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13110037 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21849 LINDY LN CONTRACTOIY?—rMT T$$E PERMIT NO: 13110037 1 offtFE),_ OWNER'S NAME: PANGRLE BARRY M AND SUZETTE K Chvvr. DATE ISSUED: 11/06/2013 OWNER'S PHONE: 4088365966 1 Wwrlm 4,040 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 0 COMMERCIAL 11 License Class Lic.# r(6' I l REMODEL(2)BATHROOMS 210 SQ FT TO INCLUDE M,E,P'S Contractor�aye,5 n�+tp lLk"A 7-1- Date %( 4' ✓� 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:$30000 I have and will maintain Worker's Compensation Insurance,as provided for by Q� Section 3700 of the Labor Code,for the performance of the work for which this APN Number:35625022.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT IRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 0 DAYS OF 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 M LAST 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 by: Date: 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. J� RE-ROOFS: Signature Date 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. 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 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: 'A Date: 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 t [is COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �v 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 �\ CUPERTINC) (408)777-3228• FAX(408)777-3333•buildingC&cupertino.org ❑NEW CONSTRUCTION ❑ ADDITION LI ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS L 9 C) t / APN# Zz - OWNER NAME tL e �� V, I� PHONE d E-MAIL STREET ADDRESS I`I/ ` I CITY, STATE,ZIP O (O C�p FAX 1. Gii ✓Y�lVlJ i 64, 7� { CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME r LICENSE NUMBER LICENSE TYPE BUS.LIC# C_ e7V,; (tie/(, , q Zy �- .� COMPANY NAME 4 vC rs �J� ,/ , It`,J 3'�C E-MAIL FAX STREET ADDRESS //,�JOa 1� (� CITY,STATE,ZIP C! PHONE n J� -2 16, C:4 ARCHITECTIENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE I CONSTR.TYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION(S) EXIST NEW FLOOR DEMO TOTAL AREA AREA NET AREA BATHROOM CHEM OTHER REMODEL AREA 2 REMODEL AREA REMODEL AREA PORCH DECK AREA TOTAL DECKPORCH AREA GARAGE AREA: EIDETACH ❑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 RECEIVEr TOTAL VALUATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? F]NO D Y: V 30, POO By my signature below,I certify to each of the following: I am the property owner or authorized agent to Act on the property ner's behalf. I have 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 1 with all a ocal ordinances and state laws relating to bu ldina construction. I authorize representatives of Cupertino to enter the above-identifi property for inspection purposes. Signature of Applicant/Agent: �' Date: r'� 13 SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP New SFD or Multifamily dwellings: Apply for demolition permit for ovER-TINE Cou15 BUILDING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of bui Ing 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 D>PT• _Copy of Planning Approval Letter or Meeting with Planning prior to >,tiaaolz ❑:SANITARY SEWER DISTRICT' submittal of Building Pen-nit application. ❑ `ENVIRONMENTAL HEALTH BldgApp_201 1.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: DATE: 11/06/2013 REVIEWED BY: mendez APN: BP#: 'VALUATION: 1$30,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Du lex PENTAMATION 1 R3SFDREM USE: p PERMIT TYPE: WORK remodel 2 bathrooms 210 sq ft to include m e 's SCOPE lfc<:1�. !'I n Cktck P omb N(w C7r,c Pic',_ Phi? L1711, 11,7!'�'rntil P,��" I lntnt�, I'tsnai!l ie- ETLl�r_ P'arrni7l``.E': 1'tec,it. irtsj> t)t(ic�r t'ir m:lr�< �. C�t,',e, 1"_W('Illy, alr�h,Insp. 1°�r<t: P'17110) /i;,1z Vc" Iae�.ln'y. {' c NOTE.This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). These fees are based on the prelimiina information available and are only an estimate. Contact the Dept-for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E,(f.' 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 210 s.f. Remodel,Bath(<=300 sf) Suppl.PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $626.00 1REMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp.Fee-0 Reg. Q OT O,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction 7'ax: zidmillistrativo Pee: Work Without Permit? 0 Yes 0 No $0.00 L 0 Advanced Planning Fee: $0.00 Select a Non-Residential 0 Building or Structure 0 (r-trti>el Dt>cttanerrtulinrt I��es: Strong Motion Fee: IBSEISMICR $3.00 Select an Administrative Item BldP_Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $5.00 $626.00 TOTAL FEE:' $631.00 Revised: 10/01/2013 LASE 7—Y fit _ f AC Cly ` T-11,CfS � � aV RA IM Rod 7'410 . �~�fi"jE Y•4�S $x:91 '. C ��F'�,CN�'P Y C(�✓�r+ ��I�(ars{ L L).U� / Om'CE C NOV 0 E 201 r- - - - - - - - - - - - - �— - - - - — � I B24R I SB24R I B24R I I a Go Y�o r I CV � o� I � N� cri\x \ 5'-7 5/8" 4'-2 7/16 GR/ r 3WS - - - - - - - - - - - - - - - - - —� �'6 s �s 11 1 kecesS (�yG�f. PONY i' v a� of VAOP , �o1 teA.sr 7z 1, Ki 6f) O;F -�. r' ov NOV Q 2013 I 13 T „ I $ -5 x 8,-11 I N � I i \ 2668 Qe 9eD -44 X�Ee7 Two ar- v o Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: 218-1119 LlIkAl 114 PERMIT# OWNER'S NAME: PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: 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. I am not using any subcontractors: j Signature date Please check applicable subcontractors and complete the following information: 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 liate