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14010094 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10397 VISTA KNOLL BLVD CONTRACTOR:EAGLE CONSTRUCTION PERMIT NO: 14010094 OWNER'S NAME: MCLAUGHLIN DENNIS R 1123 SHADE DALE AVE DATE ISSUED:01/16/2014 OWNER'S PHONE: 4087334819 CAMPBELL,CA 95008 PHONE NO:(408)371-2355 9 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL License Class Q Lic.# C) G REMODEL MASTER BATH 80 SQ FT TO INCLUDE NEW I LAYOUT Contractor. Date l^ Y REMOVE WINDOW ADD,3 SKYLIGHTS I 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 performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$150000 I have and will maintain Worker's Compensation Insurance,as provided for by ection 3700 of the Labor Code,for the performance of the work for which this APN Number:32613036.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is PERMIT E WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 80 DAYS OF P RMIT 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 M 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 / 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. C I RE-ROOFS: Signature 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 I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date: 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 225505 25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: — Date:J 16-1 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,l 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 10 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 \nC\O CUPERTINO (408)777-3228• FAX(408)777-3333• building(a1cupertino.org woU ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED \ORI`GINAL PERMIT# PROJECT ADDRESS APN# > 2 0 3`1 7 V i � ,-, t Li i�i I-:,tr e1 t.'� �.. i v, i1 r► OWNER NAME q PHONE '4_g'13 _ i- r, E-MAIL �t��ti1,5 hlZ� �i7iJ� "v1CL�'�(I .l'i( II`3 133 :LIC L. 2-3�(<�Gwl.tt�.n STREET ADDRESS ) CITY,STATE,ZIP FAX iv t-- CONTACT - CONTACT NAME P ONE E-MAIL -1I:Z S i,��� h�♦ L,%(.At LIQ j� ��i/� lj �'J Cfc1 (. 0 STREET ADDRESS, CITY,STATE,ZIP. FAX = � vlsha k.�=-'�� �3�.�J � .,����-�� �Ir=� <•� �is�,�tt OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME _ LICENSE NUMBER LICENSE TYPE BUS.LIC# COMPANY NAME E-MAIL FAX n STREET ADDRESS CITY,STATE,ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK I :r> �.;n ! � '..-, }J �.J �iC 1 ��^Uf% �I p..;�j l•WJ i I f� :'c''�Li_ ,����'.� ���-. (_-° t_'At. i �.J EXISTING USE PROPOSED USE CONSTR.TYPE #STORIES USE TYPE OCC, SQ.FT. VALUATION(S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA�O REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK PORCH AREA GARAGE AREA: DETACH ❑ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED? ❑NO ADDITION? ❑NO PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES RECEIVED BY:- TOTAL VALUATION: PLANNINGAPPL# ❑NO PLANNING APPROVAL LETTER EICHLERHONIE? ❑NO Q Q By my signature below,I certify to each of the following: I am the property owner or authorized agent to on th 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 ve it is acc te. 1 agree to comply with all applicable Ioca] ordinances and state laws relating to building c cuonh authorize representatives of CupertinoL.enter t ove-ideiintifiedf property for inspection purposes. Signature of Applicant/Agent: r0 Date: �` i Iy 1 SUPPLEMENTAL INFORMATION REQUIRED P CK TYPE R2 �G SLIP- New SFD or Multifamily dwellings: Apply for demolition permit for OVER-THE-COUNTER­ BUILnINCPAN itEtiIEtit . existing building(s). Demolition permit is required prior to issuance of buil g permit for new building. "EXPJtEss ❑ PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ sTANDARD ❑ PUSLIcWORKS fonn if any Hazardous Materials are being used as part of this project. ❑'LARGE © FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to �' MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp 2011.doc revised 06121111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10397 knoll blvd DATE: 01/16/2014 REVIEWED BY: Mendez APN: i(7 BP#: l�CG��. *VALUATION: 1$150,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration/ Repair PRIMARY SFD or Duplex PENTAMATION 1 R3SFDREM USE: PERMIT TYPE: WORK remodel bathroom 80 sq ft to include 3 skylights SCOPE Wo h. 1 l:n(';t,rk 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 grelimina information available and are only an estimate. Contact the Dept-for addn'l info. FEE ITEMS (Fee Resolution 11-053 E . 71L Q FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1 80 1 s.f. Remodel,Bath(<=300 sf) Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 $626.00 IREMRESBAT PME Plan Check: $0.00 1 3 1 # Window/Sliding Glass Door Permit Fee: $0.00 $418.00 IWINREP Replacement Suppl. Insp. Fee.-O Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 ,1dmr'ni.crrativ��1�'c�c_ Work Without Permit? 0 Yes No $0.00 E) Advanced Planning Fee: $0.00 Select a Non-Residential 0 Iralvl 00rronct"tu!ion Tees. Building or Structure i Strong Motion Fee: 1BSEISMICR $15.00 Select an Administrative Item B1dg,Stds Commission Fee: IBCBSC $6.00 SUBTOTALS. $21.00 $1,044.00 , TOTAL FEE: F$1,065,001 Revised: 01115/2014 v� f +�\I/ ?. `� 1 �'"- 4� i `/�'^� 1 �� �' ,,--���„Fa�.l.: tr,�jj) �.F3,�l I't-••,n' v�J�•r� .ls i _ , i .-,...,. •_....._„'�-� � Y.. ._. »�. i -- -"-- — �'- _1_ `:._.-i '�, t �.,'-�,,a�,, .( } .a '(9 � Illi /. i T i I t i } j /- +��--i `�-. r!ji.•.i ���:. t,.;r�w � z � i �, ;;. . �;-' >..,may., , ��' ;�. � i _^ "�`_ f ' \ � } C/i ��� 1 ,� --�• 7�' � -._... __..-.__.. ._ _.�...____.__.. .. :; \ 1/11 �!..t r�`} �� � >, '^` �'� i �"'� _ ` � � � is '�- -. ! � .� 1 t`' � � •..� } j ' f • }.:_..-sr.,.«--•___.«r,_._. s • � �, __—vim ._ _._ — � toad Ji i F / i j S f .. � `. '. � Jit f,i' i _......._..__._'--•.c,�_ 77 TWO i F1 j I 1 tv OP a�. 31z ;A, y }V ofA ,Fr � a +t u pt DePartment xwn aUG T J WkWed By: flown G i 1 I. 2.t the aily IV - — r r 2 7 LN, _)T j I I _ 16rO� w a i ! ��,� ! �`.d \j yt,, RAY �`S eN•:<.