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15020138CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11221 MONTEREY CT CONTRACTOR: MARK R LONG PERMIT NO: 15020138 CONSTRUCTION, INC. OWNER'S NAME: TSUI FRANKLIN R AND MOSS ELLEN R 15976 LINDA AVE DATE ISSUED: 02/24/2015 OWNER'S PHONE: 4084721270 LOS GATOS, CA 95032 PHONE NO: (408) 348-4038 L LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ REMODEL MASTER BATHROOM 60 SQ FT TO INCLUDE 1B818ff License Class Lie. #Jtprp M,E,P'S Contractor MARK LD, ;Cg Date 1 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 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: $18000 rformance of the work for which this permit is issued. d 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: 35621017.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 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 to building construction, and hereby authorize representatives of this city to enter WITHIN 180 D YS OF PERMIT ISSUANCE OR upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FR AST CALLED INSP CTION. 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 Issued by: Date: with all non-poiabure ulations per the Cupertino Municipal Code, Section 9.18. ., `t RE -ROOFS: Signature Date J"t 1 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 1, as owner of the property, or my employees with wages as their sole compensation, wil I do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, 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 1 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 BArea Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the up tino Municipal Code, Chapter 9.12 and 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 the Health & Safety Code, S N s 25 5 533, and 25534. vL JZ`♦ (S� 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, 1 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 1 have read this application and state that the above information is correct. 1 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingQ-cuper ino.org NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT 9 PROJECT ADDRESS j f 2 I /�e :f7( 1 Y"L APN k / SZQ 2 b1 I V\ 0/-7.60 OWNER NAME PHONEE-MAIL q) . 2� STREET ADDRESS' I� `�]�o CITY, STA ,ZIP FAX Y�/ "� � Y iZD�� CONTACT NAME PHONE E-MAIL STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWIvERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAN,E�'{�{//y�,yl}tj, ${ �(�� LIC SI-NU),!rF- LICENSE TYPE BUS, LIC 9 1 „ V� Imo/ " / W COMPANY NAME E-MAIL FAX STREET ADDRESS/� CITY, STATE, ZIP `�' � � 5-, _,PHONE / c�vv ARCHITECT/ENGINEER NA -1%4E LICENSE NUMBER BUS. LIC 9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORKMop �e/_ ` e2tl� EXISTING USE PROPOSED USE CONSTR TYPE k STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA 46 REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH AREA GARAGE AREA: LJDETACH ❑ ATTACH K DWELLING UNITS: IS A SECOND UNIT E] YES SECOND STORY ❑ YES BEING ADDED? ONO ADDITION? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN' ❑ YES R.E�,E F.7) '$'' ! �/{ , i { f �"fip 1 r y +t ! TOTAL VALUATION: PLANNINGADPL- ❑NO PLANNING APPROVAL LEITER EICHLER HONIE? 0Ny ��' s z � 41�- i'� �r �r l . o acs By my signature below, I certify to each the ollowing: I am the property owner or authorized a ent to ct on the property owner's behalf. I have read this application and the information ave ovide Is c er,t. I have read the Description of Work and v-e-TiTy it is accurate. I agree to comply with all applicable local ordinances and state laws relatin ildi n ct n. I auth ize representatives of Cupertino to enter the abo e-iden fied property for inspection purposes. - Date: i Signature of Applicant/Agent: SUPPLEMENTAL NFORMATION REQ D r s °fie �r,v sr' qtr New SFD or Multifamily dwellings: Apply for demolition permit for �r A ER TH$ COLJI\T1 R $UILDING PLAN RE}SEW r existing building(s). Demolition permit is required prior to issuance of build permit for new building. �� LX1IE&S r s a f + ' P �� 1vINGP SAN R> VIEN 5r I< Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ISTANDAr ,�h �, �� a ❑ �L7BLIC1V7RKSe� t µti form if any Hazardous Materials are being used as part of this project. �{�L,AhGE,b.? r '�e ��FI ❑/�"J.�. �� iry'�t %,: Letter Planning ��.I�. ,r y S n �'-,'�;�nR`m,�.mj,7 rr e rrN z ,)'hrrrffr��r't;�r /E. AEP-I'`�x�,�r ,r,` F%a �, yl�ry,sy+ld "� �'�+� tk%lxYlvr�Y"� !)•i �, 7�V �-. Copy of Planning Approval or Meeting With � prior to ,C Ctit�'Y 7l" ¢r' R' XSTRrCTt6,`1 submittal of Building Permit application. �D�A , sr�ii�'i �� }✓ srI�d�e'� a ��' t�r" LmTA' + ' x r ',; nr'fn Eh�`6VIROhA4ENTA1 [IE ,hu ,t,, Bld,App_201 Ldoc revised 06/21/11 CITY OF CUPERTINO VA -70 FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Aic/rirt_ otr_ )_ Those foo.v aro ba.cod an tho nroliminary informatinn available and aro anly an estimate_ Contact the Dont for addn'l into_ FEE ITEMS (Fee Resolulion 11-053 Eff.' 711113) ADDRESS: 11221 monterey ct DATE: 02/24/2015 REVIEWED BY: Mendez APN: BP#: /S669, 01,3 S' `VALUATION: 1$18,000 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Suppl. PC Fee: Q Reg. () OT PENTAMATION 1 R3SFDREM PERMIT TYPE: WORK remodel master bathroom 60 sq ft to include m e 's SCOPE NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School Aic/rirt_ otr_ )_ Those foo.v aro ba.cod an tho nroliminary informatinn available and aro anly an estimate_ Contact the Dont for addn'l into_ FEE ITEMS (Fee Resolulion 11-053 Eff.' 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 =s.f. $645.00 Remodel, Bath (<=300 sf) 1REMRESBAT Suppl. PC Fee: Q Reg. () OT 0,0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 � rrf�,r�F rrr•��r�r� "l cr:r: E) Work Without Permit? Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 /r:et��r�, l�r,r°rtr,�t�:r1l<xt'rnrr ,��:�rti� Strong Motion Fee: /BSE/SM/CR $2.34 Select an Administrative Item Bldg_Stds Commission Fee: /BCBSC $1.00 8lA $3.34 $645.00 ; °+bTL SEE. $648.34 Revised: 02114/2015 'Cljr%N f , GENERAL NOTES ......... .Jnr 13CAtlFORNIARESIDENTIALCODE 13CALIFORNIAPLUMUNG CADE 'Cljr%N f , GENERAL NOTES 13CAtlFORNIARESIDENTIALCODE 13CALIFORNIAPLUMUNG CADE M13CALIFORNIAMECHANICAL CORE NZ CALIFORIUA ELECTRICAL CODE =3 CALIFORNIA ENERGY CODE i TITLE 24 PART 6 2013 CALIFORNIA FIRE CODE KEY NOT ENLARGED DEMOLITION FLOOR PIAN fl 23 smre ED E*16R6ED PROPOSED FLOOR M" 'Cljr%N f , 13CAtlFORNIARESIDENTIALCODE 13CALIFORNIAPLUMUNG CADE M13CALIFORNIAMECHANICAL CORE NZ CALIFORIUA ELECTRICAL CODE =3 CALIFORNIA ENERGY CODE i TITLE 24 PART 6 2013 CALIFORNIA FIRE CODE