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14070138
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11531 BIANCHINI LN CONTRACTOR:DON WILLIAMS PERMIT NO: 14070138 REMODELING OWNER'S NAME: HAQUE IMTIYAZ TRUSTEE 14950 CAMDEN AVE DATE ISSUED:07/31/2014 OWNER'S PHONE: 4089731660 SAN JOSE,CA 95124 PHONE NO:(408)813-4455 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL REMOVE AND REPLACE TUB. License Classy_ Lic.# Z 3 3 Contractor l,�(Zy G.) r/l �k r Date / I hereby affirm that I am licensed under the provisions of Cha ter 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:$800 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 APN Number:36658022.00 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 DAYS FROM 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 Issued by: fi�� Date: 3l'/ 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. RE-ROOFS: Signat6 ' A�_ Date ' 3 / 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: 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 agegt. ��- Date: 3 /� 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 /GlD 70135 CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 GUPERTINO (408)777-3228•FAX(408)777-3333•buildina(acuoertino.ora ❑NEW CONSTRUCTION ❑ ADDITION Z]ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT# PROJECT ADDRESSPS-31 P 3 r �]!g� / l o- 1• LuC APN#�� `� •D OWNER NAME ` /� Cjh PHONE ✓E-MAIL STREET ADDRESS CITY,STATE,ZIP L FAX !1531 l3���e�I hT Lavle �, /y S"D�/ CONTACT NAME PHONE E-MAIL / �sK (,1JI Q 5 y0,? b'l3-y%fS' we` /ao�s/lJt?C�wts�t/�vu° STREET ADDRESS CITY,STATE,ZIP FAX �l SSZ� l�d1Ave- -Sa- J G J`/.2 4/0's,191-1 -9l1;1v ❑OWNER ❑ OWNER-BUILDER ❑owNERAGENT 8-CoNTRACrOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME '� - LICENSE NUMBER LICENSE TYPE BUS.LIC# _ ,�Ovt J Q _9 COMPANY NAME E MAII FAX WS .G0 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 ` a �� f C3,11a 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 REMODELAREA REMODELAREA REMODELAREA PORCH AREA DECK AREPBEINGADDED? TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: ECD UNIT OYES SECOND STORY []YES ❑NO ADDITION? ONO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RE BY_', '' TOTAL VALUDATION: PLANNING APPL# ❑NO PLANNING APPROVAL LETTER EICHLER HOME? ❑NO (/�/v By my signature below,I certify to each of the following: I am the property owner or authorized agent 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 and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAf NFORMATION REQUIRED ROUTINGSLIP New SFD or Multifamily dwellings: Apply for demolition permit for OVER-THP CbI7NTEit LLBUH DING PLAN REVIEW existing building(s). Demolition permit is required prior to issuance of building permit for new building. ERPRESS,_ ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 17 str rmaitu ❑ �PXJBLIC WORKS form if any Hazardous Materials are being used as part of this project. © vARCE;, ❑ nIE DErT _Copy of Planning Approval Letter or Meeting with Planning prior to © >vrA7Ox ❑ sdN►TAreV SEWER DISTRICT submittal of Building Permit application, >. „`: - ❑ ENYIRONIIIENTAL HEALTH BldgApp_2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR—BUILDING DIVISION ADDRESS: 11531 bianchini Ln DATE: 07/31/2014 REVIEWED BY: Sean APN: BP#: "VALUATION: $800 —� PERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration /Addition / Repair PRIMARY ------t-PENTAMATION 1 RPFIX USE: SFD or Duplex PERMIT TYPE: i WORKRemove and replace tub. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Fixture or Trap 1BPFIXTURE 1 # $10 TOTALS: $10.00 21Plumb.Plan Check "LL t>��. _ <''� Plumb. t�_Other Plumb Insp. Tr ,;��.LniF�., ,ec. ��rf NOTE: This estimate does not include fees due to other Departments(�.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These fees are based on the preliminaryinformation available and are onlyan estimate. Contact the Dept or addn'l info. ppFEE ITEMS (see Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS PME Plan Check: $0.00 PME Unit Fee: ✓ $10.00 PME Permit Fee: $48.00 Administrative Fee: ]ADMIN ✓J$45.00Work Without Permit? 0 Yes � No "0 :7>7"f'ti "[:Ii'st i,tt"<s Fees: Travel Documentation Fee: 1TRAvDoc ./ $48.00 Strom Motion Fee: IBSEISMICR v/ $0.50 Select an Administrative Item Bldg*Stds Commission Fee: IBCBSC ✓ $1.00 _ � TALS $152.501 $0.00 TOTAL FEE: $152.50 Revised: 07/10/2014 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: //•-59/ / G /K/ alV PERMIT# D O OWNER'S NAME: 1"-14 4::v PHONE# D GENERAL CONTRACTOR: 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 D to Please check applicable subcontractors and complete the following information: V 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 Owner/Contractor Signature Date �. x' � .sT� ► ��1 G � � 5 3 ( ►311 �� C �-f � � �.�� �� CvPERT ! NO DUPERTINO Building Department z JUL 312Oi4 REVIEWED FOR CODE COMPLIANCE Reviewed By. 149" AREA OF INTERIOR IMPROVEMENTS: Osc CODES IN EFFECT- -2013 CALIFORNIA RESIDENTIAL CODE -2013 CALIFORNIA GREEN BUILDING CODE -2013 CALIFORNIA PLUMBING CODE O -2013 CALIFORNIA MECHANICAL CODE -2013 CALIFORNIA ELECTRICAL CODE -2013 CALIFORNIA FIRE CODE OPYits co c� d' N 04' FFICE C W CTI COMMUNIrTY DI VELOOUENT DEPARTMENT BUILDING DWISION-CUPERTINO APPROVED This set of plans and specifications MUST be kept at the job site during construction. It is unlawful to make any changes or alterations on same, or to deviate L� 1 therefrom, without approval from the Building Official. I The Stamping of this plan and specifications SHALL NOT be held to permit or to be an approval of the violation of any provisions of any City Ordinance or State Law. sr DATE / J PERMIT NO yD 7D 1 I - 5'95 C��r i r2/-�Tof2 1153 ) LANE G 149" L`�f S C 1�.1 �' T rUA.TFoP-,',l TwS 7a rKfESTAN0In$6 TV13 -iNG � � i ila rn CA - t " CUpERTINO C7 a Building DepatyMM JUL 3 12014 .art=t ., t;()DE COMPLIANCE ..9,99 i�ul\f j W ) LLl)�vnS Lv N T l;Z A '1- R FILE.. SMOKE / CARBON MONOXIDE ALARMS its OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION GUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333•building a0cupertino.orp Permit No. Address /SGS � #of Alarms Smoke: Carbon Monoxide: 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 wm� $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 X X bedroom(s) 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 of attic,basement or crawl space.Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2.An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been installed in accordance with the manufacturer's instructions and 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 comply with the terms and conditi s of this statement Owner r Owner Agent' )Name: ................................Date: .................. Contractor Name: 1001, Sinature...................................................................Lic.*......................................Date: ................... Smoke and CO form.doc revised 03/18/14