Loading...
15110160gd' , 6 CITY OF CUPER'TINO BUILDING PERMIT BUILDING ADDRESS: 10228 PALO VISTA RD CONTRACTOR: BAY AREA CUSTOM PERMIT NO: 15110160 BUILDERS INC OWNER'S NAME: CHARLES & TERRI YAGER 1002 S DE ANZA BLVD STE Al DATE ISSUED: 11/20/2015 OWNER'S PHONE: 4088323811 SAN JOSE, CA 95129 PHONE NO: (408) 446-1200 LICENSED CONTRACTOR'S DECLARATION 60 JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL REMODEL HALL BATH (35 SF) AND BATH 2 (105 SF) WITH License Class Lic. # Y NO ELECTRICAL WORD; REMODEL MASTER BATH (182 �� 1-,161C.� 'f o fy� �� If u �n " SF) Contr nor ate �— I hereby affirm that I am licensed under the provisi ns 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. k1. 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: 35702060.00 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 WITIIIN 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 expenses which may accrue against said City in consequence of the Issued by: Date: 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 Dat � / J e S r ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is any 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. 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, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized a ent;:�` / g DateP S permit is issued. r / 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 1 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 CONSTRUCTION PERMIT APPLICA T ION COMIdiUNITY DEVELOPIdiENT DEPARTh4ENT - BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) i I I-3228 - r-,""(.08) r r7-3333 L)U!1uin0(WCt]DcrtlnO.OrQ �- CUPERT[t�(O I I f ❑ 13BW CONSTRUCTION LJ ADDrfiON . ❑ ALT-HPATION / TI ❑ REVISION / DEFERRED ORIGIN AT PERMIT - 1 b PROjX ADDRESS J eg 22_8 PV \ � X211 R C `('1 - OVr"NER NAI,M �-- i I P HOWE _ N IUL /errs e� a STREc 1 ADDRESS I Ci'TY, STA; E, Zu'' Q r 1 �% I FAy, CON,, ACT N.42 B PHO'_ i A B-N\� ST, RE_i ADDRESS CITY, STATE, ZiP I FAX ❑ MWER. OV, W- P,-3LJII.D:n ❑ oq'1_Zi AG=tiT ❑ COh'TR.4COR ❑ CON-.7.4CTORAGT'T ❑ A L=cT ❑ :_NkN*T CONTRALTO IJ �I T C-I.'S'^.IvJl1�i?ER I LICENSETYFL I BUS. LIC 9 eut - �l C01✓2A1v-Y NAbr f I E-N4IL C b. �rh ��y,) �✓ F.4XO "7 C STREET ADDR'-SS CITSTAT Y, STA, ZiP A'ZA 13 1 PH01, = co 2- v� -xo' C ARCTTIB CTr1vGLNEERN, AMB LI CENSEE NFU W -BER I BUS. LIC COMPANY NAME I E-M,,FiL I r -PX STREET tDDkESS I CITY. STATE: ZIP I PHOT`r DESCR3T10N0F WORK �✓5 ��d�s� - �� b- ►�2w�c (, - VIC) e 7PVAS`� ") ��50 2Y V►� o EA7STL13G USE PROPOSED LSE CONSTR TYPE STORIES I USE I TYPE OCC. SQ.FT. VALUATION (i) Br -S70 NEW FLOOR DEMIO TOTAL AREA I AREA f kEA I ITE -7 AREA BAT? -ROOM KiFF="EN O i � R REMODEL AREA 13 a S P.=I.IODEL AREA REI,.ODEL AREA PORCH f.REA DECK F3 E.4 TOTAL DECK?ORC i A Eh G: RAGE P.R.A: Lj DErAC=d ❑ ATT.4CId 9DItIELLD\'C—UTrS: 1SAS£CONDUNIT E] YES SECOND STORY ❑1=S BEING ADDED? ❑NO I ADDITION? D. "O pP`_UPLICATION ILS IF1'S, PROF'IDE COPY OF ❑ 1sT-r:E 1?LDG AN YES ❑ r_ 'h .. _ --'=� K --C = '�� � � TOTAL \%ALUATION: PLfXTNG �?PL 2 ❑ NO PLANh�G AP?ROYAL L_TP I EICHLER HOME? ❑ NO - - S OOU By my Signa ure below, I ceri y to each of the f0110%ving: I am the property owner or authori_ed agent to net on t - open ov„Ier's behalf. I have r ead this application -and the -information -I -have -provided is co„ect:--I-heve-read the Description of York and verijl-it-is accurate -.- ordinances and state laws relating to building construction. I authorize representatives'of Cupertino to enter the above-identi led property for inspection purposes, ..._SianahlreofADDlicantlr.gent:..