13050167CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS, 1,0140 PASADENA AVE
CONTRACTOR: BATH FITTER
PERMIT NO: 13050167
NORTHERN CALIFORNIA
OWNER'S NAME:I GEORGE OMEN
2118 ZANKER RD
DATE ISSUED: 05/22/2013
OWNER'S PHONE 4084644757
SAN JOSE, CA 95133 PHONE NO: (408).834-1111
-LICENSED CO CTOR'S DE ARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL EI
01 •
License Class Lrq
REPLACE (E) WATER MIXING VALVE &I (E) BATHTUB
Contractor . Date O�
I hereby, affirm that I am' licensed under the. provisi ns of Chapter 9
(commencing with; Section, 7000) of Division 3 of the Business & Professions
Code and that mylicenseis in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certtfipate'o . consent to self-insure for Worker's
Compensation asprovided for by Section 3700 of the Labor Code, for the
performance of the work. for which this permitis issued.
Sq. Ft Floor Area:
Valuation: $2900
I have and will maintain Workers Compensation Insurance, as provided for by
APN Number: 35717094.00
Occupancy Type:
Section 3700 of the!Labor'Code„for the performance of the work for which this
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
COI 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
WIT 180 DAYS O RMIT ISSUANCE OR'
upon the,above mentioned property for inspection' purposes. (We) agree to save
1 D YS F 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 theV.
b fi711)
granting of this permitill. Additionally; the applipant understands and will comply
With all non-point source zegulationsiper the Cupertino Municipal Code, Section
918. 'I
6ny
Signature' � Date
roofing
All roofs shall be inspected prior to any roofing material being installed: If a roof is
tJill
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
l
❑ BUILDEk'4CLARATION,
I' i' �WNE13
-r
l I,I ii
I hereby affirmthat am egempt from the Contractor's License Law for one of
Signature ofApplicant: Date:
the following twp reasorls.l �'i ;I '
I as ovyger of the tiY prope pr m i alploypes with wages as their sole compensation,
ALL ROOF COVERINGS TO BE CLASS "A'! OR BETTER
X I
will do Iihe work, and the'stn cture is not rirtended or offered for sale (Sec.7044,
Business 4 Professionsodej
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (!Sec17044 )iusiness &Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
''•'I
I hereby,;affirm underi'ppunity of perlu one of the following three
California Health & Safety Code, Sections 2550$, 25533,.and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations. ; .!, I� i'
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a,Certrficate of Consent to self-insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
CompenslI ation as pigyidgd for b , Sgct cir 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I.
the Cupertino uuicipal Code, Chapter 912 and
performance of the:ivork �or;wilich this permit'is issued.
will maintain compliance with
I have and wilt maint in Y &kerls,Conp nsation Insurance, as provided for by
Sectio 700 f ``!!elLal�o}C de,or the performance of the work for which this
the Health & Safety Code, Sections 2550 5533, and 534;
Date:
n
Owner or authorized agent:
permtt' isl issued.) i
I certify that m the perfo ante of the. work for which this permit is issued, I shall
Worker's
not'em toyan �inany,marinerlso, as to become subject to the
Compile at IawS�oflC �fornia tf; aftefilmaking this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
nu
becpmubJect to the Wrker s compensation, provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performanceof
work's for which this permit is issued (Sec. 3097, Civ C.)
fo hwf Iclom I� w�su�hiprov'sroirloi t#r s permit shall be deemed revoked.
p t
Lenders Name
P ii l li
11 l
u :
II �•'•,.
IiI'APPLICAN Cl•;RTIFICATION
Lender's Address
I cert�fythatiI have reed t i5'applicaoon and,state.thatithe:above information is
state laws
correct;', 1, agree to con}ply with a)1 city and•county ordinances and 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
indemnify andlheep harmless the) City, of Cupertino against liabilities, judgments,
ARCHITECT'S DECLARATION
costs, and ex enses w wla may accrue against said City in consequence of the
p
I understand my plans shall be used as public records.
