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15090091I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 20153 JOHN DR I CONTRACTOR : ALPS CONSTRUCTION & I PERMIT NO: 15090091 REMODEL OWNER'S NAME: MCLEOD DAVID A AND MOKRZYCKI MARIA OWNER'S PHONE: 6502796540 1011 S DE ANZA BLVD I DATE ISSUED: 09/15/2015 SAN JOSE, CA 95129 1 PHONE NO: (408) 898-6474 Q n LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ '1 C� REMODEL MASTER BATHROOM AND HALLWAY BATHROOM (120 Bio qLi 3 3 S.F.) REMOVE AND REPLACE 2 WINDOWS IN BATHROOMS T irrn r1acc fir......,.---, i.,,. 1- 1 Contractor A'tr �S GOAT s?'f �C� ('/1'1 Date ? 1 t V 1 6- 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. 1 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 ,?er/formance of the work for which this permit is issued. (1. Wiave 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 the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this pe i Additionally, the applicant understands and will comply with all non -point sou tions per the Cupertino Municipal Code, Section 9.18. Signature Dated ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that 1 ani 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: 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. a. 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 Sq. Ft Floor Area: I N aluation: $20000 APN Number: 36933038.00 1 Occupancy T%pe: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 D �S,{ FROM fMj LAST CALLED INSP CT ON. Issued by: nl.s�, SLcc�l�s�/ 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. 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 defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & S fety Code, Sections 25505, 25533, and 25534. Ownfjp, o ' d. gent: t7o�� Date: d 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 Professional CONSTRUCTION PERMIT APPLICATION 1%9OL'9 I COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • buildin4 a(�-cuper ino.org ❑ NEW CONSTRUCTION ❑ ADDITION ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT n PRoswr ADDRESS (�/ 3 TU T APN # �0 �� /0 OWNER NAME )'(AV,I^ 6 / /t1 f P_ 1W J PHONE uC �D 2;7q 9 Y qo E-MAIL CCCiii0ttt WW� /TU` STREET ADDRESS 7 w / r h CII -Y, STATE ZIP C' / Aeil 7 ,iJ.�.1( O� /�� FAX lE-11 CONTACT NAME PHONE .(O C6 e6q f, &147 -Li Q / 5.-- C017,517 -u % o -p Q?,, / / u 144 O l e ' 4 STREET ADDRESS �I U / I S: t7e fl 112p, j V O CITY, STATE, ZIP o - Spm Ss E FAX �-�// OWNER ❑ OWNER -BUILDER 11 OWNER AGENT m CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER. ❑ DEVELOPER ❑ TENANT L.e� LICENSE NUMBER gQ q 4 3 3 CONTRACTOR NAMEC,O11514 r LICENSE BUS. LIC # / COMPANY NAME %�t, ,�5 607!54,y e -4 -to YJ �TYPE - q / ,�. EMAIL /1Gs CO�S�YUG7 i(1iliJ� yGi/IW.CG/�- FAX STREET ADDRESS /r,�1/ I I IS, r2e Ayt2� CrI1', ST/A"TE, ZIP m PHONE qo g 0 q /-- 7 t l� T ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE / DESCRIPTION OF WORK µn)�e-y ffl7-00'in L 0A 13,11k A"Ofe�i14 - �QpIA�e Z �, n�`O� .- "/vcG/ \I01qJfhe5 7v. �� s _ nrew flaw, lei E(eC-riC 4'14-11-5 — HV Ll Tc,� b EXISTING USE PROPOSED USE CONSTR TYPE # STORIES 1 L'SE TYPE OCC. SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA 7_ - BATHROOM REMODEL AREA I� ( KITCHEN OTHER REMODEL AREA REMODEL AREA PORCH AREA DECK11S TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ATTACH # DWELLING UNITS: A SECOND UNIT ❑ YES SECONDSTORY ❑YES JIGADDEDr ❑NO ADDITION' ONO PRE -APPLICATION ❑YES ff YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES _ EIVED B -=- - :•. T TAI, VALUATION: PLANNING APPL # 0 N PLANNING APPROVAL LEITER EICHLERHOME? 0 N - _ _ = F �n ®dO .4.(J if 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 provi s 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 b ' on cti0n. I thorize representatives of Cupertino to enter the above-Iidentified property for inspection purposes. SignatureofApplicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED PLA,NcBECFCTIPE = ror.I INC; i:P New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building o� rF. I III c ounTER BL rLDINc I'L AN REvtFw permit for new building. l-,XPRESs _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 0 S7 A\SARI, ❑PUBLICwoRIs" form if any Hazardous Materials are being used as part of this project. _.. - C� `. LARGE _ Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. MAJOR S'NJT.ARYSLGI ERDISTRICI' - ENVIRONMIFNIALHEAL III BldgApp_201 1. doc revised 06/21/11 WW CITY OF CUPERTINO `�01 FEE ESTIMATOR - BUILDING DIVISION WIADDRESS: 20153 John Dr. Plumb. Plan Che6 DATE: 09/15/2015 REVIEWED BY: PAUL Plumb. Permit /:CC APN: 369 33 038 BP#: Other Plumb trtsp 'VALUATION: 1$20,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY USE: SFD or Duplex hrs $0.00 PENTAMATION PERMIT TYPE: 1 R3SFDRE i WORK Remodel Master bathroom and Hallway bathroom 120 S.f. Remove and replace 2 windows in SCOPE bathrooms (No structural changes) Permit Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta). These fees are based on the Dreliminary information available and are onlv an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 711113) tfech. Plan Check Plumb. Plan Che6 c. Plan Check Mech. Permit Fe Plumb. Permit /:CC F lec Permit Fee Other• ,Wcch lrrsp. Other Plumb trtsp Other I�lec. Insp. / ee. t'htntb Vc". r I,, 1. NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. eta). These fees are based on the Dreliminary information available and are onlv an estimate Contact the Dent for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff. 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 F-1-20-1 s.f. $645.00 Remodel, Bath sf) IREMRESBAT Suppl. PC Fee: Reg. ®OT 0.0 hrs $0.00 PME Plan Check: $0.00 2 # $431.00 Window / Sliding Glass Door IWINREP Replacement 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. Administrative Fee: Q G Work Without Permit? 0 Yes (D No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential Building or Structure 0 O i I'mmel Documentation Fees: Strong Motion Fee: IBSEISMICR $2.60 Select an Administrative Item Bldp- Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $3.60 $1,076.00 TOTAL FEE: $1,079.60 Revised: 07/02/2015 S © ,201 13 O n� ►i�in� PMENT DEPARTMENT BUILDIN DIVISION - CUPERTINO This set of plans nd specifications MUST be kept at the changes or a t .rations on same, or to deviate c� u The Stamping of is plan and specificaC,ons SHALL NOT beheldtepeFR OFFICE COPY Building Department SEP 15 2015 2 REVIEW€D FOR CODE COMPLIANCE ' I Reviewed By: TA"NW�W or any visiui DATE Q - — a +✓!✓ V s ��leQi a Tub D SEPY52015 •