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16010013CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10440 CORTE DE SEVILLE CONTRACTOR: KITCHENS BY MEYER PERMIT NO: 16010013 OWNER'S NAME: O'KEEFE GERALD T AND FAY M TRUSTEE 861 E EL CAMINO REAL DATE ISSUED: 01/04/2016 OWNER'S PHONE: 4082573047 MOUNTAIN VIEW, CA 94040 PHONE NO: (415)968-8318 " LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL E] COMMERCIAL E] MASTER BATHROOM REMODEL (89 S.F.) 3��( License Class Lic. # Contractor Negate / ` Cf —z�/� I hereby of miss, and provisions of Chapter 9 (commenci g with Section 7000) of ' Ision 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: $28000 pIerformance of the work for which this permit is issued. 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: 37505016.00 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 D YS FROM LAST CALLED INSPEC ION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the &Date: I granting of this permit. Additionally, the applicant understands and will comply Issued by: ,w�® ` w with all non -point so a regul do er u ertino Municipal Code, Section 9.18. /.4j RE -ROOFS: Signature'oo ate 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 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 Cup no unicipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, S or 50 , 3 and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: 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 CONSTRUCTION PERMIT APPLICATION 1601(DC)13 COMMUNITY DEVELOPMENT, DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUP ERTINO, CA 95014-3255 . (408) 777-3228 - FAX (408) 777-3333 • buildino cDcuoertino.org CUPERTINO ^ 1-7 =117 1�r%'.TC"T•DT II-rT(1T.i I7 A rin TTIIN I I e T TT -R dTTONT / TT / XI REVISION / DEFERRED ORIGIN?AL PER= 4' LJ 1\Y YY VV3rJ 11\V \.1av1. {� • � � --�- -' PROJECT ADDRESS S 0 n N1 LI APN R :31S090� OWNERNAME F(A v s FF' STREETADDRESS I�� 1e� I RI� �[�h1 FAX CONTACT NAME HONE_—'�I®V9L, E e `V �� �C1 ['•v`� STREET ADDRESS ❑ OWNER ❑ OWNER -BUILDER OWT.TERAGEI.T CONTRACTOR El CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINFEER ❑ DEVELOPER ❑ TENANT J�/p❑l CONTRACTOR NAME ®a U PI I LICENSE NU74BER LICENSETYPE I BUS. LIC R COMPAKY NAME• •V`�nens� . �► F �y STREETADD S ARCHTTEC IENGINTEER NA1,4E LICENSE NUMBER BUS. LIC,' COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP' PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE I CONTSTR TYPE I '-STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTG sL AREA g�, r S (d NE\V FL00 AREA DEN40 TOTAL AREA NEl' AREA �a(4�i �1 � BATHROOM%q �'5 REMODEL AREA REM OTHER REMODEL AREA REMODEL AREA PORCH AREA I DEC= TOTAL DECK/PORCH AREA GARAGE AREA:DETACH ❑ ATTACH m DWELLING UNITS: IS A SECOND UNIT ❑ YES BEING ADDED? ❑ NO SECOND STORY [:IYES ADDITION? ❑NOlry�- -PRI-AEPLiC�rTION-01€S—ir YES.PRELOPLOF _ISSUE BLDG .4TH I -I YES }ZECIIDBY 'r� - TOTAL VP LU TION: PLANTNING APPL m ❑ NO PLANINT TG APPROVAL LETTER I EICHLER HOME? E]NO WV E - X art f i, F it _ : �,.- :. .� k .S, �.�+Fr:= .Je •ems .A:= By my signature below, I certify to each oft o o'n-• am the properg! owner or authorized agent to act on the property owner's behalf. I have read this application and the inform tion I have vided is ct. have r scription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state la"', elating to it � const cti I au riz esen atives of Cupertino to enter the above-' entifie proper/ty for inspection purposes. Opp S i mature of Appl icant/Agent: Date: C y SUPPLER TAL INTFORMATION REQUIRED 3* �� "�PL31 CT�PE>v TI�s R0 J3�G. LTPng ; j a x� � X , L des � }�1 O,S'ERHE COTJRTER ;,1F-'3 fit" � L' -a'` Ri,M36`�N, bi b�j JIIbLGPLAT I ! New SFD orMultifamily dv� ellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of buildingzT,T`4���tcfY x+� permit for neer building. +� Hazardous Materials Disclosure � €' _Commercial Bldgs: Provide a completed FST DAT2D' � "' t 4,RIJBLTG,i;%ORKSy� 9 I form if anHazardous Materials are being used as art of this ro ect. y P P 1 z xE�>Y Ito n 1M e aRMI _ Copy of Planning Approval Letter or Meeting with Planning prior to ,.... ,-rY'v-f.