granting',of this pe rrtrt Additron�ljy;l the applicant understands and will comply
with all Inon pq' t s a ce lre,gulattppns per tl}e Cupertino Municipal Code, Section
ii
'nl
Licensed Professional
918'�IIIj�,I
• , I II'I i' III' � '�;� 'i Ili
' l 11111-10
Srgnatutc itI:� ' Date'
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DMSION MEP
� O
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 O�
(408) 777-3228 • FAX (408) 777-3333 • buiiding6kupertino ora , '1 misc
PROJECT ADDRESS ' 1 p
1 n t n i-� Q G. i� `T1 t� A ► Q— 19x1 j '� F Z i 7 _ . t 'a— _ , f �l ll
❑ OWNER ❑ OWNER-XMDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCmTEcT ❑ ENm7 ❑ DEVELOPER ❑ 'rmyr
CONTRACTOR NAME
1p}�
' n z-, A I IA --k l 1 1=: TT T ricR A r r1 nu E _ _ . i I BUS. WC
ARCMTECT/ENaXM NAME
COWANY NAME '
STREET ADDRESS
USE Of 'r DUPLEX
W=ING: o comm I=L
DESCRnMON OF WORK
LICENSE NU11O3EJZ
E-MAM
CRY, STATE, W
MULTI-FAICLY I PROJECTW WIIALAND ❑ YES
URBAN INTERFACE AM ❑ NO
PROIECTIN ❑ YES
FLOOD ZONE ❑ NO
08 —$�x4-1112
L-mg—w%(
BUS. Lit: #
FAX
PHONE
LS THE BLDG AN ❑ YES
EXHLER HOhm? ❑ NO
TOTAL VALUATION: t'?L
BY my signature below, I certify to each of the following. I am the property owner or authorized agent on th owner's I have read this
application and the information I have provided is have
ordinances and state laws relating to s Description of Work and verify it is ac " te. I agree to y with all applicable local
representatives of Cupertino to enter the above -i ti&d
SignaMm ofApplicant/Agmt
Date:
oa —A�
4
❑ EXPRESS
v
❑ STANDARD
❑ LARGE
I
❑ mmoR
A ENWTCApp 2011.doc revised 06/11/11
a ..
MEm
1 1 see _Ai �.! ►V1
. �I , , f
❑ OWNER ❑ OWNER-XMDER ❑ OWNERAGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCmTEcT ❑ ENm7 ❑ DEVELOPER ❑ 'rmyr
CONTRACTOR NAME
1p}�
' n z-, A I IA --k l 1 1=: TT T ricR A r r1 nu E _ _ . i I BUS. WC
ARCMTECT/ENaXM NAME
COWANY NAME '
STREET ADDRESS
USE Of 'r DUPLEX
W=ING: o comm I=L
DESCRnMON OF WORK
LICENSE NU11O3EJZ
E-MAM
CRY, STATE, W
MULTI-FAICLY I PROJECTW WIIALAND ❑ YES
URBAN INTERFACE AM ❑ NO
PROIECTIN ❑ YES
FLOOD ZONE ❑ NO
08 —$�x4-1112
L-mg—w%(
BUS. Lit: #
FAX
PHONE
LS THE BLDG AN ❑ YES
EXHLER HOhm? ❑ NO
TOTAL VALUATION: t'?L
BY my signature below, I certify to each of the following. I am the property owner or authorized agent on th owner's I have read this
application and the information I have provided is have
ordinances and state laws relating to s Description of Work and verify it is ac " te. I agree to y with all applicable local
representatives of Cupertino to enter the above -i ti&d
SignaMm ofApplicant/Agmt
Date:
oa —A�
4
❑ EXPRESS
v
❑ STANDARD
❑ LARGE
I
❑ mmoR
A ENWTCApp 2011.doc revised 06/11/11
APPLIANCE /. EQUIP TYPE FEE ID QTY UNITS BP FEES
Fixture Set on One Trap 1BPFIXTURE 1 # $10
FEE 'ITEMS (Fee'Resolutlon II -053E . 7ff 11/12)
ADDRESS: 10140 PASADENA AVE
DATE: 05/22/2013
REVIEWED BY: MELISSA
Plein Check Fee:
APN: 35717 094
BP#:
`VALUATION:
$2,900
-PERMIT TYPE: Plumbing Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY .
SFD or Duplex
$0.00
PENTAMATION 1 RPFIX
PERMIT TYPE: i
USE:.
S41.)Rr It s, red
Vt'ORK
REPLACE WATER MIXING VALVE &BATHTUB
.SCOPE
$10.00
APPLIANCE /. EQUIP TYPE FEE ID QTY UNITS BP FEES
Fixture Set on One Trap 1BPFIXTURE 1 # $10
FEE 'ITEMS (Fee'Resolutlon II -053E . 7ff 11/12)
FEE
QTY/FEE
MISC. ITEMS
Plein Check Fee:
Srrlal. FC!I cc,l
PME Plan Check:
$0.00
Permit Fee
S41.)Rr It s, red
P1VIE Unit Fee
$10.00
F1VIE',Permi Fee: '.
