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11050188 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7664 BERLAND CT CONTRACTOR:ARNOLDS KITCHENS& PERMIT NO: 11050188 BATHS OWNER'S NAME: NATASHA GOLDENBERG 1403 HUNTER CREEK DR DATE ISSUED:05/23/2011 ;ER'S PHONE: 4082051330 PATTERSON,CA 95363 PHONE NO:(209)895-4793 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class /03 Lic.# n��t /S�I� ,J /�5, �r�� ) MECH� RESIDENTIAL COMMERCIAL r Contractor.�/ t /7'?�J/1 Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:MASTER BATHROOM REMODEL(l OOSQFT),CHANGE ALL (commencing with Section 7000)of Division 3 of the Business&Professions FIXTURES&TILE;NON-STRUCTURAL 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:$15000 permit is issued. APPLICANT CERTIFICATION APN Number:36225035.00 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. A I/� i " Issued byr"" i• _" _ Date: , Z �c Signature ,) / Date l� 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: 1,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(x)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 Own o hori d a 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 it' ^nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address ind expenses which may accrue against said City in consequence of the gn.nang of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36225035. 00 DATE ISSUED. . . . . . . : 05/23/2011 RECEIPT #. . . . . . . . . BS000013539 REFERENCE ID # . . . : 11050188 SITE ADDRESS . . . . . : 7664 BERLAND CT SUBDIVISION . . . . . . : CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : NATASHA GOLDENBERG ADDRESS . . . . . . . . . . : 7664 BERLAND CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : WM ARNOLD DBA ARNOL CONTRACTOR . . . . . . . : WILLIAM ARNOLD LIC # 29202 COMPANY . . . . . . . . . . : ARNOLDS KITCHENS & BATHS ADDRESS . . . . . . . . . . : 1403 HUNTER CREEK DR CITY/STATE/ZIP . . . : PATTERSON, CA 95363 TELEPHONE . . . . . . . . : (209) 895-4793 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 15, 000 .00 1. 00 0. 00 1. 00 0 . 00 1BSEISMICR VALUATION 15, 000 .00 1.50 0. 00 1.50 0. 00 1REMRESKIT SQ FEET 100 .00 570. 00 0. 00 570 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 572 . 50 0. 00 572 .50 0. 00 05 0`�fi CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 "URERTfNC? (408) 777-3228• FAX (408) 777-3 3--buildin-g cupertino.or4 ❑NEW CONSTRUCTION ❑ ADDITION ��TERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS e Q ` S OWNFRNAM[EA,4eA 1 ,Q�/1 �(� PHONE 4MX- �7� �F-MAIL STREET ADDRESS ��/�,O //1 /� CITY, STATE,ZIP FAX CONTACT NAME / J� '�'� ,/�Z,/� /tel i)J PHONE -MAIL -MAII STREET ADDRESS /// ( (/[ CITY,STATE, ZIP ❑OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT _;R�ONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME aj ,A „/y) ,Q�n vl ) LICENSE NUMBER�% `a� LICENSE TYPE BUS.LIC# COMPANY NAME � /�1' 1 E MAII 0 (/ FAX STREET ADDRESS"f`��O�L�\ /I,,(� CITY,STATE,ZIP PHONE ARCHITECTIENGINEER NAME ^` ^ LICENSE NUMBER BUS.LIC# COMPANY NAME ✓V v, t E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE 'SCRIPTION OF WORK06 EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES EXISTG NEW FLOOR DEMO TOTAL , k y e AREA AREA AREA NET AREA BATHROOM KrrCHEN OTHER a REMODEL AREA REMODEL AREA REMODEL AREAINE x.. PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: ❑ DETACH F3 '36 ❑ ATTACH #DWELLING UMTS: IS A SECOND UNIT ❑YES SECONDSTORY ❑YES `' "" ` BEING ADDED' NO ADDMONS NO g, � a 'a '£'x"" "" %% ,�,.