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11060211CITY OF CUPERTINO BUILDING PERM ,a 5 r l BUILDING ADDRESS: 21432 ELM CT CONTRACTOR: SARATOGA KI PERMIT NO: 11060211 BATH OWNER'S NAME: WAGNER & DOUGHERTY 20430 SARATOGA LOS GATOS RD DATE ISSUED: 06/27/2011 OWNER'S PHONE: 4089961872 SARATOGA, CA 95070 PHONE NO: (408) 867-0771 LICENSED CONTRACTOR'S DECLARATION License Class Lic. # �� BUILDING PERMIT INFO: BLDG ELECT PLUMB Tm MECH) RESIDENTIAL COMMERCIAL � Contractor 1-4t- Date .2 — a 7—lL 1 hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION: MASTER BATH REMODEL(90SQFT),REPLACE (commencing with Section 7000) of Division 3 of the Business & Professions SHOWER,PLUMBING F[XTURES.UPDATE Code and that my license is in full force and effect. ELECTRICAL,L[GHTING.REPA[R SHEETROCK AS NEEED. NEW I hereby affirm under penalty of perjury one of the following two declarations: 2/23/2012 - REV# I- ADD BEAM IN CEILING TO ALLOW FOR WALL REMOVAL - REV# I ISS'D 2/23/2012 l 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: $600 permit is issued. APPLICANT CERTIFICATION APN Number: 34201013.00 Occupancy Type: I certify that l have read this application and state that the above information is correct. l 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR withal[ non -point source regulations p the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. . Signature Date — F Z 2 Issued b ate: ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE -ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is 1, as owner of the property, or my employees with wages as their sole compensation, installed without first obtaining an inspection, I agree to remove all new materials for will do the work, and the structure is not intended or offered for sale (Sec.7044, inspection. Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project (Sec.7044, Business & Professions Code). 1 hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain Section 3700 of the Labor Code, for the performance of the work for which this compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. permit is issued. Additionally, should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued, I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation laws of California. If, after making this certificate of exemption, I Health & Safety Code, Sections 25505, 25533, and 25534. become subject to the Worker's Compensation provisions of the Labor Code, l must forthwith comply with such provisions or this permit shall be deemed revoked. a Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY "herebyoaffflflr�m. 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 ere is a construction lending agency for the performance of Hork's to building construction, and hereby authorize representatives of this city to enter for which this permit is issued (Sec. 3097, Civ C.) upon the above mentioned property for inspection purposes. (We) agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section ARCHITECT'S DECLARATION 9. l 8. 1 understand my plans shall be used as public records. Signature Date Licensed Professional G :OI :o JP it Sif CITY OF CUPERTINO BUILDING PERMIT 11LDING ADDRESS: 21432 ELM CT CONTRACTOR: SARATOGA KITCHEN & PERMIT NO: 1106021 l BATH 7VNER'S NAME: WAGNER & DOUGHERTY 20430 SARATOGA LOS GATOS RD DATE ISSUED: 06/27/2011 ER'S PHONE: 4089961872 SARATOGA, CA 95070 PHONE NO: (408) 8674)7/1 LICENSED CONTRACTOR'S DECLARATION r r— ELECT r sense Class 2 9 G Lic. # 7 g l 3-10 BUILDING PERMIT INFO: BLDG PLUMB r r—COMMERCIAL r ntractor 5&> A-7-006,4 917 & -Watt 2 I % ) MECH RESIDENTIAL ereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: MASTER BATH REMODEL(90SQFT),REPLACE rmmencing with Section 7000) of Division 3 of the Business & Professions SHOWER PLUMBING FIX'[1JRES.UPDATE ELECTRICAL,LIGHTING.REPAIR SHEETROCK AS NEEED. NEW ode and that my license is In full force and effect. ereby affirm under penalty of perjury one of the following two decration ave and will maintain a certificate of consent to self -insure for Worker's mpensation, as provided for by Section 3700 of the Labor Code, for the formance of the work for which this permit is issued. ave and will maintain Worker's Compensation Insurance, as provided for by Sq. Ft Floor Area: Valuation: $5000 :tion 3700 of the Labor Code, for the performance of the work for which this mit is issued. APPLICANT CERTIFICATION APN Number: 34201013.00 Occupancy Type: ortify that I have read this application and state that the above information is -rect. I agree to comply with all city and county ordinances and state laws relating building construction, and hereby authorize representatives of this city to enter Dn the above mentioned property for inspection purposes. (We) agree to save PERMIT EXPIRES IF WORK IS NOT STARTED lemnify and keep harmless the City of Cupertino against liabilities, judgments, Its, and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR unting of this permit. Additionally, the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. h all non -point source regulations per the Cupertino Municipal Code, Section Issued by: Date: ;nature Date Z7 �� -'O 'NER-BUILDER DECLARATION RE -ROOFS: ereby affirm that 1 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 : following two reasons: installed without first obtaining an inspection, I agree to remove all new materials for a; owner of the property, or my employees with wages as their sole compensation, inspection. II