10110161 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7480 ROLLINGDELL DR CONTRACTOR:BLACK DIAMOND PERMIT NO: 10 110 161
DESIGNS
l ZR'S NAME: BRUSH CAROL A AND JAMES A 3481 DEL NORTE DR DATE ISSUED: 11/23/2010
OWNER'S PHONE: 4084462660 SAN JOSE,CA 95132 PHONE NO:(408)272-5959
❑ LICENSED CONTRACTOR'S DECLARATIONr- F_
--7 BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class (>�'L C/z Lic.# l l z1 r r—
� / MECH RESIDENTIAL COMMERCIAL
Contractor°/`�A_c k 726,o., Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:MASTER BATH,HALL BATH,NON-STRUCTURAL(100SQ)
(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. Sq.Ft Floor Area: Valuation:$30000
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. APN Number:35931061.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply / _2__740
with all non-point source regulations per the Cupertino Municipal Code,Section Issued Date//
9.18.
S ire Gt, ! G —Date / e r"
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION 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
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
1,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
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 ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
I have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Health&Safety Code,Sections 25505,25533,and 25534.
1 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 Owner ora thorized agent:
Compensation laws of California. If,after making this certificate of exemption,I Dater/G�
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. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
correct.I agree to comply with all city and county ordinances and state laws relating
tr iing construction,and hereby authorize representatives of this city to enter Lender's Address
ui _ie 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 ARCHITECT'S DECLARATION
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 7480 rollingdell dr. DATE: 11/23/2010 REVIEWED BY: bobs.
APN: BP#: "VALUATION: 1$30,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex 70-11 II, PENTAMATION
USE: F1.t>t1h 11t!::1:
PERMIT TYPE: 1 R3SFDREM
WORK master and hall bath remodel non structural
SCOPE
14",1r_
�Ii°li('t` lii"t_Il. ,Y iF3 El t-lF f , r1't t-ri ( 0'wi J"!'
Li
NOTE: Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info.
FEE ITEMS (Fee Resohition 09-051 Et /7"1",10) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 EIKI s.f. Remodel,Bath(<=300 sf)
Suppl. PC Fee: E) Reg. 0 OT 0.0 hrs $0.00 $570.00 1REMRESBAT
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Feer Reg. 0 OT0.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Cons1rilution Ln
Acoustical Fee: 0 Yes G No $0.00 Q
Work Without Permit? 0 Yes (F) No $0.00 E)
Planning I ee: $0.00 Select a Non-Residential E)
Building or Structure 0
Strong Motion Fee: IBSEISMICR $3.00 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $2.00
SUBTOTALS: 1 $5.00 $570.00 TOTAL FEE: $575.00
Revised: 11/08/2010
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35931061 . 00
DATE ISSUED. . . . . . . : 11/23/2010
RECEIPT #. . . . . . . . . : BS000012084
REFERENCE ID # • . • : 10110161
SITE ADDRESS . . . . . : 7480 ROLLINGDELL DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BRUSH CAROL A AND JAMES A
ADDRESS . . . . . . . . . . : 7480 ROLLINGDELL DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4705
RECEIVED FROM . . . . : BRADFORD S MUELLER
CONTRACTOR . . . . . . . : MUELLER, CRAIG D LIC # 18104
COMPANY . . . . . . . . . . : BLACK DIAMOND DESIGNS
ADDRESS . . . . . . . . . . : 3481 DEL NORTE DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95132
TELEPHONE . . . . . . . . : (408) 272-5959
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 30, 000. 00 2 . 00 0. 00 2 . 00 0 . 00
1BSEISMICR VALUATION 30, 000. 00 3 . 00 0. 00 3 . 00 0 .00
1REMRESBAT SQ FEET 100. 00 570 . 00 0. 00 570. 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 575. 00 0 .00 575. 00 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 575 .00 #1800
---------------
TOTAL RECEIPT 575.00
RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number: Ct—
Name of owner.
Project address. 7 ' ' '9 L2 Ti,o i /2e
Contact person. Phone. Z02 R!zo Z-,.
Fax.
Net square footage of lot. —
Existing Proposed
Square footage: First floor:
Second floor:
Garage:
TOTAL:
Are there at least two 10 foot by 20 foot clear spaces inside the garage? Yom---"N
Is privacy protection planting required for the project? �-
Build it Green Total Points
On what floor(s) is work being done?
Brief description of work. c,, > r� C
,
Code editions:2007 CBC ON)2007 CFC CY-,�N)2007 CMC d(3)-N)
2007 CPC j�� )2007 NEC -76�-N)
Effective 1/1/08
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Plan Review Process Work Book Page-8-Revised 8/05/08
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Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: "7 ', o PERMIT#
OWNER'S NAME: ; PHONE# 'fid -:,;7V OOC-451
GENERAL CONTRACTOR:'}3tict,-k ',,� BUSINESS LICENSE#
ADDRESS: I I 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 SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. /
I am not using any subcontractors: ��l�Cle-e�'��
Signature Date
Please check applicable subcontractors and complete the following information:
V 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
/0// cam/
CITY OF CUPERTINO
ADDITION/REMODEL
CUPERTINO FEE SCHEDULE
APN# J� Date: 2 l�
Is a 2, unit being added? Yes ❑ No If es, please fill out the permit application for 2nd unit.
Building Address:
Mailing Address (if different from building address):
Owner's Name: Phone# :
Contractor: Phone#: _
Fax#: Z C?`�
Cupertino Business License: /l> State Contractor License#:
Contact: Phone#• elf-
Vi
fr
0 C� 1 Fax#:
Landscape Ordinance Compliance:
Landscape area in sq. ft. (includes all irrigated areas):
If 2,500 sq. ft. or less, compliance with the Landscape Water-Efficiency Checklist is required.
If more than 2,500 sq. ft., a complete Landscape Project Submittal is required.
Compliance Method: ❑ Plant Type ❑ Water Budget
Building Permit Info:
Bldg. ❑ Elect. Plumb. 9 Mech. ❑ Hillside ❑
Job Description:
Addition-What is being added?(Be Specific):
What is being remodeled (not including addition)?
V4 C..e-t
Remodel Includes Re-Roof. Yes ❑ No ( If yes list number of squares
Remodel Includes Structural: Yes ❑ No
Do you have the pre-application planning approval? Yes ❑ No ❑
If yes, please provide aeopy of your planning approval letter. Planners name:
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen Bath /'CY Other
Type of Construction (Usage Class): Occupancy-Type:
1-A, 1-B ❑ IMII/V-A ❑ II/VI B, IV-HT, V-B Valuation.
Please check this box if the project is a
Project Size: Ex ress Standard ❑ Large ❑ Major ❑ second-story addition ❑
Please complete relevant portion of the Green Building
Checklist& attach it to the application or if applicable, Green Building Points Achieved^
include in plan set& the sheet index. (�
Revised 05/18/10