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15070193C CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22417 BALUSTROL CT CONTRACTOR: S D BOWYER CO PERMIT NO: 15070193 OWNER'S NAME: MORIYA STANLEY AND EILEEN H TRUSTEE 3481 EDEN DR DATE ISSUED: 07/27/2015 OWNER'S PHONE: 4082570248 SANTA CLARA, CA 95051 PHONE NO: (408)247-7217 rrJ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL p " L 33 9/ BATHROOM REMODEL (42 S.F.), INSTALL NEW License Classy' Lic. # __?C/ RETROFIT Contractor J' '� ' '��� QDate 7/�7//f BATHROOM WINDOW (NO STRUCTURAL CHANGES) 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: $17500 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 APN Number: 35603012.00 Occupancc "1'.N pr. 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 180YS FROM LAST CALLED INSP CTI N. 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: ' 'V Date: �W4 granting of this permit. Additionally, the applicant understands and will comply with all non -point source gulations per th pertino Municipal Code, Section RE -ROOFS: 9.18. y Signature Date ( �� 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: 1 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. 1 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, Sectio 5, 255 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized age 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 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 R] CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22417 BALUSTROL CT CONTRACTOR: S D BOWYER CO PERMIT NO: 15070193 OWNER'S NAME: MORIYA STANLEY AND EILEEN H TRUSTEE 3481 EDEN DR DATE ISSUED: 07/27/2015 OWNER'S PHONE: 4082570248 SANTA CLARA, CA 95051 PHONE NO: (408)247-7217 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E]ANWA BATHROOM REMODEL (42 S.F.), INSTALL NEW License Class t Lic. # RETROFIT ��° BATHROOM WINDOW (NO STRUCTURAL CHANGES) Contractor J + z/.'Date 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: $17500 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 APN Number: 35603012.00 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 INSP CTI N. indemnify and keep harmless the City of Cupertino against liabilities, judgments, rp costs, and expenses which may accrue against said City in consequence of ther� /X0 granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: ` with all non -point source gulations per the pertino Municipal Code, Section 9.18. Signature' Date '" RE -ROOFS: 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 1, 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 Section 3700 of the Labor Code, for the performance of the work for which this the Health & Safety Code, Section 505, 2553.3 x. 25534. _. m m ' permit is issued. Owner or authorized age '" 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 CONSTRUCTION PERMIT APPLICATION 150�?O lc33 COMIAUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building 5)cuDerlino.org ❑ NEW CONSTRUCTION Il ADDITION 6RATION TI ❑ REVISION /DEFERRED ORIGINAL PERMIT PROJECT ADDRESS..7.Z,1J 7 .Q�� / ��/��'0 G� I APN R Q Y = 1 (J vJ /SA l!✓Y` ORR PHONE l v E-MAIL INTNAivIc f/J STREET ADDRESS I CITY, STATE, ZIP FAX CONTACT NAME PHONE X�'/E-MAIL STREET ADDRESS%✓✓✓ �lJ�(l������L� �U� CITY '(/Q/T n 3wCz_ 6" '❑7 F AX UD� �yk e7g 1❑ OR'NER ❑. tEl OWNcR AGENT' �NIRACTOR 1:1CO1A77RCTTTOORAGENT ARCHITECT 11❑/ ENGINEER DEVELOPER ❑ icNA' N -r CONTRACTORNAMB�C it c �f ,. /'P -/'n LICE1SSENU1,4BER - 56 171,7LICENSETYP A �� ` f / dN coV Sj BUS.LIC0 r�q 2 ,?JV6 COMPANY NAME �' E-MAIL FAX e1®F 7 7767 STREET ADDRESS / /1 �V !J CITY, STATE, ZIP ��c /�� PHONE* RLICENSE NU-W3FR ACHITECT/ENGLNEER NA]vfE BUS. LIC COMPANY NA.;4E