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14060065CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22386 HARTMAN DR CONTRACTOR: PORTITALIA PERMIT NO: 14060065 CONSTRUCTION OWNER'S NAME: NADIA JADVAR 5841 ARAPAHO DR DATE ISSUED: 06/11/2014 OWNER'S PHONE: 4087322868 SAN JOSE, CA 95123 PHONE NO: (408) 210 -4917 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E] REMODEL (E) MASTER BEDROOM (240 S.F.) & (E) License Class Lic. # 011 *4331 2— MASTER Contractor �rk1�01�1Q� Date 0� j �'� BATH (115 S.F.) ADD 1 (N) WINDOW IN BATH (TEMPERED) 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 Sq. Ft Floor Area: Valuation: $35000 performance of the work for which this permit is issued. 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: 32613133 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 OT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DA E 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 + D 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 granting of this permit. Additionally, the applicant understands and will comply ed by: Date: 4�la with all non -point source regulations per the Cupertino Municipal Code, Sectio 9 18. 06 "' 1 RE- ROOFS: Signature Date I g 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 (See.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, Section j 25505, 2,A5�5ss33.�and Section 3700 of the Labor Code, for the performance of the work for which this ^^25534. Owner or authorized agent: �\h14 Date: 06"if"� 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 CUPERTINO r1 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building ftupertino.orq v r1 IVI ___ ,— M "Milvi TAT /TIRFFRRFTI ORTCUNAT. PF.RMTT4 LJ NEW CONS IKUC:I ION L—I A1JLJ111V1v 4 IJ„.L _A APN # ,OETD 'C ' I ? / 3 OWNERNAME NAd� c�a�lvwf' PHONE %- `3,Z +rip &^ f D 1'j E -MAIL STREET ADDRESS CITY, $TATS, G w �O FAX 1Z/IIPo CONTACT NAME PHONE E -MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER - BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME s Chris More.�(.o LICENSE NUMBER qt, * �' n `� i.. LICENSE TYPE BUS. LIC # %VS Jf COMPANY NAME ♦ , 'Dr }.t.k ,(ti COws�yv G}�p r E -MAIL IS QaR.T11��AWA �CNS] � aN FAX STREET ADDRESS , S`�dy t �rrq ko Qrw CITY, STATE, ZIP tO S Art� CA PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK ��11 "; 6 � l e4+ R2Vr10 pc��v a o wn ^- 2 h �� r cw,c,✓' -40 � t.c. % dA e6_C:6 1 C4 k ewc u t, QJJ C Ct U �A U 'pilt QA i A t. l n C (0JA+ . r♦ frotjM G pV1 EXI NGUSE PROPOSED USE CONSTK rYPE #STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM REMODEL AREA lit 5 91 I KITCHEN REMODEL AREA OTHER REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: LJ DETACH []ATTACH # DWELLING UNITS: IS A SECOND UNrr ❑ YES SECOND STORY -[]YES BEING ADDED? ❑NO ADDITION? []NO PRE - APPLICATION []YES IF YES, PROVIDE COPY OF PLANNING APPL# ❑NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES El EICHLER HOME ?O ,r - ' TOTAL VALUATION: 35' 000 _ _ By my signature below, I certify to each of the following: I am the property owner or authorized age n the owner'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 a ate. I agree to comply with all applicable local ordinances and state laws relating to Ilding constructio . uthorize representatives of Cupertino to enter above - identified property for inspection purposes. '` �'� 'n Date: Signature of Applicant>Agent: SUPPLEMENTAL INFORMATION REQUIRED , ,rl'aTv cIMCK TYPE, .` 1 ;. i buTHVC SLIP . New SFD or Multifamily dwellings: Apply for demolition permit for - ❑ TH rUCOUNTER ❑ BUILDING, AN REVIEW existing building(s). Demolition permit is required prior to issuance of building Oift rh s h permit for new building. C EXPRESSi ❑ PLANNn`Gra AN RI vlEw Commercial Bldgs: Provide a completed Hazardous Materials Disclosure sTA DnRD' ❑ PuBra47 WORKS _ form if any Hazardous Materials are being used as part of this project. ❑ FIREVErT Copy of Planning Approval Letter or Meeting with Planning prior to MAJOR ❑ SANITARY sEiz nLSTRrcT _ submittal of Building Permit application. z a ❑r: ENVIRONMENTAL HEALTH- BldgApp_2011.doc revised 06121111 WE CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION 22386 HARTMAN DR FEE DATE: 06111/2014 REVIEWED BY: MELISSA 1WADDRESS: APN: 32613133 BP #: *VALUATION: 1$35,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: p Suppl. PC Fee: E; Reg. 0 OT O.0 PENTAMATION 1 R3SFDRE PERMIT TYPE: i WORK REMODEL E MASTER BEDROOM 240 S.F. & E MASTER BATH 115 S.F. ADD 1 N WINDOW SCOPE IN BATH (TEMPERED) 240 s.f. $418.00 L1e�ttr, I'larr ('heck liec:/r_ Pc>rmif Fee: NOTE: This estimate does not Plumb. Permit Fyea;: Other PlvMb fns'rr. 11I:.,rzi?. Inv). Fee: J,°e, . Pion Check Eicc Perth Fee %ibex 1,sc,C Imq,". Insp. 1 I-c: due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Ilicfrirf vir 1 Thnco foot — hacod nn fiha nrolirnin— infnrm"dnn auailahlo and aro nnlu an octiwrato Cnntart tho Dant fnr addn'l ;"fn_ FEE ITEMS (Fee Resolution 11 -053 Ef. . 711113,) FEE QTY /FEE MISC ITEMS Plan Check Fee: $0.00 115 s.f. $626.00 Remodel, Bath (< =300 sf) IREMRESBAT Suppl. PC Fee: E; Reg. 0 OT O.0 Thrs $0.00 PME Plan Check: $0.00 240 s.f. $418.00 Remodel, Other IREMRESOTH Permit Fee: $0.00 Suppl. Insp. Fee:G Reg. ® OT O,Q hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 _T_7T Cons!1`uc ion 747a: E) Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential I Building or Structure i 1r« lvl Dovlwnwnlul orl Fees: Strong Motion Fee: IBSEISMICR $3.50 Select an Administrative Item Bldg Stds Commission .Fee: 1BCBSC $2.00 $5.50 $1,044.00 To, FEE: $1,049.50 Revised: 04/01/2014 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: 72.2734b4 Pmr V PERMIT # 0d6..5— OWNER'S NAME: WO.0 0 a, PHONE #; t{0 � 3z 28(08 GENERAL CONTRACTOR: -PO 4 A-. K I'% A Cons " c�ha r% BUSINESS LICENSE # 3 q2B ADDRESS: 5bq I hvAprko Dr we q5 12,3 CITY /ZIPCODE: .C_v , ,Aiti b • 01'501LA *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: �ffi. , Owner / Contractor Signature 1 � 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile �ffi. , Owner / Contractor Signature 1 � Date CUPERTINO CONTRACTOR/ Iq LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: -2--Z�9-L PERMIT #/1/ 6 006-5- OWNER'S NAME: Wock',c, 3.A,ov- PHONE #, GENERAL CONTRACTOR: N,�',VcOta BUSINESS LICENSE # .ADDRESS: Sb�t P,,cdako Qv\�p cvtis10 --AS 12 CITY/ZIPCODE:, C v A-rr c, D(LA *Our municipal code requires allbusinesses working in the city to have a City of Cupertinobusiness license. NO BUILDING FINAL .OR .FINAL "OCCUPANCY INSPECTIONS) 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 applicabW%;subcon- - 0 orsan& complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum /Wood b 2 -7 C>-7 Glass / Glazing V V (D -2 Heating Insulation Landscaping Lathing Masonry Painting Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile C�z 22 e)-7 Owner /'Contractor Signature Date m =; a pz "a' 53 /st- :� u, g. r i r+ o ti O W p— Z i MASTER f "� a "•-( lam-- �C, `�. cep 1 r 80 o ° cn ° < m 3 (n can ��-< ® mp. ,L .o . C v O CA =1 0- a D � —1 z� , enc�a °am O� r r JADVA REST cep tv% .a 2 o ` CD 3 o m s scvwE : R�oQ MASTER BEDR' _ M & BATHROOM; -� Ce) LIGHTING. PLAN 1/4' = V-0' 1/7/14 CHARUSMA DESIGN �� ®,� _ GE GODE RE�1E Rev'ON BY JADVAR RESIDENCE MASTER BEDROOM & EXISTING PLAN 1/4" = V -0' 12/20/13 CHARISMA DESIGN �::jiaa�l�lul 7 Wo �fl��t r� C9440 JADVAR RESIDENCE MASTER BEDROOM & BATHROOM LIGHTING PLAN 1/4' = i' -0° 1/7/14 CHARISMA DESIGN JADVAR RESIDENCE MASTER BEDROOM & BATHROOM ELECTRICAL PLAN 1/40 = 1/8/14 7'/ CHARISMA DESIGN ,,, �� co[J4 Cokp