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15070171114 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10800 NORTHOAK SQ CONTRACTOR: HAN'S CONSTRUCTION PERMIT NO: 15070171 OWNER'S NAME: PARDINI EMIO J AND ELLEN M TRU 1873 MERIDIAN AVE DATE ISSUED: 07/23/2015 OWNER'S PHONE: 6507964345 SAN JOSE, CA 95125 PHONE NO: (408) 561 -5565 ❑1 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] License Class Lic. # REMODEL (E) MASTER BATH (64 S.F.) NO STRUCTURAL CHANGES Contractor k&l` -" Date :2 r 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: $3000 performance of the work for which this permit is issued. 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 LPN Number: 31641001.00 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 1 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 -- Z granting of this permit. Addition Ily, the plicant understands and will comp y d b e: with all non -point source re o s Cupertino Municipal Code, Section 9.18. �-7 // �i3 RE- ROOFS: Signatu Date ! (J 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 Municiy4 Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25 ?;M5534 . Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: " Z" l 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 ,s CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 •FAX (408) 777 -3333 • building(a cupertino.org /50 u I,EW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT ;# PROJECT ADDRESS ` o Vo la APN J -00 / , &VK OWNERNAME PH E -MAIL ' �o _ ✓Y. STREET ADDRESS _ / _ GJ (/ e�— FAX TTY Sub 5-v ' �ff CONTACT NAME / i PHONE STREET ADDRESS / /, 7 / CITY, STATE, ZIP FAX (/CL , c✓� I] OWNER ❑ OWNER- BurLDER ❑ OWNERAGFNT [VCONrRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # 1 COMPANY NAME E -MAIL FAX 84 14 e STREET ADDRESS C� CITY, STATE, ZIP s'� H Tj se PHONE 6,, -�..ti a ARCHIfECT/ENGINEF.R NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE r✓ DESCRIPTION OF WORK yq EXISTING USE PROPOSED USE CONSTR. TYPE #STORIES USE TYPE I OCC. SQ.FT. VALUATION (S) EXISTG AREA NEW FLOOR AREA DEMO AREA TOTAL NET AREA r� Dv 0 BATHROOM ! KITCHEN OTHER REMODEL AREA / f / REMODEL AREA REMODEL AREA PORCH AREA DECK ASEA TOTAL DECK /PORCH AREA GARAGE AREA: DETACH ATrACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑YES BEING ADDED? [3 NO ADDITION? ❑NO PRE - .APPLICATION [3 YES IF YES, PROVIDE COPY OF IS THE BLDG AN - - - _ A -''. TOT VALUATIQN: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER = By my signature below, I certify to each of the following: I am the property er orized agent toWA<Aoe property owner's behalf. I have read this application and the information I have provided is co ct. I hav read rlption of Work it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building cc ctio . esentatives of Cupertino to enter the above- identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORVIATION REQUIRED New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building � TICOUhTER NMI: 8 G RII3 1 permit for new building. Wan- —Nsm _ Commercial Bldgs: Provide a completed Hazardous Materials DisclosureannAlL� form if any Hazardous Materials are being used as part of this project.�� o 5 . _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. BIdgApp_2011.doc revised 06121111 FM_7 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt_ otr ) Thoco foes are hated an the nreliminary information available and are only an estimate. Contact the DeDt for addn 7 info. FEE ITEMS (Fee Resolution II -053 Eff.' 7 %1!13) 10800 NORTHOAK SQ DATE: 07/23/2015 REVIEWED BY: MELISSA IlaADDRESS: APN: 316 41 001 BP #: `VALUATION: 1$3,000 xPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Suppl. PC Fee: E) Reg. 0 OT PENTAMATION 1 R3SFDREM PERMIT TYPE: AI WORK I REMODEL E MASTER BATH 64 S.F. NO STRUCTURAL CHANGES SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt_ otr ) Thoco foes are hated an the nreliminary information available and are only an estimate. Contact the DeDt for addn 7 info. FEE ITEMS (Fee Resolution II -053 Eff.' 7 %1!13) Hech. flan Check Phunb. Plan Cheel; Zilec..Plan Check :ltec %r. P, < _ 1 1 .. Plumb. 