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14060089 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21481 ELM CT CONTRACTOR:SIGURA PERMIT NO: 14060089 CONSTRUCTION INC OWNER'S NAME: MAHROUYAN REZA AND AZAR 614 NATIONAL AVE DATE ISSUED:06/13/2014 OWNER'S PHONE: 4085157428 MOUNTAIN VIEW,CA 94043 PHONE NO:(408)736-7952 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION:RESIDENTIAL COMMERCIAL B,C .� _ MASTER BATHROOM REMODEL 30 SQ FT TO INCLDUE License Class c Lic.# � �� M,E,P'S Contractor} 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. 1 hereby affirm under penalty of perjury one of the following two declarations: Vhhav and will maintain a certificate of consent to self-insure for Worker's ensation,as provided for by Section 3700 of the Labor Code,for the mance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$10100 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:3620]021.00 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 WITHIN 1 S O 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 FROM 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: ltl with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. (,, 1 3 ) 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 1,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(See.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(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 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 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this _J„ l Owner or authorized agent,,- Dat 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION 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. Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION (1 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 V CUPERTINO (408)777-3228•FAX(408)777-3333•buildinclacupertinO.org Y 1 ❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION./DEFERRED ORIGINAL PERMIT# PROJECT ADDRESS OIL/g/ , ) em co i_^ APN N �(0"? n 1 OWNERNAME 1 ;Z/ " PHONE 4 515 7y2& E-MAIL►"I R nOv STREETADDRESSjao CITY,STATE,ZIP FAX CO CT NAME E-MAIL •"� MAr MIDI S d2 IDI• w. •STREET AI�DRESSO KL- �i CITY,STATE,ZIP 'l F X •!' 1 ❑OWNER 13OWNER-BUILDER11OWNER AGENT I�,/CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECTU ❑ENGINEER ❑ DEVELOPER 13 TENANT CONTRACTOR NAME n L ENS�,NUMBER LIC3SE YPE BUS.kIC0 COMPANY NAME {� f 11/! bE-MAIL lJ FAX y IAC Lx- 04 AI kjMi 0 o 4,Q6 N STREET ADDRESS PHONE C614 )Wl�l au4 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE DESCRIPTION OF WORK &)t)0& ` n4f� EXISTING USE PROPOSED USE CONSTR.TYPE #STORES USE TYPE OCC. SQ.FT. VALUATION($) EXISTGNEW FLO DEMO TOTAL AREA AREA AREA NET AREA BATHROOM /X JFJTCHEN OTHER REMODEL ARE Z REMODEL AREA REMODEL AREA PORCH AREA 15ECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH []ATTACH #DWELLING UNITS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES BEING ADDED' Q'NO ADDITION" W;O PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF IS THE BLDG AN ❑YES r ' TOTAL VALUATION: PLANNING APPL N ❑NO PLANNING APPROVAL LETTER EICHLER HOME' �O 11 ., 0 /V By my signature below,I certify to each of the following: I am the property owner or authorized agent t the property owner's behalf. I have read this application and the information I have provided is correct. I have read a Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating t building construction. I authoriz rt resentatiyes of Cupertino to enter the ab a-id ntified property for inspection purposes. Signature of Applicant/Agent:, Date: SUPPLEMENTAL INFORMATION REQUIRED _New SFD or Multifamily dwellings: Apply for demolition permit for •' r' existing building(s). Demolition permit is required prior to issuance of buildin permit for new building. # s Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ° fo_rm if any Hazardous Materials are being used as part of this project. 4 j I _Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. 4 BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 21841 elm ct DATE: 06/13/2014 REVIEWED BY: Mendez APN: BP#: 00 'VALUATION: j$10,100 'PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex PENTAMATION IR3SFDREM USE: PERMIT TYPE: WORK master bath remodel SCOPE NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School District,etc. . Theseees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMSEe Resolition 11-053 E ' 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 = s.f. Remodel, Bath(<=300 sf) Suppi. PC Fee: (j) Reg. 0 OTT 0.0 hrs $0.00 $626.00 IREMRESBAT PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. Q OT rO.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 0 Work Without Permit? ® Yes :j No $0.00 Advanced Planning Fee: $0.00 Select a Non-Residential Building or Structure Strong Motion Fee: IBSEISMICR $1.01 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $2.01 $626.00 TOTAL FEE: $628.01 Revised: 04/0112014 7 F1 � L CAPEXENGINEERING INC.- RO BOX 14198,FREMONT.CA 94539 Tel:(510)668-1815 Fax:(510)490-8690 Project No. 9279 August 20.20 l4 Building Department City of Cupertino 10300 Torre Avenue Cupertino, CA 9-S014-3232 Subject: Residence at 21481 Elm Ct. Cupertino, CA (Permit No. 14060089) FINAL AFFIDAVIT FOR LATH SHOWER,WATER PROOFING, PLUMBING AND DRYWALL AT BATHROOM Dear Sir: This letter to verify that Sigura Construction installed the lath shower with building paper, lath chicken Nvire and roofing nails, water proofing of the shower pan at the bottom with hot-mop, plumbing and drywall at the bath rooms installed in accordance to the approved plans. Capex Engineering was on site and inspected the property. Capex Engineering advised that Sigura Construction installed all the items.above to the specifications of California Building Code. Sincerely. CAPEX ENGINEERING INC., RY FESSI 01V H Gary su, P.E Principal NM 44e i:_ s�,ry�.y .I� 71 CNIL OF 0 (01 MW ' ..*Now* 0 CL mmmmmw.� » '* am t m C X M -4 m 0 :0 00 C Ula a m Shower head Shower control _ K, K + 0 —. rP) -n m C: c • • ~ 1"A C ELECTRICA . .EGEND �► � ��OV APP . _E .. .o.. • SWITCH -- This ns if l kq�t at the '""+�„ job site during con it is uni l to rnake any m changes or alterations or to dewate therefrom,without approval from Building Official. The Stamping of this plan and specific9ions SHALL NOT be held to permit or to be an approval of the violation GFCIOUTL T " of any previsions of a Ordinance or Stite Law. «.. � /- DEDICATED .INE .� F ,, 117 NO,_ I �EXHAU FAN/FLOURESCENT Z OFFICE COPY LIGHT COMBO 0 Penetration through roof for exhaust fan CUPER INC. part hent e. : JUN 13 2011 * REVIEWED FOP CODE COMPLIANCE Reviewed By a 4