10030174 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10453 SCENIC CT CONTRACTOR:GAIL&RON HIROSE PERMIT NO: 10030174
OWNER'S NAME: GAIL&RON HIROSE 10453 SCENIC CT DATE ISSUED:03/30/2010
NER'S PHONE: 4086052082 CUPERTINO CA,CA 95014-2765 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class Lic.#
MECH r— RESIDENTIAL r— COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMODEL 2 BATHROOMS,NOT STRUCTURAL,
(commencing with Section 7000)of Division 3 of the Business&Professions MECHANICAL,
Code and that my license is in full force and effect. ELECTRICAL,PLUMBING(116SQ)
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 Sq.Ft Floor Area: Valuation:$35000
permit is issued.
APPLICANT CERTIFICATION APN Number:35707013.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs;and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. f�
Issued by: Date: +
Signature Date
ki OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I I
become subject to the Worker's Compensation provisions of the Labor Code,I must Ow �r or aut rized t:
forthwith comply with such provisions or this permit shall be deemed revoked. Date: 3
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
unify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
.,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-p int source re=Cupertino Municipal Code,Section
9.18. I understand my plans shall be used as public records.
Signature Date 1 �b Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN 35707013 . 00
DATE ISSUED. . . . . . . : 03/30/2010
RECEIPT # . . . . . . . . . BS000010062
REFERENCE ID # . . . : 10030174
SITE ADDRESS . . . . . : 10453 SCENIC CT
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER GAIL & RON HIROSE
ADDRESS 10453 SCENIC CT
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2765
RECEIVED FROM GAIL T HIROSE
CONTRACTOR LIC # *OWNER*
COMPANY GAIL & RON HIROSE
ADDRESS 10453 SCENIC CT
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2765
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 35, 000 . 00 2 . 00 0 . 00 2 . 00 0 . 00
1BSEISMICR VALUATION 35, 000 . 00 3 . 50 0 . 00 3 . 50 0 . 00
1REMRESBAT SQ FEET 116 .00 570 . 00 0 . 00 570 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 575 . 50 0 . 00 575 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 575 . 50 AMEX
---------------
TOTAL RECEIPT 575 . 50
\ f
CITY OF CUPERTINO
ADDITION/REMODEL
CUPEkTINO PERMIT APPLICATION FORM
Date: Z 3
APN # 3 -1 1 D 136
Is a 2° unit being added? Yes ❑ No ® If yes, please fill out the permit application for 2° unit.
Building Address:
9S61.9_1
Mailing Address (if different from building address):
Owner's Name: / Phone#
�_168) 665. Z_.zV<'__
Contractor: Phone#:
N i Fax#:
Contractor License#:
Cupertino Business License#:
Contact: Phone#:
Fax #:
Building Permit Info:
Bldg. [a- Elect. ❑ Plumb. Mech. [g' Hillside ❑
Job Description:
Job
Addition-What is being added?(Be Specific):
What is being remodeled (not including addition)5 730+VSKvm
14 c•^ L.- , ESL -(-/2 /CA
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 2
If yes, please provide a copy of your planning approval letter. Planners name:
Square Footage:
Addition: Porch: Deck: Garage: Detached Attached
Remodel: Kitchen Bath << (o¢' Other
Type of Construction (Usage Class): Occupancy Type:
1-A, 1-B ❑ II/III/V-A ❑ IUIII B, IV-HT, V-B FE S 'F�' F`,1
Valuation: Please check this box if the project is a
/ I�S 6A66,— second-story addition ❑
Project Size: Express ❑ Standard ❑ Large ❑ Major❑
Please complete relevant portion of the Green Building
Checklist & attach it to the application or if applicable, Green Building Points Achieved: 19
include in plan set& the sheet index.
