The URL can be used to link to this page

07110023 CTTY OF CUPERTINO ' " - BUILDINC DIVISIdl�i PERMIT �� "��` ' ,�;. -., ,:... ;: ;::. .. ;�..... BUILDING ADDRESS: PERMIT NO. 10162 BRET AVE CALIFOF:NIA BATHROOM 07110023 . .1ER'S NAME: � PERMITLS6UEDATE GALINA BELOGOLWSKY 783 RE(JENT PARK DR 11/05/2007 PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUIC,DING PERMiTINFO BTH RMI)L, NON-STRCTRL B��c E�.ecr PLUMH MECH 0 0 � 0 u O p LICENSED CON!'RAC'I�R'S DECLARATION JOU DeSCi1pL1011 � 1 M.�cby affirm Uut I am liccnscd unJer provisions af CAaptcr 9(commcncing � Z� wi�h SccGon 7000) of Division 3 of �hc Busincss and Profcssions Codc, and my licenac is �� y in full force and eftect �� 7 � � � Z License Class L�. * �'-� F, p Da1c 4 Contranar 4t'N�v' ti— �' pRCHiTECI"5 DECLARATION � o�t � I undcrsiand my plans shall bc used u public records �qU - ; u. y Licensed Ptufcssional � y � OWNER-BUILDER DECLARATION I hercby ntTirm that 1 am cxcmpt from ihc Comractors Liccnsc Lew for ttic � p O following icason. (Scction 7031.5, Business and P[ofccaiuns Catc: Any city or county �t m Pi which rcquiccs s pctmit m conswct, altcr, improvc, dcmulich, cu repair any swcwre '� Z� prior �o i�s issuancc, alw rcquims thc applicant Cor such permit io filc a signed sta�cment �; , Ft. Floor Area Valuation � � � that hc is liccnscd pursuant m thc provisions of thc ConUactor's Liccnsc Law (Chapicr 9 q y F- �(commencing wi�h Sccdon 7000) of Division 3 of Ihc Busincss and Profeuions Cade) or y �.. ihu he is exempt the�efrom and the buis for �6e allegcd exempdon. Any violauon o( Section 7031.5 by a�ry app►icant [or a pecmit subjecu the applicant to a civi! penalty of APN Number Occupancy Type not more �han fiw hundred dollazs (SS00� � I, u owner of d�e peopcty. or my empioyces with wages u the'v sole compensation, will do the work and ihe stcucwre is not intended or oftcred for sale (Sec. 7044. Business Re uired Ins ecti ons and Professions Code: '!lu Conuactor's License Law does not apply w an owur of Q � property who builds a improves thercon, and who das such Work himult or tMrough his own employces, providcd that such improvements ue not in�ended ar otiercd [or sale• If. dowever, the building or improvement ia sold within one year oC completion. We ownu- builder will have Uu burden of proving Wat he did no� build or improvc [or puryose of sa1cJ. ❑ I, as owner of the property, am enclusively conuuGng wiih lianxd rnnuactors to d wnswct the p�njea (Sec. 7044. Businas and Pro[essions Cade:) The Coatractnr's Li- �*t ccnse I�w docs wt apply w an owner o( propeny who builds or impmvrs thaeon, snd . ��,� !, who convacls for such pmjects with a conuactar(s) iicensed pursuant w ihe Convactor's License L.aw. 1 am uempt undu Sec. , B& P C fw this rcason ,.vnu Date W ORKER'S COMPENSATION DECLARATION I hercby �em under penaity o[ perjury one of the following declarations: ❑ 1 hs+e and will mainuin a Cenificate of Consent w self-insure fw Workers Compen- ution, u providcd for 6y Sectian 