$45.00
Q fakZJttttc'ltUn ZcT.1.
Administrative Fee:, IADMIN
$42.00
Work Without Permrt7: !0 Yes 19 No
$0.00
ll'.YG1i1�1 /LMinn�, 1'G'L'$
I- e'. '''
'ravel Docum;eiitatrbn,e , ITRAVDOC
$ 45.00
Stron 1V1� o 'hee ;' �' ;� IBSEISMICR
�
$0.50
Select an Administrative Item
Bld Sg tds ommission Fee IBCBSC
$1.00.
$143.50
$0.00 $143.50
�\ • Revised: 04/29/2013
.noxi ., ...� ... - s "�Y: - � - .. -•. .. - T: - A � _ ..;`1 _ .,
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
C O P E RT I N O Telephone: 408-777-3228
Fax: 408-777-3333
CONTRACTOR /SUBCONTRACTOR LIST
JOB ADDRESS: 7
at 5-a lellaP q //-e
PERMIT #.-: , L7 U
OWNER'S NAME: {p
oxel( l(
PHONE # - -'771-1
GENERAL CONTRACTOR•
, f e—P-
BUSINESS LICENSE:-#.
ADDRESS: n� ad'P ,P!/
�a Old
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 SUBCONTRA T RS HAVE OBTAINER"A CITY OF CUPERTINO
BUSINESS LICENSE. 9
I am not using any subcontractors. oC
Signature bate
Please check annlicable subcontractors and comnlete the following information:
s/ 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
I
I
CITY OF 'CUPERTINO BUILDING PERMIT
BUILDING ADDRESS 19900 OLIVEWOOD ST
CONTRACTOR: ABE CONSTRUCTION,
PERMIT NO: 13050166
INC
OWNER'S NAME;, ESSEX PROPERTY TRUST
528 E WEDDELL DR STE 4
DATE ISSUED: 05/22/2013
OWNER'S PHONE,6504943700 • .
SUNNYVALE, CA 94089 PHONE NO: (408) 734-8416
JOB DESCRIPTION: RESIDENTIAL COMMERCIALS
. LICENSED CONTRA&TOR'S DECLARATION
/�%i� C,I
License Class_ c '# ' q (0 3 3 —I
UNIT D- REMODEL BATHROOM, KITCHEN ADD NEW
ate 5 2
LAUNDRY
ROOM, UPGRADE ELECTRICAL PANEL
Contractor'—13—
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with! Section 7000); of Divisio*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: the Labor Code, for the
performance of the; work f.or which this:permit is issued.
Sq. Ft Floor Area: Valuation $24000
orkers Compensation Insurance, as provided for by
I have and will maintain :,;,J
Section 3700 of the Labor Code, for the performance of the work for which this
APN Number: 31643004.19900 Occupancy Type:
permitis. issued.
APPLICANT CERTIFICATION
I certify, the I have lead is application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct! lagree to complwith all city and caunty;ord;nances and state laws relating
WITHIN 80 DAYS OF PERMIT ISSUANCE OR
to building, construc�hgn, and hergbY auihoi.� representatives of this city to enter
upon, the'�'iiboye mehtrone, property for inspectior>; purposes. (We) agree to save
180 DA OM LAST CALLED INSPEC ION .
indemnify and keep ha►miess the, i itylof Pgpertino against liabilities, judgments,
costsnd �wltiFti may apgrueiglamst said City in consequence of the
Date: 13:
exp$nseS
of this perrnrt 4dditionall} ;the applicant understands and will comply
Issued by
granting
withpl at Irlon pgmt s `1 I t a lat r the Cupertino Municipal Code, Section
Ij�I!I
I I
Srgnatµre II I Date
RE-ROOFS:'
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
j
[3'; ; Ili' !I I,' OWNER-BUILDER DECLARATION
inspection.
Date:
Signature of Applicant:
I hereby affirin thatiI am exem t from,the:Contractor's License Law for one of
the following two reasotls:i" �'
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 dolthe work, a d � c structure rsl,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
construl. Ict;the project (Sec,7044 Business & Professions Code).
I have read the hazardous materials requirements under. Chapter 6.95 of the
I',
JillI hereby, affirm, under penalty of perjury one of the following three
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations. 1 ,' I j
I have and will of Consent to self-insure for Worker's
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which,emit hazardous
maintain a:&rtifrcate
Compensaiio.r 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
compliance with the Cu tin nid pal Code, Chapter 912 and
perforiiiance of the wgrk or'whiQb thislpermit is issued.
