14040184 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10495 MADERA DR CONTRACTOR:Tat PERMIT NO: 14040184
OWNER'S NAME: PAMELA BRANDS TRUSTEE DATE ISSUED:04/28/2014
OWNER'S PHONE: 4087395141 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL ❑ COMMERCIAL
/ BATHROOM REMODEL,LED LIGHTS,EXHAUST FAN
License Class Lic.# ?J L 1 ,SHOWER
Contractor 4,4, ate POCKET DOOR TILE SHOWER VALVE.
—���157721.(� 1 hU
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
e rmance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$12000
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:32635069 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 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 D p;RaCALLED 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 g ) y
granting of this permit. Additionally,the applicant understands and will co Date: leo l
with all non-point source regulations per the Cupertino Municipal Code,Sec ion
918.
RE-ROOFS:
Signature Date Y C/ 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
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
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,Sections 25505,25533,and 25534. /
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: Date: b �Y
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 ciiy 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 k4D
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION O
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTIlrlO (408)777-3228• FAX(408)777-3333•building a(-cupertino.org
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS / A' ' APN# Z/ – 0 6
WC�
ONER NAME PHONE, �(Q)�f £-MAIL /
STREET ADDRESS -- DfCITY STATE,ZIP / FAX
CONTACT NAME �.
Fpk&
-� f AIL n6
_7
STREET ADDREILk(p `TTY,STATE, FAX
I _
❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 4&CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRA OR NAME I LICENSE NUMBS LICENSE TYPE BUS.LIC#
COMPANY NAME E-MAIL FAX
r
STREET ADDRESS ^ CFY,STATE,ZIP (&NE U —�
U –nr� G71-16S
ARCMTECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK )Nlit.�K _1_2 ` F-7 I F n
EXISTING USE PROPOSED USE CONSTR TYPE #STORIES
USE TYPE OCC. SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NET AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA 6ECKI
AREA TOTALDECK/PORCH AREA GARAGEAREA: DETACH
❑ATTACH
#DWELLING UNITS: IS A SECOND UNIT []YES SECOND STORY E]YES
BEING ADDED? []NO ADDITION? ❑NO
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YE C(;I,VED:B�Y * - ... w;cm,
;: TOTAL VALUATION:
PLANNING ADPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ F }
By my signature below,I certify to each of the following: I am the property owner or authorized agen o o ,", 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 to comply with all applicable local
ordinances and state laws relatin7e-beil�mg construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: Z L
SUPPLEMENT RMATION.REQUIRED y —W—MO ;;�
.� h r
New SFD or Multifamily dwellings: Apply for demolition permit for S � . �= -�.
OVER_ HI+rCO.: J✓R�������BUJLDIItGP1;AN�2ES'IEW c�-�
existing building(s). Demolition permit is required prior to issuance of building �� � f
permit for new building. [ arx5ss. PLAI, 1NGP)TANREVIJi _
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosures n rlJst>clioxKs
form if any Hazardous Materials are being used as part of this project.
_Copy of Planning Approval Letter or Meeting with Planning prior toEm I VWSFx
submittal of Building Permit application. ' TJO ` �
,-C���ENVIROI�fi4ENTAL'FIEALTH ��,-r�>--
B1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10495 MADERA DR DATE: 04/28/2014 REVIEWED BY: LARRYS
APN: 3Z4 1 BP#: "VALUATION: 1$12,000
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair
PRIMARY 2nd Unit? Yes No PENTAMATION
USE: SFD or Duplex OTC? 0 Yes (E)No PERMIT TYPE: 1 R3SFDRE
WORK BATHROOM REMODEL LED LIGHTS EXHAUST FAN SHOWER POCKET DOOR TILE SHOWER
SCOPE VALVE.
OCCUPANCY TYPE: TYPE OF FLR AREA PC FEES PC FEE ID BP FEES BP FEE ID
CONSTR. s.f.
R-3 (Custom) II-B,111-B,IV,V-B 0 $0.00 $0.00
TOTALS: 0 $0.00 $0.00
MECH,HOURLY Q `e tTllB H'OfiTRLY Q Yes No ELEC,HOURI;Y' ® Yes No
,V9,,:7._ Pian f,&,rk Pl2wb' Nan Ch,"ck
L1 ;`r. 1'erw;l Fee: Plumh. 11(xmit FeC
01'-hc f ;t/cc'lt. Iav' 07ker•Plumb IrisP. Li ofht rT I;zec.
�'kc bIns(. F.:c: P/Mith, hi.V), Fee: t ler.Ins,
NOTE:This estimate does not include fees due to other Departments(Ge.Planning,Public Works,Fire,Sanitary Sewer District,School
District,etc. . Theseees are based on the prelimina information available and are only an estimate. Contact the Dept./or addn'l info.
FEE ITEMS (Fee Resolution 11-053 Lff. 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 60 s.f. Remodel,Bath(<=300 sf)
Suppl. PC Fee: (j) Reg. ® OT 0.0 1 hrs $0.00 $626.00 IREMRESBAT
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Feer Reg. C) OT0 0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Con:;Irllc'iorl 7'ax: F7
V(?("' 0
Work Without Permit? ® Yes (R) No $0.00 1 G
Advanced Planning Fee: $0.00 Select a Non-Residential E)
711th el L3or.:rr n erlf atrarr Fees: Building or Structure 0
Strom Motion Fee: 1BSEISMICR $1.20 Select an Administrative Item
Blda Stds Commission Fee: IBCBSC $1.00
t $2.20 $626.00 : TOTAL FEE: $628.20
Revised: 04/01/2014
backing for gr ars
hand sprayer
48" 46"
32"
71
- - i
L ! • LED lighting
. Tile shower walls
ue (n)under ount sink
(n)toilet
•New exhaust fan
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.shower door
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he (e)window • GR
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