3700 ot Urc Iabor Code, for the petformancc oC thc work [or whic6 �his permit is issucd. '�"I have and will muntain Worker's Compensatian Insunnce, u �equired by Scction �00 oC the Labor Code, Cw the performance of the work for w6icA ihis permi� is issued. My Worker's CompensaGon Insunnx nrtier and Policy number arc: cartier: ST�'lr F✓+`^D Poliry No.: �-� °� -� n I z Y'qd CER17F[CA7'E OF EXEMPI70N FROM WORKERS' COMPENSATIONINSURANCE ' (1]�is sectian necd not be complc�cJ if the pecmi� is for anc hundred dollan (S I00) nr Icu.) � I cenify thnt in t6c performance of Wc work for which �his permit is iuucd. I shall not employ any person in any manncr so az to becomc subject a �he Workcrs' Compensation Laws of Califomia. Da1c Applicam NOT(CE TO APPCICANT: If, ahcr making �his CcrtiCca�e of ExempGon, you shoulJ bixome subjcct w �hc Worker's Compcnsation provisions of thc Labor Codc, you muu � O (onhwith comply with such provisions or this permi� shall be dcemcd �evokcd. z "' CONSfRUCT10N LENDING AGENCY [� � I hue6y aRirm Uut ihere is s consuucdan knding agency for the per[urmance u! p�., � �he work for which ihis pertnit is iuued (Scc. 3097, Civ. CJ W A Lendcr's Namc ' ] z Lenders Address (� � I cenify ihat I have rcad this application and su�c ihat thc above informaliun is w � cortccL 1 sgrce w comply with all city �nd county ordinantts and state laws celating w 0 U building consuucUon, and hereby authoria �cpresenuGvcs of ihis ciry w cntcr upon ihc � W atwve-mentioned property for inspection purposes a (Wc) ayce to save. indcmnify and keep harmless ihe Ciry of Cuperuno against �� liabilitiu, judgmenLS, costs and eacpcnses which may in any way sccruc against said City V,'� in consequence oC IAc grantlng of this permi� Date �.S-t'l� �""� APPLICANT UNDERSTANDS AND W1LL COMPLY WITH ALL NON-POINT Issued by: SOURCE ULATTO S. - / /� � ��° 1��°� Re-roofs �/ Signatureo ApphcanUConuactor �� T e of Rc►of HAZARDOUS MATERIALS D[SCLOSURE yp �II Ihc applicant or futurc building occupant uorc or handlc ha•rardous mamrial �ncd by the Cupenino Municipa! Codc. Chaptcr 9.12, md [he Hcal�h and Safcty .ak. Scc�on 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑ Ycs ❑ No Will the applicant or futuec building accupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove cmil harardous air contaminant5 u dcfincd by the Bay Arca Air Qualiry Managcmcm all neW IIliltCilalS fOi IASPCCCIOII. Disuict? ❑ Ycs ❑ Nu 1 havc rcad the haiardau ma�crisls requiremcn�s undcr Chap�cr 6.95 of �hc Cali[or- nia Hcalih & SatctyCodc. Scctions 25505.25533 anJ 25534.1 undcrsw�d thaz if Ihc building docs not curtently havc a �enan4 ihat it is my responsibility w nodfy �hc occupant nf ihc rcyuircmcnts whi h ust be pciorw issuancc of a Ccnificaic of Oc Nry. Signature ��f Applicant Date /�I �7 0 �� p �� . All roof coverings to be Class "B" or better Owner or autho ' .cd agcni CITY OF �UPERTINO 10 ITEMS OF 10 PERMIT RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 37511037.00 DATE