other Plumb Insp. 2.0 hrs $42.00Li Plumb.Insp.Fee: IPLMBINSP $252.00 NOTE. Theseees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fede Resolution 09-051 Eff. 7,-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 Strom Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $385.501 $0.00 TOTAL FEE: 1 $385.50 Revised: 01/15/2011 PROJECT DATA - RESIDENTIAL COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•building cDcugertino.org cUPEtiT`NO P T RESS 7N# s NAME��O �y PHO ' E-MAIL CW S DRESS � n C�I�' TATE ZIP w • APP ANT N ME H( IF3 _ E-MAIL �4 � S T DDRE S J� g4�j ATF Z� AS O ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT DESG !(}F�tQRI r F. :4 EXISTING USE(S): n PROPOSED USE( OCCUPANCY(S): / TYPE OF PARCEL CONSTRUCTION: AREA: FIRE Y N WUI AREA: Y N FLOOD AREA: Y N SIESMIC AREA: Y N SPRINKLERS: Existing Proposed Floor Area: First Floor: s.f s.f. + tj Second Floor: s.f s f �°Y Garage f. .f E TOTAL: s.L a 3$ o G- Q c m X,- c�3 Are there at least two 10 feet by 20 feet clear spaces inside the garage? Y N zr v LLJ 01 --J E a xz � � c N WO Is privacy protection planting required for the project? Y N g o 0 o 0 -a c 1 ` Governing Codes: 2010 California Building Code(based on the 2009 International Buigigd1 ?p CL to o U� 2010 California Residential Code based on the 2009 Internationalsadeal v, `o •o 40 2010 California Plumbing Code(based on the 2009-Uniform P1umbmL9Code) 0 o E o ` 2010 California Mechanical Code(based on the 2009 Uniform Mec"cal Ce�' 3 � �� m � 2010 California Electrical Code(based on the 2009 International Elitrical Ccia'e� OF o a oa>n o 2010 California Energy Code — m E 2 y, z 2010 California Green Building Standards Code 40 w Cupertino Municipal Code o o >- Q w m v a ProjectData-ResidentiaLdoc revised 03/09/11 Building Department City Of Cupertino 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: ds- 2 % c� d 2_ PERMIT# 116 �-(d PZ OWNER'S NAM4,7,,4T F PHONE L GENERAL CONTRA TOR: ,. - 2-:210� --ki BUSINESS LICENSE# ADDRESS: qj �' av Fr - _f Z *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: 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 �-7Tile Owner/Contractor Signature Date j c)L 12 GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•building(cDcupertino.org misc CUPER INO ' PLITMP iN^ ❑NIECHANTCAL ❑ELECTRICAL ❑MISCELLANEOUS --� - .� 7APNO �.�6 76E �Q A PHONE f)c. E-MAIL REBS q ` 510 E-MAIL ff-ffSS ^ TEAx ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT C OR NAME LI BUS.LIC# \ • CO ANY �S kw C" FAX S S ^ CnY STA , s PHONE ` � v ARCH TECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MkIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE SE OF ESFD or Duplex ❑ Multi-Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERI'ACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ No DESCRIPTION OF WORY<Do `. - • TOTAL VALUATION: RE BIG i - r a ter: 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 autho ' representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: f 11 SUPPLEMENTAL INFORMATION REQUIRED MEPMiscApp_2011.doc revised 03/16/11