do the work, and the structure is not intended or offered for sale (Sec.7044, siness & Professions Code) Signature of Applicant: Date: s owner of the property, am exclusively contracting with licensed contractors to istruct the project (Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER ereby affirm under penalty of perjury one of the following three ations: ave ave and will maintain a Certificate of Consent to self -insure for Worker's HAZARDOUS MATERIALS DISCLOSURE mpensation, as provided for by Section 3700 of the Labor Code, for the 1 have read the hazardous materials requirements under Chapter 6.95 of the -formance of the work for which this permit is issued. California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain ave and will maintain Worker's Compensation Insurance, as provided for by compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & tion 3700 of the Labor Code, for the performance of the work for which this Safety Code, Section 25532(a) should 1 store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air mit is issued. contaminants as defined by the Bay Area Air Quality Management District I will r.rtify 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 I employ any person in any manner so as to become subject to the Worker's Health & Safety Code, Sections 25505, 25533, and 25534. mpensation laws of California. If, after making this certificate of exemption, I ;ome subject to the Worker's Compensation provisions of the Labor Code, I must Owner or au ized agent: thwith comply with such provisions or this permit shall be deemed revoked. Date' APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY ertify 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 Irect. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued (Sec. 3097, Civ C.) building construction, and hereby authorize representatives of this city to enter Lender's Name Dn the above mentioned property for inspection purposes. (We) agree to save ' -inify 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 _.ung of this permit. Additionally, the applicant understands and will comply DECLARATION th all non -point source regulations per the Cupertino Municipal Code, Section ARCHITECT'S 8. I understand my plans shall be used as public records. mature Date Licensed Professional CITY OF CUPERTINO W—W FEE ESTIMATOR — BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (ie. Planning, Public Works, Fire, Sanitary Sewer Distric4 School Diciript otc. L Thoco fooc aro hacoti nn tho nrolininary infnrmn/inn availahlo anti aro nnly an octimnto_ Cnntnrt tho Dont far nddn't in fn_ FEE ITEMS (Fee Resolution 11-053 L'f. 7,'1.%111 ADDRESS: 21432 elm st DATE: 02/23/2012 REVIEWED BY: a. salvador Plan Check Fee: Hourly Only? ® Yes 0 No APN: BP#: / a 0c:;,? / "VALUATION: 1$1,500 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: PME Plan Check: PENTAMATION 1 GENRES PERMIT TYPE: wORK REVISION: Add beam in ceiling to allow for wall removal. SCOPE Suppl. [nsp. Fee:) Reg. Q OT NOTE: This estimate does not include fees due to other Departments (ie. Planning, Public Works, Fire, Sanitary Sewer Distric4 School Diciript otc. L Thoco fooc aro hacoti nn tho nrolininary infnrmn/inn availahlo anti aro nnly an octimnto_ Cnntnrt tho Dont far nddn't in fn_ FEE ITEMS (Fee Resolution 11-053 L'f. 7,'1.%111 FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? ® Yes 0 No $0.00 17 hours Plan Check, Hourly $130.00 1STPLNCK Suppl. PC Fee: Q Reg. Q OT0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. [nsp. Fee:) Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 G Work Without Permit? Yes (F) No $0.00 Advanced Plannine Fee: $0.00 Select a Non -Residential G Building or Structure Strona, Motion, Fee: 1BSE1SMICR $O.tSU Select an Administrative Item Bld.gStds Commission Fee: 1BCBSC $�v0 1.50 130.0 �� � q, �..::>�'�;� 1.50 Revised: 1/1912012 1 CITY OF CUPERTINO ISI FEE ESTIMATOR — BUILDING DIVISION OCCUPANCY TYPE:TYPE ADDRESS: 21432 Elm St. DATE: 06/27/2011 REVIEWED BY: jsg PC FEE ID APN: BPI#: `VALUATION: 1$5,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: 2nd Unit? Yes No OTC. 0 Yes (E)No PENTAMATION 1 R3SFDREM PERMIT TYPE: WORK I Master bath remodel. Replace shower,plumbing fixtures electrical upgrade. No structural SCOPE PME Plan Check: OCCUPANCY TYPE:TYPE OF CONSTR. FLR AREA s.f. PC FEES PC FEE ID BP FEES BP FEE ID R-3 (Custom) II-B,III-B,MV-B 0 $0.00 $0.00 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee4D Reg. © OT 0.0 hrs TOTALS: 0 $0.00 PME Unit Fee: $0.00 PME Permit Fee: MECH, HOURLY © Yes O No PLUMB, HOURLY Q Yes, Q No ELEC, HOURLY © Yes Q No QTY/FEE MISC ITEMS �Lif:Y.F'!.•t ,�tf1 f';.:�.. F't....� �'('i.. .`'t'. ... �. f'('!'!+t!. /•C'%. $0.00 iwl' li7`/%. Suppl. PC Fee: 0 Reg. O OT 0.0 hrs NOTE: These fees are based on the nrelimlnary information available and are onlv an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 09-051 F . 7!1;•10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 90 s.f. Remodel, Bath (<=300 sf) $570.00 1REMRESBAT Suppl. PC Fee: 0 Reg. O OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee4D Reg. © OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 oai 'I�wcfi-(Jn Ka.v Acoustical Fee: © Yes (E) No $0.00 Q G Work Without Permit? 0 Yes (E) No $0.00 Planning Fee: $0.00 Select a Non -Residential Building or Structure Q (Strong Motion Fee: 1BSEISMtCR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $1.501 $570.00 TOTAL IFEEi. $571.50 Revised: 04/29/2011