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13030045 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21079 WHITE FIk CT CONTRACTOR: PERMIT NO:13030045= owNS�y�� OWNER'S NAME: SHINOHARA KAZUMICHI/MICHIYO DATE ISSUED:03/11/2013 OWNER'S PHONE: 4084065794 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL❑ COMMERCIAL LJ License Class Lic.# (17E) ( .. .Z REMOVE AND REPLACE FIXTURES IN BATHROOM LIKE .14,A4-1. 5! FOR Contractor M6,u v e L 4 s 4A 4 Date �'� /1 ?j LIKE,40 LIGHTING FIXTURES AND 6 CIRCUITS I hereby affirm that I am licensed under the provisions of Chapter 9 THROUGH (commencing with Section 7000)of Division 3 of the Business&Professions OUT 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. Sq.Ft Floor Area: Valuation:$12000 1 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 APN Number:35905069.00 Occupancy Type:. permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAPERMIT ISSUANCE OR to building construction,.and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DA O ST CALLED INSPECTION. 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. A ition ,the applicant understands and will comply sued b Date: with all non-point so rc r ul so s per a Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date Q �3 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. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided.for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor.Code,for theerformance of the work for which this p Owner or authorized agent: 9 et'?1/L �Z e 4& Date: .® l( 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 CONST C N LE AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this perm is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all cityand 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,andexpenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 21079 white fir ct DATE: 03/11/2013 REVIEWED BY: mendez APN: BP#: *VALUATION: $12,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1REAP10 USE: p PERMIT TYPE: WORK remove and replace fixtures in bathroom like for like 40 lighting fixtures and 6 circuits through out SCOPE IxP �� ti XleIch.Plan Check Plumb. Plan(Check Elec.Plan Check 0.0 hrs $0.00 ;Wch. Permit Fee: Plumb.Permit Fee: Elec.Permit Fee: IEPERMIT Other,llech.Insp. _ " L-] Li Other Plumb Insp. Other Elea Insp. 0.0 hrs $45.00 Alech.Insp,Fee: Plumb. hap.Fee: Elee.Insp,I'eee: NOTE:This estimate does not include fees due to other Departments('tie.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Theseees are based on the prelimina information available and are only an estimate Contact the De t or addn7 info. FEE ITEMS(Fee Resolution 11-053 Eff.7/1/12) FEE . QTY/FEE MISC ITEMS Plan Check Fee: $0.00 © # Electrical Suppl.PC Fee:. (E) Reg. ® OT 0.0 hrs $0.00 $45.00 1BREMRECEP I Recep/Switch/Outlets PME Plan Check: $0.00 = Electrical Permit Fee: Hourly Only? ®Yes Q No $0.00 $167.00 IBREMFIXT Fixtures,Lighting Suppl. Insp.Fee-0 Reg. ®OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $45.00 Construction ::Tax: -F] Administrative Fee: lADMIN $42.00 Work Without Permit? ® Yes (E) No $0.00 G Advanced Planning-Fee: $0.00 hours Inspections G Travel Documentation.Fee: 1TRAVDOC $45.00 $266.00 ISTINSP Inspection,Hourly 0 Strong Motion Fee: IBSEISMICR $1.20 Select an Administrative Item Bldg-Stds Commission Fee: 1BCBSC $1.00 pg $134.20 $478.00 �� x' $612.20 Revised: 01/01/2013 0 L p jF_OPMENT DEPARTM2NT BUILGI IG IVIS 33'- 1 1 " PR'g^w This set of plans a d pecificatC)UST be ept at the st Uction. I art d lake any �� - �� - �� job site during c �}1U or to de late -4 3 4 '-3'-2" 2 1 1 changes or to cions on CLOSET therefrom,witho t proval fa 8uildin Official. REFRIGE. N 5' 0' The stamping oft is Ian and ea vallof th Violation OT be held to perm 0 to be anFFP� al o t ate Law. DINIG ROOM of any royisio o any City L BY ( O H fj DATE II \ BATH ROOM PERMIT N0. (N) SUN TUNNEL U O ROOM OM 2 N Cn if Q o �J 8 PAN RYXG. y 2 IL O Project KAZUMICNI 5HINOHARfi O N RE51DEN5E N ! 21079 WHITE PIR Cr W ❑ CUPERTINO,CA95014 Title sneer FLOOR PIAN FURNACE LIVING ROOM CL SET# F^ Cfl ENO. 09-1001 N . CSis �? LOSET o p~ M c- N ROOM # I `cv R ' at 21,711 m f py m -- ! . A55HONN I MAIN ENTRANCE sneEr: A. 1 .2 3 Building Department City Of Cupertino Ty 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RTI N O Fax: 408-777-3333 CONTRACTOR/SUBCONTRACTOR LIST::, JOB ADDRESS: 10W wtq i f . 50 PERMIT# " c� OWNER'S NAME:K&7 C2g j 14 j uo .4 PHONE# GENERAL CONTRACTOR: s vc-ft bo BUSINESS LICENSE# ADDRESS: S 22— CITY/ZIPCODE:' *Our municipal code requires all businesses 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 SUBC T C RS t?E OBTAINED-A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: ig614 T nature Date Please check applicable subcontractorsnd complete the following.information:. - ✓ 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 Date