Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
13090167
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10695 MERRIMAN RD CONTRACTOR:NOR CAL PERMIT NO:13090167 CONSTRUCTION AND OWNER'S NAME: SPARKS WILLIAM R AND JOAN M 4181 1ST ST DATE ISSUED:09/23/2013 OWNER'S PHONE: 4089232055 LIVERMORE,CA 94551 PHONE NO:(925)449-7774 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 1 COMMERCIAL II License Class_ Lic.# `7 cld REMODEL(E)HALL BATH TO INCLUDE(N)SHOWER, PAN, Contractor 1 L+d,.S.,. .Alf0Date , I�-13 LIGHT FIXTURE&TILE I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 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 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$3000 1 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:34216128.00 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 DAY RMIT 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 DAO 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 Date: zzoh granting of this permit. Additionally,the applicant understands and will comply sue with all non-point souce regulations per the Cupertino Municipal Code,Section 9.18. ,�A r RE-ROOFS: Signature '`" Date s 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) I,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. I 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,Sectio 5 553 nd 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: ��3 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 Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY 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 CONSTRUCTION PERMIT APPLICATION �b COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION G 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228.FAX(408)777-3333-buildinta0cupertino.org �( L.✓, ❑NEW CONSTRUCTION ❑ ADDmoN ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS 10 V r APN# 3 2 _ (o OWNERNAME "Mo� O �M' w I� iqeaPIA!; H'15rA 14, STREET ADDRESSWO 1 m�,Jl r) �� C STATE"r I in oO IIf FAX CONTACT NAME 11!+ C 1 S PHO 3^� 7 q 2 -MAIL STREET ADDRESS L ` �. C Y STATE,ZIP /S D FAX �1 gl -1-gr 4 iJl+�w�o� r M rt "A q ❑OWNER ❑ OwNER,-/BUILDER 13OwNER AGENT 13 CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT 11 ENGINEER 11 DEVELOPER 11 TENANT CONTRACTOR NAM / ►E 0 (4 C, 1Q5 1 Ig y le CENSE % vLICENSE BUS.LIC# COMPANY NAME or CAI Con I evE.MAII !O V S D �r S t► LSTA ZIP C ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL. FAX --TSTREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORKyr ev I EXISTING USE PROPOSED USE CONSTR T7 77 USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMO I TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA �© PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? []NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO By my signature below,I certify to each of the following: I am the property owner or autho' agent toact on owner's behalf. I have read this application and the information I have provided is correct. a read the Description of Work and verify'g1pacarate. I agree to comply with all applicable local ordinances and state laws relating t do authorize representatives of Cupertino to enter the abov identif d property for inspection purposes. Signature of Applicant/Agent: Date: 3 SUPPLEM INF TIO QUIRED PLAN CRECK'Mx ROUTING SLIP _New SFD or Multifamily dwellings: Apply for demolition permit for ❑ OVER THE-COUNTER ❑ BUILDING PLAN REVLEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ "MUC 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 ❑' MAJOR: ❑ sANiTARY SEWER DISTRICT submittal of Building Permit application. ❑ 'ENVIRONMENTALHEALTH B1dgApp 2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10695 MERRIMAN RD DATE: 09/23/2013 REVIEWED BY: MELISSA APN: 342 16 128 BP#: *VALUATION: 1$3,000 'PERMIT TYPE: Building PermitI PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: I I PERMIT TYPE: WORK I REMODEL HALL BATH WITH N SHOWER PAN TILE LIGHT AND SHOWER FIXTURES SCOPE Circ 'ttt±L;,'rec: Plumb.Ph.n L he,,;" h. /';F;i't:^7T?./`£:e: �t€iP;1T.I'y£'..r;Pill :: Z£'.£'..Per7i7YF:c. 111,%€C'i'r�£:C=3,iYf?Sr%. (,)t1d:'a',�tlf.=?P,#•f€.1'j3, .1`,1;:'i:". Li 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 preliminar information available and are on an estimate. Contact the De t or addn'1 info. FEE ITEMS (Fee Resolution 11-053 E . 7/1113,) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 20 s.f. Remodel,Bath(<=300 sf) Suppl.PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 $626.00 IREMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl.Insp.Fee.-(j) Reg. ® OT 0,0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C o'r"fit?'fiction' Tax.` Fee: 0 Work Without Permit? 0 Yes (F) No $0.00 G Advanced Planning Fee: $0.00 Select a Non-Residential G 7 y Building or Structure CI 1 I"Lf5°F.''I.f..�f)e%�IdIYIE;J"IXCPITfSI?1`F�E�,�', � Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 giB € ALS $1.50 $626.00 TOTAL FEE: $627.50 Revised: 08/01/2013 Closet (1) _ M0 DEPARTMENT G �• V�,1 I�ORSION-CUPERTIhO APPROVED This set of plans and specifications DUST be kept at the job site during construction. It is unlawful to make any changes or alterations on same, or to deviate therefrom,witb ut approval from the Building Official. The Stamping of this olan and specifications SHALL NOT Bedroom be hel It or to n approval of the violation ce or State Law. OT kso , } PERWT NO. r dou wma C Emm offiffiky Ba r m CUPERTINO D EP 2 3 2013 3uilding Dene S h rtrnent EP 2 2013 BY �4, 4,SZ> REVIEWED FOR CODE COMPLIANCE Reviewed By: