13090095CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7491 TIPTOE LN
CONTRACTOR: REMODEL WEST
PERMIT NO: 13090095
CONSTRUCTION, INC
OWNER'S NAME: MARK & SHELLIE PEERCY
12333 SARATOGA SUNNYVALE RD
DATE ISSUED: 09/12/2013
OWNER'S PHONE: 4087253263
SARATOGA, CA 95070
PHONE NO: (408)2574900
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL LJ
License Class 6 Lic. # &0O y( 3
REMODEL EXISTING BATH, ADD WALL TO CONVERT
Contractor �Aw�lQ�r✓gt Co�.al'h, Date ��/Z�/?�
TO 2ND
BATH TO INCLUDE M,E,P'S
I hereby affirm that I am licensed un er 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: $75000
performance of the work for which this permit is issued.
1 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: 35928007.00
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 1 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 DAY 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
4, 0,13
7
granting of this permit. Additionally, the applicant understands and will comply
Issued by: Date:
with all non-point source regulations per the Cupertino Municipal Code, Section
9.18.
..._
/2
RE-ROOFS:
Si ature Date
�
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)
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. I 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(x) 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 505, 25533, and 25534.
Section 3700 of the Labor Code, for the performance of the work for which this
Owner or authorized agent: Date: '1//.Z
permit is issued.
I certify that in the performance of the work for which this permit is issued, l 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
'J
CONSTRUCTION PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO 1 (408) 777-3228 • FAX (408) 777-3333 • building(@cupertino.org
El NEW CONSTRUCTION ❑ ADDITION 0ALTERATION / Ti ❑ REVISION /DEFERRED ORIGINAL PERMIT #
PROJECT ADDRESS
APN H �;L_r �L
OWNER NAME PHONE
E-MAIL
STREET ADDRESS
7Y9 /.' t, G�.-r .
CITY, STATE, ZIP
FAX
CONTACT NAME L f�
PHONE�
E-MAIL
STREET ADDRESS I i
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT JCON RACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONITRACTOIa_NAME c y
J
LICENSE NUMBER&,?p �f& 3
LICENSETYPE 3
BUS. LIC H
COMPANY NAME E-MAIL
FAX
STREET ADDRESS CITY, STAT P
9'5� 7a
PHONE
ARCHITECT/ENGINEER NAME
LICENSE NUMBER
BUS. LIC k
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
c
EXISTING USE
PROPOSED USECONSTR_
TYPE
N STORIES
USE
TYPE
OCC. SQ.FT.
VALUATION ($)
EXISTG
N9W FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM KITCHEN
REMODEL AREA r Jr5�14 REMODEL AREA
OTHER
REMODEL AREA
PORCH AREA
DECK AREA
TOTAL DECK/PORCH AREA
GARAGE AREA: DETACH
❑ ATTACH
H DWELLING UMTS;
IS A SECOND UNIT ❑YES
SECOND STORY []YES
BEING ADDED? ❑NO
ADDITION' []NO
PRE -APPLICATION ❑YES EYES, PROVIDE COPY OF
PLANNING APPL N ❑ NO PLANNING APPROVAL LETTER
IS THE BLDG AN ❑YES
EICHLER HOME? ❑
�ly
i
���j////jri��,!�/, / of/i� iii//
I�/%%l�ii�j,1/'i
, TOT VALUATION:
�] &—,w
By my signature below, I certify to each of the following: I am the property owner or authorized agg6t tiVact on the property owner's behalf I have read this
application and the information I have provided is 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 building c traction. I au hor representatives of Cupertino to enter the above -identified property for inspection purposes.
S ignature of Applicant/Agent: Y Date: T/
SUPPLEMENTAL INFORMATION REQUIRED
Nib /%j/12
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of buildin
permit for new building.
Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
form if any Hazardous Materis are being used as part of this project.
�'/�i�'�i i�'ii /, �/,�,�/, i � �i, it i� � � ,�//i„ �;ii�/�//✓//,%�i//,/�/
_Copy of Planning Approval Letter or Meeting with Planning prior to
ii/i ii'// %ii, ✓/Iii %i !r%i i/% / %/i % i�/f%
submittal of Building Permit application.
BldgApp_2011.doc revised 06/11/11
CITY OF CUPERTINO
FM --7 FEE ESTIMATOR — BUILDING DIVISION
lalADDRESS:
7491 tip toe In
DATE: 09/12/2013
REVIEWED BY: Mendez
APN:
BP#: 3 t)Q "
`VALUATION: 1$75,000
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 existing bath add wall to convert to 2nd bath
SCOPE
L c/r. /'fart Plo (' we A 11('c. ('/a C'hcck
Mwnh r o?ni/ 1""c f./eec /ye/mi/ ! ec:
01h(q 'tfci h, hdzp 01/wr 1111'of0 h />. 0//wr /'/o h7s1)'
11 'fc(h. finp 1'('c' Nurtrh. hi',p. Fc'e. tl7n' lnp Fcc.
NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School
Aiviriet_ otr_)_ Thew foot aro hated an the nreliminary information availahle and are only an estimate. Contact the Dent for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
99 s. f.
$626.00
Remodel, Bath (<=300 sfl
IREMRESBAT
Suppl. PC Fee: Q Reg. () OT
0.0
1 hrs
$0.00
PME Plan Check:
$0.00
Permit Fee:
$0.00
Suppl. Insp. Fee -0 Reg. Q OT
0,0
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$0.00
0
Work Without Permit? 0 Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
0
0
1 n-m;cl 00( inc'fltuli« r'r pot's:
Strom Motion Fee: IBSEISMICR
$7.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$3.00
19 `ls"'
$10.50
$626.00
° ''+�J►1+':
636.50
Revised: 08/01/2013
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