I have will maintain orkers.Compensation Insurance, as provided for by
will maintain
the Health & Safety Code, Sect' n 25 5, 5 ,and 25534.
and
Section 3700 of thelLabo�Codeorlthe performance of the work for which this
Owner or author' d agent Date: Z�
permit �sl, issued ,, �' J I Ill
I that in the, of the work for which this permit is issued, I shall
certify, performance
not employ any person ml I any manner so, as to become subject to the Worker's
ofalifom a 'I after malpr►g this certificate of exemption, I
Compensation f
CONSTRUCTION LENDING AGENCY
llaws'i , } o li
!subject thelW iter s Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of
becom. to
forthwipl comply, witiilsuhlprouisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
I
Lender's Name
I
I!IIII I, ",PLI ANT ERTIFICATION
Lender's Address
I certr that,i hate Ee I tslapotic40, and,state thatthe,above information is
`�'
correct II agree to l with crt}� anc� county ordinances and state laws relating
tt l d TJ brae representatives of this city to enter
to huill}�rig comstfi► rls lh
upon the, above nienrrgpedl property] form pecUon; purposes. (We) agree to save
miji6i rr� ' dlkeep h ess the, City ot`�upertmo against liabilities, judgments,
11ay e1g in of the
ARCHITECT'S DECLARATION
I my shall be used as public records.
costs and' e:tpenslgs1 rc1�I ac iainst said City consequence
IQf and will comply
understand plans
m flrr peri�r Additronallthe &pplicant understands
with, �alnon p int' s eG a latrons perk a Cupertino Municipal Code, Section
i III ! t
1. h
911i
Licensed Professional
I
I ail I S I Ii Date
Signature
IIII'IIh l
III
.. .
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 - building(a)cuoertino.org
❑ NEW CONSTRUCTION ❑ ADDITION ICA ALTERATION / TI ❑ REVISION / DEFERRED
130��
JAL PERMIT #
PROJECTADDRESS'ggW Ol�vev�oocL - D
APN# (� I- qf�°
OWNER NAMECo/y
PHC/ —LP4- Z;
E-MAII
STREET ADD S
C TATE ^ ^ A I FAX
CONTACT NAME`
P ,` S ICS `l?CO Z
�'t
E-MAIL
STREET ADDRESS
CITY, STATE, ZIP
F,yX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRAC NAME
LI
E BUS. LIC #
&ME
E -MAIL FAX
— —
STREET ADDRE,Z�t M`��S CLTY,STATE, ZIP PHONE _7 `�
1
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC #
COMPANY NAME
E-MAIL FAX
STREET ADDRESS
CITY, STATE, ZIP PHONE
DESCRIPTION OF WORK `
1
EXLSTWGUSE
PROPOSED USE
CONSTR TYPE
#STORIES
I
USE
TYPE
OCC.
SQ.FT.
VALUATION ($)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
2 O
2�0
2 lL
BATHROOM KITCHEN OTHER
REMODEL ARBA �ZO REMODELARBA 1 REMODEL AREA
PORCH AREA
DECKAREA
TOTAL DECK/PORCH AREA
GARAGE AREA DETACH
❑ ATTACH
I
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEINGADDED? ONO
ADDITION? ONO
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
RECEIVED $ ;
TOTAL VALUATION:
2Q, Mn
By my signature below, I certify to each of the following: I am the property owner or authorized ag nt act on the property owner's behalf. I have read this
application and the informatio ve p is co have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws rel g •fib ding o I authorize representatives Of Cupertino to enter the above -i n�ti7fieedd roperty for inspection purposes.
Signature of Applicant/Agen Date: �+L--
SUPPLE ION REQUIRED
PLAN CHECK TYPE
ROUTING SLIP
_ New SFD or Multifamily dwellings: Apply for demolition permit forOVER-THE
existing building(s). Demolition permit is required prior to issuance of building
COUVIER
❑ BUIIAING PLAN REVIEW
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
❑ STANDARD
❑ PUBLIC WORKS
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
submittal of Building Permit application.