1" r Elec. Permit ! < other :11ech. Insp Oilier Plumb Imp. Other I;k;c. Insp. ! I''C ; I'"t' Suppl. PC Fee: E) Reg. 0 OT FO, 0 NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt_ otr ) Thoco foes are hated an the nreliminary information available and are only an estimate. Contact the DeDt for addn 7 info. FEE ITEMS (Fee Resolution II -053 Eff.' 7 %1!13) FEE QTY /FEE MISC ITEMS Plan Check Fee: $0.00 64 s.f. $645.00 Remodel, Bath (< =300 sf) IREMRESBAT Suppl. PC Fee: E) Reg. 0 OT FO, 0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee.-E) Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: i.alt7tFifS'lT "t�tll`° /`Cc'° G Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning_Fee: $0.00 Select a Non - Residential Building or Structure E) i 'I 'ruvel L1ocutneniafiz,,n Strom; Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldp, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $645.00 TOTAL FEE: 1 $646.50 Revised: 07/02/2015 K &OC- '4/jv�tld ; /i 10800 NORTHOAK SQUARE WORK SCOPE FOR BATH: (NAN'5'1��) REMOVE EXSITING FIXTURE, VENITY REMAIN STAY.`CG TILING SHOWER WALL & FLOOR AREA tt,� 2013 6A SL-D(5) c oD 6-5 A -PPS -1 OFFIG� 8 RECEIVED JUL 2 3 2015 SY cU R � ° 9 a n �.4/V :ITY DEVEL.crN1ENT DEPARTMENT ...DING D;VIS':ON - CUPERTINO APPROVED of plans and specifications FAUST be kept at the during cof's: ruction. It is unlav fui to make any es or alienations on same, or to deviate rm, tiv tnc.. aup, oval from t "e Building Official. !an and sped rc SHALL NOT I tc rC'r '!' an appr- the violation i,4ace or State Law. CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10800 NORTHOAK SQ CONTRACTOR: HAN'S CONSTRUCTION PERMIT NO: 15070171 OWNER'S NAME: PARDINI EMIO J AND ELLEN M TRU 647 LANFAIR CT DATE ISSUED: 07/23/2015 OWNER'S PHONE: 6507964345 SAN JOSE, CA 95136 PHONE NO: (408) 966 -0885 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL REMODEL (E) MASTER BATH (64 S.F.) NO STRUCTURAL License Class_ Lic.# CHANGES /�/ II // Ale Revision #1 - Remodel kitchen (100 S.f.) and Install (N) 40 Contractor HC�tn Date Gallon Water Heater, Same Location - ISSUED 8/6/2015 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. REWIV'ON 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: $3000 performance of the work for which this permit is issued. 61 I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the,�ode, for the performance of the work for which this permit is issued. APN Number: 31641001.00 Occupancy Type: 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 YS FROM LAST CALLED INSPE TI N. indemnify and keep harmless the City Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the a ( �u � M)n-5 granting of this permit. Additionally, the applicant understands and will comply -�`� Issued by: Date: with all non -point sourc re ti ns er the Cupertino Municipal Code, Section 9.18. � Signature Date —� 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) 1, 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 255 , 25533, id 25534. Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Owner or authorized agent: Date: 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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 CUP RTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ,�• 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building(a)cugertino.org u NEW CONSTRUCTION U ^ADDITION H ALTERATION / Ti U REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS .•� /�v �^aD %�� APN # OWNERNAME 1 C l PHONE `�� E -MAIL 44- STREET ADDRESS CITY, STATE, ZIPS FAX CONTACT NAME PHONE E -MAIL STREET ADDRESS CITY, STATE, ZIP I FAX ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME I LICENSE NUMBR, LICENSE TYPE BUS. LIC # COMPANY NAME J, 1` �/• `�� E -MAIL (( FAX STREET ADDRESS CITY, STATE, ZIP Ski �� / 7 P1 ��� 0�0 50L PL ARCHITECT/ENGINEER NAME LICENSE NUMBER [ ) BUS. LIC # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK 1dc��s -`ten, SUPPLEMENTAL INFORMATION REQUIRED ROUTING SLIT New SFD or Multifamily dwellings: Apply for demolition permit for USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR AREA DEMO - AREA TOTAL NETAREA L.