ISSUED.......: 11/05/2007 RECEIPT #.........: BS000003162 REFERENCE ID # ...: 07110023 SITE ADDRESS .....: 10162 BRET AVE SUBDIVISION ....... CITY .............. CUFERTINO IMPACT AREA ....... OWNER ............: GALINA BELOGOLWSKY ADDRESS ..........: 10162 BRET AVE CITY/STATE/ZIP ...: CUFERTINO, CA 95014 RECEIVED FROM ....: ALIYN K JOHNSON CONTRACTOR .......: JOFNSON, ALLYN K LIC # 21160 COMPANY ..........: CALIFORNIA BATHROOM REMODELERS ADDRESS ..........: 78= REGENT PARK DR CITY/STATE/ZIP ...: SAI�i JOSE, CA 95123 TELEPHONE ........: 40�3609706 FEE ID UNIT QUANTITY �,MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 191.16 91.76 0.00 91.76 0.00 BPERMFEE VALUATION 12,000.00 191.16 0.00 191.16 0.00 BPFIXTURE UNITS 3.00 27.00 0.00 27.00 0.00 BREMKECEPT NO. OUTLETS 2.00 2.40 0.00 2.40 0.00 BREMVENFAN NO UNITS 1.00 45.39 0.00 45.39 0.00 BSEISMICRE VALUATION 12,000.00 1.20 0.00 1.20 0.00 BUSLIC FLAT RATE 1.00 107.00 0.00 107.00 0.00 EPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 MPERMITFEE FLAT R.ATE 1.00 40.79 0.00 40.79 0.00 PPERMITFEE FLAT RATE 1.00 40.79 0.00 40.79 0.00 ----------- ---------- ---------- ---------- TOTAL PERMIT : 588.28 0.00 588.28 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 588.28 MC --------------- TOTAL RECEIPT : 588.28 -`� � . � �_ � "X l:t'vtri f'It�;;s7i:7� . :�_ �:�,��.t , . <,`'�ui(�C�' �� i'S,;�t1�:y i.:t'[�f;STric�rts;:tf� �� r. �"�' - i C �S� P' ,�u%! � � _ ,._ . ri ..�� _ . � . _ , . ;�., .. , , r, �. � I L5 �� ' '�`` ��,�� ,�,�.t. r;�_u c J�-,v, :� 9- � ri�t _ �:� `�J�r% � �ah: �++.)cS-""�i-�/:% _ � 4� �3 r � G- o L a vf ��y � r� o��c 2 �� 7 _!t _� f 6 �- (� 6t�� T �-✓� - _ � . G��P� 2 r��D 9 S�"� � y_ �-�-�� -�-� 1�-� � L� n, � t �T��r2 r�s ��A-,r� e�. C.o �l3Ti O�v __ �Y, S r�,v � (�-r'= R IiP��- ; / / / // i / / / p�.,�f�,� � _ ---� , _ R. � P�n-cQ � �; �n�4 " � — - ri� �st .�c ►-� . .' _ � S l�l,� w� .� S+� � TC l�- t� � r�� j i �_ _,p Cc,v P�NC y .— i VA Lv� �., �,��-- _; -� _ / i � (Z" f � / �_ ' � � r„ , �r„ � __ a � , _ -- � �3/kT -` �� P � 2 �-d i �,N `� �/ _ F � � /3-N ��2-eP�✓ �v�2d ._ � �c k� I T✓�✓ G- / O v� �- �7'� i'� � 1� � 2� N � / �'' l� n'Z /�- � _ � i o (� �L / ///� ' � / / //�.�// � � �� _ . , �— �n�5� cT .�„ 1 q �- ,�,�f�a� � � � �' t-�9-T H � iN �P�"ci�v�✓ �� _ � t� �t"a `' +1�i�1r`�4ey�,� i�1�'ai�'� �� C�� Qii _ . �n�� c�� r�n ��t��t�cES ' j'` rs�� G�U' � � � ° .� /�� _ _ ��;��' ;:t:atictr�� 7 t ��,, , c� �> �:' 4r � ., �� t ; �,.� .,,, � ,� :-a�� ,. .. � t,.�:�;,�s Gr•,� �t is un � h c , r:�; rC a:�erati�rts � J�S'�.� . i( �'� 9e^ , z, � k � � , � ,' 9 � . « ia t� j1� i7t`$S+t3f4 TCl1111 ( � { � . 1 ; �i ia Pr _ �t.�l f r} '--��Ji ; ��l� *! �,� ) . �� l.l �lf � 1'rtl7� ; . . . . �. t- t�+ ij w! � � w �'t W�+ ' � �� 1 . � . f .�xt{n � �'�ti 'G,. �I s'a� S � ^61� i1 i::, c+...�� 1� �� rtliii - 1 p��, � }�y� +� �,�_[}3�t E)P te k.� :3�� - �� y�frY�iL Nw'-J �a � . .w � . n;t ' .. { .1 � .:� st� yY^.i`.��. . � u+l �,�, • � �;� � ;l. � . . . a`:_t"�';�kL•'t�� 4 th.xa. � t . Y, • .",'; . -�='�a" s,..a^+�.f"" , , .. :+�� .