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11030043I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10394 GLENVIEW AVE ACTOR: TBD - PERMIT NO: 11030043 CONTRACTOR: OWNER'S NAME: RICHARD J DENESHA OL�(.�� k 11 C kephe ATE ISSUED: 03/10/2011 0"'NER'S PHONE: 4082570542 G LICENSED CONTRACTOR'S DECLARATION License Class Lic. # �J Contractor4� t n✓' Date -3-4c)—� I I hereby affirm that I am licensed under the provisions of Chapter 9 (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. 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. �� APPLICANT CERTIFICATION / r 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 -1 W I Z1 Date OWNER -BUILDER DECLARATION I hereby affirm that I 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). I 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, 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 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, and expenses which may accrue against said City in consequence of the ng of this permit. Additionally, the applicant understands and will comply wrtn all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date PHONE NO: BUILDING PERMIT INFO: BLDG F ELECT r- PLUMB r MECH F RESIDENTIAL F COMMERCIAL F JOB DESCRIPTION: REPLACE BATHROOM SHOWER/VALVE, REPAIR DRYROT DAMAGE TO SUBFLOOR AND WALL FRAMING, REPLACE BATHROOM WINDOW;CLEARING CODE ENFORCEMENT CASE;NO Sq. Ft Floor Area: I Valuation: $4000 APN Number: 36911021.00 1 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: 3- �' 1 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 Applicant: 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 I 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 25534. O rer or aut rize nt: �0 (' Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 La (408) 777-3228 • FAX (408) 777-3333 • building(d)cupertino.org CUPERTINO ❑ NEW CONSTRUCTION ❑ ADDITION/ ALTERATION ❑ REVISION / DEFERRED SUBMITTAL PROJECT ADDRESS `� n Lj / ` r� „ - ` ` �- p PN # - �(�9 i G OWNER NAME 1 ( Y 1 n GJ��� ,) r� F;�l� -V Vu C �s E-MAIL STREET ADDRESS �U`�I GrrY, 5 I w 1 n, alr APPLICANT NAME r PHONE k1a /Q_ E-MAIL STREET ADDRESS % `� �ll n ` % CITY, STATE, ZIPSA" O �/� GiJ FAX ❑ OWNER ❑ �OWNER-BUILDER K❑� OWNER AGENT �j CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR N CLICENjgaj�aVLICENSrPE BUS. LIC # COMPANY NAME ° ( `�E-MAIL N FAX (lo� . P� Sl D�Nlr� I card r� �' l ;� CITY, STATE PHONE / STREET ADDRESS i.\, C /� ARCHITECT/ENGINEER NAME u LICENSE NUMBER J / O` -, BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE L EXISTING USE I PROPOSED USE i CONSTR. TYPE i # STORIES IEXISTG NEW FLOOR DEMO TOTAL a ARFA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL ARE A/V REMODEL AREA REMODEL AREA GARAGE AREA: ❑ DETACH PORCH AREA DECK AREA TOTAL DECKIPORCH AREA ATTACH N DWELLING UNITS: 1S A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑ NO ADDITION? ❑ NO 'sz PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNER'S NAME: RECEIVED BY; To ^ PLANNING APPL N ❑ 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 relatingtepuilding coo structi I authorize repres tives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for .Ptc�ex7rE1Vi�]iiG'Shlt? existing building(s). Demolition permit is required prior to issuance of building ' permit for new building. FMaVlEkTZ3E-COi111�l>!1GP�W E�aPeEss 'p �,Ivtv�Ncr>;Atrfvt^ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure _ form if any Hazardous Materials are being used as part of this project. [] aTAivnaRn ©"pllsirGwaiixS ; _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑, LARc> ❑ .'1=DEPT . submittal of Building Permit application." a�'MAJO�` " - CENVIRDNMENT'AL HEALTH BldgApp_201 1. doc revised 03/03/11 CITY OF CUPERTINO FF.F. FCTIMATOR — RIMMING DIVISION ka,ADDRESS: 10394 glenview ave DATE: 03/10/2011 REVIEWED BY: bobs APN: BP#: 'VALUATION: 1$4,000 %PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Du lex USE: p 0.0 PENTAMATION 1GENRES PERMIT TYPE: WORK To Clear Code Enforcement Case: replace bathroom shower/valve repair dryrot damage to subfoor SCOPE and wall framing, replace bathroom window. Plumb. Plan Check 10.0 1 hrs $0.00 Plumb. Permit Fee: IPPERMIT I I Other Plumb Insp. 11.01hrs 1 $42.00 " u Plumb. Insp. Fee: IPLMBINSP $126.00 l►7/1Tc. TL.... ,. ! ,... .. .. R......./ __ //.n -f H"hio ""d nr0 n"hy nn octirnni0_ Canta rt tho Dont for Qddn'1 info. FEE ITEMS (Fee Resolution 09-051 Eft 7;'1.%1O) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 # $380.00 Window / Sliding Glass Door 1WINREP Replacement Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 0 # $8.00 Plumbing 1BPFIXTURE Fixture or Trap Permit Fee: $0.00 Suppl. Insp. Fee:' Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $168.00 Acoustical Fee: 0 Yes E) No $0.00 0 E) Work Without Permit? E) Yes 0 No $556.00 Planning Fee: $0.00 Select a Non -Residential Building or Structure G 0 A Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $767.50 $388.00 TOTAL FEE: $1,155.50 Revised: 01 /15/2011 CUPERTINO PROJECT DATA - RESIDENTIAL COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building5cupertino.org PROJECT ADDRESS `� �� t Q- l APN # D !, ` � — 11 0 WNER NAME \ ^ N PHONE r ,�9T 3 t 4 `oq q EMAIL STREET ADDRESS a r ` CPI Y, STATE, ZIP r I ( % FA}C APPLICANT NAME FN y PHONE Ll (5`0 E-MAIL STREET ADDRESS(0 CTIY SATE, ZIP `r--� ^ FAX ❑ OWNER 11 OWNER -BUILDER ❑ OWNER AGENT X CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT EXISTING USE(S): OCCUPANCY(S): ?arcel Area: square feet Floor Area: Existing PROPOSED USE(S): TYPE OF \ r CONSTRUCTIONy r Proposed, First Floor: s.f. s.f. Second Floor: s.f. s ;f.� Garage f ------ TOTAL: s.f. s.L Are there at least two 10 feet by 20 feet clear spaces inside the garage? Is privacy protection planting required for the project? 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 Electrical Code) 2010 California Energy Code 2010 California Green Building Standards Code Cupertino Municipal Code ProjectData.doc revised 02/23/11 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: /Digg /Dig PERMIT # OWNER'S NAME: R\(-VVula PHONE # b cad 06 -- GENERAL CONTRACTOR: t�-Ci ` r,, , ` USINESS LICENSE # ADDRESS: ( �; �� CITY/ZIPC0DE: Sa* -, o k S 23 *Our municipal code requires all businesses working in the city to have a City of Cupertino nusmess ucense. 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 Please check applicable subcontractors and complete the following information: Date Owner / Contractor Signature T 10 I(/ Date 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 T 10 I(/ Date