***For Office Use Only***
Over-the-Counter 0 Revised 07/06/09
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
DECKS 1R3SFDADD OR
1R3SFDREM
1 DECKWOOD Deck (Wood)-Each B
(Each)
1 DECKRAIL Deck Railing-Each B
(Each)
GARAGES 1R3SFDADD OR
DETACHED 1R3SFDREM
1 GARDTW<=1 K Wood Frame up to B
1,000 SF (each)
1 GARDTM<=1 K Masonry up to 1,000 SF B
(each)
1 BCONSTAXR Construction Tax Res
(new detachedgarage)
PATIO'S OPEN 1R3SFDADD OR
1R3SFDREM
1PATIOWOOD Wood Frame up to 300 B
SF
1PATIOMETAL Metal Frame up to 300 B
SF
1 PATIOOTHER Other Frame up to 300 SF B
PATIO'S CLOSED 1R3SFDADD OR
& SUN ROOMS 1R3SFDREM
1PATIOENCLW Enclosed Wood up to 300 B
SF
1 PATIOENCLM Enclosed Metal up to 300 B
SF
1PATIOENCLO Other Enclosed Patio up B
to 300 SF
1 COVPORCH Porch Covered-Each B
(Each)
REMODELS 1R3SFDREM
1REMRESKIT Kitchen Remodel up to B (Deduct "$"for ea plan
300 SF check
1REMRESBAT Bath Remodel up to 300 B "
�j SF
1REMREOTH Other Remodel up to 300 B "
SF
CITY OF CUPERTINO
ADDITON/REMODEL
FEE SCHEDULE
Quantity Fee ID Fee Description Fee Group Permit Type
Sq Ft
1MECPLNCK Stand Alone Mechanical M
Pln Ck (hourly
1PLMPLNCK Stand Alone Plumbing P
Pln Ck (hourly)
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1 TRAVDOC Travel & Documentation B
1BUSLIC Business License B
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent, spouse or child) will perform:
A. All the work authorized by this permit
B. — A portion of the work
C. _ None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. — All of the work
B. _ A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
PersorVFirm Address/City Phone Number Type of work to be
erformed
...........................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct: 1 have read and understand the
Owner-Builder Information(rever
Date:
Property Owners Signature: �eside,.
r�
Job Address: �j
l C� �T Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
lam / 7c/
RESIDENTIAL PROJECT COVER SHEET
Assessor's Parcel Number: 357 b 7 D (3 0
Name of owner. k 0rA671-31'e--
Project
1-3'e—
Project address. l b 7` -� 5 6-67V �7 OG'�'�i''`�0, �f� 9-56�fL
Contact person. ��< C-- 14126 S(� Phone. 4016
�A.
Net square footage of lot. )v -4
Existing Proposed
Square footage: First floor: .
Second floor:
Garage: k,.(
TOTAL: L►
Are there at least two 10 foot by 20 foot clear spaces inside the garage? N \
Is privacy protection planting required for the project?
3uild it Green Total Points
On what floor(s) is work being done? 2 ap
Brief description of work. 1 6,6 —
n o✓t
Code editions:2007 CBC N)2007 CFC N)2007 CMC (LDN)
2007 CPC -N)2007 NEC N)
OF
WITH APF'I�UVED
IN t
HE GIT'Y
ac,� )
lINOCODE ANDORDINANCES
Effective 1/1/08 CAPE -
DAT ------
SIGNED ,t„atrons MUST
This set of plans a-i spec-
be kept on the Iou at all trees and it is
unlawful to make any c.tianges or alterations
on same without written permission from
the Building De artn�ent.City of Cupe uon
d ifications
The stamping o this;plan an spec
SHALL NOT be held to Permityor to provisions
an
n s4 ionsa`
approval of the ,' � an
of any City(lr irnan<:e()r`.Mate l.aw.
BY
.
Plan Review Process Work Book Page-8-Revised 8/05/08
REMODEL PERMIT APPLICATION
APN # 357-07-013-00 Date: 3-23-2010
Gail Hirose
10453 Scenic Court
Cupertino, CA 95014
(408) 605-2082
Owner remodel—cosmetic facelift of existing structures, removing fixtures,
replacing finishes with new finishes, floor, counter and tub surround. All
measurements will remain the same for placement of plumbing. Will add fan/light
combos in both bathrooms with occupanc . Will replace old toilets with
new low flow toilets -1.6 gallons. /�`1m0-V-`
Hall bath: replace counter, sinks, faucets, toilet, lights, tub, tub surround, floor.
Adding a fan/light combo and occupancy dimmers.
Master bath: replace counter, sinks, faucets, toilet, shower stall, floor.
Adding a fan/light combo and occupancy dimmers
r
e i1
N
w. .__...� a ..
4-�" � FF
--
L
n s GFI `
H. 'rose HAIIBATH. 3/201
D��E sGr��lc
�1�
Msf
47
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