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13050140 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7592 HOLLANDERRY PL CONTRACTOR:RE-BATH BY SCHICKER PERMIT NO:13050140 OWNER'S NAME: FARKAS STANLEY R AND HILLARY J 1059 DETROIT AVE DATE ISSUED:05/20/2013 OWNER'S PHONE: 4082576487 CONCORD,CA 94518 PHONE NO:(925)676-8422 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIAL❑ License Class / Z Li..# 3bZ. REMODEL(E)MASTER BATH,REMOVE&REPLACE(E) BATH Contractor,"� I�y'� � � &REPLACE WITH(1)SHOWER STALL&TOWER,GRAB I hereby affirm that I am licensed under the provisions of Chapter 9 BAR (commencing with Section 7000)of Division 3 of the Business&Professions &SHOWER DOOR,&REPLACE ALL SHOWER FIXTURES 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:$9200 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:36229007.00 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 D F PERMIT 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 T 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 Issued Date � LOLl 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. �y RE-ROOFS: Signaturey " / _ Date 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 I,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. 1 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,,,2255339 and 25534. q Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: �— ` r Date: Z0-)- 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 CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance 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 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 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses 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 10 x CONSTRUCTION PERMIT APPLICATION 01 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 �O CUPERTINO (408)777-3228•FAX(408)777-3333•building(ftupertino.orgNA �-I [:]NEW CONSTRUCTION ❑ ADDITION Lai ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS 7 5 ^ 1' APN# -3 (br7 2- - Q - QC OWNER NAME �'✓ PHONE Z V V E-MAIL 71V STREET ADDRESS q �rSC, STAT _ _ ,AV- el 5 Q/ FAX AI CONTACT NAME �^ /r I j L PHO / ^ E-MAIL b 6qzi STREET ADDRESS CTI'Y,STATE,ZIP '�AJ FAX ❑OWNER ❑ OWNER-BUII.D OWNERAGENTCONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT 4W L CONTRACTOR NAME^ LICENSE LI SE TYPE.., BUS.LIC# J CO NAME V E-MAIL EAX �� C b b 7(o STREET ADDRESS C 'ATE,ZIP / HONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK , (112i(e " 44 ,y /V� 7 f L✓ri fM� 5 . 1.l/Y✓t 31 AJt fl�� f /Al 5 ?vw f1 G -f3 011< 122 574A'16� 0602, 54V/41( ter✓ fj EXISTING USE PROPOSED USECONSTR TYPE #ST RIIiS Jzt�/� �y USE TYPE OCC. SQ.FT. VALUATIONEXIST ($) AREALNEW FLOOR'f 6 AREA S�?�_��/7�', ="A `/I8 C1-7 INET AREA BATHROOM KITCHEN lJ OTHER REMODEL AREA-7,S REMODEL AREA REMODEL AREA PORCH AREA I DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES 1 / `/ /1- BEING ADDED? �I�IO ADDTTION? JaNO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RRECETOTAL 77777 UATION: PLANNING APPL# NO PLANNING APPROVAL LETTER EICHLER HOME? NO0117-00 , W .. .., U 0 , By my signature below,I certify to each of the following: I am the property owner o thor ed agent on the property owner's behalf. I h ve read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building cons�n_ch1g/1 authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMAenON REQUIRED PL ;CHEcxTPE_ Ra1)TINGSLIP New SFD or Multifamily dwellings: Apply for demolition permit for Q ovER-THE-CC&NTER ❑"suuDmGrLANREviEw existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLANREVIEw _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 STANDARD ❑ PUBLICwoRKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE+ ❑ FIRE DEPT _Copy of Planning Approval Letter or Meeting with Planning prior to MM<?R' ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. *r ❑ ENVII20NME1VTAL HEALTH B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 7592 HOLLANDERRY PL DATE: 05/2012013 REVIEWED BY: MELISSA APN: 362 29 007 BP#: *VALUATION: 1$9,200 %PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1R3SFDREM USE: P PERMIT TYPE: i WORK REMODEL E MASTER BATH REMOVE & REPLACE E BATH & REPLACE WITH N SHOWER SCOPE STALL&TOWER, GRAB BAR&SHOWER DOOR, & REPLACE ALL SHOWER FIXTURES ' Meclr.Plan Check Phrsrrb.Plan Check Elec.Plan(::heck Xle(.;h.Permit Fee: Plumb.Permit Fee: Elec. Permit Fee: Other,Wech.Insp. Other Plumb Insp. Other Elec.Insp, Ll Afech.In.sp.Fce: Plumb.Insp.Fee: Elec.Insp. Fee: NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These ees are based on the relimina information available and are onlyan estimate Contact the Dept or addn'l in o. FEE ITEMS(Fee Resolution 11-053 Eff.' 7/1/12) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 26 1 s.