` �' : ,a ❑ ❑ z?r'aa'�r�r �� '..,.,.:. �F� �iar,na e x, PRE-APPLICATION [3 YES IFME YES,PROVIDE COPY OF PLANNER'S NA : �k ` `" w N'' `�` PLANNING APPL# ❑ NO PLANNING APPROVAL LETTER . 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 con action. I au presentatives of Cupertino to enter the above-identified property for inspection purposes. J 1 Signature of Applicant/Agent: J Date: 23 SUPPLEMENTAL INFORMATION REQUIREDq� _New SFD or Multifamily dwellings: Apply for demolition permit for �� existing building(s). Demolition permit is required prior to issuance of building permit for new building. k � IS1tE1 04 ft Commercial Bldgs: Provide a completed Hazardous Materials DisclosureF311 : m if any Hazardous Materials are being used as part of this project. _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. BldgApp 2011.doc revised 03/16111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 7664 beriand ct. DATE: 05/23/2011 REVIEWED BY: bobs. APN: BP#: "VALUATION: 1$15,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: PERMIT TYPE: WORK master bath remodel non structural. SCOPE NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info. FEE ITEMS (Foe Resolution 09-05I f.ff.' ''l.'10) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel,Bath(<=300 sf) Suppl.PC Fee: G Reg. 0 OT 0.0 1 hrs $0.00 $570.00 1REMRESBAT 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 E) No $0.00 Q Work Without Permit? 0 Yes G No $0.00 G PlannirngFee: $0.00 Select a Non-Residential E) Building or Structure 0 Strong Motion Fee: 1BSEISMICR $1.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $2.50 $570.00 TOTAL FEE: $572.50 Revised: 04/29/2011 COMMUNr1Y DMC)pMENT DEPARTMEyT PROJECT DATA - RESIDENTIAL BUILDING DIVISION-CUPERTINO COMMUNITY DEVELOPMENT DEPARTMENT_)UILDINf DIVISI r 'PROVED 10300 TORRE AVENUE•CUPERTINO, CA 950��3Ig oplans and specifications MUST be#rapt at the during construction. It is unlawful to make arly CUPEIaT NO (408)777-3228• FAX(408)777-3333• bui1din_q(Qcu9S1Itb99=or alterations on same,or to deviate therefrom, without approval from the Building OfficfaL The✓tam in of ' PROJECT ADDRESS ,.fjA /� 0 hermit or to be an approval of the violation G Efrovis'ons OWNER N ,Q �j�� PHONE/� � E-MAIL t STREET ADDRESS CITY, STATE, = FAX APPLICANT NAMFif J� , PHONE STREET ADDRESS7 ?4), /� _/yQ n��0 CITY,STATE, ZIP ❑OWNER ❑ OWNER-BUUDER ❑ OWNERS�A/GENr v CONTRACTOR ❑CONfRACTORAGENT ❑ ARCHITECT ❑ENCD(EER ❑ DEVELOPER ❑ TENANT Tx,..1011-0-0. la"I"i I W-1 , EXISTING USE(S): S-F(1 PROPOSED USE(S):LJr / OCCUPANCY(S): �7 TYPE OF �� , PARCEL FIRE CONSTRUCTION: AREA: SPRINKLERS: Y N wUI AREA: Y N FLOOD AREA: Y N SIBSMIC AREA: Y N SPR Existing Proposed Floor Area: First Floor: s.f. s.f. Second Fldvr- s.f. s.f. Garage s.f. s.f. ,- TOTAL: s.L f. 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 2009 International Residential Codi 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 Electrical Code) 2010 California Energy Code 2010 California Green Building Standards Code Cupertino Municipal Code ProjectData-Residential.doc revised 03/09/11 � o �� .� � � � � � �� . o � � � � � �. � � � � o -w,�_. � � � �� C � v '� � � .. `� � �� j ' la 5 1 FI V\ 1 (• U � v 3 It f � _