__.------.--•:__.-- .-_-_.._--.:_.____---.-.-.---...._�.__._._.._. __-Date:.-------__.___..__-- -_--.--._.__.—_ ___ _.... _ SL-PPLEMIE-E IT? L TN OR��LkTION REQUIRED ' _. __ �.:P..L.'i�?,C�CT����?Er---•�.._ -1 -.v = .. OL'Ti�G �LIP.�_�:t�:......: _New -,FD or l�Tuiti?znily d;;-ellin�s: Apply :or de volition pe -nit or �� - existing building(s). Demolition permit is required prior t0 1ssUu-lce of building snit for new buildin P``' oQ. Commercial Bldgs: Provide a completed N-Lardous Materials Disclosure _ ion if any Hazardous Materials are being used as part of this project. — Y Copy of Pla>1- lag Approval Letter or I\�eetirg with Plarn ng prior to u _ - II a submittal of Bu:ld:r_, Pe: -mit application. NL470R� �x��NTraiYS£RRDI�iRiCT i B?dg:.�Pp_2011.doc revised 06121/11 EFFSMT/M" CITY OF CUPERTINO FEF ESTIMATOR — BUILDING DIVISION Alech. 1'/a T ('.he.ck .1lerh..�'errrai� I ee: Other .V4i'eh. hi p. :ife& li %p. 3T?1r}tY;, l�itil7 i 7'li'i'n:. 0d,wr 131?sib jn,sp. 131tmib..lrly It. Fee: l'_iec. Plan (Jietc I Pert?at Fee: 0' -'her h7 e. 1IN11). glee. Map. ( e 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 aaan'l info. FEE ITEMS (Fee Resolution 11-0.53 Ef. . 7/1/13) 10228 Palo Vista Rd. DATE: 11/20/2015 REVIEWED BY: Phuong limADDRESS: APN: 357-02-060 BP#: VALUATION: 1$25,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: 0.0 PENTAMATION 1 R3SFDREM I PERMIT TYPE: woRK Remodel hall bath 35 SF and bath 2 105 SF with no electrical work; remodel master bath 182 SF SCOPE Alech. 1'/a T ('.he.ck .1lerh..�'errrai� I ee: Other .V4i'eh. hi p. :ife& li %p. 3T?1r}tY;, l�itil7 i 7'li'i'n:. 0d,wr 131?sib jn,sp. 131tmib..lrly It. Fee: l'_iec. Plan (Jietc I Pert?at Fee: 0' -'her h7 e. 1IN11). glee. Map. ( e 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 aaan'l info. FEE ITEMS (Fee Resolution 11-0.53 Ef. . 7/1/13) FEE QTY/FEE I MISC ITEMS Plan Check Fee: $0.00 DKI s.f. $645.00 Remodel, Bath (<=300 sf) 1REMRESBAT Suppl. PC Fee: Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 C,`onsiyuc'lion 711X: f$z/ani�Xis'la"alit e Work Without Permit? 0 Yes •; No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E;• 7aYAW .Doc;rrmenfarion /Fees: Strong Motion Fee: IBSEISMICR $3.25 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS $4.25 $645.00 TOTAL FEE: $649.25 Revised: 10/01/2015 6) cc Ck 0, —ay-D"vp , R 3 C49M C-0 p ���I I�atii b��� bcA a \wl A(,o le.(ac4r,I c,, 2-01� CRL/ CpCI C& CUPERTINO BuildIng Department ........... tx NOV 2 0 2015 REVILE --WED FOR CODE COMPLIANCE Reviewed By: 7� r iEN'TDEPAnTMENT 111"3 UIV;C CUPL:nTINO LZ D MUST be ke ff CEL Lrje uLl 9ke any lul to ML –7 no, or to deviate Building official. "'If'catiOns SHALL NOT A '74)rOval of the violation ()I arly ITY Ordh-janc, or State Law. OFFICE COPY HALL BATH ( 35- 5V) �\l umli 2 c'7' �0-15 .04 cc CUPERTINO BuildIng Department ........... tx NOV 2 0 2015 REVILE --WED FOR CODE COMPLIANCE Reviewed By: 7� r iEN'TDEPAnTMENT 111"3 UIV;C CUPL:nTINO LZ D MUST be ke ff CEL Lrje uLl 9ke any lul to ML –7 no, or to deviate Building official. "'If'catiOns SHALL NOT A '74)rOval of the violation ()I arly ITY Ordh-janc, or State Law. OFFICE COPY HALL BATH ( 35- 5V) �\l umli 2 c'7' �0-15 5ATH 02 C 1 o � sF-) CA � 5 C) ) L-A ............. CUPERTINO Building Oepartment NOV 2 0 2015 REVIEWED FOR CODE COMPLIANCE Reviewed By: 10'L2.% '�cl.IC> 4 V�Aa Q'I. MASTER BATI-E CI s 2 5 F) CUPEiRTINO suliding t)epBrtMent NOV 2 0 2015 D FOR CODE COMPLIANCE awed By: