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11030096I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10700 STOKES AVE CONTRACTOR: I PERMIT NO: 11030096 I OWNER'S NAME: MILLS THEODORE J AND LINDA M �,c�Srbf-t �� r1L DATE ISSUED: 03/21/2011 NER'S PHONE: 4083554238 1 , I PHONE NO: I LICENSED CONTRACTOR'S DECLAR,Ar�TION License Class i Lic. # Contractor W3iti✓�/*�6y + 1� Z -21—k( 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 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 sourcelagulatic ns per the Cupertino Municipal Code, Section 9.18. Signature Date Ll OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, 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, 1 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 demnify 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 BUILDING PERMIT INFO: BLDG ELECT PLUMB MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: REMODEL 90 SQ FT TO (2) BATHROOMS Sq. Ft Floor Area: I Valuation: $22000 APN Number: 32649012.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN I DAYS OF PERMIT ISSUANCE OR 180 DA OM 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, 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. I 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 Cupertula.Municipal Code, Chapter 9.12 and the Health & Safety Code, SectiogW502 i3, and 25534. Owner or authorized agent. 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 ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32649012.00 DATE ISSUED.......: 03/21/2011 RECEIPT #.........: BS000012951 REFERENCE ID # ...: 11030096 SITE ADDRESS .....: 10700 STOKES AVE SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............: MILLS THEODORE J AND LINDA M ADDRESS ..........: 10700 STOKES AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014-1237 RECEIVED FROM ....: WL CONSTRUCTION CONTRACTOR .......: TBD - TO BE DETERMINED LIC # 00096 COMPANY ..........: TBD - TO BE DETERMINED ADDRESS .......... CITY/STATE/ZIP ...: , TELEPHONE ........ FEE ID UNIT QUANTITY 1BCBSC VALUATION 22,000.00 1BSEISMICR VALUATION 22,000.00 1BUSLIC FLAT RATE 1.00 1REMRESBAT SQ FEET 90.00 TOTAL PERMIT : METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT AMOUNT --------------- 688.20 --------------- 688.20 AMOUNT PD -TO -DT 1.00 0.00 2.20 0.00 115.00 0.00 570.00 0.00 1.00 0.00 2.20 0.00 115.00 0.00 570.00 0.00 REFERENCE NUMBER -------------------- 1039 C:fslt�►�i � � CITY OF CUPERTINO FF.F FgTIMATOR — BUILDING DIVISION im,ADDRESS: 10700 stokes DATE: 03/21/2011 REVIEWED BY: 3-21-11 APN: BP#: "VALUATION: 1$22,000 Y` PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Remodel, Bath (300 s.f. max) PRIMARY Residential USE: PENTAMATION 1 R3SFDREM PERMIT TYPE: 19 WORK SCOPE FEE ID FLR AREA s.f. 1REMRESBAT 90 NOTE: These fees are based on the Pretiminary information available and are on[v an estimate. contact the uept_for aaan -i info. FEE ITEMS (P' e Resolution 09-05I I?ff" ' J.-"102 FEE QTY/FEE MISC ITEMS Permit Fee: $570.00 Work Without Permit? 0 Yes No $0.00 Stronjz Motion Fee: IBSEISMICR $2.20 Select an Administrative Item 1314,, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $573.20 $0.00 TOTAL FEE: $573.20 Revised: 01/15/2011 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 ' I (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org CUPERTINO n NEW CONSTRUCTION [71 ADDITION ALTERATION 1 TI ElREVISION !DEFERRED t to"50011 CP ORIGINAL PERMIT # PROJECT ADDRESS ^ J ' ", A.- APN # t OWNER NAME I I PpI,% f- T r I E-MAIL STRE&T CTIY,ST✓AT�$ ZIP /J �^ 1 FAX J CONTACT NAMEt% ✓ t'�'/ % I. -S` ` Y�3� E-MAIL STREET AD CITY, STATE, ZIP kq;:T r4 is' ( ,2 9j FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT kCONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMENi! j LICENSE NUMBER �% a LICENSE TYPE BUS. LIC # t, \� COMPANY NAME �) _ j, -n .0� � �^ FAX VI � i STREET ADDRESS `[�� � h CITY, STATE, ZIP �. LC -� ,p !� PHQ r6 e -- i � J r V27� 7 - ARCHITECT/ENGINEERJ NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRUMON OF WORK -?g EXISTING USE PROPOSED USE I CONS IL TYPE # STORIES OCC, TYPE DESCRIPTION SO -IM V EX% -M NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM g9aIKTICNEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA I GARAGE AREA- ❑ DETACH ❑ ATTACH DWFII.M (RATS: ISA SRCOND UNU ❑ YES Saco" STORY ❑ YES 1MG ADDED NO ADDIMOr NO PRE -APPLICATION ❑ YES IF YfS, PROVIDE COPY OF PLAMM'S NAM-: RECEIVED BY-ATION- V ' J PLAMIINO APPL # NO PLAMANO APPROVAL LETTER o By my signature below, I certify to each of the following: m owner or authorized agent to act on the property owner's behalf. t have ead this `ti]a application and the information I have provided is corr L'G Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building constru r Tesentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicanttAgent: Date: SUPPLEMENTAL INFORMATION REQUIRED KAN CHECK TYPE ROUTING SUP OVER-Ttf,COONTER ❑ MJU DING PLAN REVIEW _ 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. ❑ EXPRESS ❑ PLANNING PLAN REVMW 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 ❑ I= Dir _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application ❑ isiVIAONa�NTALHEALTH BidgApp aot Ldoc wised 03116q 1 CUPERTINO PROJECT DATA - RESIDENTIAL COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(&cupertino.org OCCUPANCY(S) r—� TYPE OF 1 1 PARCEL _1 CONSTRUCTION: v T AREA: FIRE y N WUI AREA: Y N FLOOD AREA: y N SIESMIC AREA: Y N SPRINKLERS: Existing Floor Area: First Floor:.f., . Second Floor: S Garage s. f. TOTAL: s.f. Are there at least two 10 feet by 20 feet clear spaces inside the garage? 6 N Is privacy protection planting required for the project? Governing Codes: 2010 California Building Code (based on the 2009 International Bidding Code) 2010 California Residential Code (based on the 2009 I ational Residential Code) 2010 California Plumbing Code (based on the 2009 U o e 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