�. !�•' �" � '. � _':'.�i �I�b; 'q '° ` , �r .��< �, � � � �.�� ( g � `_ . �* �� l..Jfil i�.�� r� � .�J") t ' I j.'L�. 1' f C:; l,citliy" i.iClii5fil{dl �l'.(�/ � � � �� wa , � " +` �, i � ` � 5 Y � � 1 � . ` � -t � -., � • �.�! �'l� C'�.�-ti c � r - ss�y'7�}}t' :,i � � +�c � o �� c �_ ,r, ' � . . .. . �.� _�� ,�,v _ ��:-.�, l,L �cf,�. -t.).: �_��;-.�/�% ._ . __. , . � �� (�3 � c.-a G- o L o vf l�y G?-�: r� D,�,�c 2 ��.-� �r, 7. !t n I 6�-- (� 4Li� T�a�✓� - _ �- � v � �-c,� t3� _ G- _ �P� �r�.� 9 S y _ �' .! _ i�-� � 1. ra--� n- �� u r�rt � 1 Sie--r�� L o GA7-i O.iv __ �iy, � r�,v c. �rt-S. _ 21L P ��-t- �- , / / / // � / / / / p�.��l f�,� � , � � ' - �� A �✓c �� Q.� P��-ca � �; �n�4 ' _ - . _ •' �- � � S /-�,� w( ti s� � t l-� t� t ru� %j � _,p � cc� P�9-�✓� y � ' V A �� _ ,/ �,�'� �_ _ , � / � R � �.,, �. � �/-� � � ;� i • � � � — �/k �' � a �- � r�.� �,�. �� _ t - c.K` ' ` �_ _ �( k- F'Y�-N O V P✓�-- ��., _ � � �k� !T✓�✓U � L� i (Li N� �� P� /� 7 -- 0 �!� iN 1��cr�e�l � / /// � � � / g T _T�rP�% � � . � �---> > �/�� . � � �' - � � )� e C �' �-- / I ��"�0 7 � . =;` � '.��' �y � � `.�;:� G _ �n � � _ �.n __;. � _ _ n O � O� � � oc�2.� CITY OF I�UPERTINO r CUPEI�TINO pERMIT APPL�ICATION FORM APN # Date: �7J (C��OU �� S�o7 Building Address: Mailing Address (if different from building address): � � 6 �-- (� �? � �- ,4 v�z - c v�p �i. G� r, �+� o � 4 � ra � y Owner's Name: Phone #: �(�Go�ovs� Zs -3�/GZ Contractor: License #: �- �� o�.,��n ,�r��-�,� � i Tc if2 � Rf�ra�itc. c. 6�I g 71 �' Contact: Phone: y o�- 3 6�-q � a� Cupertino Business License#: � �Y'�t/ —� 1-1NS.��/ Fax: yod -36 °``t'7�) c�� O � Building Permit Info: Bld Elect Plumb Mec Job Description: c� Residential �I Q� ��" � M� D lc. �-- Nn �� 1�-` ommercial ❑ Sq.Ft. Floor Area: � Sq.Ft.: Cost of Project: � Occupancy rou� / Zoo� — Type of Construction: � Please check this box if the project is a \1sv second-sto addition: � Project Size: Standard ❑ Large ❑ M�.'or ❑ Quanti Fee ID Fee Descri tion Fee Grou ' BAPPLOTHER Other A liances MECHANICAL BBOILERI Boiler <= 100,000 Btu MECHANICAL BBOILER2 BoilE;r > 100K to SOOK Btu MECHANICAL BBOILER3 Boi ler > SOOK to 1M Btu MECHANICAL BBOILER4 Boil�;r > 1M to 1.75 M Btu MECHANICAL BBOILERS Ftoiler > 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX In d/Off/Comm/Quasi BUILDING BCONSTAXBQ Cc�n. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Cc nstax — Resi/Mobile BUILDING BELEC 1000 E ec 600V <= l 000A ELECTRICAL BELEC1001 F�lec 600V > 1000A ELECTRICAL BELEC200 ' Elec Svcs 600V <= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING : of 3 CITY OF (�UPERTINO CuPE T�NO PE�IT APPL[CATION FORM R. Quanti Fee ID Fee Descri tion Fee Grou BMISCELL Pdiscellaneous Fee BUILDING BMITIGATC Con�m. Housin Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM Ne�v Comm Mechanical MECHANICAL BNUCOMMP 1`lew Comm Plumb PLIJMBING BOVERTIME Ir.s ection Overtime BUILDING BPBACKFLOW Atmos heric Vacuum PLUMBING