�� l" / �¢}yl�bQ� _ form if any Hazardous Materials are being used as part of this project. �-y7 A G /s —O 6 BATHROOM KITCHEN OTHER submittal of Building Permit application. z ..F C � N •• ❑ `""ENVIRONMENTAL HEALTH' REMODEL AREA REMODEL AREA D REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH I []ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? []NO ADDITION? []NO PRE - APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES XVED$Y <. TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO 5 OCk- By my Signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read t e Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building con cti th epresentatives of rtino to enter the above- identifie property for inspection purposes. � Signature of Applicant/Agent: _ Date: SUPPLEMENTAL INFORMATION REQUIRED ROUTING SLIT New SFD or Multifamily dwellings: Apply for demolition permit for ❑ PLAN ' _ existing building(s). Demolition permit is required prior to issuance of building OVER THE COUNTER BUHAING REVIEW permit for new building. ❑ EXPRE5$ F ❑ PI ANNINGPLAN REVIEW"' Commercial Bldgs: Provide a completed Hazardous Materials Disclosure STANDARD r"° El PUBLICwoRxs _ form if any Hazardous Materials are being used as part of this project. ❑x.I ❑ FI DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ARGE MA70R E ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. z ..F C � N •• ❑ `""ENVIRONMENTAL HEALTH' BldgApp_201 1. doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION �lecla. Plart Check I I I Plumb. Plan Check 10, 0 1 hrs $0.00 I -1ec'. P/an Check 11c>ch. Perwil Fee: Plumb. Permit Fee: IPPERMIT I glee. Permit Fe" Other :ilech. Insp. I I I I Other Plumb Insp. 10.0 I hrs I $48.001 (1t/aer Eiec. Insp. ilech. Insp. Fee. I Phznib. hisp. l-ee: I flec.Insp. Fee: NUT E: [his estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District otc.)_ Thoco foot aro hacod nn tho nrolimmaru infnrsnatinn myailahla and aro nnhe an — dsssato r—f—f iho n i fnr aJJ., l :..F FEE ITEMS (Fee Resolution 11 -053 E . 711113,) 10800 NORTHOAK SQ. DATE: 08/06/2015 REVIEWED BY: PAUL IlaADDRESS: APN: 316 41 001 BP #: JS © $0.00 "VALUATION: 1$15,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: FO.0 PENTAMATION 1 R3SFDREM PERMIT TYPE: WORK Revision #1 - Remodel kitchen 100 S.f. and Install N 40 Gallon Water Heater Same Location SCOPE $0.00 �lecla. Plart Check I I I Plumb. Plan Check 10, 0 1 hrs $0.00 I -1ec'. P/an Check 11c>ch. Perwil Fee: Plumb. Permit Fee: IPPERMIT I glee. Permit Fe" Other :ilech. Insp. I I I I Other Plumb Insp. 10.0 I hrs I $48.001 (1t/aer Eiec. Insp. ilech. Insp. Fee. I Phznib. hisp. l-ee: I flec.Insp. Fee: NUT E: [his estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District otc.)_ Thoco foot aro hacod nn tho nrolimmaru infnrsnatinn myailahla and aro nnhe an — dsssato r—f—f iho n i fnr aJJ., l :..F FEE ITEMS (Fee Resolution 11 -053 E . 711113,) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. $645.00 Remodel, Kitchen (< =300 sf) 1REMRESKIT Suppl. PC Fee: (E) Reg. 0 OT FO.0 I hrs $0.00 PME Plan Check: $0.00 1 # $29,00 Plumbing IPRWHEATR Water Heater Permit Fee: $0.00 Suppl. Insp. Fee Q Reg. 0 OT 0 ,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 Construction Tax: -FT Administrative Fee: IADMIN $45.00 C) Work Without Permit? ® Yes (E) No $0.00 Advanced Planning Fee: $0.00 Select a Non - Residential Building or Structure Q 0 i Travel Documentation Fee: 1TRAVDOC $48.00 Strong Motion Fee: IBSEISMICR $1.95 Select an Administrative Item Bldg Stds Com mission Fee: IBCBSC $1.00 at"d $14 395 67400 $817.95 Revised: 07/02/2015 CUPERTINO Building Department AUG 0 s 2015 OFFICE COPY 8' -5 1/2" 0,4 COMMUNITY DEVELOPMEN PARTMENT BUILDING DIVISION - CLIPIRTINO APPROVE 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 therefrom, without approval from the Building Official. The Stamping of this plan and specifications SHALL NOT be held to permit or to be an approval of the violation of any p visions of any City Ordinance or State Law. BY i (L CLA .y- DATE &31Q(q0L5 PERMIT #