`'t ❑��70�fi�. �5 ©k S�fi1T,ARI'SEi'1�R7�ISTRICTc�r'S. ;,"- submittal of Building Permit application. s �^- "_ :�s_.x >��..d�. Lsn°`r* .r`�7i.:�r �••;;�•, �"'❑.� El��'IROT��fEr A�:HEA3�TH �.'�Ii,. B1dgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO 160005 WFM_70 FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10440 Corte De Seville DATE: 01/04/2016 REVIEWED BY: PAUL APN: 375 05 016 BP#: *VALUATION: 1$28,000 PERMIT TYPE: Building Permit =s. f. Remodel, Bath (<=300 sf) $645.00 1REMRESBAT PLAN CHECK TYPE: Alteration / Repair PRIMARY USE: SFD or Duplex 1 hrs PENTAMATION PERMIT TYPE: 1 R3SFDREC; WORK Master Bathroom Remodel 89 S.f. SCOPE Permit Fee: $0.00 Fi je,h. I'}e'i'?i27? Fee: I I'i:dtr{l3. Plan ",'heck Phot-!b. E'fec. b';s :. Fee 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 prelimina information available and are only an estimate, Contact the De t or addiz7 info. FEE ITEMS (Fee .Resolution .1.1-053 .Qjf. 7'1/13) FEE QTY/FEE7 MISC ITEMS Plan Check Fee: $0.00 =s. f. Remodel, Bath (<=300 sf) $645.00 1REMRESBAT Suppl. PC Fee: (F) Reg. Q OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:=• Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 Permit Fee: $0.00 ssPMEp l9 Clft'.f7i:)f:'G;tvi't'. S`C'E', 0 0 Work Without Permit? C) Yes (j) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential G Building or Structure 0 � 7 y 1``�L�L�t, Strong Motion Fee: IBSEISMICR $3.64 Select an Administrative Item Bldg; Suds Commission Fee: 1BCBSC $2.00 SUBTOTALS: $5.64 $645.00 TOTAL FEE: $650.64 Revi d: 10/0112015 COMBUNITY DEVELOPMENT UILDNG DIVISION -CUPERTNO ENT APPROVED This set of plans and specifications MUST be kept at the job site during construction. It is unlawful to make any chanaes or alterations on same, or to deviate therefrom, without approval from the Building Official. The stamping of this plan and specifications SHALL NOT be held; to permit or to be an approval oviolation of E provisions of any City Ordinance or State Law. D!{TE _ ..-W� PE,iVIT No MR FD JAN 0 4 2016 All dimensions _size designations given are subject to verification on job site and adjustment to fit job conditions. O Keefe As -Built This is an original design and must g g iECI4N0L0G1ES not be released or copied unless applicable fee has been paid or job order placed. All Designed: 8/10/2015 Printed: 11/21/2015 i®yyc) (ro �4c At Drawing #: 1 I Scale : 0 1/211 = 1' 00 95-41" 178" 472" 30 s" 35-41" 582" 1 It 78 4 11 11 364" 4" 38411 W�i TOIL.STD TV361 FTV3D18 --------------------------- ------------------------ ---- ----- �S H CILM P -A10, RM . Shy _ II —0—' 1 LJ(o�. W3636 I 1782" —141; " 73-8111 7 tt 8 All dimensions _size designations given are subject to verification on job site and adjustment to fit job conditions. O Keefe 5G 192" 21 CA) 4 CIO .p NI-+ 92" 21 CUPERTINO Building Department DEC 0 6 2096 REVIEWED FOR CODE COMPLIANCE Reviewed By: Thuo'�-d 210 20"' 'Phis is an original design and roust TE r , not be released or copied ca�No�ociEs op ed unless applicable fee has been paid or job order placed. All Drawing #: 1 Designed: 8/7/2015 Printed: 10/31/201-4 �oy5'C� Co -�D eSEair1 Scale : 0 1/2 11 = 1' LEGEND 4 RECESSED LIGHTS RECESSED LIGHTS -DAMP LOCATION WALL HUNG LIGHT FAN S SINGLE POLE SWITCHES S„ SINGLE POLE SWITCH WITH VACANCY SENSOR JETTED TUB RADIANT FLOOR DUPLEX RECEPTACLE 42" AFF q DUPLEX RECEPTACLE 18" AFF 210 20"' 'Phis is an original design and roust TE r , not be released or copied ca�No�ociEs op ed unless applicable fee has been paid or job order placed. All Drawing #: 1 Designed: 8/7/2015 Printed: 10/31/201-4 �oy5'C� Co -�D eSEair1 Scale : 0 1/2 11 = 1'