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15080106I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10151 WESTERN DR I CONTRACTOR: OZ HOMES INC PERMIT NO: 15080106 OWNER'S NAME: SCHROEDER MICHAEL D AND LESLIE D OWNER'S PHONE: 4159991394 C31 LICENSED CONTRACTOR'S DECLARATION License Class Lic.# 7 0 Contractor J e 2f' M�j CSS Q NWDate 201 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. 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. 2. 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 permit is issued. APPLICANT CERTIFICATION 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 thq City of Cupertino against liabilities, judgments, costs, and expenses may ccrue against said City in consequence of the granting this pe it. A di ' Wally, the applicant understands and will omply with all non -p int sour r gu s per the Cupertino Municipal Code, SeVon 9 18. Signature iZ Date D e 0/ fi ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: t. 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. 2. 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 permit is issued. 3. 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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. costs, and expenses which may accrue against said City in consequence of the 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. Date 1261 LINCOLN AVE 1 DATE ISSUED: 08/13/2015 SAN JOSE, CA 95125 1 PHONE NO: (408) 404-0940 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ BATHROOM REMODEL (40 S.F.) REVISION # 1 - UPGRADE (E) PANEL TO (N) 200 AMP – ISSUED 9/8/2015 Sq. Ft Floor Arca: I Valuation: $25000 APN Number: 35911001.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 D S FROM LAST CALLED INSP TION. Issued by: ' tom" �'6""' Date: L J 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as define by the Bay Area Air Quality Management District I will mL.thSafep Z Cupertino Municipal Code, Chapter 9.12 and the Hns 25505, 25533, and 25534. O Date: -2 U /Z711 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed W C;UPERTINO GENERAL PERMI i APPLICAi ION t50501(ya COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildina(c1cuoertino.oro ❑ ?LUA'MING ❑ MBCHANTICAL b4LF.CTRICAL ❑ l"RSCELLANEOUS PROJECT ADDRESS10 r J `- �.RN ,J¢ I APN R OWNER NAME NiONE&JAIL k -L a L(Es�AF,e ���/I -z3�3 l CF�.CoF�FR�Ii .Fart STREETJ.DDRESS CITY. S ZIP FAX of T -a R pi 15APj 16SE C'A gSI2 CONTACT N. P F l Hd STREET ADDRESS 2 L' lv c v v.! v ��. CITY, STA �� Q r� , z ' FAX ❑ OwaR ❑ OwNrimaunzER ❑ oWNERAGENT ❑ CONTRACTOR ❑ CON MACTOR AGENT ❑ ARCFIriECT ❑ M4G110.1M ❑ DEVELOPER ❑ TE.NAJ.T CONTRACTOR X4J,1 k- p c05 6 R �� LIC ' ! Eltr LICr-tdSE TYPE I BUS. LIC C,Q&PANY n � 7-6 +A 146 , A t s E•M FAX STREET ADDRES t'Z 1 �l NCULNikVF I CITY, STATE, ZIP PHONE ARCH1TECT/ENGINTER NAME LICENSE NUMBER I BUS. LIC n COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONATE USE OF FD or DUPLEX ❑ MULTI.F.A.),CLY I . PROJECT LN WILDLANTD ❑ YES PROJECT IN ❑ YFS BU YO: ro COMMERCIAL URBAN I,\=ACE A.REA ❑ NO FLOODZONB ❑ NO IS THE BLDG AN ❑ .S EICHI.ERHOMET ❑ NO DESCRIPTION OF WORK A zc5z—) AM TOTF.L VJ.LU.ATIO;.*: 2 By my signature below, I certify toe ch oVfoUoA' g: I am the property owner or authorized agent to act on the p perty owner's behalf. I have read this application and the' I ave proct I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state la�� s relating to buildon. I au orize re resentatives of Cupertino to enter the abov -id� ed operty for inspection purposes. Signature of Applicant/Agent: Date: 20 / SUPPLEhIENT'ALI17YTION REQUIRED T"--- XL, A,fEFkflSC 4pp_2011.doc revised 06121/11 M CITY OF CUPERTINO FW_ FEE ESTIMATOR - BUILDING DIVISION imiADDRESS: 10151 Western Dr. DATE: 09/08/2015 REVIEWED BY: PAUL Mech. APN: 359 11 001 BP#: 15080106 *VALUATION: 1$2,500 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY USE: SFD or Duplex Phrmb. Inst; lire; PENTAMATION PERMIT TYPE: 1 REAP WORK Revision #1 - Upgrade Epanel to N 200 amp panel SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. 