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B-2016-1182 Permit, App & FeeCITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2016-1182 10092 BIANCHI WAY CUPERTINO, CA 950144273 (359 07 010) M WLk4STR A,IC, OWNER'S NAME: CUPERTINO COMMUNITY HOUSING DISABLED INC DATE ISSUED: 01/13/2016 OWNER'S PHONE: - PHONE NO: LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class Lic.# L1V21i`kV A.0Glt7 Contractor Date Yl,-0117 XBLDG _ELECT _PLUMB MECH X RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Cade and that my license is in'full force and effect. SOB DESCRIPTION: Units #111; #112; #114 and #209 - Replace (E) showers with (N) shower I hereby affirm under penalty of perjury one of the following two declarations: enclosures, Same Location r. '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 Cade, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation hnsurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued, Sq. Ft Hear Area: Valuation: $19000.00 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 APN Number: Occupancy Type: ordinances and state laws relating to building construction, and hereby 35907 010 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 PERMIT EXPIRES IF WORK IS NOT STARTED expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal 180 DAYS FROM LAST CALLED INSPECTION. Code, Section 9.1 B. — -��/6 Signature _ Date p Issued:19 b 1 LV Date: I' OWNER -BUDDER DECLARATION RE ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of the All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: installed without fast obtaining an inspection, I agree to remove all new materials for t. I, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: 2. I, as owner of the property, am exclusively contracting with licensed Date: contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER r. 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 2. I have and will maintain Worker's Compensation Insurance, as provided for California IIealth & Safety Code, Sections 25505, 25533, and 25534. 1 will by Section 3700 of the Labor Code, for the performance of the work for which maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the this permit is issued Health & Safety Code, Section 25532(a) should I store or handle hazardous s. I certify that in the performance of the work for which this permit is issued, I material. Additionally should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. 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 Owner or authorized agent: be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is Issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, Lender's Address judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant ARCHITECT'S DECLARATION understands and will comply with all non -point source regulations per the I understand my plans shall be used as public records. Cupertino Municipal Code, Section 9A8. Licensed Signature Date Professional. CUPERTINO GENERAL PERMIT APPLICATION 6XIb I )Sa COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildinclacupertino.ora 560LUMBING ❑MECHANICAL ❑ELECTRICAL I —(MISCELLANEOUS MEP M ISC PROJECTADDRESS {/t0 APN ,72 Q/'. i i 4 -3-5� (®/� I !E-MAIL OWNER NAME/ PHONE 7 / '3 95o '36fmm L' lle H1i6 .f, STREET ADDRESS +103 I/n��Gr�, `Z5o Y/ CITY, STATE, ZIP��,.y.y�oy FAX _ CONTACT NAME �raesf �ih�s PHONE L ryi ZG o�/3 E-MAIL ` �fJ c3inJhcs Grz✓Jlo-7usYr�s,Cath STREET ADDRESS 7 d ij rJ C4_ fAX L Ca L /�6--PS97 ❑ OWNER ❑ OWNER -BUILDER ❑ OWNERAGENT ❑ CONTRACTOR XCONTRACTORAGENT ❑ ARCIJII'RCI❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME dus. �.,/ %�Gy LICENSENUMBER U� oP, LICENASET`YPPEG/O /µ¢- L� BUS. LIC E G /C'�O).i COMPANYNAME / ,71_1 %`/kC�L._LS Y�KGI v 4^Yr! %YJ �.c�l E-MAII. e�s,/y� G✓L✓lI'kfr'//rCS.CG1'M PAX ,�� yd STRF.L+'I'ADDRL•SS f/f 53y6 SLo, s CITY ST B, ZIP s s =e/ PHONE L/2 07V3 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC COMPANYNAMP. E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑SFD or DUPLEX X MULTI -FAMILY BUILDING. ❑M COMERCIAL PROJECT IN WILDLAND ❑ YF;E URBAN INTERFACE AREA 'NO ❑a YES PROJECTIN IN FLOOD LONE AyO ISTHEBLOGAN ElYES EICHLER HOME? �NO DESCRIPTION OF WORK 'TOTAL VALUATION: RECEIVED BY �I CW �/ 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 provided is correct. I have read the Desciiption of Work and verity it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives e£Cupertimo to enter the above -id nI II d roperty for inspection purposes. Signaturcof Applicant/Agent: Date: 6 �g!� SUPPLEMENTAL INFO T-1QN- IRED OFFICE USE ONLY OVER-THE-COUNTER 5 H ❑ EXPRESS q ❑ STANDARD. V y ❑ LARGE E ❑ MAJOR MEPMrscApp_2011.doc revised 06/21/11 CITY OF CUPERTINOp�Ol('j [ `` FEE ESTIMATOR - BUILDING DIVISION JAFADDRESS: 10092 Bianchi Way DATE: 0111312016 REVIEWED BY: PAUL APN: 359 07 010 BP#: VALUATION: $19,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY Multi -Family Dwelling USE: Buildino is 3 Stories 0 Yes (D No PENTAMATION 1GENRES PERMIT TYPE: WORK Units #111 #112 #114 and #209 - Replace E showers with N shower enclosures Same Location SCOPE ,'1 tef:IL Plcn Chea:lz P/ianr.b. I'Iaur C'he"A 7:'ltec. Alm Check Idech. Permit ,Fee: Piu ,an. I e).pl"F".". I.lec. Pruitt J•or 07h;'r ,Wl'h. &tSp- C7rhty !'htn?6 jmp. Ofho h1cc. lrtcl3. .'fear, 1rsp, hve Phimh. hup, Fee; Elac. ins/r. f ee 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 Prellminar information available and are onL an estimate. Contact the Dept for addn'l info, FEE ITEMS aW Resohrticm 11-053 E1f'.' 7/1L132 FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? C) Yes Q No $0.00 = hours $143.00 Plan Check, Hourly LSTPLNCK Suppl. PC Fee: (E) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes Q No $0.00 Suppl. Insp. Fee:Q Reg. 0 OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ("csauirucaion 'tcrx: Aclrninistralive 1 e e� 0 0 Work Without Permit? 0 Yes (j) No $0.00 Advanced Planning, Fee: $0.00 Select a Non -Residential E) Building or Structure e Tr•L'rri�/I1ax;ratraemrstitrn £•ees. Strom Motion Fee: IBSEISMIC2 $2.47 F8.0 hrs 1 $1,144.00 Inspections 1 IsTINsP Inspection,IIourly 13ldeStdsCommissionFee: IBCBSC $1.00 ' SUBTOTALS: $3.47 $1,287.00 TQTA:E tt,'�, $1,290.47 In �flvawfl MOM