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09080139 (2) CITY OF CUPERTINO BUILDING PERMIT BUiLDiNG ADDRESS: 7565 TIPTOE LN CONTRACTOR-TBD-TO BF PERMIT NO:09080139 DETERMINED t .'?WNER'S NAME: SLTSAN BECTON —�� DATE ISSUED:08.17;20(1 -WNER'S PHONE: 40825 ,0,612 —� � PHONE NO: ❑ LICENSED CONTR4,C TOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLCMR License Class _ Lic.# MEC11 RESIDENTIAL COMMERCIAL Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DE�C'RIPI'?ON BATHROOM REMODEL,TILE,DRYW ALT , (commencing with Section 7000)of Division 3 of the Business&Professions NEW VANITIES. � Code and that my license is in full force and effect. I 1 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: Vahration:$10000 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 APN Number: 15930011.00 Occupancy Type: It permit is issued. APPLICANT CERTIFICATION j i certify that 1 have read this application and state that the above intormation is PERMIT EXPIRES IF WORK IS NOT STARTED I correct.1 agree to comply with all city and county ordinances and state laws relatint' WITHIN 180 DAYS OF PFR-MIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspe^tion purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnity and keep harmless the City of Cupertino against liabilities, udgments, costs,and expenses which may accrue against said City in consequence of the { granting of this permit. Additionally,the applicant understands and will comply Issued by: __— _i— _ Date: with ail non-point source regulations per the Cupertino Municipal Code,Section y RE-ROOFS: I' mature _ N` Date R !�' All roofs scall be inspected prior to any roofing material being,installed. if a roof is installed without first obtaining an inspection,I agree to rei:.ove all new materials ioi t ir inspection. OWNER-BUILDER DECLARATION Signature of Applicant:___—-- __ Dat:. 1 hereby affirm that I am exempt from the Contractor's License Law for orae of the following two reasons: ALL ROOF COVERINGS TO BE CLASS +'OR BETTER 1,as owner of the property,or my employees with wages as their sole compensatior,, wilt do the work,and the structure is riot intended or offered for sale(Sec.7044, a Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS.MATERIALS DiSCLOSURF ' construct the prooect I Sec.7044,Business&Professions Code). 1 have read the hazardous matey ials requirements under Chapter 6.95 of the California Health&Safety Code,Sertions 25505,25533,and 25534. 1 will 1 i hereby affirm under penaity of perjury one of the following three maintain compliance with the Cupertino Municipai 0.ide,Chapter 9.12 and the declarations: Health a Safety Code,Section 25532(a)should I stoic or handle hazardous. I I have ane•will maintain a Certificate of Conse-rt to self-insure for Worker's material. ✓tuditic nally,should I use equipment or devices which emit ha•,ardods Compensation,as rrcvid-A for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management DiVriot I performance of the work for which this permit is issued. mill maintain compliance with the Cupertino Municipai Code,C napter 9.12 a9d I have and will maintain Worker's Compensation,insurance,as provided for by the Health&Safe`y Code,Sections 25505,25532,and 25534. "S'ction 3700 of the Labor Cone,for the performance of the work for which thik Owner or autborized agent:_ �+- -G=Date: permit is issued. r 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 CONSTRUCTION LENDING•AGENCY C;'orrpensation laws or Califomia. If,after making this certificate of exemption,i become subject to the Worker's Compensation provisions of the Labor Code,1 mina t 1 hereby aftirrn tnat there is a construction lending agency for the peri.