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. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) :11ech. Plan Check Phimb. flan Check Elec. Plan Check 0.0 hrs $0.00 Mech. Phrmb, Permit Fera Elec. Permit Fee: IEPERMIT <hher.11eeh..lnsp.F-1 L t )ii er f'lurnb lav/ .E]__L_ Other Elec. Insp. Elhrs $48.00 i tech. hup. Fce - Phrmb. Inst; lire; 0.0 NOTE: This estimate does not include fees due to other Departments (i.e. 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. FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 200 amps Electrical $48.00 IBELEC200 Services Suppl. PC Fee: Q Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT0 0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 Construction Yia Administrative Fee: 1ADMIN $45.00 0 E) Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) 0 i Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 - SUBTOTALS: $142.50 $48.00 TOTAL FEE: $190.50 Revised: 07/02/2015 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10151 WESTERN DR CONTRACTOR: PERMIT NO: 15080106 02 Hmes IW-. OWNER'S NAME: SCHROEDER MICHAEL D AND LESLIE D G6 I -MQ/N AVE DATE ISSUED: 08/13/2015 OWNER'S PHONE: 4159991394 l� V.'15 G �) PHONE NO: LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL I ©� BATHROOM REMODEL (40 S.F.) License Clla-sss—� Li,. # Contractor Jice- Q F-1'1 vi S Q d� Wkate 13/Z-6 1 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: $25000 '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: 35911001.00 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 expense hich may ccrue against said City in consequence of the n i sj Issued by:�-`--� Date: ✓ f this pe it. ddit Wally, the applicant understands and will comply grantingtri-point with alls urc re tions per the Cupertino Municipal e, Section 9.18. g r3 �O RE -ROOFS: Signature Date )T 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 c"ipmert 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 a Air Quality Management District I performance of the work for which this permit is issued. will maintain compliancewith he Cupert ' Municipal Code, Chapter 9. 2 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Se ions 2 0 533, an 25534. Section 3700 of the Labor Code, for the performance of the work for which this l 3 zd 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 Califomia. 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 0 CUPERTINO CONSTRUCTION PERMIT APPLICATION j5C90106 . COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinq(a)cupertino.org ❑ NEW CONSTRUCTION 56 ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT AD RES W� i F 2 aV APN # OWNER NAME IC A L �- (]FCNED, 4"Q (� 'oy�Q-J!2 -MAIL - t It #,e ovew&co STREET ADD SS Q R TY, STATE, ZIP CJ�a s� I FAX O I I w �t r� .v 1� CONT AiJ I`� i`��C1L pFr�,�� l ��� C�J qL/ lL E 'I�AZCUI1b-H'4A+". IC S 17TCD�ESS N' C C C STATE, E ` c 9✓� z�� FAX 1:1OWNER// ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR XCONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NA &A tj Jfp� LICEE B 049 LICENSE TYPE BUS. LIC # COMPANY 6EZ 4_ I-1 FL "C �✓ Z C UJ i oM FAx ST AD R S 6 CI , STAT %�� �� ��— E Q /'7c4�07 O 1 �S CDL f� V O 7b� ARCHITECT/ENGINEER NAME ` �J LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE risRA-,--'( PROPOSED USE (Kgo-oH CONSTR. TYPE oQ61_ # STORIES ' USE TYPE OCC. SQ.FT. VALUATION (S) EXISTGNEW AREA FLO AREA DEMO AREA TOTAL NET AREA ZS,iI BATHROOM'KITCH =AREA OTHER REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DI CK/PORCH AREA GARAGE AREA: DETACH I ❑ ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES .EEADD.NO ADDITION? ❑ NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF PLANNRNGAPPL# []NO PLANNING APPROVAL LETTER IS THE BLDG AN ❑ YES EICHLERHOME? E] NO LVED BY: fftLQ L y9LUATION: /'YJr71 By my signature below, I certify to each of olio ing: I am the property owner or autho zed agent to act on the property owner's behalf. 