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11060216 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 1108 NOVEMBER DR CONTRACTOR:' PERMIT NO: 11060216 OWNER'S NAME: JILL&KEVIN PLOUSE -� iC t �� DATE ISSUED:06/28/2011 O`-'NER'S PHONE: 4085645107 PHONE NO: L LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class Lie.# 00 'l / MECH RESIDENTIAL COMMERCIAL Contractor ACL91)7r U�O Date r / I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE REPLACE BATHROOM IN DOWNSTAIRS (commencing with Section 7000)of Division 3 of the Business&Professions HALLWAY Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declare r n` 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:$11000 permit is issued. APPLICANT CERTIFICATION APN Number:36217057.1108 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 Date: Signature Date J ( 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 I,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. 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(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. 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 C' and expenses which may accrue against said City in consequence of the g of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION w._.,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 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36217057 .1108 DATE ISSUED. . . . . . . : 06/28/2011 RECEIPT #. . . . . . . . . BS000013907 REFERENCE ID # . . . : 11060216 SITE ADDRESS . . . . . : 1108 NOVEMBER DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER JILL & KEVIN PLOUSE ADDRESS 1108 NOVEMBER DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : JILL A SCOBY 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 11, 000 . 00 1. 00 0. 00 1.00 0. 00 1BSEISMICR VALUATION 11, 000 .00 1. 10 0. 00 1.10 0 . 00 1REMRESBAT SQ FEET 1. 00 570 . 00 0 . 00 570.00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 572 . 10 0. 00 572 .10 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 572 . 10 #1552 --------------- TOTAL RECEIPT 572 . 10 Building Department City Of Cupertino La 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: P /1�C�11C'v�h� PERMIT Ila 6�Z OWNER'S NAME: PHONE # O W -6-?6e GENERAL CONTRACTOR: BUSINESS LICENSE ADDRESS: CITY/ZIPCODE: *Our municipal code requires all 6usinesses 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 '"ake&I-e- Owner/Contractor Signature Date COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION-CUPERTINO APPROVED PROJECT DATA - RESIDENTIATIs set of Flans and specifications MUST be kept at the h situ during construction. It is unlawful to make any COMMUNITY DEVELOPMENT DEPARTMENT- BUILDII9t'b#Vltf54lterat;ons on same,or to deviate th��ef.orn, without approval from the Building Official. 10300 TORRE AVENUE -CUPERTINO, CA 95014-3tA La (408)777-3228• FAX(408)777-3333 •building aeciii eiuro na of this plan and specifications SHALL NOT LUPI R 1ISIC3 I,o he l6,o ,-ermit or to be an approval of the violation ol any provisions of any City Ordinance or State Law. PROJECT ADDRESS 1/0S 10 1 �( r OWNER NAME, I1 0 !1�V' O OU " PHONE 1�0 _ VP 11111 {�, E-MAIL 76—LI STREET ADDRESS 1 JO CITY, STATE,ZIP V FAX APPLICANT NAMEA fi PHONE E-MAIL A f 1 Yl�rGr � �'ph,,? i-! n' Lf 0 3 - , t miw'IdeY YC�a1�.c-Uyt� STREET ADDRESS CITY,STATE, ZIP FAX 605"'t 13tir n ba vik 5a» 60S. lA 951 zo - S-6zon ❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT L � 3 y L �.... �:� � •�l:cr Z�. '. .. .c3A3�'4.�. _r �:�`�" 1 �,'R S &'t �.. ��„: EXISTING USE(S): _fro fr^ PROPOSED USE(S): OCCUPANCY(S): TYPE OF j` , PARCEL r 7 CONSTRUCTION: v AREA: FIRE Y N wu1 AREA: Y N FLOOD AREA: Y N SIESNUC AREA: Y N SPRINKLERS: Existina Proposed Floor Area: First Floor: s.f. s.f. Second Floor: --sf. s.f. F” h ;• Garage sx. _ TOTAL: s.f. SA. Are there at least two 10 feet by 20 feet clear spaces inside the garage? Y N • `:lam 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 2009 International Residential Code) 2010 California Plumbing Code (based on the 2009 Uniform Plumbing Code) 2010 California Mechanical Code(based on the 2009 Uniform Mechanical Code) ` � 2010 California Electrical Code(based on the 2009 International ElectricaC]. ..