11040076CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10312 PARLETT PL CONTRACTOR: MCQUEEN PERMIT NO: 11040076
CONSTRUCTION
OWNER'S NAME: CAROTHERS W D JR AND MARY A 237 STILL CREEK RD DATE ISSUED: 04/12/2011
OWNER'S PHONE: 4084460988 DANVILLE, CA 94.506 PHONE NO: (925) 837-3680
❑ LICENSED CONTRACTOR'S DECLARATION
License Class ' Lic.
Contractor Date
1 hereby (firm t ` t I am licensed under the provisions of Chapter 9
(commen in ith Section 7000) of Division 3 of the Business & Professions
and that my license is in full force and effect.
lyhereby 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.
i APPLICANT CERTIFICATION
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 lations per the Cupertino Municipal Code, Section
9.18.
Signature , Date
❑ OWNER -BUILDER DECLARATION
1 hereby affirm that 1 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).
1 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, l 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
BUILDING PERMIT INFO: BLDG F_ ELECT I— PLUMB I—
MECH f— RESIDENTIAL I— COMMERCIAL F
JOB DESCRIPTION: UPSTAIRS HALL BATHROOM REMODEL(60SQFT)
NON-STRUCTURAL MECk/ELEC/PLUMBING(ADD 4 LIGHTS,ONE
CIRCUITS&ONE FAN,RELACE SINKS,TUB&TOILET
Sq. Ft Floor Area: I Valuation: $24432
APN Number: 31646043.00 I 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:
RE -ROOFS:
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.
Signature of Appl
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. 1 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 1 use equipment or devices which emit hazardous air
contaminants as defined by the Bay Area Air Quality Management District I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 255,34.
Owtter or orize agent:
;r Date: ` l
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a; construction lending agency for the performance of Hork's
for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's
ARCHITECT'S DECLARATION
1 understand my plans shall be used as public records.
Licensed Professional
CITY OF CUPERTINO
FEE ESTIMATOR -BUILDING DIVISION
NOTE: These fees are teased on the nreliminary information available and are only an estimate. Contact the Dept for addit7 info.
FEE ITEMS (Fee Resohnlon 09-051 Elf. 7//1/01
ADDRESS: 10312 parlett
DATE: 04/12/2011
REVIEWED BY: bobs.
;Neck. Pernhic Fee:
AM
OP#:
`VALUATION:
$24,432
*PERMIT TYPE: Building Permit
PLAN CIIECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Elee. Imp. Fee:
PENTAMATION 1R3SFDREM
PERMIT TYPE:
WORK
bathroom remodel non strucural include M E Ps.
SCOPE
$0.00
NOTE: These fees are teased on the nreliminary information available and are only an estimate. Contact the Dept for addit7 info.
FEE ITEMS (Fee Resohnlon 09-051 Elf. 7//1/01
Afe•h, Phur Cheek
Ph an b. Plan Clwk
Eler. Plan Check
;Neck. Pernhic Fee:
Plomh. Permit Fee:
Flee Pernhi+ Fee:
Other.I tech. Imp.
Jther Plaudi hr:P.
Orfra. Elea Imp. ,
A1•ch. Imp. Fee:
Minh Imp. Fee:
Elee. Imp. Fee:
NOTE: These fees are teased on the nreliminary information available and are only an estimate. Contact the Dept for addit7 info.
FEE ITEMS (Fee Resohnlon 09-051 Elf. 7//1/01
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
60 s. f.
$570.00
Remodel, Bath (<=300 so
/REA9RESRAT
Suppl. PC Fee: G Reg. O OT0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. O OT
0.0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Constniclion Tat
Acoustical Fee: O Yes 0 No
$0.00
0
0
Work Without Permit? O Yes G) No
$0.00
Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
Q
0
A
Travel Docametn<vion Fees:
Strong Motion Fee: IBSEISMICR
$2.44
Select an Administrative Item
Bldg Stds Commission Fee: IRCDSC
$1.00
SUBTOTALS:
$3.44
$570.00
TOTAL FEE:
.$573.44
Revised: 01/15/2011
CUPERTINO I
I -I
1 1 NF\V Cr1NSTRl1(Tln N1
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • building0cuoertino.oro
F1 ADDITInN VY AITFRATInIJ/'r1 I I RIlVl1;l0N/DrrFRRID ORIGINAL_ PI:RMIT#
PROJECT ADDRESS �1 ..