1 have read this application and the informaric)n I have proJ�de d t.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 buildgCons tion. I auth 'ere resentatives of Cupertino to enter the abov i entified perty for inspection purposes. Date: J Signature of Applicant/Agent: SUPPLEMENTAL INFORMATION D PLAN CHECK TYPE ROUTING SLIP OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW —New SFD or Multifamily dwellings: Apply for de 011tlon permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ` ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT _ Copy of Planning Approval Letter or Meeting with Planning prior to MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_2011.doc revised 06/21/11 M Oma` CITY OF CUPERTINO I pp��� �/ INM— `5 1 FEE ESTIMATOR — BUILDING DIVISION M1w imlADDRESS: 10151 Western Dr. DATE: 08/13/2015 REVIEWED BY: PAUL lleclt. Fermi APN: 359 11 001 BP#: *VALUATION: $25,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: ?'lump. Insp. Fee, PENTAMATION 1 R3SFDREM PERMIT TYPE. WORK Bathroom remodel 40 S.F. SCOPE NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt_ etc) Thove foot are hated an the nreliminary information available and are onlv an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef: 711113) Alech, Plan Check `lurnb. Plan Creek I;iec. Plan Check lleclt. Fermi Plumb. Permir Fee: Elec. Permit Fee Other ;Meeh. hasp. )Ater Plumb ht«r, Other Elec. Imp. ;tlech. Insp. Fec ?'lump. Insp. Fee, 14ec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrirt_ etc) Thove foot are hated an the nreliminary information available and are onlv an estimate. Contact the Dept for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Ef: 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 I s.f. $645.00 Remodel, Bath (<=300 sf) 1REMRESBAT Suppl. PC Fee: 0 Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee,0 Reg. ® OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 onstruction Tax: IcIministrative Fec, 0 E) Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure I 0 0 A Travel Doc innenlulion Fees_ Strong Motion Fee: 1BSEISMICR $3.25 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $4.25 $645.00 TOTAL FEE: $649.25 Revised: 07/02/2015 LETTER OF AUTHORIZATION To Whom it May Concern: �rn�.��sDgol:k; PO Box 8501, San Jose, CA 95155 Phone: 408-404-0940 Fax: 408-904-7306 Email: info@ozcustomhomes.com I am the Owner and Licensed Contractor for Oz Custom Homes. Brad Kupper is the Project Manager for Oz Custom Domes. He has my fu)) authorization to make decisions, submit documents and sign any necessary agreements or authorizations on my company's behalf for the remodel project on the Schroeder Residence at 10151 Western Drive in Cupertino. If you have any further questions, please feel free to contact me at 408-404-0940. 160 August 13, 2015 RECEIV1Ej AUG 13 2015 iiY `T1goo ��Ti� HJV 1L -- X17 G �-' t-1 �iZI r-�c0 F -L .� 79V PANEL- 1�Y (^ Nor 1!2p1441'V�VA ; dKDW- w/ nNL*� V�I;61r't> Em T 11 'COMMUNITY DEVELOPMENT DEPARTMEiPLJA"U ME'�- BUILDING DIVISION - CUPERTINO APPROVED r - -- + NL/ Cu IT _t ---- j L4+01 iCkf f ,. 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 hold to permit or to be an approval of the violation of an rovisions of any. ±� City Ordinance or State Law. R0 Y l i:►�W DATE 6-015 PERMIT NO. NJ -"tcr-4_ W�v klcNvl'. RINYi 1i L5 1W9f- OLf L11 V5r- Kve', :)Py CSV r "fto REVIEWED FOR CODE COMPLIANCE 14 R�i� aids RECEIVED AUG 13 2015 F)9 lay �v PC-,QTc Iic)B , <-8-,t ► 37 3 2,. 71'5ro11.,-