BPCESSPOOL Cess ool PLUMBING BPERMFEE 131d Permit Fees BUILDING BPFIXTURE Pbl Fixture PLUMBING BPGAS Ga� Pi ing S stem Fee PLLJMBING BPINTERCEP In3 Waste Interce tor PLUMBING BPLANCHK Plan Check Fee BUILDING ' BPLANCKADD Pls�n Check Add Multi BUILDING BPLANCKREP Pl�n Check Re eat Fee BUILDING BPREPIPE R.e i e Of Fixtures PLUMBING BPSEWAGE Sewa e Dis osal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK La`vn S rinklerBackflo PLLTMBING BPSTORM ��torm/Rain Water PLUMBING gpT�p Kitchen Tra PLLTMBING BPVENT �.lt of Drain & Vent PLUMBING BPWATER Ins1alVAlter Water Pi e PLUMBING BPWHEATER V�ater Heater/Vent PLUMBING BPWSVCS T7ain Water Service PLUMBING BREINSPECT Reins ection Fee BUILDING BREMACOVER A/� Unit > 10,000 cfin MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfrn MECHAI�ICAL BREMAPPLI Appliance Install MECHAI�TICAL BREMBUSWAY Zemodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN R�,location of Furnace MECHAlvICAL BREMFURNOV Re lo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD L�stallation of Hood MECHANICAL BREMMISC Misc Ap aratus ELECTRICAL BREMNRApp Rein Non-Res A liance ELECTRICAL BREMPOLE P��le/Platform Fixture ELECTRICAL BREMPOWER Pov��er Device/A aratus ELECTRICAL . BREMRECEPT Rc rtl, Switch & Outlets ELECTRICAL BREMRELOCA ]Zelocation of Hood MECHANICAL BREMREPALT R_epair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 CITY OF i�UPERTINO CUPEt�TINO PERMIT APPI,ICATION FORM Quanti Fee ID Fee Descri tion Fee Grou BREMSIGNAD Rnidl Signs Add Branch ELECTRICAL BREMSIGNS Rernodel Si s, Maz uee ELECTRICAL BREMTHEATR Tr.eatrical Lighting Fix ELECTRICAL BREMVENFAN V��nt Fan Sin le Duct MECHANICAL BREMVENSYS �"entilation S stems MECHANICAL BSCBLVD Scb S ecific Plan BUILDING BSEISMICOM S��ismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL S ecialIns ection BUILDING BSWIM Swimming Pool BUILDING BTEMP 'Cem ora Power ELECTRICAL BTEMPPERM Ter.z ora Bld Permit BUILDING BTEMPSVCS Tem Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical s foot ELECTRICAL EPERMITFEE El ec Permit Issuance ELECTRICAL MPERMFEE Prlechanical sq. foot MECHANICAL MPERMITFEE M�;ch Permit Issuance MECHANICAL / PPERMITFEE Plu.mbin Permit Issue PLUMBING PPLBG P.umbing Fee s foot PLUMBING PLLONGRNGC Plannin;T LR Comme/ Multi-Fam PLANNING PLLONGRNGR Plannin�� Lon Ran e Residential PLANNING : of 3 � ° �.: Community Development �,, 10300 Torre Avenue a� .; �� ,�. Cupertino CA 95014 '�":` � Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 CUPEf�,TINO Buildi:n De artment JOB ADDRESS: PERMIT # / O/( Z- Y� t fZ-'� �T ,A- v h._ �«�'2-3 OWNER'S NAME: � G_d �, S � PHONE # �/o�- o-�'70 0 GENERAL CONTRACTOR: C'A � � � . ��Tr� d ,� c�+�,� ,vl . FAX # y � - � � � - � � .L ti-C . I am not using any subcontractors: / �� °�� Si�;nature Da e Please check a licable subcontractors and com �lete the followin information: SUBCONTRACTOR BUSITfESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linolewn / 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