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13110065CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10980 MARIA ROSA WAY CONTRACTOR: -TBBjf6 Bl± PERMIT NO: 13110065 OWNER'S NAME: BECCIA ANTHONY R AND DORIS C T I _TAen & i n r 141J4S/eU,.A7r j I DATE ISSUED: 11/12/2013 —1 OWNER'S PHONE: 4082530428 PHONE NO: tZ LICENSED CONTRACTO R ' S DECLARATION License Class_ Lie. # 5V,0!203 Contractor (-OM) C SJR SI . Date 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. 4 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 permit is issued. APPLICANT CERTIFICATION I certify that I have read this. application and state that the aboveinformation 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 indemnify and keep harmless the Cityof Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 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 l— Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. 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 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 become subject to the Worker's Compensation, provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the 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. Date JOB DESCRIPTION: RESIDENTIAL REMODEL (2) BATHROOMS HALL & M.BATH 181 SQ FT c ?rte lwdt , M, E; Ps - Sq. Ft Floor Area: I Valuation: $20000 APN Number: 35618004.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN DAYS OF PERMIT ISSUANCE OR 180 DAY ROM LAST CALLED INSPECTION. Issued by: Date: %Z /%. 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 inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cu lino Municipal Code, Chapter 9.12 and the Health & Safety Code, Secti 505, 25533 5534. Owner or authorized agent: Date:��" CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 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.cupertino.org [:]NEW CONSTRUCTION ❑ ADDITION X ALTERATION / TI ❑ REVISION /DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS / 1 /%� 9 b 0 ! APN # 35 I G r' S rj !/` OWNER NAME 7E Ce (Co- 1t1 0 �S ��/1V�S &MAIL VCS L/' STREET ADDRESS M n , CITY, ATE, ZIP FAX CONTACT NAME� i � PHONE 06 E-MAIL c'vtd)•Ciw� STREET ADDRESS r CITY, ST , P CA 2 Z� FAX O / �0 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT WCONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME1 LICENSE NUMBER LICENS TYPE BUS. LIC # rL, COMPANY NAME E-MAIL STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE / ZDESCRIPTION OF WORK pt l // EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA(.� � REMODEL AREA REMODEL AREA 1ti CDC) V 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 F1YES IF YES, PROVIDE COPY OF IS THE BLDG AN ElYES �sRECEN'2 ,-..�. TOTAL VALUATION: PLANNING APPL # E] NO PLANNING APPROVAL LETTER EICHLER HOME? [:]NO �� x s �yt , r �} 5� �...: .r"a _...;. By my signature below, I certify to each of the following: I am the property owner or authoriz ent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work* a& verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building cons on. I autho ' es of Cupertino to enter the above -identified property for inspection purposes. Signature Applicant/Agent: of Date: SUPPLEMENTAL INFORMATION REQUIRED pLnT=TYPE, r �ouT�cslP+ New SFD or Multifamily dwellings: Apply for demolition permit for dV " PLAN _ existing building(s). Demolition permit is required prior to issuance of buildm ER THE-COIR�TER '00 SSS k UILDII!G RES IEw� permit for new building. PLA111\INGPLAN REy E�� y _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. sTANDaRD k ❑rusLlcuoltics FI�RE�DEPT ` _ Copy of Planning Approval Letter or Meeting with Planning prior to GE x� SAI�rTARXSEViERDTSTRI T submittal of Building Permit application. rJ0��s a..` „&NYIROr7�iEN ATsHEA1 B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO 1 Ti T FCTTMATnR — RTT11.DING DIVISION La ADDRESS: 10980 MARIA ROSA WAY DATE: 11/12/2013 REVIEWED BY: MENDEZ APN: BP#: 'VALUATION: $20,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: hrs PENTAMATION 1 R3SFDREM PERMIT TYPE: WORK REMODEL 2 BATHROOMS HALL & M.BATH 181 SQ FT SCOPE A,1ech: Flan Check Phaub. Plan Check Elecc. Plan (."heck %ech_Permit Fee:. Plumb. Permit Foe": T, lee. Permit Fee. lurr ;ilech. Ira p. OtherOther Plumb Insp.EIF Other Elee. Insp. (i ED :/tech. Insp. Ire: Plumb. Insp. Fee: Elec. Insp. f°ee: NOTE: This estimate does not include fees due to other Departments (Le Planning, Public Works, Fire, Sanitary Sewer District, School These e— are based on the rehmtna to ormanon avauante ana are untv an e3senacur a vieeuu M. is rte , FEE ITEMS (Fee Resolution 11-053 E . 7/1113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =s.f. Remodel, Bath (<=300 sf) $626.00 IREAIMSBAT Supp/. PC Fee: Reg. Q OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Feer Reg. 0 OT O,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Consiru °tion Tax: cl.dininistrative Fee: Work Without Permit? ® Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure Travel Docurnentcation Fees: Strong Motion. Fee: IBSEISMICR $2.00 Select an Administrative Item Bldg Stds Commission Fee:IBCBSC $1.00 $3.00 $626.00, .00 Revised: 10/01/2013 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS:�J �f e(r`c� �e sc� PERMIT # 0u OWNER'S NAME: PHONE # GENERAL CONTRACTOR: c 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: 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 �' �Gcr, �► 152(p Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner / Contractor Signature Date T7 ;I 6T14 XdPW .::. 1. C ITY EL OP ME CT DEPARTMENT JLDI ISI t D +•�-�� i s MUST be ke the >'unlawf I ake any J� s or alterations on same o d ,via:e therefrom, without approval f e Building Official. ti The stamping of this and specifications S. r to be an ,; roval of the G �•I of any provisions of any City Ordinance or State Law. HALL BATH BY V14 -- DATE 11,12 /S Replace Tub PERMIT NO %31/00LOS Replace Toilet Replace Vanity Replace Vanity counter CUPERTINO Replace the floor and tub enclosure Ruildina D--partment Add LED can light i Nov 12 2013 REVIEWED FOR CODE COMPLIANCE 'OFFICE 'COO' .114 Reviewed By: ¢' 10980 Maria Rosa Way Cupertino, CA 95014 3 VI( MASTER BATH �'NO 1170 Replace tile floor and in shower CUF'VRTjj4o t Add heated floor �.,��+ Replace vanity counter Replace ventilation fan with vent/light/he? Replace closet doorsBUD e COMPO �e�iewed By