£ Remodel,Bath(<=300 sf) Suppl.PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $600.00 IREAMESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-0 Reg., Q OT0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Adrninistrative.Fee: Work Without Permit? ® Yes (E) No $0.00 0 Advanced Planning Fee $0.00 Select a Non-Residential G Building or Structure ® Travel Documentation Fees: � Strong Motion Fee: IBSEISMICR $0.92 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 $1.921 $600.00 \" Revised: 04/29/2013 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Lill L Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR'LIST JOB ADDRESS: Ol-(- 994,41 APERMIT#' OWNER'S NAME:9W Y PHONE# 41ob-.Zs, GENERAL CONTRACTOR: G BUSINESS LICENSE# �lS ADDRESS: Q J C0 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. �J 7 r I am not using any subcontractors: C•'� Sign a 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 Reath by Schicker Home Improvement Agr( it Wath'Expel ' This agreement, between ReBath by Schicker and owner/pu. r eRe-Ben - "'`� �• _ ol � � !� v►, 1� Work Order N 2 �J t /moi Purchaser Date )Ao \\Iam"kaw Address Media Installed on I _ I: City Zip .Sale Rep. Installed by EI Hornp Cell Work �J (�IPt�'� i PERM I T INST. DAYS '' ff t y�, I n . N lur r /1W .Z' �r a G i CA 0 I � �. .3 oo $r"9(C- Sr i M �vrn .h dcJo fl i. m CZ�� v r d N n LjPv� c ve"77 11104/ I r1b 6- -f-0 I S�J��(t i -o P — 0 n fD 01 I' c CD CD ! iFD v, Y, i� cn 0 o Zn 1~ t VJ ,gOMMUNITY Dair- C' lo DEPARTMENT I 0 3 BUILDING DIVISII7 CUPERTINO 0 AP� Cn VED cn Thls-qet of plans and specifications MUST be kept CUPERTIN Joy"R'y during construction. It Is unlawful to m=:< 'os or alterations on same,or to devic Buildiog Qepartme nc� lit ' tl;trc;rnt� without approval from the Building G MAY z Q0'3 O Tr sty,m at this REV! ging Is 56P plan ecificatior►s SHA EWED FOR CODE CO N w b,I;,r:S�,to of . proval of the vi,. MP I Is' Reviewed By. COMPLIANCE Ordinance or Stan. er `� PERMiT Isl / d S^E7/ Ask Pf 14-CIE �J_ 5� 1�/t CUPERTINO Building Departrnent MAY 2 0 2013 ` . REVIEWED FOR CODE COMPLIANCE • , , Rellathby Schicker Home improvement Agr( it e e N This agreement, between ReBath by Schicker and owner/Pu, r . � 'fieRrBarh&perlen�^ i Work Order N 0 `, _., - °.`' Purchaser Date 8 > QTY Address Media Installed on N�I fip, � q'LD�'� �b 1�1 L City Zip Sale Rep. Installed by Horn , 0� Cell Work Z ��-Ohl•- ��%rt� co A -t Gr,4e d,z- pN 5i'' or CUPERTINO Building Depart hent EIVIMAY z 0 2013 REVIEWED FOR C Reviewed By. or)a COMPLIANCE f ReBath by Schlcker Home Improvement Agri 4 This agreement,between ReBath by Schicker and owner/pu. G0 11 IJ Work Order0 I Purchaser Date N_ Yi II 3 5 0 m 1• _ Address Media Installed on xMRU qSl)I Zpbi l City Zip Sale Rep. Installed by ILA Hom �(lp� Cell Work Emai Description of the Project and Description of Significant Materials to be Used and Equipment to be Installed. Contractor will furnish all labor and materials to construct and complete the work to be performed in a good,workmanlike,and substantial manner. A description of = the project and a description of the significant materials to be used and equipment to be installed is set forth below: QTY. Package#: Bathroom: AMOUNT ---I - (Nt v�e,-' K- --- I-t ' yr�rpuk' - �_ n` JJ a- -�-I+ k — --' J+ -�I i-L-4 i — l l �II �� _ -, I--I�I- �� I` S� I1 I-Ff—� 1 — � --T —I I c0UU plan I �I� C 00F F- I I- -- - ub_rotal Pe mi I Cost: $ I t Changl Order and./or adc�itio al terns: $ I I I I I ��'�— C IMPORTANT:C ert. initial ellj/Qv /�r Slip resistant coating on the tub or the shower pan: YES NO El initial —R A* d ng oepc /t V o FV/F ? (THE DOWN PAYMENT MAY NOT EXCEED$1,000 OR 10 PERCENT OF THE AGREEMENT PRICE,WHICHEVER IS LESS.) �FD tC®�C� 013 R@ � II I� $ V/e"v�d E ��GQ�9 Cardholder's Name 7-0Date Check# p�( Total y pQA Credit Card# Expiration Date CCV Approval Code Down Payment $ # $ Bank Loan Loan Approval# Finan is I t't ton Type of Loan Progress Payment Approx.Start Date Approx.Completion Date Si a re Balance 1059 Detroit Ave.Concord,California 94518,tel.925-676-8422,License#: 915382 ��