(, riance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name — —------- ---- --- --- APPLICANT CERTiFICATION Len ler's Address-__-_--_ 1:;ertify that r.have read this application aad state that the above information is correct.l agree to c:,mply wish all city and county ordinances and state laws:eiatin; to building construction,and hereby authorize representatives of this city to enter :the above mentioned property for inspectiae purposes.(We)agree to save. j ARCHITECT'S DECLARATION -mnify and Keep nar,less the City of Cupertino against liabilities,judgments, cost,.and expenses which may accrue against said City in consequence of the I understand ity plans shall be v ed as public records. m4riling ofthis pe:nit.Additionally,the applicant understands and will comply with allnon-mint source regulations per rhe Cupertino Municipal Code,Section Licensed Professional Signaturc ---- i -- Date "� 7 ✓��_ Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF -UPE�TINO Fax(408)777-3333 Building Department JOB ADDRESS: PERMIT #'7 S-6 s- -r/'p 6t) pq-�-fi�-V 0 ��,2 f?�� OWNER'S NAME: S u saw Sta-ze i3el oma,. PHONE # y 6$-Z S-Z - 06/Z GENERAL CONTRACTOR TQ FAX# I am not using any subcontractors: S.gnature Date Please check applicable subcontractors and com lete the following information: 60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO ADDITION/REMODEL CUPEkTINO PERMIT APPLICATION FORM 06 C7,)13 APN # l,- Date: Is a 2" unit being added? Yes ❑ No If yes, please fill out the permit ap lica ion for 2" unit. Building Address: 7S6S TI V9 Mailing Address (if different from building address): owner's Name: Phone# SUSaa s e Eel YOE-z-s-z- �� Contractor: Phone#: Fax#: Contractor License#: Cupertino Business License#: Contact: Phone#: Fax#: Building Permit Info: Bldg. Elect. ❑ Plumb. ( Mech. El Hillside ❑ Job Description: Addition-What is being added?(Be Specific): What is being remodeled (not including addition)? b -b)P, ovn l,,,..0 , YI et j i e s /00 Sy, Fe e4- Remodel Includes Re-Roof. Yes ❑ No If yes list number of squares Remodel Includes Structural: Yes ❑ No 5a Do you have the pre-application planning approval? Yes ❑ No If yes, please provide a copy of your planning approval letter. Planners name: Square Footage: Addition: Porch: Deck: Garage: Detached Attached Remodel: Kitchen Bath Other Type of Construction(Usage Class): Occupancy Type: 1-A, 1-B ❑ IUIIUV-A ❑ II/III B, IV-HT, V-B le z Valuation: Please check this box if the project is a ff /0000 second-story addition ❑ Project Size: EXDress ❑ Standard ❑ Large ❑ Major❑ 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. ***For Office Use Onl *** Over-the-Counter Revised 07/06/09 CITY OF �XPERTINO ADDITON/REMODEL FEE SCHEDULE Quantity Fee ID Fee Descripi;ion Fee Group Permit Type Sq Ft DECKS 1R3SFDADD OR 1R3SFDREM 1 DECKWOOD Deck (Wood)-E-ach B (Each) 1DECKRAIL Deck Railing-I?ach B (Each) GARAGES 1R3SFDADD OR DETACHED 1R3SFDREM 1GARDTW<=1K Wood Frame up to B 1,000 SF (eacf.) 1 GARDTM<=1 K Masonry up to 1,000 SF B (each) 1BCONSTAXR Construction Tax Res (new detachedgarage) PATIO'S OPEN 1R3SFDADD OR IR3SFDREM 1 PATIOWOOD Wood Frame up to 300 B SF 1 PATIOMETAL Metal Frame t p to 300 B SF 1 PATIOOTHER Other Frame up to 300 SF B PATIO'S CLOSED 1R3SFDADD OR & SUN ROOMS IR3SFDREM 1PATIOENCLW Enclosed Woad up to 300 B SF 1 PATIOENCLM Enclosed Met it up to 300 B SF 1 PATIOENCLO Other Enclosed Patio up B to 300 SF 1 COVPORCH Porch Covered-Each B (Each) REMODELS 1R3SFDREM:: 1REMRESKIT Kitchen Remi;del up to B (Deduct "$"for ea plan 300 SF check 1REMRESBAT Bath Remodel up to 300 B 66� � � SF 1REMREOTH Other Remodel up to 300 B 66 SF CITY OF 1,UPERTINO ADDITOPUREMODEL FEE SCHEDULE Quantity Fee ID Fee Description Fee Group Permit Type Sq Ft 1 MECPLNCK Stand Alone Mechanical M Pln Ck(hourly 1PLMPLNCK Stand Alone Plumbing P Pln Ck(hourly) 1 BCBSC Cal Bldg Stanc,ards B ALL PERMIT TYPES Commission F-�e 1BSEISMICRE Seismic Residi;ntial B 1TRAVDOC Travel &Documentation B 1BUSLIC Business License B