E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP I PHONE ^ DESCRIPTION OF WORK/,/ A %; EXISTINGUSEPROPOSED USE CONSTRTYPE nSTORIES USE TYPE I OCC. SQ.FT. VALUATIONS) EXISTG NEW FLOOR DEMO TOTAL AREA AREA 0 AREA NET AREA •- BATHROOM �, KITCHEN OTHER REMODEL AREA Z 3' •REMODEL AREA REMODEL AREA PORCHAREA DECK AREA TOTALDECKBORCHAREA GARAGEAREA: 0 DETACH RLATTACH m DN'ELLINGuNrrs: IS A SECOND UNIT ❑ 1 E SECOND STORY []YES BEING ADDED? ;gJNO ADDITION? BN0 PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNINGAPPL,- NO PLANNING I A� IS THE BLDG AN E] YES EICHLERHOME? �O IUEDBY - - L - �� -- TOTAL VALUATION: ' F /—//,5-00 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 provide ITect. I haver Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state lag's relating to bui ' construction. ho ' representatives of Cupertino to enter the above -identified roperty for inspection purposes. Signature Date: V��7�I� ofApplicant/Agent: SUPPLEMENTAL INFORMATION RE D ' �•r, v�P.L;�i�3CHECK�Ti'�E � �_. �- . � r-I20UTZRGSL�'_�, New SFD or Multifamily dv,'ellinQs: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building nz O� Ei2 THE COUNTER & � E E BUII DJI� G P) iI� 32E�HEFY t a permit for new building. .Ek'PESS m ©ePiAI�'IiII�GPLli'T�'S.2EY��EW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure n form if any Hazardous Materials are being used as part of this project. r� l�I � 4F�GE z F>r g�r �- }_ _ Copy of Planning Approval Letter or Meeting with Planning prior to -�`$ANiT71R.YSERD:RDIS`('RIC`� y 34>: submittal of Building Permit application. MA70R- BldgAPP_2011.doc revised 06121/11 CITY OF CUPERTINO I�Mjq3- irm FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn'l info. ITEMS (Fee Resolution 11-053 E . 7/1/13) ADDRESS: 22417 BALUSTROL CT DATE: 07/27/2015 REVIEWED BY: PAUL IAlech..Permlt Fee: APN: 356 03 012 BP#: *VALUATION: 1$17,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex Phimb. Insp. Fee: PENTAMATION 1 R3SFDRE A USE: PME Plan Check: PERMIT TYPE: WORK Bathroom remodel 42 S.f. Install new retrofit bathroom window No structural changes) SCOPE Permit Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn'l info. ITEMS (Fee Resolution 11-053 E . 7/1/13) lilech. Plan Check Phrmb. Ilan Check Elec. Plan Check IAlech..Permlt Fee: Plumb. Permit Fee: .Elec. Permit FCC:: Other.tllech. hzsp.F1 L Other Plwnb Insp. 01her Elec. Insp. ;tlech. Insp. Fee: Phimb. Insp. Fee: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn'l info. ITEMS (Fee Resolution 11-053 E . 7/1/13) FEE ___7FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 42 s.f. $645.00 Remodel, Bath (<=300 sf) IREMRESBAT Suppl. PC Fee: (F) Reg. O OT 0.0 hrs $0.00 PME Plan Check: $0.00 = # $431.00 Window / Sliding Glass Door 1 WINREP Replacement Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. OOT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C."onslruelion Tax: chnlnistrative Fee: O G Work Without Permit? 0 Yes (D No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) 0 A Travel Documentation Tees: Strong Motion Fee: IBSEISMICR $2.28 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $3.28 $1,076.00 TOTALYEE: 2, Revised: 07/02/2015 N) Aad C ON 11A 3d 8, pe el e�j 1 , da AS ON nawo ��oo o 09 BinB nr,e-1 alez� ao sb eulj ..x..Aue o uolsino._ e oZ ,nr'' uoiJnioln a ; �o lanoi-ide 1 Js�.aad pi ' q S�oZ N �l dHS suolle loads pue.uejd'srq0 6u— leloigo 6u pllne xjl xnoa oy�lnn uo��elay} ONLLI3d 03e1ne; 01 Jo `awLRs uo suol.itia}l o se 'ueyo rJ Aue o)lew I InImt jun sl jI uoijbnajsuoo, up p a is q� c � 41 je ;da�i q 1Sn d s�s�e0l}�aad (aueeld;o has sly�� oNi1d Idno - NOISV11a oNla a 1N3 UdVd 30 1 Woo i'3 NfllN oa I 17 71— 7v rn