11030014�y
BUILDING ADDRESS: 10012 SCENIC BLVD
01,VNER'S NAME:
CITY OF CUPERTINO BUILDING PERMIT
CONTRACTOR: REMODEL WEST
CONSTRUCTION, INC
12333 SARATOGA SUNNYVALE RD
❑ LICENSED CONTRACTOR'S DECLARATION
License Class -e Lica# 1 e, FV �
Contrac Date
I hereby,t fflrm'that 1 am'ticensed unt er 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
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 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)
1, 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. 1 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
ndemnify and keep harmless the City of Cupertino against liabilities, judgments,
osts, 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
Date
SARATOGA, CA 95070
PERMIT NO: 11030014
DATE ISSUED: 03/02/2011
PHONE NO: (408)257-4900
BUILDING PERMIT INFO: BLDG I— ELECT I— PLUMB r
MECH' RESIDENTIAL COMMERCIAL r
JOB DESCRIPTION: CONVERT TUB TO SHOWER(I5SQFT)
Sq. Ft Floor Area: I Valuation: $5000
APN Number: 35709051.60 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:
RE -ROOFS:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, 1 agree to remove all new materials for
inspection.
Signature of Applicant:
Date:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
HAZARDOUS MATERIALS DISCLOSURE
1 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 1 will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
Owner or authorized agG;nt:
Date:
CONSTRUCTION LENDING AGENCY
1 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 Professiona
RM -7
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
Xfcc.•h. Plan Check
ADDRESS: 10012 scenic blvd
DATE: 03/02/2011
REVIEWED BY: larry s
Plnmh. PrT. ail Fee:
-I_
APN:
BP#:
"VALUATION: 1$5,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE:
Elec Inq: Fee:
PENTAMATION 1R3SFDREM
PERMIT TYPE:
WORK I
remove shower tub and replace with tub.
SCOPE
Xfcc.•h. Plan Check
Plwnh. Plan Cla�el;
E/ec:. Plan Cheek
,bf"ch. Pernril fire:
Plnmh. PrT. ail Fee:
-I_
lslec. Permit Fee
OYhcr Alec h. fn.s p.
Other Plumb In.t�p.Li
Ocher Tlec. Imp.
ET
1kch. Insp. Fee:
Phrwh. lay. Fee:
Elec Inq: Fee:
NOTE: These fees are hased on the nreliminary information availahle and are only an estimate. Contact the Dent for addn 7 info.
FEE ITEMS (Fee Resolution 09-051 E . 711110)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
15 s.f.
$570.00
Remodel, Bath (<=300 sf)
IREMRESBAT
Suppl. PC Fee: 0 Reg. 0 OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -0 Reg. 0 OT
0.0
1 hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
Consiruction Tux
Acoustical Fee: 0 Yes (E) No
$0.00
E)
Work Without Permit? 0 Yes (E) No
$0.00
PlanninFee:
$0.00
Select a Non -Residential
Building or Structure
E)
i
Trui,el Documentation Foes:
Strom; Motion Fee: 1BSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$1.501
$570.00
VOTA1, ffE:
$571.50
Revised: 01/15/2011
CUPERTINO
CITY OF CUPERTINO
REPIPE/SEWER/MAIN SERVICE
PERMIT APPLICATION FORM
11b3(-),)g1q
APN #=6 z-Jl n D /
(/
Date:���
Buildii Address:
Fee
Group
. ate/�- S Cel
I
Owner's Name-
Phone #:
Co ctor:
Phone #:�-
Fax #: 7 —a
Contact:
Phone #:
Commercial re -pipe per fixture
Fax/e-mail: �'�c • d Gear'.
Contractor License #:
Cupertino Business License #: y ��
Commercial Gas Piping System
1-4 Outlets
Job Description: L
Residential Commercial ❑
Valuation: 3 ��
Cal Bldg Standards Commission
Fee
Project Size: Counter ❑ Express ❑ Standard ❑ Large ❑
Major ❑
Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the
application or if applicable, include in plan set & the sheet index.
Seismic Commercial
Green Building Points:
Quantity
Fee ID
Fee Description
Fee
Group
Permit Type
1PCSEWER
Commercial building
sewer/sanitary sewer
P
1CPSS
1BPREPIPE
Commercial re -pipe per fixture
P
1CPRP
1PGASCOM
Commercial Gas Piping System
1-4 Outlets
P
1BCBSC
Cal Bldg Standards Commission
Fee
B
ALL PERMIT
TYPES
1BSEISMICOM
Seismic Commercial
P
Revised 12/06/10
w5�
RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number:
Name of owner.
Project address.
Contact person. l / 1�-�c�-- Phone. W j -p -,57r3 z77y9
Fax. '2,-�
Net square footage of lot.
Existiniz
Square footage: First floor:
Second floor:
Garage:
TOTAL:
Proposed
Are there at least two 10 foot by 20 foot clear spaces inside the garage? (K)
Is privacy protection planting required for the project? Y
Build it Green Total Points
On what floor(s) is work being done? J //• `` - /�
Brief description of work. C-04 ,11�—J
64I
Code editions: 2007 CBC (Y - N)2007 CFC (Y - N)2007 CMC (Y-r��,]
2007 CPC (Y - N) 2007 NEC (Y - N)
4JSA 2 MI
Effective 1/1/08
�t
OFFICE COPY
Plan Review Process Work Book Page -8- Revised 06-15-10
APPROVED
IN ACCORDANCE WITH THE CITY OF
CUPERTINO CODES AND ORDINANCES
DATE
SINNED MUST
This set of Plans and specificatons
be kept on the job at all times and 4 is
unlawful to make any changes or alterations
on same without written perrmss'on from
the Building Department, City of Cupertino.
The stamping o this plan and specifications
SHALL NOT be held to permit or to . an
approval of the violation of any provisions
of any City Ordinance or State Law.
Existing Tub/Shower
New Shower
Remove existing tub/shower combination and repalce with shower only.
Install hot mop tapered water proof shower pan up walls and above bench
area a minimum of 3" above drain.
FLOOR PLAN
SCALE: 1/2" = 1'-0"
MAR 0 2 7.01'
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DRAWN
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CHECKED
KG
DATE
03/01/11
SCALE
AS NOTED
JOB NAME
Beard
SHEET
A2.00
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Existing Tub/Shower
New Shower
Remove existing tub/shower combination and repalce with shower only.
Install hot mop tapered water proof shower pan up walls and above bench
area a minimum of 3" above drain.
FLOOR PLAN
SCALE: 1/2" = 1'-0"
MAR 0 2 7.01'
0
0
LO
o,
Q
U
0
0
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9X
DRAWN
KG
CHECKED
KG
DATE
03/01/11
SCALE
AS NOTED
JOB NAME
Beard
SHEET
A2.00