��,j 2010 California Energy Code 2010 California Green Building Standards Code JUN 29 2.011 Cupertino Municipal Code B�o 0 ProjectData-Residential.doc revised 03/09/11 Jill & Kevin Plouse Residence 1108 November Drive, Cupertino, California 95014 C4� rpVeV) b00rd w, �' wr'J`�oa �eo� �oX ��v cns�-a j N 1 r 1,A Scope of Work: •�ED • Remove and replace existing bathroom plumbing in existing location • Update all electrical by pulling dedicated circuit and adding GFCI receptacles • Addition of 1,fluorescent recessed, moisture rated light in shower enclosure area .3 • Complete removal and replacement of tile,vanity, shower door,sheetrock,toilet, faucets, fixtures, and lighting fixtures (all renovations to comply with current city codes and Title 24 compliance as well including sensor swAch for main bathroom light). 6 V(nG CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 1108 november dr. DATE: 06/28/2011 REVIEWED BY: bobs. APN: BP#: 'VALUATION: j$11,000 7;PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: I I PERMIT TYPE: wORK remodel hallway bath non structural. SCOPE Li NOTE. Thesefees are based on the prelintinary information available and are only an estimate. Contact the De t or addn'1 info, FEE ITEMS,0�e Resolution 09-051 f;tf.' 1.-10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel,Bath(<=300 sf) Suppl.PC Fee: E) Reg. 0 OT 0.0 1 hrs $0.00 $570.00 IREMRESBAT] A PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.e Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Acoustical Fee: 0 Yes (j) No $0.00 Q Work Without Permit? 0 Yes G) No $0.00 E) Planning Fee: $0.00 Select a Non-Residential E) Building or Structure i Strom Motion Fee: IBSEISMICR $1.10 Select an Administrative Item B1d,Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.10 $570.00 TOTAL FEE: $572.10 Revised: 04/29/2011 /� 6) �0 0 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333•buildingacupertino.org CUPERTINO ❑NEW CONSTRUCTION ❑ ADDITION 91/ALTERATION/Ti ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS i APN# OWNER NAME t./' O V6 I PHONE 'YOP_56 N-5107 E-MAIL S'T'REET'ADDRESS / 1 /� CITY, STATE,ZIP O // /�, FAX ^f CONTACT NAME 11^ [� yy� PHONE E-MAIL/� !l n i k A 1xA�i I o 1 Q:1')1 1101-117-7-66S /1/ 1 Y�G� �f 1 �` C Y2�1 C CIS` STREET ADDRESS CITY,STATE,ZIP FAX O I,b �� 1. 5 S :1� I 161�--z617- OWNER ❑ OWNER-BUILDER ❑ OWNERAGF.NT VCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 4 LICENSE NUMBER LICENSE TYPE BUS.LIC# Hn rl i� �� {1�1 COMPANY NAME 14/ E-MAIL k),ix-_, FAX elr- bol��e� Y►1a11. �0�-26�_h�� STREET ADDRESS ��' CITY,STATE,ZIP PHONE 605HtArr, >1 < <e CIj/Z U yog-'1 YY-7E 6.5 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREETADDRESS A CITY,ST ZIP PHONE DESCRIPTION OF WORK / // 1 ll I eiY7 O I2 /ace b«7nrnoYY) )'n d owVtd(A I'r5 rla (/wa EXISTING USE PROPOSED USE CONST TYPF, #STQRIES / ✓ USE TYPE OCC. SQ.FT. VALUATION(S) XIS'I'G NEW FLOOR DEMO TOTAL A AREA AREA AREA NET AREA BATHROOM KITCHEN ✓� OTHER REMODEL AREA '15 Sfq I REMODEL AREA REMODEL.AREA PORCH AREA DECK AREA "1'OT'AL DECK/PORCH AREA GARAGE AREA DETACH ��• .� .� ❑ATTACH N DWELLING UNITS: ISA SECOND UNIT YES SECOND STORY E Y BEING ADDED? O ADDITION? PRE-APPLICAT ION ❑Y LF YES,PROVIDE COPY OF IS THE BLDG AN [IY ____[RECEIVED BY: TOTAL VALUATION: PLANNING APPL# PLANNING APPROVAL LETTER EICHLER HOME? By my signature below,1 certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. 1 have read this application and the information 1 have provided is corre ave read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatinP to representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: / ;, � y, Date: 6— —00 11 SUPPLEM- AL 19-FORMATION REQUIRED PLAN CHECK TYPE ��ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for OVER-THE-COUNTER L-f"BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC 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 submittal of Building Permit application. 1:1 MAJOR ❑ SANITARY SEWER DISTRICT ❑ ENVIRONMENTAL HEALTH B1dgApp 201 I.doc revised 06/21/11