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13110080 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10352 PALO VISTA RD CONTRACTOR:ADVANCED HOME PERMIT NO:13110080 IMPROVEMENT OWNER'S NAME: ALLISON SCHWANDA 879 E HAMILTON AVE DATE ISSUED:11/12/2013 OWNER'S PHONE: 4088369645 CAMPBELL,CA 95008 PHONE NO:(408)559-0999 le LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALL] License Class Lic.# q 50 REMODEL GUEST BATHROOM 42.5 SQ FT Contractor Date t'r 7_-► I hereby affirm that I ar rcensed 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 erformance of the work for which this permit is issued.ISq.Ft Floor Area: Valuation:$8000 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:35702052.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the aboveinformation is PERMIT EXPIRES 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 DAY OM 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 Date: 11,12,f granting of this permit. Additionally,the applicant understands and will comply Issued by: 61 with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Signature Date l� 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 1,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,Se 'ons 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized age tI Date: !'t Z'r permit is issued. l 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 CONSTRUCTION LENDING AGENCY 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 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 rr`` COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION v� 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228•FAX(408)777-3333•building ancupertino.org CUPERTINO ✓✓ ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS APN OWNER NAME ! G F(� 6N IJG�lwrl PHONE Q LJ/ ' E-MAIL ` STREET ADDRESS �n 9 �l / CITY,S;T E,ZIIT� �l /b ILL EF � CONTACT NAME �N Wt PHONE (• E-MAIL STREET ADDRESS CITY,STATE,ZIP FAX ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAMEAt;,,V _ )n,� ( K� JMpr _LICENSE BER���© LICENSE TYPE BUS.LIC# COMPANY NAME 1/V(� f'r0 E-MAIL FAX STREET ADDRESS,1 /7 �s rfiArt��,D+J_ 14j� CITY,STATE,ZIP PHONE " ! � - ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK g Jr Ih� to > _ EXISTING USE PROPOSED USE CONSTR TYPE 1 #STORIES USE TYPE OCC. SQ.FT. VALUATION($) EXISTG NEW FLOOR DEMOTOTAL AREA AREA AREA NET AREA BATHROOMj'� KITCHEN OTHER REMODEL AREIiZ W , REMODEL AREA REMODEL AREA PORCH AREA I DECK AREA TOTAL.DECKIPORCH-AREA I GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNrr ❑YES SECOND STORY []YES BEING ADDED? [3 NO ADDITION? []NO PRE-APPLICATION ❑YESIF 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 authorized agent ct on the property owner's behalf. I have read this application and the information I h provided is co ect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to uildi s - I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INF TION REQUIRED _New SFD or Multifamily dwellings: Apply for demolition permit for + ku�Cs sBiT1Lb11HC,�PLANREi'I�W°' ? k k� existing building(s). Demolition permit is required prior to issuance of building i t3 permit for new building. ��, 'rri❑ I d,Nr>NrxPt AN,R>v i v� Commercial Bldgs: Provide a completed Hazardous Materials Disclosure xn.> " C1 pUBLICwoKs , fo_rm if any Hazardous Materials are being usedaspart of this project. rS _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. kN�oSt �Jr y ` SAN3T'ARY ESIERI)ISTRiCT : av,t �,, �� ,� g� „�, �❑�:��[#b=ivlvrFlVTdrpi�.aLTa �,�Y BldgApp_2011.doc revised 06/21/11 J J --= ---lo � �a1a= , -' = - - - - -- - - -- - - -- - - = -- - I--+ —=-= - - --- - - - --- ---- - - -- - - - — - - - - ------- - — - -- T� i �- -' = — - !� __-__ _-___-_- ___ __ t - L - -- l-- —y---— -- — - - - -- - ------ ---- - -- ---- -- �/4n -,- - - ------T -— - - - - - -- -—-- — T r y IT- j. -- - = -- — — - - ------- - --- — A�_�.-1 1 i D ' CO MUNITY bEVELOPItEN}'DEPARTiv1EN rt C�OTL-DIN Ulv"Icui'dj'�£}c RAIN© _ ? -___ 1 I ���---rrr ' .,are t' MOST¢RG e kept s.t the --- - -=—r 5 tSgL of pfd" to eke an- - - - -- - I during con�truc icn. 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