14060038CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11002 NORTHSEAL SQ
CONTRACTOR: COSTA BELLA
PERMIT NO: 14060038
BUILDERS
OWNER'S NAME: BOHRINGER WILLIAM F AND PAULINE TRU
PO BOX 2963
DATE ISSUED: 06/09/2014
OWNER'S PHONE: 4083153326
SANTA CRUZ, CA 95063
PHONE NO: (831) 818 -9847
JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL [
❑ LICENSED CONTRACTOR'S DECLARATION
BATHROOM REMODEL 70 SQ FT TO INCLUDE M,E,P 1 S
License Class_ Lic. # 6 5 -�,e.? ��
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cJi�� 7N�ZRN ,1` '7 ) Date AI
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: $12300
I have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 31640038.00
Occupancy Type:
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 above information is
PERMIT E IRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 8 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 RrM LAST CALLED INSPE TION.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
in the
costs, and expenses which may accrue against said City consequence of
Issued by: Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regula ions per the Cupertino Municipal Code, Section
9 18.
RE- ROOFS:
Signature Date y
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:
for Worker's
Health & Safety Code, Section 25532(a) should I store or handle hazardous
Additionally, I use equipment or devices which emit hazardous
I have and will maintain a Certificate of Consent to self - insure
Compensation, as provided for by Section 3700 of the Labor Code, for the
material. should
air contaminants as defined by the Bay Area Air Quality Management District I
of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
performance
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, Sections 25505 25533, and 25534. /q /
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent. �— 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
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
I
I hereby affirm that there is a construction lending agency for the performance of
become subject to the Worker's Compensation provisions of the Labor Code, must
work's for which this permit is issued (Sec. 3097, Civ C.)
forthwith comply with such provisions or this permit shall be deemed revoked.
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
CUPERTINO
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 FAX (408) 777 -3333 • buildinclacupertino.org
❑ TERATION / TI ❑ REVISION / DEFERRED
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ORIGINAL PERMIT #
NEW SI ADfDeITa IO�
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APN #
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OWNERNAME L
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STREET ADDRESS
CITY, STATE, ZIP
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CONTACT NAME 7/ '' � i /ZA%y
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STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT ❑. CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME J t•, � TN /7 A n/ a W
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LICENSE NUMB%. C�
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LICENSE TYPE
BUS. LIC #
COMPANY NAME /� t /J /( 1 p,r r
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E -MAIL
FAX
STREET ADDRESS
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
` o c Z;Z— !'�zaT(OI ° U _/b 1 Lt / S�2 e w yt t/cQiir� L 9
I
EXISTING USE
PROPOSED USE V
CONS IK TYPE
# STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION (S)
EXISTG
AREA
NEW FLOOR
AREA
DEMO
AREA
TOTAL
NET AREA
BATHROOM
REMODEL AREA 7D �
KITCHEN OTHER
REMODEL AREA REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA DETACH
❑ ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
BEING ADDED? []NO
SECOND STORY []YES
ADDITION? []NO
PRE- APPLICATION ❑ YES IF YES, PROVIDE COPY OF
PLANNING APPROVAL LETTER
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
'JIREQEI VEDA$ � ^ ?,
�i + 'vxi ; •-
TOTAL VALUATION:
/ .� p-�
PLANNING APPL # ❑ NO
MIR
By my signature below, I certify to each of the following: I am the property owner or authorized agent t act on the property owner's behalf. I have read this
application and the information I have provi d incorrect. I have read the Description of Work and veri it is accurate. I agree to comply with all applicable local
ordinances and state laws relat ildin o truction. I authorize representatives of Cupertino to enter the above-id e tiff/ property for inspection purposes.
Signature of Applicant/Agent
SUPPL AL INFORMATION REQUIRED
PLAN CiIEC K TYPE.
ROUTING.SLIP ,
p� OVER THE-OOUNTER
❑Y su1LD>IVC PLAN RE�Ew
New SFD or Multifamily dwellings: Apply for demolition permit for
_
existing building(s). Demolition permit is required prior to issuance of builds g
t
Y
permit for new building.
_❑ °EXPRESS`S
❑ rLANNIi?G PLAN REVrEw
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
p sTnNnARD
❑ srUBLIC wOltxs
_
form if any Hazardous Materials are being used as part of this project.
s❑ LARGE
❑ FM DEPT =
Copy of Planning Approval Letter or Meeting with Planning prior to
f R
❑; s e ivlTAxY SEIE� 'DISTAI
_
submittal of Building Permit application.
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p EiwrxoivmENTai'r�nLTa;`
B1dgApp_2011.doc revised 06121111
i
CITY OF CUPERTINO
1 1 F1P FCTIMAT0R — RIIILDING DIVISION
LAIADDRESS: 110002 nothseal
DATE: 06/09/2014
REVIEWED BY: Mendez
APN:
BP #:
*VALUATION: 1$12,300
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration / Repair
PRIMARY SFD or Duplex
USE: p
Remodel, Bath (< =300 sf)
IREMRESBAT
PENTAMATION 1 R3SFDREM
PERMIT TYPE: A
WORK
bathroom remodel 70 sq ft to include m e 's
SCOPE
$0.00
NOTE: This estimate does not include fees due to other Departments (i.e. rianning, runic rr orKs, ["ere, aun[tury newer "gaff to-I, . k,isuu
.._ _r. r ;t .e a .,d ..,e„ .., mot:", .to /'nntnrt tha n0nt fnr nddn'1 info_
.�.,......, � Z. — I...........____ ..... _ ... ---
FEE ITEMS (Fee Resolution 11 -053 Eff. 711113)
-- - --- - - - - --
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
70 s.f.
$626.00
Remodel, Bath (< =300 sf)
IREMRESBAT
Suppl. PC Fee: Reg. ®OT
0.0
hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee: Reg. ® OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
E)
Work Without Permit? 0 Yes (F) No
$0.00
Advanced Planning_Fee:
$0.00
Select a Non - Residential
Building or Structure
0
7'rirt c'? r?c,c tr ?YI '. f1C lion Fees:
Strom Motion Fee: IBSEISMICR
$1.23
Select an Administrative Item
Bldg Stds Commission .Fee: IBCBSC
$1.00
$2.23
$626.00
TOTAL FEE:
$628.23
Revised: 04/01/2014
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APPROVED--
,ts and specifications MUST be kept at the
construction. It is unlawful to make any
or alterations on same, or to deviate
i.
thout approval from the Building 0";* licia 1
of t1lis plan and specifications SHALL NOT
;rmit or to be an approval Of t?13 violation
stgps of py City Ordinance or State Law-
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CUPERTINt
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SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 •FAX (408) 777 -3333 • building
0- cupertino.org
Pert
# of Alarms Smoke: '?
V 66rv.7,p
PURPOSE
This affidavit is a self- certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single - family and multi- family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon
Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
X
X
On every level of a dwelling unit including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel- burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means c, basement or crawl
space. Refer to CRC Section 8314 and CBC Sections 907.2.11.4 an 2 tri rmit is required for
alarms which must be connected to the building wiring.
� I i
As owner of the above - referenced property, I hereby certify that ar ) referen d a ove has/have been
installed in accordance with the manufacturer's instructions an in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
I have read and agree to camOv with the terms and Anditions of this statement
Own 6 �o� wner ent's) Name:
a
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/
Sinature...... ... ........................ .............................. ............................... Date: .................
Contractor Na e:
�5r,", &/
C� �� ............ Date: .......l
Smoke and CO form.doc revised 03118114