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❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT 0G -ONTRACI'OR ❑CONTRACTORAGENI❑ ARCHn'ECT' ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CO TRACrOR NAbi F:
LICENSE NUMB/ER
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ARCHITECTiENGINEER NAME
LICENSE NUMBER
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COMPANY NAME
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DESCRIPTION OF WORKIJ
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REMODF.LAREA �A
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TOTAL DECIUPORCH AREA
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❑ ATTACH
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PLAFSp'G APP0.0VAL lETfEF
By my signature below. I certify to each of the following: I am the propcny owner or authorized agent to act on thL roperty owner's behalf. 1 have read this
application and the information I have provided is correct. I have mad the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and slate laws relating to etion. I authorize represenmtives Of Cupenino to enter (he denit flied property for inspection purposes.
Labove
Signature of Applicant/Agcn Date: _-� 1 / 1//
SUPPLEM AL INFORMATION REQUIRED
PLANCHECKTVPE
ROUTINGSLUP
,Fy
ty
❑
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
IP OYER -THE -COUNTER
BUILDING PLAN REVIEW
permit for new building.
❑ EXPRESS
❑. PLANNING PIAN FS IEW '
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
Cls-rANDARD
❑ PUBLIC WORKS
_
form if anv Hazardous Materials are being used as part of this project
❑.
❑
uace.
FIRE DEPT -
_ Copy of Planning Approval Letter or Meeting with Planning prior to
El
-;
11
submittal of Building Permit application.
MAJOR
sA�irwnY,SEN•eutiisrR;R7.
ENVIRON.MEPTAL HEALTH.
BldgApp_201 Ldoc revised 03116111
-i CUPERTINO
PROJECT DATA - RESIDENTIAL
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 - building(0)cupedino.or0
PR 1b A,D REP
APN N
O ER NAME
P O
�� 46—ai
E-MAIL
TRE T D SSTY,
STATE ZIP
FAX
0 IZ
PPLICANT N ME
E
36 9,r,
L 37
$�Ij�ETAD
n_/
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'ZIP
�E-EMAIL
X'
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�SeP6
837 3620
❑ OM'NkR ❑ OWNP -S DM
❑ OW RAGEN
KcON croR ❑cONn aoR AGENr ❑
ARO cr ❑ ENGINEER ❑ DEV OPER ❑ T NANr
DE
EXISTING USE(S): ^
Y,
PROPOSED USE(S):
(�
�y/
OCCUPANCY(S):
TYPE OF
PARCEL
J
C�
CONSTRUCTION:
AREA:
FIRE Y N
WUTAREA:
I
Y N
FLOODAREA: Y
I
N
SIESMICAREA: Y N
I
SPRINKLERS:
Existiniz
Floor Area: First Floor:
s. f.
Pr000sed
Iwo
Second Floor: s.f. s. f.
Garage s.f.s.f.
TOTAL: s.f. s.fj' .�
Are there at least two 10 feet by 20 feet clear spaces inside the garage? Y N
Is privacy protection planting required for the project?
Y N
Governing Codes: 2010 California Building Code (based on the 2009 International Building Code)
2010 California Residential Code (based on the 2069 International AWCode)
2010 California Plumbing Code (based on the 2009 Uni1`gpA(VJ0ffdAnC.%0THE CITY OF
2010 California Mechanical Code (based on the 2009 ll®1lDifiTM@dlt�fda MDINA1NCES
2010 California Electrical Code (based on the 2009 Intemati: lectric
2010 California Energy Code
2010 California Green Building Standards Code SIGNED
Cupertino Municipal Code This set of plans and spec ications MUST
be kept on the job at all times and it is
unlawful to make any charges or alterations
on same without written permisrion from
the Building Department, City of Cupertino.
S The stamping of this plan and specifications
SHALL NOT be held t0 permit or to be an
approval of the violation of any provisions
Of any City Ordinance or State Law.
ProjectData-Residential.doc revised 03/09/1 !
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rn CAROTHER5 UPSTAIRS HALL BATH McQUEEN CON5TRUCTION CO. DATE: 3.14.1 1 REVISED:
10312 PARLM PLACE GENERAL CONTRACTOR5 - CA Uc.# 602651 5CALE: 1/2" = P-0"
CUPERTINO, CA 95014 237 5till Creek Rd, Danville CA 94506 4.9.'1 1
925 417.7453 - FAX 925 417.7429 DRAWN BY: Mary Kate Pine
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