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15090063CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10595 ORANGE TREE LN CONTRACTOR: LA ROCA BUILDERS PERMIT NO: 15090063 OWNER'S NAME: SHERMAN RICHARD J AND MARY W 3465 CHARING CROSS LN DATE ISSUED: 09/10/2015 OWNER'S PHONE: 4082554671 SAN JOSE, CA 95132 PHONE NO: (408) 835-5160 ® LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REMODEL BOTH (E) MASTER & HALL BATHS (153 S.F), License Class Lic. # — ! 7 7 g LIKE FOR LIKE Contractor 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. Sq. Ft Floor Area: Valuation: $ 15000 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 APN Number: 31634008.00 Occupancy Type: pensation, as provided for by Section 3700 of the Labor Code, for the erformance of the work for which this permit is issued. 2. 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. PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 18 IT ISSUANCE OR APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is 1 FROM LED INSPECTION. correct. I agree to comply with all city and county ordinances and state laws relat to building construction, and hereby authorize representatives of this city to en upon the above mentioned property for inspection purposes. (We) agree to save Date: l b 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 ROOFS: all non -point source re s per the Cupertino Municipal Code, Section 9.18. All roofs shall be inspected prior to anyy roofing material being installed. If a roof is dJ Signature Date L lr installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: ❑ O ER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER the following two reasons: 1. 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 HAZARDOUS MATERIALS DISCLOSURE sale (Sec.7044, Business & Professions Code) I have read the hazardous materials requirements under Chapter 6.95 of the 2. I, as owner of the property, am exclusively contracting with licensed contractors to California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain construct the project (Sec.7044, Business & Professions Code). compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. I hereby affirm under penalty of perjury one of the following three declarations: Additionally, should I use equipment or devices which emit hazardous air 1. I have and will maintain a Certificate of Consent to self -insure for Worker's contaminants as defined by the Bay Area Air Quality Management District I will Compensation, as provided for by Section 3700 of the Labor Code, for the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. performance of the work for which this permit is issued. 2 I have and will maintain Worker's Compensation Insurance, as provided for by Ower or authorized agent: Section 3700 of the Labor Code, for the performance of the work for which this 3 6*!t /dj/> Dater permit is issued. 3. I certify that in the performance of the work for which this permit is issued, I shall CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's become subject to the Worker's Compensation provisions of the Labor Code, I for which this permit is issued (Sec. 3097, Civ C.) Lender's Name must forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Address APPLICANT CERTIFICATION ARCHITECT'S DECLARATION I certify that I have read this application and state that the above information is I understand my plans shall be used as public records. 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 Licensed Professional 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. Signature Date 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 ��o 6) ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGNAL PERMIT 9 PROJECT ADDRESS S � D ir�'t `% J2 iZ �I K APN R OWNER NAME PHONEE-MAIL -ZSST-W67 STREET ADDRESS© CITY, STATE, ZIP I FAX 7/ (! 1 CONTACT NAME PHONE _�✓ V:5 S-- ��lG E-MAIL (i STREET ADDRE S c t s`�✓'i Li CITY, STATE, ZIP 3'� tf �1 FAX El OWNER ❑. OWNER -BUILDER ❑ OWNER AGENT 0 CONTRACTOR ❑ CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUA E A LICENSE -TYPE ! BUS. LIC k COMPANY NAMEvtE-MAIL r FAX UI M^� G V r STREET ADDRESS C STATE, ZIP C PH - 83 s- /co ARCHIIECT/ENGINEER N,42vIE LICENSE NUMBER BUS. LIC R COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE SCRIPTION F WORK LCL EXISTING USE PROPOSED USE CONSTR TYPE » STORIES I USE TYPE I OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA - BATHROOM KITCHEN OTHER MODEL AREA �('�� )DECK REMODEL AREA REMODEL AREA PORCH AREA AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH I ❑ ATTACH I k DWELLINGUNTTS: 1S A SECOND UNIT ❑ YES SECOND STORY ❑YES BEING ADDED? []NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN_ _. TOTAL VALUATION: PLANNTNGAPPL» ❑NO PLANNING APPROVAL LETTER _ EICHLERHOAIE?- I Q•� By my sisnature below, I certify to each of the following: I am the property own r or a orize _ nt to act e pro Nmer's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and veri so a e. I agree to comply with all applicable local ordinances and state laws relating to building c ctmn. I authorize representatives of Cupertino to e above -identified property for inspection purposes. Si--natureofApplicant/Agent: Date: SUPPLEMENTA 1F N REQUI D 01 Pial. c>cxTYPE _ , �-_ _ M <: RouTinc sLiP New SFD or Multifamily t>'e Apply for demolition permit for ❑ o«R T>cou .T existing building s). Demolition permit is required prior to issuance of building <TER BuuvL�GPLaNREviL�v - permit for new building. ExPxsss ©�PLANAL�GPLATv RE�w _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ZkPUBLrcwoRTs_ - form if any Hazardous Materials are being used as part of this project. r DEPT - ° FIRE y Copy of Planning Approval Letter or Meeting with Planning prior to `© - r� a submittal of Building Permit application. _MA30R -SAI�'TTARYSE�iRDISTRICT- ENviROlmv nrAx PTEA via BldgApp_2 011. doc revised 06/21/11 CITY OF CUPERTINO Eft FEE ESTIMATOR - BUILDING DIVISION im,ADDRESS: 10595 ORANGE TREE LN DATE: 09/10/2015 REVIEWED BY: MELISSA :lfech. Perrrtit Hee APN: 316 34 008 BP#: 'VALUATION: 1$15,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex :3Ji ilfb7''p. V1 -c. PENTAMATION PERMIT TYPE: 1 R3SFDRE WORK REMODEL BOTH E MASTER & HALL BATHS 153 S.17),LIKE FOR LIKE 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 preliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff 7,%1/13,) F�fech. Plan Check Plumb. Plan Check Elec. Plan Chc=ck :lfech. Perrrtit Hee plumb. t' F,lec. permit F. Other hlech. Insp Oiher plumb Insp Other Elec. Insp. J7. i`"" :3Ji ilfb7''p. V1 -c. h .��-. vi i't'c 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 preliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff 7,%1/13,) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 153 s.f. $645.00 Remodel, Bath (<=300 sf) 1REMRESBAT 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. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tdr. Administrative Fee: Work Without Permit? 0 Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 0 i 7Yut-el Documeniation Tees: Strong Motion Fee: IBSEISMICR $1.95 Select an Administrative Item Bldp, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.951 $645.00 TOTAL FEE: $647.95 Revised: 07/02/2015 6tvntt = jz` cLx l n-c� a �ss�•�c� S� S frri T2s 5VLU'rvLe%0 Cox u,u�,itz ( t t i KL r�-or 14z j`-� 47,J ) dost v L3,*Z,; sem; kws V ysw�C� �" w� hoidiv l -,f COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION - CUPERTINO APPROVED This set of plans and specifications MUST be kept at the job site during corstructlon. It is unla.tiful to make any changes or alterations on same. or to deviate therefrom, %V;thcu; approval from erre :;gilding Official. The Stampin(; cf'N ;:!an and s;:ec:r, ,'.,•„s SHA.LL NOT be held to of any pr_ "'e Vnolat;on — ! avi. A r, lS dot oG�317� f `Doo\r- .SV,khg RECEIVED SEP 10 2015 BY CUP€RTINO Building Department SEP 10 2015 At -4- Zc)13 Cif QLD GatOc� REVIEWED FOR CODE COMPLIANCE "P LV Reviewed By.