13030150 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10017 SPANISH OAK CT CONTRACTOR:BATHROOMS BY PERMIT NO:13030150
REMODELING
OWNER'S NAME: PALMER 1422 SARATOGA AVE DATE ISSUED:03/27/2013
OWNER'S PHONE: 4082524996 SAN JOSE,CA 95129 PHONE NO:(408)378-6700
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL El COMMERCIAL0
License Class_ Lic.# �o ;2`-S 45 SQ FT BATHROOM REMODEL,LIKE FOR LIKE
REPLACEMENT OF ALL PLUMBING FIXTURES,
Contractor S' Date �J ' Z -—,3 LIGHTING
I hereby affirm that I am licensed under the provisions of Chapter 9 FIXTURES AND VENT SYSTEM
(commencing with 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. Sq.Ft Floor Area: Valuation:$12500
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:34232082.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXP WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIN AY F 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 �S FR CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in of the
granting of this permit. Additionally,the appy t understands and will compl ssued by: Date:
withnnosource regulat' s p r the Cupert o Municipal Code,Section9.18 -7 yaRE-ROOFS:
Sign Date LL 7 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
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 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. Iwill
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(a)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 equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance wit Cupertino pal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Co ,Sections 505,2 33,and 2
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date
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 CONS UCTION 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
1,6;11
CONSTRUCTION PERMIT APPLICATION ,
[is COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION [�
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•building(aDcupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS � APN# Z
OWNERNAME Qp I PHONE E-MAIL Q
STREET ADDRESS �� ( M A1i C Q CITY,STATE,ZIP - q�Q J - FAX
CONTACT NAME `•�"w` '-T PHONE ! E-
STREET ADDRESS C S P FAX
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME��Z.p n^ LICE/N�SE NUMBER LICENSE TYPE BUS.LIC#
'W tV
COMPANY NAME E-MAIL FAX
STREET nDDRESSe2 ZZn A TD� I
CITY,STATE, F. _ �-^�� PHO CAOX-3 u
ARCHITECTIENGINEER NAME LICENSE NUMBER 3 #
COMPANY NAME FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK / ' n r
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�Q7P�atQ >r ///S/-At.- ` {
EXISTING USE PRO SED USE / CONSTR.TYPE rORIES
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEW FLOOR DEMO TOTAL 1
AREA AREA AREA NETAREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: DETACH
❑ATTACH
#DWELLING UNTFS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? ❑NO ADDITION? []NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED TOTAL VALUATION:
PLANNING APPL# ❑NO PLANNING APPROVAL LEITER EICHLER HOME? ❑NO 12
By my signature below,I certify to each of the following: I am the property owner or authorized �veriaccurate
erty owner's behalf. I have read this
application and the information I have provided is correct. 1 hav ead the Description of' or dI.agree to comply with all applicable local
ordinances and state laws relating to � mg c struction. I thorize representatil f Cupertinoentified property for inspection purposes.
Signature of Applicant/Agent: Date: �; —,7—
SUPPLEMgNTALt!^FATION REQUIRED PLAN CHECK TYPE ROUTING SLIP
_New SFD or Multifamily dwellings: Apply for demolition permit for VER-THE-COUNTERBUILDING PLAN REVIEW
existing building(s). Demolition permit is required prior to issuance of building eqQ
permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ElSTANDARD ElPUBLIC WORKS
form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRON6tENTAL HEALTH
BldgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10017 SPANISH OAK CT DATE: 03/27/2013 REVIEWED BY: MELISSA
APN: 342 32 082 BP#: *VALUATION: 1$12,500
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair
PRIMARY PENTAMATION
USE: SFD or Duplex PERMIT TYPE: 1 R3SFDRE i
WORK 45 SQ FT BATHROOM REMODEL LIKE FOR LIKE REPLACEMENT OF ALL PLUMBING FIXTURES
SCOPE LIGHTING FIXTURES AND VENT SYSTEM
sx!
Xtech.Plan Check Phunb.Plan Check Elec.Plan(.,heck
Alech.Permit Fee: Plumb.Permit Fee. Elec. Permit Fee:
Other itlecrh.Insp. Other Plumb Insp. Other Elec.Insp.
1..Wech.Insp. Fee: Plumb. Insp.Fee: Flec,Insp.Fee:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc). Theseees are based on the relinddh information available and are only an estimate Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-053 E f 711112) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 = s.f. Remodel,Bath(<=300 A)
Suppl.PC Fee: (D Reg. ® OT 0.0 hrs $0.00 $600.00 1REMRESBAT
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp.Feer Reg. ®OT 0,0 hrs $0.00
PME Unit Feer $0.00
PME Permit Fee: J_T $0.00
Cclnso-Lection Tax:
Adi'n l n lStrat ive.l`ee:
Work Without Permit? ® Yes (E) No $0.00
Advanced Planning Fee: $0.00 Select a Non-Residential E
Travel Documentation Fees: Building or Structure 0
Strong Motion Fee: IBSEISMICR $1.25 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
=�� � '""' $2.25 $600.00 .` OALFEE $602.25
�1�, Revised: 01/01/2013
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BRSBathrooms by Remodeling Specialists
www.bbrs.us• 408 378 6700 • Lic#674083 DateI I l I I l
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Building Department
City Of Cupertino
10300 Tone 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: p n P.4�/C { c'7 CYc�7,i b PERMIT# D C�
OWNER'S NAME: A PA PHONE#
GENERAL CONTRACTOR: as BUSINESS.LICENSE#
ADDRESS: ZZ A"rbc A vc CITY/ZIPCODE: S-41 04—c pC 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 SUBCONT ORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors-
Signature Date
Please check applicable subcontractors andcomplete the following information:
6/ 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