El NLAJOR
❑ S_AAITARY SEWER DISTRICT
❑ ENVIRONMENTAL HEALTH
BldgApp_2011.doc revised 06/21111
CITY OF CUPERTINO
TTT Tonrink i A TlID DITTT nTN!_ nTVI<el<(1N
llech Ptan .Cheek Plumb. Plan Check Elec. Plan Check 0.0 hrs $0.00
Lteclr..l'trnait l ee` Plumb. Permit Fee: Elee. Permit Fee: IEPERMIT
DtTze r �gech: hasp! Other Plumb Insp.El
Other Elec. Insp. 0.0 hrsL$45.00
fldech. Insp. Fee: Plumb. hasp. Pee: Elee. Insp. Fee:
,NOTE: This estimate'.does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
lL...t..nttbo Aontfnraddn'1 info
District; eta). These fees are: basea on tneprellnUnarY
FEE ITEMS (Fee Resdlution41-053 Eff.' 7/1112)
Plan Check Fee:
Suppl. PC Fee: O .Reg. O OT 0.0 hrs
PME Plan Check:
Permit Fee: Hourly Only? O Yes O No
Supp1: Insp. Fee:= .Reg. O.OT 0.0 hrs
PME Unit Fee::
PME Permit Fee:
Construction .raX
Administrative Fee: IADMIN
Work Without Permit?' O Yes O No
Advanced Planning Fee
Travel:Documentation Fee: ITRAMOC
Strom 1Vlotiori Fee. IBSEISMICR
Bldg Stds iCommission Fee: 1BCBSC
FEE QTY/FEE MISC ITEMS
$0.00::L
0.00125 amps Electrical
$0.00 $45.00 IBELEC200 Services
$0.00
$0.00
$0.00
$0.00
$45.00
$42.00 V
$0.00
$0.001I 5 I hours Inspections
$45.00 $665.00 1STINSP Inspection, Hourly
$2.40 Select an Administrative Item
$1.00
$135.40 $710.00 $845.40
Revise 13
19900 OLIVEWOOD ST #D
DATE: 05/22/2013
REVIEWED BY:
ILIADDRESS:
APN:
BP#:
*VALUATION:
$24,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY
SFD or Duplex
PENTAMATION 1 REAP2
PERMIT TYPE: i
USE:
wORK
UNIT D- REMODEL BATHROOM KITCHEN ADD NEW LAUNDRY ROOM UPGRADE ELECTRICAL
SCOPE
PANEL .
llech Ptan .Cheek Plumb. Plan Check Elec. Plan Check 0.0 hrs $0.00
Lteclr..l'trnait l ee` Plumb. Permit Fee: Elee. Permit Fee: IEPERMIT
DtTze r �gech: hasp! Other Plumb Insp.El
Other Elec. Insp. 0.0 hrsL$45.00
fldech. Insp. Fee: Plumb. hasp. Pee: Elee. Insp. Fee:
,NOTE: This estimate'.does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
lL...t..nttbo Aontfnraddn'1 info
District; eta). These fees are: basea on tneprellnUnarY
FEE ITEMS (Fee Resdlution41-053 Eff.' 7/1112)
Plan Check Fee:
Suppl. PC Fee: O .Reg. O OT 0.0 hrs
PME Plan Check:
Permit Fee: Hourly Only? O Yes O No
Supp1: Insp. Fee:= .Reg. O.OT 0.0 hrs
PME Unit Fee::
PME Permit Fee:
Construction .raX
Administrative Fee: IADMIN
Work Without Permit?' O Yes O No
Advanced Planning Fee
Travel:Documentation Fee: ITRAMOC
Strom 1Vlotiori Fee. IBSEISMICR
Bldg Stds iCommission Fee: 1BCBSC
FEE QTY/FEE MISC ITEMS
$0.00::L
0.00125 amps Electrical
$0.00 $45.00 IBELEC200 Services
$0.00
$0.00
$0.00
$0.00
$45.00
$42.00 V
$0.00
$0.001I 5 I hours Inspections
$45.00 $665.00 1STINSP Inspection, Hourly
$2.40 Select an Administrative Item
$1.00
$135.40 $710.00 $845.40
Revise 13
Building Department
City Of Cupertino
La 10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C U P E RT I N OFax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: 10CIC0 / L/,0G(/p(X4 Ste -)PERMIT #
SUBCONTRACTOR
OWNER'S NAME: 1'iJ PHONE #
-.BUSINESS LICENSE #
GENERAL CONTRACTOR: BUSINESS LICENSE #
Cabinets & Millwork
ADDRESS: CITY/ZIPCODE:. Y &
*Our municipal code requires all businesses Working in the city to have ik.,City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL,BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCO T CTO HAVE .OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:<
Signature Date
Please check applicable subcontractors and complete the following information
Owner / Contractor Signature
Date
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